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  1. 1. IsolationIn order to get reimbursed by insurance for isolationcharges, there must be documentation every shift that isolationprecautions are being observed Document• Type of isolation initiated• Education of patient and family on initiation and daily• Airborne isolation, document fit-testing offered to family/friends• Observation of isolation precautions every shift
  2. 2. Isolation (continued)There are many ways to document the observation of isolationprecautions in Point of Care • Problem List • Nursing Activities • MedAct • EducationAssociate MedAct Interventions with the Problem List tostreamline documentationAlways place the appropriately completed IsolationCommunication sheet under doctor’s orders
  3. 3. Isolation (continued) The number one way to prevent the spread of infection is through handwashing When the hands are not visibly soiled, a hospital approved alcohol based hand sanitizer (Purell) may be used Chlorhexidine gluconate (CHG, Hibiclens, Calgon Vestal) is used to wash your hands when your patient is in isolation precautions If patient is on isolation precautions for C-Difficile remember to wash hands with Chlorhexidine gluconate in patient’s room. Alcohol based hand sanitizers do not wash off C-Difficile
  4. 4. Isolation (continued) When your patient is on airborne precautions, they are placed in a negative pressure isolation room Negative pressure rooms include an anteroom Both the interior and exterior door will remain closed – When entering or leaving the room only one door should be open at a time You must wear a properly fitted N95 respirator mask to enter the room Fit testing is done in Associate Health yearly Entering an airborne isolation room without a properly fitted mask puts you at risk for exposure
  5. 5. Isolation (continued)Isolation carts are obtained by calling Materials Management andrequesting one be brought to the unit• If Materials Management is closed, the associate can ask the House Supervisor to get oneWhen the isolation is discontinued:• Clean and disinfect the isolation cart - make sure to saturate the cart with Virex and allow it to sit for at least 10 minutes• All items used in the patient’s room are thrown away• Call Materials Management to pick up the cart after it has been disinfected
  6. 6. Isolation (continued)Isolation carts contain items used in the isolation patient’sroom A stethoscope is provided that is disposed of when the patient is removed from isolation or discharged Appropriate personal protective equipment is provided including gowns, gloves, and masks Disposable thermometers are provided (please only take what you need into the patient’s room) Signage for the door is provided Calgon Vestal soap is provided – wash with this for all isolation patients
  7. 7. Isolation (continued)An item must first be cleaned before it is disinfected Virex II 256 is used as a general disinfectant If an item is contaminated with blood or other potentially infectious material, Expose must be used To disinfect an item, Virex must be sprayed on liberally and left to sit for ten minutes When cleaning an item that has been contaminated with blood, use Expose allowing it to sit for 10 minutes, clean afterward with Virex to remove any residue
  8. 8. Isolation (continued) Codes – Isolation codes not only communicate that the patient is in isolation but also the type: • A = Airborne • D = Droplet • C = Contact • P = Protective Isolation These codes are added to the demographics and print to the following: Patient summary Mini Census (I column) Demographic view on Virtual Chart Ancillary screens
  9. 9. Isolation (continued)It is the primary nurse’s responsibility toplace the patient in isolation on admission ifnecessary by history or if patient isadmitted with abscesses, drainingwounds, or diabetic foot ulcers or otherapproved isolation criteria such as: • Suspected TB • C-Difficile • Chicken Pox • Rubella, Mumps, Diphtheria • Hepatitis A (Continued on next slide)
  10. 10. Isolation (continued)  Salmonellosis  Herpes Zoster (shingles)  Neonatal herpes simples/Viral infections  Pediatric respiratory illnesses  Meningitis  Staph Aureus/MRSA, VRE  Multi-drug resistant organisms *The patients with any of these mentioned isolation criteria; will have isolation initiated immediately on admission and Infection Control notified by phone * If history indicates-cultures of previously infected areas should be obtained at this time; then if patient is cleared by acceptable culture, isolation is discontinued
  11. 11. Isolation (continued) The nurse then notifies infection control of culture results which clears the isolation status Likewise, the infection control nurse should be notified if patient is placed in isolation on admission If patient is placed in isolation after business hours or on the weekend, leave a message with the infection control nurse at 380-1063 The admission clerk should notify the receiving unit and infection control nurse when a patient who is known to have previously cultured positive for VRE or MRSA is admitted
  12. 12. Isolation (continued) It is also vital for nursing to check and see if the patient is positive for VRE or MRSA on admission as well This is done by hovering the cursor over the arrow by “Patient Care” on the virtual chart If patient has a history of MRSA or VRE there will be a “Y” in the respective place If this is the case, the patient has not been “cleared” and must immediately be placed in isolation, infection control notified and the isolation code “C” placed in demographics screen so it pulls to the virtual chart The “C” does not pull from stay to stay so admissions and nursing need to be vigilant in looking for these patients on admission and applying the “C” if indicated
  13. 13. Isolation (continued)Discontinuing Isolation When isolation is discontinued the code is removed from the demographics screen. Isolation is discontinued per protocols or once the patient is cleared• MRSA is cleared by one negative culture• VRE is cleared by 3 sets of 3 cultures with each set collected at least one week apart