Optimal placement whilst patient is considered infectious and until resolution of symptoms

Transcription

1 Appendix 11 Aide memire fr Optimal Patient Placement and Respiratry Prtective Equipment (RPE) fr Infectius agents whilst a patient is in hspital The clinical judgement and expertise f the Infectin Preventin and Cntrl Team r the Health Prtectin Team shuld be sught fr nvel, unusual r an increase in cases f knwn r suspected infectius agents in any care setting. This table is fr infectin preventin and cntrl measures i.e. t minimise risk f crss- f infectin t self and thers when prviding direct patient care. This is distinct fr example frm the principles f cntact tracing where the patient will have cmmenced antibitic therapy and the interviewer will be at least 3 feet (1 metre) apart. The fllwing table utlines the TBPs required fr a number f infectius agents/diseases primarily; Optimal patient placement whilst the patient is cnsidered infectius; and The recmmended RPE t minimise risk f crss infectin t staff, patients and visitrs. Clinical decisins made by staff regarding use/nn-use f RPE will depend n a risk assessment which shuld include e.g. the presenting symptms, risk f acquisitin and the availability f treatment. Suspected r tifiable under Acinetbacter baumannii Adenvirus 1 Bacillus anthracis Pneumnia, bacteraemia, skin and sft tissue infectins. Upper +/- lwer respiratry tract infectin Cnjunctivitis, gastrenteritis Injectin, inhalatin, gastrintestinal r cutaneus Anthrax in high risk settings e.g. ICU/PICU/NICU, requirement fr RPE requirement fr RPE requirement fr RPE Health Prtectin Sctland, February

2 tifiable under Bacillus cereus Brdetella pertussis Gastrenteritis, sepsis, pneumnia, endcarditis, central nervus system (CNS) and cular infectins requirement fr RPE Whping Cugh until patient has been established n Candida auris Carbapenemase prducing Enterbacteriaceae (CPE) (either swab psitive r psitive as per clinical risk assessment criteria) Ear, wund and bldstream infectin Clnisatin, device assciated infectins urinary tract infectin, catheter assciated bacteraemia in high risk requirement fr RPE requirement fr RPE Chlamydia pneumniae Pneumnia in high risk Clstridium difficile Clstridium difficile infectin (CDI) requirement fr RPE Health Prtectin Sctland, February

3 tifiable under Crnavirus 1, 4 (n SARSCV/ MersCV) Acute respiratry syndrme Crynebacterium diphtheria r Crynebacterium ulcerans Diphtheria Cutaneus, Pharyngeal (txigenic strains), (If Pharyngeal) (if pharyngeal) Entervirus D68 Mild t mderate upper respiratry tract infectins, can cause severe respiratry illness and rarely acute flaccid myelitis (AFM) Gastrintestinal infectins e.g Salmnella spp. Gastrenteritis (FRSM) if vmiting is present. (Sme GI Infectins are ntifiable. Refer t guidance) Haemphilus influenzae type b Epiglttitis, meningitis, pneumnia, septicaemia until patient has been established n Hepatitis A virus Hepatitis, Gastrenteritis (FRSM) if vmiting is present. Health Prtectin Sctland, February

4 tifiable under Herpes zster (Shingles) (varicella-zster) 2 Shingles (vesicle fluid) Shingles (lesins in the respiratry tract) /airbrne If lesins cannt be cvered Islatin rm/suite Influenza virus (Endemic strains) 4 Influenza requirement fr RPE Measles virus 2 Methicillin resistant Staphylcccus aureus (MRSA) (either swab psitive r psitive as per clinical risk assessment criteria) Mumps virus 2 Mycbacterium tuberculsis cmplex Measles (rubela) Clnisatin, skin and wund infectins, endcarditis, pneumnia, stemyelitis, urinary tract infectins and bacteraemia. Mumps (infectius partitis) Extrapulmnary Tuberculsis Pulmnary r laryngeal disease Tuberculsis / Airbrne Islatin rm/suite FFP3 r Hd fr rutine care and AGPs FFP3 r nly if pneumnia FFP3 r Airbrne Islatin rm/suite until patient has been established n and always if the patient has MDR r XDR TB FFP3 r Hd fr rutine care and AGPs until patient has been established n apprpriate antimicrbial treatment 6 and always if the patient has MDR r XDR TB Health Prtectin Sctland, February

5 tifiable under Mycplasma pneumniae Pneumnia Neisseria meningitides Meningitis meningcccal (Or presentatin f clinical meningitis f unknwn rigin), septicaemia until patient has been established n rvirus Winter vmiting disease (FRSM) if vmiting is present. vel crnavirus 4 Pantn Valentine Leukcidin (PVL) psitive Staphylcccus aureus Parainfluenza virus 1 Severe respiratry illness with/ut gastrenteritis, pneumnia Skin and sft tissues infectin, necrtising pneumnia, necrtising fasciitis, stemyelitis, septic arthritis and pymysitis, purpura fulminans Upper +/- lwer respiratry tract infectin May be unknwn, assume airbrne until further infrmatin available. Islatin rm/suite FFP3 r Hd fr rutine care and AGPs (nly if pneumnia) (unless SARS) Health Prtectin Sctland, February

6 tifiable under Parvvirus B19 (Erythema infectisum Erythrvirus B19) Pneumcystis jirvecii Pseudmnas aeruginsa Respiratry syncytial virus (RSV) 1 Slapped cheek syndrme Pneumnia Pneumnia, bacteraemia, wund r surgical site infectins, catheter-assciated urinary tract infectins, cnjunctivitis in nenates Upper +/- lwer respiratry tract infectin until the rash+/- arthralgia has develped in high risk in high risk (t required if the rash+/- arthralgia has develped) requirement fr RPE requirement fr RPE Rtavirus Gastrenteritis requirement fr RPE Rubella virus 2 German Measles Serratia marcescens Staphylcccus aureus (Entertxigenic) Pneumnia, bacteraemia, urinary tract infectins, wund infectins Gastrenteritis, scalded skin syndrme in high risk (nt required if lesins can be cvered) requirement fr RPE requirement fr RPE Health Prtectin Sctland, February

7 tifiable under Stentrphmnas maltphilia Streptcccus pygenes (Grup A Strep) Streptcccus pneumniae Bacteraemia, respiratry infectins, urinary tract and surgical-site infectins Respiratry infectin Bacteraemia, meningitis, wund infectin r infectin in ther nrmally sterile site Pneumnia Bacteraemia, meningitis, wund infectin r infectin in ther nrmally sterile site in high risk (until patient has been established n apprpriate antimicrbial treatment 6 ) (until patient has been established n apprpriate antimicrbial treatment 6 ) (until patient has been established n apprpriate antimicrbial treatment 6 ) (until patient has been established n apprpriate antimicrbial treatment 6 ) requirement fr RPE until patient has been established n requirement fr RPE until patient has been established n requirement fr RPE (presence in the wund is nt ntifiable) Varicella virus 2 Chickenpx Airbrne Islatin rm/suite FFP3 r Hd fr rutine care and AGPs Shiga-txin reducing Escherichia cli (STEC) Gastrenteritis, haemlytic uremic syndrme, thrmbtic thrmbcytpaenic purpura. requirement fr RPE Health Prtectin Sctland, February

8 tifiable under Viral Haemrrhagic Fever (VHF) See Ftnte 1 In rutine clinical practice healthcare wrkers d nt cmmnly wear masks when dealing with patients presenting with the cmmn cld r influenza like illness. Hwever, in a patient with undiagnsed respiratry illness where cughing and sneezing are significant features, r in the cntext f knwn widespread respiratry virus activity in the cmmunity r a suspected r utbreak f a respiratry illness in a clsed r semi-clsed setting, the need fr apprpriate respiratry and facial prtectin t be wrn shuld be cnsidered. Ftnte 2 In relatin t childhd illnesses and use f RPE, n vaccine ffers 100% prtectin and a small prprtin f individuals acquire/becme infected despite vaccinatin r knwn IgG immunity (previus infectin). Vaccinatin is still the best prtectin against many infectius diseases. If staff are uncertain f their immunisatin status they shuld discuss this with their ccupatinal health prvider. It is recmmended that vaccinated individuals wear RPE as detailed in this appendix t minimise any residual risk, and t prmte cnsistency in practice acrss all staff grups. Ftnte 3 The cular rute f fr pathgens spread by the drplet/airbrne rute whilst plausible lacks scientific evidence. This lack f evidence includes having very little certainty abut what the incremental benefit f using eye prtectin rutinely when using a FRSM/FFP3 respiratr. Eye prtectin is cnsidered t be necessary and wrn if there is a risk f spraying r splashing f bld/bdy fluids frm patient cntact r prcedure, and always when used with respiratrs during the perfrmance f AGPs. This is line with published infectin cntrl guidance e7-8aa aacb361&acdnat= _4ba30f9973ee78c5ff37255f70b8fa1f Aersl Generating Prcedures (AGPs) can prduce drplets <5 micrns in size which may cause infectin if they are inhaled. These small drplets, cntaining pathgens, can remain in the air, travel ver a distance and still be infectius. AGPs prcedures shuld nly be carried ut when essential. Where pssible, these prcedures shuld be carried ut in well-ventilated single rms with the drs shut. Only thse healthcare wrkers wh are needed t undertake the prcedure shuld be present. Aersl Generating Prcedures (AGPs) are defined as: Intubatin, extubatin and related prcedures, fr example manual ventilatin and pen suctining. Cardipulmnary resuscitatin. Health Prtectin Sctland, February

9 Brnchscpy. Surgery and pst mrtem prcedures in which high-speed devices are used. Sme Dental prcedures (e.g drilling) n Invasive Ventilatin (NIV) e.g. Bilevel Psitive Airway Pressure Ventilatin (BiPAP) and Cntinuus Psitive Airway Pressure Ventilatin (CPAP). High Frequency Oscillatry Ventilatin (HFOV). Inductin f sputum Ftnte 4 Additinal guidance shuld be fllwed fr knwn/suspected cases f nvel influenza viruses, including avian influenza, MERS CV. Ftnte 5 tificatins may be made n clinical suspicin by registered medical practitiner ( ntifiable diseases ) r nce the rganism is by the directr f the diagnstic labratry ( ntifiable rganisms ). Cnditins may fall under ne r bth f these categries, and medical prfessinals and labratries have a duty t be aware f their respnsibilities under the etc Ftnte 6 Apprpriate antimicrbial treatment will include the chice f treatment, dse, frequency and number f days f treatment. It will vary by rganism and shuld be determined by the clinical team and infrmed by lcal and natinal prescribing guidance where available. Health Prtectin Sctland, February