SUBJECT: ISOLATION PRECAUTIONS REFERENCE #6003 PAGE: 1 DEPARTMENT: REHABILITATION SERVICES OF: 6 EFFECTIVE:

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1 PAGE: 1 STANDARD PRECAUTIONS: Precautions which are designed for care of all patients, regardless of diagnosis or presumed infection status to reduce the risk of transmission from both recognized and unrecognized sources of infection. TRANSMISSION BASED PRECAUTIONS: Precautions which are designed for care of patients known or suspected of being infected or colonized with epidemiologically important pathogens for which additional precautions beyond Standard Precautions are necessary. There are five main categories of transmission: Airborne Transmission and Precautions: Airborne transmission - This mode of transmission occurs by the spreading of either airborne droplet nuclei (small particle residue of 5 microns or smaller of evaporated droplets which contain microorganisms that remain suspended in the air for long periods of time) or dust particles containing the microorganism. Special air handling and ventilation are required to prevent airborne transmission due to the fact that microorganisms can be dispersed widely by air currents and may become inhaled by a susceptible host. Airborne Precautions include the following: Patient Placement - The patient must be placed in a private room that has the following: Monitored negative air pressure in relation to the surrounding areas; Six (6) to twelve (12) air changes per hour; An appropriate discharge of air to the outdoors or monitored high efficiency filtration of room air before the air is circulated into other areas of the facility. The patient must stay in the room with the room door closed. If a private room is not available, contact the hospital's infection control professionals for advice on patient placement.

2 PAGE: 2 Respiratory Protection - Respiratory protection must be worn when entering the room of a patient known or suspected of having infectious pulmonary tuberculosis. When entering the room of a patient known or suspected of having measles (rubeola) or varicella (chickenpox), persons who are immune to measles (rubeola) or varicella (chickenpox) need not wear respiratory protection. Persons who are susceptible should not enter the room of patients known or suspected of having rubeola or varicella. If a susceptible person must enter the room, they must wear respiratory protection. Patient Transport - Patient movement and transport must be limited to essential purposes only. If movement or transport becomes necessary, place a surgical mask on the patient to minimize dispersal of droplet nuclei. Additional Precautions for Preventing Tuberculosis Transmission - Consult the CDC's "Guidelines for Preventing the Transmission of Tuberculosis in Health Care Facilities", MMWR 1994;43 (RR-13):1-132, and Federal Register 1994;59(208): Examples of Diseases or Conditions Requiring Airborne Precautions: Measles (rubeola); Tuberculosis; Varicella (chickenpox), including disseminated zoster. Droplet Transmission and Precautions: Droplet transmission, in theory, is a form of contact transmission, but will be considered a separate route of transmission because the mechanism of transfer to the host is very distinct from contact transmissions. Droplets are transmitted from the host source by coughing, sneezing, talking or during procedures such as suctioning or bronchoscopy. Transmission occurs when droplets containing the microorganism are propelled through the air a short distance and contact a host's conjunctivae, nasal mucosa or mouth. These droplets do not remain suspended, thus special air handling and ventilation systems are not required. Droplet Precautions include the following:

3 PAGE: 3 Patient Placement - If at all possible, place patient in a private room. If a private room is not available, the patient may be placed in a room with a patient(s) who has an active infection with the same microorganism, but has no other infection (cohorting). If cohorting is not possible, maintain a spatial separation of a minimum of three (3) feet between the infected patient and other patients and visitors. The patient's room door may remain open and special air handling and ventilation are not necessary. Mask - A mask must be worn when working within three (3) feet of the patient, in addition to Standard Precautions. (Some facilities may wish to implement wearing a mask to enter the room.) Patient Transport - Patient movement and transport must be limited to essential purposes only. If movement or transport becomes necessary, place a mask on the patient to minimize dispersal of droplets. Examples of Diseases or Conditions Requiring Droplet Precautions: Invasive Haemophilus influenzae type B disease, including meningitis, pneumonia, epiglottitis and sepsis; Invasive Neisseria meningitidis disease, including meningitis, pneumonia and sepsis; Diphtheria (pharyngeal); Mycoplasma pneumonia; Pertussis (whooping cough); Pneumonic plague; Streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children; Adenovirus; Influenza; Mumps;

4 PAGE: 4 Parvovirus B 19; Rubella. Contact Transmission and Precautions: Contact transmission is the most important and frequent mode of transmission. Contact transmission is divided into two subgroups: Direct Contact Transmission - This mode of transmission involves direct body surface to body surface contact with physical transfer of microorganisms between a susceptible host and an infected or colonized person. Examples of this type of transmission include: turning a patient, giving a patient a bath or other patient care activities which require direct personal contact. Indirect Contact Transmission - This mode of transmission involves contact with an intermediate object (usually inanimate) and a susceptible host. Such objects may include contaminated instruments, needles, dressings or contaminated hands which have not been washed or gloves not changed between patients. Contact Precautions include the following: Patient Placement - If at all possible place patient in a private room. If a private room is not available, the patient may be placed in a room with a patient(s) who has an active infection with the same microorganism, but has no other infection (cohorting). If cohorting is not possible, consider the epidemiology of the microorganism and the patient population. Consult the hospital's infection control professionals for advice on patient placement prior to placing the patient. Gloves and Handwashing - Wear clean, nonsterile gloves as outlined under Standard Precautions, when entering the room. When providing care to the patient, gloves shall be changed after contact with the infective material (i.e., fecal material and wound drainage). Always remove gloves prior to leaving the patient's environment and wash hands promptly with an antimicrobial agent or a waterless antiseptic agent. Once gloves have been removed and handwashing completed, do not touch potentially contaminated surfaces or items in the patient's room. This will avoid transfer of the microorganism to other patients and/or environments.

5 PAGE: 5 Gown - Wear a gown as outlined under Standard Precautions, when entering the room, if you expect that your clothing may come in substantial contact with the patient, surfaces or items in the patient's room, or if the patient has diarrhea, an ileostomy, a colostomy, wound drainage not contained in a dressing or is incontinent. Always remove the gown prior to leaving the patient's room. Once the gown has been removed make sure that your clothing does not come in contact with potentially contaminated surfaces. Patient Transport - Patient movement and transport must be limited to essential purposes only. If movement or transport becomes necessary make sure that precautions are maintained, to reduce the risk of transmission of microorganisms to others and contamination of environmental surfaces and equipment. Patient Care Equipment - The use of noncritical patient care equipment should be dedicated to a single patient whenever possible. If use of common patient care equipment or items is unavoidable, the equipment or items must be adequately cleaned and disinfected prior to use on another patient. Examples of Diseases or Conditions Requiring Contact Precautions: Gastrointestinal, respiratory, skin or wound infections or colonizations with multidrug resistant bacteria which have been judged to be of special clinical and epidemiologic significance; Clostridium difficile; Enterohemorrhagic Escherichia coli O157:H7, Shigella, hepatitis A, rotavirus in diapered or incontinent patients; Respiratory syncytial virus, parainfluenza virus or enteroviral infections in infants and young children; Diphtheria (cutaneous); Herpes simplex virus (neonatal or mucocutaneous); Impetigo; Major (noncontained) abscesses, cellulitis or decubiti;

6 PAGE: 6 Pediculosis (lice); Scabies; Staphylococcal furunculosis in infants and young children; Zoster (disseminated or in the immunocompromised patient); Viral hemorrhagic infections including Ebola, Lassa or Marburg. Common Vehicle Transmission: Common Vehicle Transmission - This mode of transmission occurs by microorganisms being transmitted in contaminated items, i.e., food, water, medications, devices and equipment. This mode of transmission does not play a significant role in typical nosocomial infections. Vectorborne Transmission: Vectorborne Transmission - This mode of transmission occurs when mosquitoes, flies, rats and other vermin transmit microorganisms. Vectorborne transmission is less significant in facilities in the United States than in other regions of the world.