1. Infection Prevention and Control
ROCKCASTLE HOSPITAL & RESPIRATORY CARE CENTER, INC.
2008

2. Isolation Precautions
Recommended
Isolation Precautions

3. TWO TIERS OF ISOLATION PRECAUTIONS
STANDARD PRECAUTION
TRANSMISSION-BASED
AIRBORNE
DROPLET
CONTACT
TRANSMISSION
STANDARD

4. RATIONALE
Transmission of infection within any health care facility requires three elements: a source of infecting organisms; a susceptible host, and a means of transmission for the organism.

5. SOURCE
Human sources of infecting microorganisms in health care may be patients, personnel, and on occasion visitors.
Sometimes environmental surfaces or objects may be a source for microorganisms

6. HOST Some persons may become carriers Some may demonstrate resistance
Some may become infected

7. TRANSMISSION ROUTES CONTACT TRANSMISSION DROPLET TRANSMISSION
AIRBORNE TRANSMISSION
COMMON VEHICLE TRANSMISSION
VECTOR-BORNE TRANSMISSION

8. Recommended Isolation Precautions
STANDARD
PRECAUTIONS:
Standard precautions are for the care of all patients at all times.

9. FUNDAMENTALS OF STANDARD PRECAUTIONS
Handwashing and gloves
Patient placement
Transport of infected patients
Mask, eye protection, face shields
Gowns and protective apparel
Patient-care equipment and articles
Linen and laundry procedures

10. STANDARD PRECAUTIONS:
Blood
All body fluids, secretions and excretions regardless of whether or not they contain visible blood
Non-intact skin
Mucous membranes

11. HAND HYGIENE
Wash after touching blood, body fluids,secretions, excretions, and contaminated items
immediately after glove removal
between patient contacts, and when otherwise indicated to avoid transfer of microorganisms.

12. IN – When entering a patient care area
HAND HYGIENE
IN – When entering a patient care area
OUT - When leaving a patient care area
IN-BETWEEN– Between tasks and procedures, even on the same patient

13. HAND HYGIENE Before hand hygiene on the left
After hand hygiene on the right

14. OCCUPATIONAL HEALTH
An employee experiencing an exposure, potential exposure, or wondering what to do in the event of a exposure may find the answers in the Exposure Control Plan, the Tuberculosis Plan or the Infection Control Plan.

15. OCCUPATIONAL HEALTH
Employees with a bloodborne pathogen exposure will be evaluated for HIV, HBV, HCV
Sources of exposure will also be tested, if known
Needles or other instruments of exposure will not be tested

16. GLOVES
Wear gloves when touching blood, body fluids, secretions, excretions, and contaminated items
Before touching mucous membranes and nonintact skin

17. CHANGE GLOVES Between task and procedures even on the same patient
after contact with contaminated materials

18. REMOVE GLOVES PROMPTLY AFTER USE
BEFORE TOUCHING NONCONTAMINATED ITEMS AND ENVIRONMENTAL SURFACES
BEFORE GOING TO NEXT PATIENT

19. GOWNS Wear a gown to protect skin and prevent soiling of clothing.
Select a gown that is appropriate for the procedure
Remove the gown promptly and correctly.
Wash your hands.

20. MASK, EYE PROTECTION FACE SHIELDS
Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth.

21. PATIENT-CARE EQUIIPEMENT
Handle used equipment soiled with blood and excretions in a manner that prevents contamination.

22. ENVIRONMENTAL CONTROL
Follow adequate procedures for routine cleaning of environmental surfaces, beds, bed-rails, bedside equipment and other frequently touched surfaces.
Clean blood spills immediately

23. LINEN
Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevent skin and mucous membrane exposure, contamination of clothing, and avoids transfer of microorganisms to others.

24. Transmission Routes

25. TRANSMISSION CONTACT TRANSMISSION DROPLET TRANSMISSION
AIRBORNE TRANSMISSION
COMMON VEHICLE TRANSMISSION
VECTOR-BORNE TRANSMISSION

26. CONTACT TRANSMISSION
The most important and frequent mode of transmission of hospital acquired infections is CONTACT.
Contact transmission is divided into two subgroups:

27. CONTACT ISOLATION
DIRECT-CONTACT
INDIRECT-CONTACT

28. DIRECT CONTACT
DIRECT CONTACT –body surface to body surface contact and actual physical transfer of microorganisms between a susceptible host and an infected or colonized person. Direct contact also occurs between patients/residents where one serves as a host and the other as the source of the infecting organism.

29. INDIRECT-CONTACT INDIRECT CONTACT
contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as medical instruments, needles, dressings, or contaminated gloves that are not changed between patients/residents.

30. DROPLET TRANSMISSION
Droplets are generated from persons during coughing, sneezing, talking, or during certain procedures such as suctioning and bronchoscopy. Droplets are propelled short distance through the air.

31. AIRBORNE TRANSMISSION
Airborne droplet nuclei are small particle residue that can remain suspended in the air for long periods of time.

32. COMMON VEHICLE TRANSMISSION
Applies to microorganisms transmitted by contaminated items such as food, water, medication, devices and equipment.

33. VECTOR-BORNE TRANSMISSION
Occurs when vectors such as flies, ticks, rats, and mosquitoes transmit microorganisms; less significant in hospitals in the United States.

34. TRANSMISSION-BASED PRECAUTIONS

35. TRANSMISSION-BASED PRECAUTIONS
Transmission-based Precautions are designed for patients documented or suspected to be infected with highly transmissible or epidemiologically important pathogens for which additional precautions beyond Standard Precautions are needed to interrupt transmission.

36. AIRBORNE PRECAUTIONS
Use Airborne Precautions for patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei that remain suspended in the air.

37. AIRBORNE PRECAUTIONS PATIENT PLACEMENT
Private room that has negative pressure, six to twelve air exchanges per hour, and appropriate discharge of air outdoors.
(Room 133, 249, & ED-1)
Keep room door closed and the patient in the room.

38. RESPIRATORY PROTECTION
Wear respirator mask for pulmonary tuberculosis.
Susceptible persons should not enter the room of patients known or suspected to have measles or chickenpox. Not necessary to wear respiratory protection.

39. AIRBORNE PRECAUTIONS PATIENT TRANSPORT
Limit the movement of the patient from the room to essential purposes only.
If necessary, place a surgical mask on patient, if possible

40. DROPLET PRECAUTIONS
Used for patients known or suspected to be infected with microorganism transmitted by droplets (large-particle droplets) generated when coughing, sneezing, talking, or certain procedures. (COLDS & FLU)

41. PATIENT PLACEMENT
Private room….if private room is not available cohort…if cohorting is not achievable, maintain spatial separation of at least three feet between patients
Special air handling and ventilation are not necessary, and door may remain open

42. DROPLET PRECAUTIONS MASK
In addition to Standard Precautions, wear a mask when working within three feet of the patient.

43. PATIENT TRANSPORTATION
LIMIT MOVEMENT OF PATIENTS FROM ROOM TO ESSENTIAL PURPOSES ONLY.
If transportation is necessary, mask patient if possible.

44. CONTACT PRECAUTIONS
In addition to Standard Precautions, use Contact Precautions, for specified patients known or suspected to be infected or colonized with organisms that can be transmitted by direct contact( hand or skin-to-dry skin)

45. CONTACT PRECAUTIONS PATIENT PLACEMENT
Private room if available
If private room not available, cohort

46. GLOVES AND HAND HYGIENE
Wear gloves before contact with body secretions wound or mucous membrane or contaminated room environment
Change gloves after having contact with infected material
Remove gloves and wash hands before leaving the patient environment

47. Gowns
Wear a gown when entering the room if you anticipate your clothing will touch the patient, environmental surface, or items in the patient’s room.
Remove gown before leaving patient environment

48. PATIENT TRANSPORT
LIMIT MOVEMENT TO ESSENTIAL PURPOSES

49. PATIENT-CARE EQUIPMENT
Use single patient equipment, when possible
If not possible, adequately clean and disinfect before use on another patient

50. OCCUPATIONAL HEALTH

51. OCCUPATIONAL HEALTH
An employee experiencing an exposure, potential exposure, or wondering what to do in the event of a exposure may find the answers in the Exposure Control Plan, the Tuberculosis Plan or the Infection Control Plan.

52. PREVENTION OF EXPOSURE
TO HIV
TO HBV
TO HCV
OTHER PATHOGENIC ORGANISMS
TO PROTECT PATIENTS, STAFF, VISITORS AND OUR COMMUNITY

53. OCCUPATIONAL HEALTH
Employees with a bloodborne pathogen exposure will be evaluated for HIV, HBV, HCV
Sources of exposure will also be tested, if known
Needles or other instruments of exposure will not be tested

54. OCCUPATIONAL HEALTH AND BLOOD-BORNE PATHOGENS
Needle stick injuries
Splashes and splatters
Non-intact skin, open wounds
Exposure through mucus membranes

55. Prevention of sharps injuries
Always use proper containers to dispose of sharps
Never re-cap, bend or break needles
Always use or engage safety features of IV catheters, safety needles, etc.
Report any occurrences of sharps being used inappropriately
Always follow facility policy related to use of sharps

56. Occupational Exposure Blood Borne Pathogens
Always wear protective apparel when possible contact with blood or body fluids
Cover open areas or cuts with protective dressings
Follow facility policy related to standard precautions

57. Work Place Controls Suggestions are appreciated New ideas or processes
New equipment or products
Infection control plan – reviewed annually
Exposure control plan – reviewed annually
Policy and procedure review –
every 3 years

58. EMPLOYEE IMMUNIZATIONS
Influenza vaccine
Pneumococcal vaccine
Hepatitis B vaccine
MMR

59. Infection
Prevention
and
Control