1. ISOLATION UPDATE FOR NURSES
Department of Hospital Epidemiology and Infection Control
5-8384
Osler 425
Updated 4/28/03

2. Infection epidemic carves deadly path
Poor hygiene, overwhelmed workers contribute to thousands of deaths
First of three parts.
By Michael J. Berens Tribune staff reporter July 21, A hidden epidemic of life-threatening infections is contaminating America's hospitals, needlessly killing tens of thousands of patients each year.

3. Prevent infections by:
Practicing good hand hygiene
Following Standard Precautions and isolation instructions
Receiving vaccinations

4. Important Terms
Colonization is the presence of a pathogen in a body site without any clinical signs and symptoms. Different organisms prefer different body sites, e.g. MRSA prefers nares, VRE prefers GI tract.
An infection occurs when there are clinical signs and symptoms (fever, erythema, edema, purulent drainage, etc.)

5. STANDARD PRECAUTIONS Practiced for all patients
Keep a barrier between the HCW and the blood and/or body fluids of ALL patients
GLOVES
GOWNS
MASKS
EYEWEAR

6. Prevent Infections…
ISOLATION

7. Isolation
Isolation guidelines are based on the ways that specific organisms are spread
In order to protect patients and staff, additional isolation categories are needed to supplement Standard Precautions

8. Follow Isolation Directions
Follow the isolation sign on patient door/bed space
Check patient’s chart for isolation sticker

9. What’s New for 2003?
Nurses now have the authority to initiate isolation through a nursing order
Strict Isolation has been discontinued
Patients previously placed in Strict Isolation will now require Airborne & Contact Precautions
Examples: Chickenpox, Disseminated Herpes Zoster, Smallpox, SARS

10. What Else is New? Airborne Isolation room requirements
Negative pressure vented to the outside (suitable for TB)
Negative pressure room not vented to outside but with HEPA Filter may be used if no “TB” rooms are available
Initiation of Airborne Isolation requires ID approval (not new but now encompasses more diseases)

11. Still More New Information
Airborne Isolation requires the use of PAPR by HCW
HCW known to be immune to chickenpox, or measles do not need to wear PAPR when caring for patients with those diseases or disseminated Zoster
PAPR must be worn by all HCW when caring for patient with TB, Smallpox, SARS

12. Airborne Precautions Airborne precautions are required for:
Tuberculosis (TB), Smallpox, Chickenpox, Measles, SARS
Requirements:
ID physician approval
Negative pressure room
Staff must wear Powered-Air Purifying Respirators (PAPRs) and close door behind them
Staff remove PAPR prior to exiting ante-room
Sanitize hands after leaving room

13. PAPRs PAPRs are obtainable from Central Supply at x 5-8357
Hoods can be reused by the same HCW
Be sure to obtain more than one or two
Call HSE at x to pick up units when no longer needed
HSE will also provide training about how to use the PAPR

14. Contact Precautions Contact isolation is required for: Requirements:
MRSA, C. diff, Adenovirus, conjunctivitis, decubitus ulcer infection, etc.
Requirements:
Gown and gloves for contact with patient in room
Remove gown and gloves prior to leaving room
Sanitize hands after leaving room

15. Special Precautions Special Precautions are required for: VRE, VISA
Requirements:
Private room
Visitors and Healthcare Worker (HCW) must don a gown and gloves before entering patient room
Sanitize hands after leaving room
Dispose of gown and gloves before leaving the room

16. Fingers and Fomites: VRE
VRE (E faecium) can be recovered from gloved and ungloved fingertips for at least 60 minutes after inoculation
VRE recovered from bedrails (Up to 24 Hours), telephones, and stethoscopes (Up to 60 Minutes)
VRE recovered from countertops for up to 7 days after inoculation
Noskin, ICHE: 1995;16:

17. VISA/VRSA VISA (Vancomycin Intermediate Staphylococcus aureus)
1999- now 20 cases worldwide
Has not demonstrated transmission to health care workers
VRSA (Vancomycin Resistant Staphylococcus aureus)
cases in the United States
In both cases, patients were co-infected with MRSA/VRE

18. Droplet Precautions Droplet precautions are required for:
Influenza, (adult) RSV, Parvovirus, Croup, Mumps, Pertussis, Strept throat, etc
Requirements:
Mask, gown, gloves when within 3-6 feet of patient
Sanitize hands after leaving room

19. Pediatric Droplet
Specifically for the pediatric patient with Respiratory Syncytial Virus (RSV)
Private room preferred
Gowns and masks are required for contact
Protective attire must be removed before leaving the room
Hand hygiene must be performed after leaving the room
Cohorting is acceptable if patients have ‘similar symptoms’ (patients may be antigen negative and antigen positive in the same room)
Remember that RSV is seasonal…(October/November to March/April)
Stage I: first case through 5 cases identified
Stage II: continues until there has been no positives for 14 days.
Season is then declared over!

20. Transport of Patients Requiring Isolation
Should be limited to essential needs
Masking of patient with standard surgical mask if droplet or airborne transmission and the patient can tolerate
Notify receiving department of appropriate precautions
Make sure chart is appropriately labeled
Transportation should be limited to essential needs.
Masking of patient
Notify receiving department of appropriate precautions.

21. What’s wrong with this picture?

22. JHH Coding Procedures
If a patient presents for admission to your unit, check his magenta plate to ensure isolation is not required.
ICO1 VRE “Special”
ICO2 MRSA “Contact”
ICO4 Varicella “Airborne, Contact”
ICO7 Both MRSA and VRE “Special”
ICO8 “Contact” for any Cystic Fibrosis patient with Burkholderia cepacia (will not be on the same floor as other cystic fibrosis patients)
If a patient presents for admission to your unit, check his plate to ensure isolation is not required.
ICO1 VRE “Special”
ICO2 MRSA “Contact”
ICO4 Varicella “Strict”
ICO7 Both MRSA and VRE “Special”
ICO8 “Contact” for any Cystic Fibrosis patient with Burkholderia cepacia (will not be on the same floor as other cystic fibrosis patients)

23. Isolation Summary Sometimes “Standard Precautions” are not enough
“Isolation Precautions” protects patients and staff from spreading communicable diseases
Follow isolation signs and instructions posted on patients doors
Isolation policy is available on-line at for further information

24. Hand Hygiene: Best way to Prevent Infection