Isolation Precautions Training Handbook for Nursing and Clinical Professionals: Addressing the threat of emerging infections

Transcription

1 Isolation Precautions Training Handbook for Nursing and Clinical Professionals: Addressing the threat of emerging infections hcpro

2 Isolation Precautions Training Handbook for Nursing and Clinical Professionals: Addressing the threat of emerging infections is published by HCPro, Inc. Copyright 2003 HCPro, Inc. All rights reserved. Printed in the United States of America. ISBN No part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center (978/ ). Please notify us immediately if you have received an unauthorized copy. HCPro provides information resources for the health care industry. HCPro is not affiliated in any way with the Joint Commission on Accreditation of Healthcare Organizations, which owns the JCAHO trademark. Emily Sheahan, Managing Editor Lisa Kosan, Managing Editor Matthew Paul, Copyeditor Jean St. Pierre, Creative Director Mike Mirabello, Senior Graphic Artist Matt Sharpe, Graphic Artist Bob Croce, Group Publisher Suzanne Perney, Publisher Advice given is general. Readers should consult professional counsel for specific legal, ethical, or clinical questions. Arrangements can be made for quantity discounts. For more information, contact: HCPro, Inc. P.O. Box 1168 Marblehead, MA Telephone: 800/ or 781/ Fax: 781/ customerservice@hcpro.com Visit HCPro at its World Wide Web sites: and 08/

3 Contents Introduction Basic infection control practices Accreditation standards Who should be practicing infection control precautions? Overview of CDC guidelines related to infection control practices Types of infectious disease: How infections are transmitted How are infections transmitted? A word about SARS Infectious diseases related to bioterrorism Precautions Standard precautions Universal precautions Body substance isolation Case Scenario: I didn t touch the patient CDC isolation precautions: Transmission based Patient placement Transport of infected patients iii

4 Masks, respiratory protection, eye protection, face shields Case scenario: Expect the unexpected Gowns and protective apparel Case scenario: Removing PPE Routine and terminal cleaning Work restrictions Work restriction policies Precautions for specific infections Hepatitis B virus Hepatitis A virus Hepatitis C virus Herpes simplex viruses Measles, mumps, and rubella Staphylococcus and streptococcus Tuberculosis Varicella zoster virus Viral respiratory infections SARS Monkeypox Case scenario: The undiagnosed patient Summary Final exam Answers to the exam Certificate of completion iv

5 Isolation Precautions Training Handbook for Nursing and Clinical Professionals Addressing the threat of emerging infections Introduction The risk of contracting an infectious disease is an ever-present occupational hazard in the health care industry. Illnesses that range from mildly annoying to life-threatening can be transmitted in virtually any type of facility, including hospitals, long-term care facilities, physicians offices, and outpatient clinics. Hospital infection control policies long have been aimed at protecting patients from the hazards of nosocomial (hospital-acquired) infections. There is also a critical need to protect health care workers from life-threatening diseases. Basic infection control practices Infection control practices intend to interrupt the transmission of infectious diseases. Those practices most relevant to employee safety and health include the following: 1

6 Use of standard precautions Use of safer needle devices Observance of proper hand-hygiene practices Isolation of certain infected patients Use of work restrictions Accreditation standards The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires hospitals and other accredited facilities to have a comprehensive infection control program that encompasses employee health and includes at least one activity aimed at preventing the transmission of diseases from patients to staff. Surveyors will concentrate heavily on proper infection control techniques. Because JCAHO s new survey process calls for more survey time on patient units (as opposed to interviews and document review) and because infection control is directly in surveyors sites, facilities may be subject to tougher scrutiny than ever before on findings in infection control. Who should be practicing infection control precautions? The Centers for Disease Control and Prevention s (CDC) guideline for infection control applies to all persons working in health care settings who have the potential for exposure to infectious materials. The guideline focuses on infection control issues related to personnel directly involved with patient care (i.e., nurses, physicians, technicians, etc.) and those not directly involved in patient 2

7 care who could be exposed to infectious agents (i.e., housekeeping staff, maintenance workers, volunteers, etc.). Overview of CDC guidelines related to infection control practices CDC guidelines are a major source of infection control information. Recommendations that affect worker safety and health include the following: The 1996 Guideline for Isolation Precautions in Hospitals recommends use of (1) standard precautions when caring for all patients to prevent transmission of infectious disease and (2) transmission-based precautions when caring for patients known to be infected with microorganisms that require additional measures. The 2002 Guideline for Hand Hygiene in Health Care Settings, based on the most current research about hand hygiene, recommends the use of alcohol-based rubs to prevent the spread of bacterial infections. Gloves are still recommended for situations in which you have contact with blood or other body fluids, or when you are conducting sterile procedures. The guidance also recommends that workers who have direct contact with high-risk patients should avoid wearing artificial nails, and workers who have direct contact with any patients should keep their natural nails to less than one-quarter inch long to avoid harboring bacteria. 3

8 The 1998 Guideline for Infection Control in Health Care Personnel describes methods for reducing transmission of infections from patients to health care personnel and vice versa. The 1997 Immunization of Health Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC) recommends the use of consistent immunization programs to reduce the number of susceptible workers in health care facilities and the attendant risks for transmission of vaccine-preventable diseases to other workers and patients. The 1994 Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health Care Facilities outlines the administrative, engineering, and work practice controls that should be used to prevent transmission of tuberculosis (TB). Types of infectious diseases: How infections are transmitted How are infections transmitted? The CDC precautions are aimed at interrupting the transmission of infections. The five ways that infections may be transmitted include the following: 4

9 1. Contact transmission, the most important and frequent mode of transmission of nosocomial infections, is divided into two subgroups: direct-contact transmission and indirect-contact transmission. Direct-contact transmission involves a direct bodysurface-to-body-surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person. This can occur when a worker turns a patient, bathes a patient, or performs other patient-care activities that require direct personal contact. Indirect-contact transmission involves contact between a susceptible host and a contaminated intermediate object usually inanimate such as medical instruments, needles, or dressings, or unwashed hands and unchanged gloves despite visiting more than one patient. Some examples include bloodborne diseases, such as hepatitis B virus (HBV), human immunodeficiency virus, hepatitis C virus, and cytomegalovirus. All of these viruses may be spread via contact with blood or other specific body fluids. 2. Droplet transmission is quite distinct from either direct- or indirect-contact transmission. Droplets are primarily generated from a source when coughing, sneezing, talking, or during the performance of certain procedures such as suctioning and bronchoscopy. Transmission occurs when droplets containing 5

10 microorganisms generated by the infected person are propelled a short distance through the air and deposited on the host s conjunctivae, nasal mucosa, or mouth. Some examples include bacterial respiratory infections (i.e., invasive Haemophilus influenzae type b disease, meningitis, pneumonia, epiglottitis, sepsis, mycoplasma pneumonia, or pertussis), and viral respiratory infections (i.e., influenza, mumps, or rubella). 3. Airborne transmission occurs by dissemination of either airborne nuclei of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time, or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may be inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors. Therefore, special air-handling and ventilation systems are required to prevent airborne transmission. These include TB, varicella virus (chicken pox), measles (rubeola), monkeypox, and severe acute respiratory syndrome (SARS). 4. Common vehicle transmission applies to microorganisms transmitted by contaminated items such as food, water, medications, devices, and equipment. This is not a significant source of typical nosocomial infections. 6

11 5. Vectorborne transmission occurs when sources such as mosquitoes, flies, rats, and other vermin transmit microorganisms. This route of transmission is of less significance in hospitals in the United States than in other regions of the world. A word about SARS Since the infectivity and transmission route of SARS are unknown, health care workers treating patients known to be infected with SARS should use airborne precautions, according to the CDC. Infectious diseases related to bioterrorism The Agency for Health Care Research and Quality ( uab.edu) provides resource information and continuing education about rare infections and bioterrorism agents. The site offers images of infectious diseases, pediatric and adult continuing education modules, and summary sheets on the diseases that the CDC defines as Category A or high-priority biological diseases, such as anthrax, smallpox, botulism, tularemia, viral hemorrhagic fever, and plague. Precautions Standard precautions Standard precautions are the routine steps recommended within the CDC s isolation guideline to protect all patients and staff from the spread of bloodborne diseases. Standard precautions include the major components of universal precautions, which are designed to prevent the spread of bloodborne pathogens, and body substance 7

12 isolation, which is designed to reduce transmission of pathogens from moist body substances. Standard precautions are designed to reduce the risk of microorganism transmission from both recognized and unrecognized sources of infection in hospitals. Standard precautions require health care workers to use gloves and other personal protective equipment (PPE) to prevent exposure to blood, nonintact skin, mucous membranes, and all bodily fluids, secretions, and excretions except sweat regardless of whether they contain visible blood. Health care workers should wash their hands after touching blood, bodily fluids, secretions, excretions, and contaminated items whether or not gloves are worn immediately after gloves are removed and between patient contacts when otherwise indicated to avoid transfer of microorganisms to other patients or environments. Universal precautions The system of universal precautions requires health care workers to routinely use appropriate barrier precautions when caring for patients, regardless of the patient s known or suspected infection status. Universal precautions should be observed whenever workers may have contact with human blood, blood products, and other body fluids that contain visible blood. The precautions also apply to body tissues and to the following fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic. 8

13 The system of universal precautions requires precautions that include the following: Gloves Gloves should be worn for touching blood and bodily fluids, mucous membranes, or nonintact skin of all patients, for handling items or surfaces soiled with blood or bodily fluids. Gloves should be changed after contact with each patient. Handwashing practices Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other bodily fluids. Hands should be washed immediately after gloves are removed. Needlestick precautions All health care workers should take precautions to prevent injuries when cleaning used instruments, disposing of used needles, and handling sharp instruments after procedures. After use, disposable syringes, needles, scalpel blades, and other sharp items should be placed in puncture-resistant containers for disposal. Saliva precautions Mouthpieces, resuscitation bags, or other ventilation devices should be available for use in areas where the need for resuscitation is predictable. Body substance isolation The body substance isolation (BSI) system isolates all body substances fluid and solid from health care workers hands through the use of gloves. The Occupational Safety and Health Administration 9

14 (OSHA) has stated that BSI is an acceptable alternative to universal precautions if facilities that use this method adhere to all other provisions of the bloodborne pathogens standard. Case scenario: I didn t touch the patient A patient is on the unit with a multiple drug resistant organism. The room is clearly labeled with contact isolation signs indicating strict policies requiring gowns and gloves. Nurse Nash was standing across the unit and saw a respiratory therapist (RT) coming out of the room without a gown, removing only her gloves after a vent change. The RT explained that she was not touching the patient, but the nurse saw the RT come in substantial contact with the patient s bed. Did the RT make a mistake? What should Nurse Nash do? Given the clarity of required precautions for this patient, the RT is clearly in error for not practicing appropriate precautions and at risk of transmitting pathogens to her next patient. Intervention is important in this situation to prevent the RT from putting other patients at risk. CDC isolation precautions: Transmission based The second tier, transmission-based precautions, should be used with standard precautions in care of patients known or suspected to be infected with highly transmissible or epidemiologically important organisms. Transmission-based precautions (i.e., contact, droplet, and airborne precautions) may require use of nega- 10

15 tive-pressure isolation, respiratory protection, patient masking, and other measures in addition to standard precautions. Patient placement Appropriate patient placement is a significant component of isolation precautions. A private room is important to prevent director indirect-contact transmission when the source patient has poor hygiene habits, contaminates the environment, or cannot be expected to assist in maintaining infection control precautions to limit transmission of microorganisms (i.e., infants, children, and patients with altered mental status). When a private room is not available, an infected patient should be placed with an appropriate roommate. Patients infected by the same microorganism usually can share a room if the likelihood of reinfection with the same organism is minimal, provided they are not infected with other potentially transmissible microorganisms. Transporting infected patients Limit the movement and transport of patients infected with virulent or epidemiologically important microorganisms and ensure that such patients leave their rooms only for essential purposes. Whenever possible, services should be brought to the isolated patient. When this is not possible and patient transport is necessary, it is important that appropriate barriers (i.e., masks, impervious dressings) are worn or used by the patient, personnel in the area to which the patient is to be taken are notified, and patients are informed of methods to prevent the transmission of their infectious microorganisms to others. 11

16 Masks, respiratory protection, eye protection, face shields Hospital personnel should wear a mask that covers both the nose and the mouth, and goggles or a face shield during procedures and patient-care activities that are likely to generate splashes or sprays of blood, bodily fluids, secretions, or excretions. OSHA mandates the wearing of masks, eye protection, and face shields in specified circumstances to reduce the risk of exposures to bloodborne pathogens. Case scenario: Expect the unexpected You have taken over a shift on the critical care unit to replace a nurse who is out sick. This is not normally the unit on which you work. The floor currently has a patient in an isolation room requiring droplet precautions. Soon after you begin your shift, the patient calls for a nurse. You answer the call, but you don t see a mask left on the isolation cart outside the patient s room. You decide to skip the mask and check on the patient s needs without coming within 3 feet of the patient. When you enter the room, the patient is experiencing severe respiratory distress and needs your help. How could this have been avoided? Anytime you are drafted to work in a unit with which you re unfamiliar, be sure to locate all PPE at the beginning of your shift. If ventilation devices or masks are likely to be needed, be certain that there is a selection that includes a proper fit for you. If you don t know, ask. You could 12

17 need the equipment quickly and not have time later to look for it. Never assume that PPE is not needed because you won t touch the patient or won t approach the patient closely enough to warrant it. Prepare for the unexpected, and take maximum precautions. Gowns and protective apparel Gowns are worn to prevent contamination of clothing and to protect skin from exposures to blood and bodily fluids. Gowns that are specially treated to be impermeable to liquids, leg coverings, boots, and shoe covers provide greater protection to the skin when splashes or large quantities of infective material are present or anticipated. Case scenario: Removing PPE Dr. Luck is a third-year resident visiting a patient room where gowns and gloves are required during group rounds. He dons a gown and gloves before entering, but leaves the room without removing them and picks up an open chart while still wearing his gloves. Is there any action that can be taken by the nursing staff upon discovering this error? The real cost of poor isolation technique on the part of any staff member is the risk to patients who may be infected. Nursing staff should speak to the physician leading the group rounds and ask him or her to address this with the resident. Nursing staff should also contact the hospital infection control department. It is critical for the infection control department to collect and analyze data on such exposures in 13

18 order to implement programs that address problems. In this case, lectures or continuing education may be scheduled for the residents to address precautions and resistant infections. Routine and terminal cleaning The room, cubicle, and bedside equipment used for patients on transmission-based precautions must be cleaned with the same procedures used for patients on standard precautions, unless the infecting microorganism(s) and the amount of environmental contamination indicates special cleaning. Patients admitted to hospital rooms that were previously occupied by patients infected or colonized with such pathogens are at an increased risk of infection from contaminated environmental surfaces and bedside equipment if they have not been adequately cleaned and disinfected. The methods, thoroughness, and frequency of cleaning and the products used are determined by hospital policy. Work restrictions Work restriction policies To prevent the spread of infections among staff and patients, it may be necessary to restrict an infected or exposed employee s work duties to eliminate direct contact with all patients or with high-risk patients such as newborns and those individuals suffering from immune system impairment. 14

19 Precautions for specific infections The following pages discuss some specific infections that are common concerns in health care facilities. Types of isolation precautions to be practiced for individual diagnoses can be found on the CDC Web site at Hepatitis B virus According to the CDC, the transmission of HBV to health care workers has been documented as occurring through accidental needlesticks and broken skin or mucous membrane contact with infective material (i.e., blood, serum). Patient contact without physical exposure to blood has not been documented as a risk factor. An increased risk of contracting HBV is found in those work locations and occupational categories that put workers in frequent contact with blood from infected patients. Such work locations include blood banks, clinical laboratories, dental clinics, dialysis wards, emergency rooms, hematology/oncology wards, operating and recovery rooms, and pathology laboratories. Hepatitis A virus The primary mode of transmission of hepatitis A virus (HAV) is fecal/oral, making good personal hygiene and thorough handwashing central to preventing its spread. The risk of transmitting HAV is highest in the earliest stages of the disease, before the illness has become clinically obvious. In most persons, HAV transmission risk becomes low or negligible about seven days after the onset of jaundice. 15

20 HAV has not been reported after inadvertent needlesticks or contact with infected blood. It may, however, be spread via blood transfusion. Hepatitis C virus Health care workers, emergency response personnel, and others who have exposure to blood in the workplace are at risk for being infected with hepatitis C virus (HCV), according to the CDC s Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease. Although no recommendations currently exist to restrict professional activities of health care workers with HCV infection, the CDC recommends that HCV-positive workers should follow strict aseptic procedures and standard precautions (i.e., proper handwashing techniques, proper disposal techniques for needles and other sharps). Herpes simplex viruses Herpes simplex viruses can be transmitted among personnel and patients through skin lesions or secretions (i.e., saliva, vaginal secretions, infected amniotic fluid) that contain the virus when no lesions are apparent. Health care workers sometimes develop an infection of the fingers (herpetic whitlow or paronychia) from exposure to contaminated oral secretions. Workers can protect themselves from such infections by avoiding direct contact with lesions, wearing gloves on both hands, using a no-touch technique for all contact with oral or vaginal secretions, and thorough handwashing after patient contact. 16

21 There is no evidence that health care workers with genital infections pose a high risk to patients as long as the workers follow good patient care practices. An individual with oral infections can reduce the risk of infecting patients by wearing a mask, gauze dressing, or other barrier to prevent hand contact with the lesion, washing his or her hands before patient care, and avoiding assignments to care for patients at high risk for infections, such as neonates, patients with severe malnutrition or severe burn injuries, and patients in immunodeficient states. Measles, mumps, and rubella Measles It is essential that all personnel have documentation of measles immunity regardless of their length of employment or whether they are involved in patient care, the CDC recommends. Some states have regulations requiring measles immunity for health care personnel. Mumps An effective vaccination program is the best approach to prevent nosocomial mumps transmission, according to the CDC. Vaccination against the mumps virus is recommended, unless otherwise contraindicated. Rubella Ensuring immunity among all health care personnel is the most effective way to eliminate nosocomial transmission of rubella, the CDC says. Individuals should be considered susceptible to rubella if they lack documentation of one dose of live rubella vaccine on or after their first birthday or laboratory evidence of immunity (persons with indeterminate levels are considered susceptible). 17

22 Staphylococcus and streptococcus Staphylococcus carriage or infection occurs frequently in humans and is spread most commonly through direct contact. The CDC advises that infected health care workers should not be allowed to engage in direct patient care until skin infections caused by this organism are resolved. If certain personnel are epidemiologically linked to an increased number of infections, these persons can be cultured and, if positive, removed from patient contact until carriage is eradicated. Streptococcus can cause outbreaks of surgical wound infections. Otherwise, pharyngeal and skin infections are the most common manifestations of the bacteria, which is transmitted by direct contact. An increased incidence of surgical wound infections due to streptococcus should be followed by an immediate search for a carrier. Implicated personnel should be cultured and, if positive, removed from patient contact until treated. Tuberculosis Transmission of TB infection in the hospital is most likely to occur in cases in which a patient or employee has unsuspected pulmonary or laryngeal TB, has bacilli-laden sputum or respiratory secretions, and is coughing or sneezing into air that remains in circulation. Health care facilities should assess the risk of TB transmission in all areas and implement appropriate controls to prevent such transmission, according to the CDC s Guideline for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Facilities, Recommended controls include such preventive measures as early identification and isolation of TB patients, proper use of 18

23 ventilation and other engineering controls, use of respirators by workers who are exposed to TB, and employee training and skintesting programs. Varicella zoster virus Varicella-zoster virus (VZV), which causes chicken pox and shingles, is a well-known source of nosocomial infection among both personnel and patients. Appropriate isolation of hospitalized patients known or suspected to have the disease and restriction of susceptible health care workers should reduce the risk of transmission. Only health care workers who have had VZV or who demonstrate serologic evidence of immunity should be assigned to care for these patients. Persons who have been exposed to varicella are potentially infective to others during the latter part of the incubation period, which lasts days. Transmission of the disease is possible until all skin lesions are dry and crusted. Susceptible exposed personnel should be evaluated for exclusion from patient care duties. Viral respiratory infections Viral respiratory infections are common problems for infection control programs. Hospital personnel, patients, and visitors all are important sources of the viruses that generally may be passed on via airborne droplets emitted while sneezing, coughing, and talking, or via direct contact with infected persons or contaminated objects. Hospitals are advised to determine their policy on influenza immunization on a yearly basis, taking note of current recommendations from the Immunization Practices Advisory Committee. An antiviral drug, amantadine, may help limit the spread of disease among nonimmunized persons during an epidemic. 19

24 SARS SARS appears to spread primarily by close person-to-person contact, according to the CDC. Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (i.e., respiratory secretions) from a person who has SARS. SARS can spread by touching the skin of other people or objects that are contaminated with infectious droplets and then touching your eye(s), nose, or mouth, according to the CDC. This can happen when someone who is sick with SARS coughs or sneezes droplets onto themselves, other people, or nearby surfaces. It also is possible that SARS can be spread more broadly through the air or in other ways that are currently not known. Monkeypox Monkeypox is caused by monkeypox virus, which belongs to the orthopoxvirus group. In humans, monkeypox is similar to smallpox, although it is often milder. Unlike smallpox, monkey pox causes lymph nodes to swell (lymphadenopathy). The incubation period for monkeypox is about 12 days (range seven to 17 days). The illness begins with fever, headache, muscle aches, backache, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within one to three days (sometimes longer) after the appearance of fever, the patient develops a papular rash (i.e., raised bumps), often first on the face, but sometimes initially on other parts of the body. The lesions usually develop through several stages before crusting and falling off. The illness 20

25 typically lasts for two to four weeks. Monkeypox can spread to humans from infected animals through animal bites or direct contact with an animal s lesions or bodily fluids. The disease also can be spread from person to person, although it is much less infectious than smallpox. The virus is thought to be transmitted by respiratory droplets during direct and prolonged face-to-face contact. In addition, it is possible monkeypox can be spread by direct contact with bodily fluids from an infected person or with virus-contaminated objects, such as bedding or clothing. It is also possible that the virus can be spread through the air. Persons investigating monkeypox outbreaks and involved in caring for infected individuals or animals should receive a smallpox vaccination to protect against monkey pox. Check the CDC Web site for the monkeypox case definition and other current information about the outbreak. If a patient with a suspected monkeypox infection is seen as an outpatient or admitted to the hospital, infection control personnel should be notified immediately. A combination of standard, contact, and airborne precautions should be applied in all health care settings. These include using the following: Proper hand hygiene after all contact with an infected patient and/or the environment of care. Gowns and gloves for any contact with the patient and/or the environment of care. 21

26 Eye protection (i.e., goggles, face shield) if splash or spray of body fluids is likely. An airborne isolation room with negative pressure relative to the surrounding area. If a negative-pressure room is not available, place the patient in a private room. Proper containment and disposal of contaminated waste (i.e., dressings) in accordance with facility-specific guidelines for infectious waste or local regulations pertaining to household waste. Care when handling soiled laundry (i.e., bedding, towels, personal clothing) to avoid contact with lesion exudates. Soiled laundry should not be shaken or otherwise handled in a manner that may aerosolize infectious particles. Proper care in handling used patient-care equipment in a manner that prevents contamination of skin and clothing. Ensure that used equipment has been cleaned and processed appropriately. Procedures for cleaning and disinfecting environmental surfaces in the patient care environment. Any hospital detergent/disinfectant currently used by health care facilities for environmental sanitation and registered with the Environmental Protection Agency may be used. Manufacturer s recommendations for use-dilution (i.e., concentration), contact time, and care in handling should be followed. 22

27 Health care workers who have unprotected exposures to patients with monkeypox need not be excluded from duty, but should undergo active surveillance for symptoms, including measurement of body temperature at least twice daily for 21 days after the exposure. Before reporting for duty each day, the health care worker should be interviewed regarding symptoms and have his or her temperature measured by an employee or other designee. Case scenario: The undiagnosed patient A patient comes into an emergency room with the usual winter season symptoms: high fever, cough, muscle aches, sore throat. But instead of a gardenvariety cold, flu, or even pneumonia, it turns out the patient has an unknown disease that is potentially highly infectious. What should nursing staff do to take adequate isolation precautions? Don t wait for a diagnosis. The key to protecting against the spread of emerging infections is to develop a method for working with the unknown, and that means assuming the maximum precautions may be necessary. Certainly any potentially airborne infection should trigger the use of appropriate masking, and the patient should be placed to the extent possible in a negative-pressure isolation room. 23

28 Summary It s extremely important for you to practice proper infection control for you, your patients, and your fellow health care professionals. It s not difficult to follow proper procedure, but it does take a little effort and possibly a change in work behavior. But making these changes is part of your commitment as a clinical professional to provide your patient with the best care possible. 24

29 Final exam 1. True or False: The JCAHO requires hospitals and other accredited facilities to have an infection control program. True False 2. Which of the following types of employees do not have to be covered by an infection control program? a. Nurses with direct and prolonged patient contact b. Lab workers who handle blood and body tissue specimens c. Pharmacy staff d. Laundry workers who handle soiled linen 3. True or False: Using alcohol-based rubs to practice hand hygiene is not allowed according to the Centers for Disease Control and Prevention. True False 4. True or False: Workers who have direct contact with high-risk patients should avoid wearing artificial nails. True False 5. True or False: Standard precautions require health care workers to use gloves and other PPE to prevent exposure to blood and other bodily fluids. True False 25

30 6. Which of the following infection control practices is not considered one of the most relevant to protecting employee safety and health? a. Use of standard precautions b. Use of safer needle devices c. Proper handwashing d. Restricting employee contact with high-risk patients 7. True or False: The CDC s hand hygiene guideline requires health care workers to always wash their hands immediately after removing gloves. True False 8. True or False: Standard precautions require that staff change their gloves between patients and sometimes between activities with the same patient. True False 9. Which of the following falls under contact transmission? a. direct-contact d. low-contact b. high-contact e. a and c c. indirect-contact 10. True or False: The incubation period for Monkeypox is about 12 days. True False 26

31 11. True or False: Patient contact without physical exposure to blood has not been documented as a risk factor of hepatitis B. True False 12. True or False: The primary mode of transmission of hepatitis A virus is fecal/oral. True False Answers to the exam 1. True 2. c 3. False 4. True 5. True 6. d 7. True 8. True 9. e 10. True 11. True 12. True Need more copies? That s easy Call customer service at 800/ for more information or to order additional copies. For bulk ordering information, see below. Call: 800/ customerservice@hcpro.com Internet: Mail to: HCPro, Inc., P.O. Box 1168, Marblehead, MA Fax: 800/ For special pricing on bulk orders, please call Dave Miller toll-free at 888/

32 CERTIFICATE OF COMPLETION This is to certify that has read and successfully passed the final exam of Isolation Precautions Training Handbook for Nursing and Clinical Professionals Suzanne Perney Vice President/Publisher