Isolation precautions in clinical practice

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Isolation PrecautionsIsolation Precautions
Prepared by:Prepared by:
Dr/AHMED BESHIRDr/AHMED BESHIR
PulmonologistPulmonologist
DTQM (AUC)DTQM (AUC)
CPHQCPHQ
IPC DIRECTORIPC DIRECTOR

Learning ObjectivesLearning Objectives
 Discuss chain of infection and different types ofDiscuss chain of infection and different types of
mode of transmissionmode of transmission
 Define isolation precautions and describe differentDefine isolation precautions and describe different
types isolation precautions.types isolation precautions.
 Describe how to use contact precautions.Describe how to use contact precautions.
 Describe how to use droplet precautions.Describe how to use droplet precautions.
 Describe how to use airborne precautions.Describe how to use airborne precautions.

Chain of infectionChain of infection

Mode of transmissionMode of transmission
 A microorganism may be spread by a single orA microorganism may be spread by a single or
multiple routes.multiple routes.
 Contact, direct or indirectContact, direct or indirect
 DropletDroplet
 AirborneAirborne
 Vector-borne (usually arthropod) andVector-borne (usually arthropod) and
 Common environmental sources or vehicles - includes food-Common environmental sources or vehicles - includes food-
borne and waterborne, medications e.g., contaminated IVborne and waterborne, medications e.g., contaminated IV
fluidsfluids

Contact transmissionContact transmission
 Direct-contactDirect-contact
 Direct body surface-to-body surface contact andDirect body surface-to-body surface contact and
 Physical transfer of microorganisms between aPhysical transfer of microorganisms between a
susceptible host and an infected or colonized personsusceptible host and an infected or colonized person
 Indirect-contactIndirect-contact
 Contact of a susceptible host with a contaminatedContact of a susceptible host with a contaminated
intermediate object, usually inanimate, such asintermediate object, usually inanimate, such as
contaminated instruments, needles, or dressings, orcontaminated instruments, needles, or dressings, or
contaminated hands or glovescontaminated hands or gloves
5

droplet transmissiondroplet transmission
 Droplet generationDroplet generation
 coughing,coughing,
 sneezing,sneezing,
 talking,talking,
 procedures such as suctioning and bronchoscopyprocedures such as suctioning and bronchoscopy
 Droplet transmissionDroplet transmission
 Droplet deposited on the host’s conjunctivae, nasalDroplet deposited on the host’s conjunctivae, nasal
mucosa, or mouth.mucosa, or mouth.
6

Airborne transmissionAirborne transmission
 Small-particle residue {5µm or smaller} ofSmall-particle residue {5µm or smaller} of
evaporated droplets containing microorganismsevaporated droplets containing microorganisms
 Suspended in the air for long periods of timeSuspended in the air for long periods of time
 Dispersed by air currentsDispersed by air currents
 Inhaled by a susceptible host within the same roomInhaled by a susceptible host within the same room
or over a longer distanceor over a longer distance
7

What are Isolation Precautions?What are Isolation Precautions?
 PracticesPractices that prevent transmission of certainthat prevent transmission of certain
diseases from patients to staff, and from staff todiseases from patients to staff, and from staff to
other patientsother patients
 Type of isolation precautions is determined by how aType of isolation precautions is determined by how a
disease is transmitted (passed)disease is transmitted (passed)
 Isolation Precautions are doneIsolation Precautions are done in additionin addition to Standardto Standard
Precautions and include:Precautions and include:
 Strict adherence to hand hygieneStrict adherence to hand hygiene
 Personal protective equipment (PPE) appropriate for the type ofPersonal protective equipment (PPE) appropriate for the type of
isolation precautions in placeisolation precautions in place
 Environmental disinfectionEnvironmental disinfection
 Respiratory Hygiene and Cough EtiquetteRespiratory Hygiene and Cough Etiquette
 safe injection practicessafe injection practices

IsolationIsolation
PrecautionsPrecautions
PatientPatient
TransportTransport
Linen & laundryLinen & laundry
Patient care equipmentPatient care equipment
And articlesAnd articles
Routine andRoutine and
TerminalTerminal
CleaningCleaning
PPEPPE
Hand hygieneHand hygiene
PatientPatient
placementplacement
Isolation PrecautionsIsolation Precautions

I - Contact PrecautionsI - Contact Precautions

Contact PrecautionsContact Precautions
 Contact PrecautionsContact Precautions apply to diseasesapply to diseases
transmitted bytransmitted by direct contactdirect contact with thewith the
patient’s skin and/or infectious substancepatient’s skin and/or infectious substance
and byand by indirect contactindirect contact with the patient’swith the patient’s
environmentenvironment
 GlovesGloves andand gowns are usedgowns are used
 Masks are used in certain circumstancesMasks are used in certain circumstances

Diseases RequiringDiseases Requiring
Contact PrecautionsContact Precautions
 Clostridium difficileClostridium difficile
 Congenital rubellaCongenital rubella
 LiceLice
 ScabiesScabies
 Large woundsLarge wounds
 Burn patients in ICUBurn patients in ICU

Specific Information onSpecific Information on
AcinetobacterAcinetobacter
 Acinetobacter is a group of bacteria commonly foundAcinetobacter is a group of bacteria commonly found
in soil, water, food, and sewagein soil, water, food, and sewage
 Loves the GI tract – the “gut” flora/bugLoves the GI tract – the “gut” flora/bug
 May also be found on the skin of healthy people,May also be found on the skin of healthy people,
especially healthcare workersespecially healthcare workers
 Resulting infections are often resistant to manyResulting infections are often resistant to many
commonly prescribed antibiotics – treatment may becommonly prescribed antibiotics – treatment may be
limited to very toxic drugslimited to very toxic drugs

Specific Information onSpecific Information on
AcinetobacterAcinetobacter
 Outbreaks of Acinetobacter may occur in ICUs and inOutbreaks of Acinetobacter may occur in ICUs and in
other hospital units that house patients with weakenedother hospital units that house patients with weakened
immune systems or chronic illnessesimmune systems or chronic illnesses
 May cause pneumonia, bloodstream or urinary tractMay cause pneumonia, bloodstream or urinary tract
infections, and skin/wound infectionsinfections, and skin/wound infections
 Endocarditits, secondary meningitis, and ventriculitisEndocarditits, secondary meningitis, and ventriculitis
may also resultmay also result
 Patients placed onPatients placed on Contact PrecautionsContact Precautions for Acinetobacterfor Acinetobacter
infection remain on isolation precautions throughout theirinfection remain on isolation precautions throughout their
hospitalizationhospitalization

Specific InformationSpecific Information
on MRSAon MRSA
 Methicillin-resistantMethicillin-resistant Staphylococcus aureusStaphylococcus aureus (MRSA)(MRSA)
is the commonly called “staph” bacteria that hasis the commonly called “staph” bacteria that has
become resistant to many antibioticsbecome resistant to many antibiotics
 Patients who have invasive procedures, lengthyPatients who have invasive procedures, lengthy
hospital stays, weakened immune systems, or whohospital stays, weakened immune systems, or who
receive dialysis are at increased risk of developingreceive dialysis are at increased risk of developing
MRSAMRSA
 Community-acquired MRSA (CA-MRSA) is increasingCommunity-acquired MRSA (CA-MRSA) is increasing
among patients who haveamong patients who have nevernever been hospitalizedbeen hospitalized

 About 30% of the US population have “staph”About 30% of the US population have “staph”
bacteria that normally live on the skin and in nasalbacteria that normally live on the skin and in nasal
passages without causing harm (colonized)passages without causing harm (colonized)
 Common infections caused by MRSA include skinCommon infections caused by MRSA include skin
abscesses, boils, and impetigoabscesses, boils, and impetigo
 More serious infections that may develop includeMore serious infections that may develop include
deep soft tissue abscess, blood stream infections,deep soft tissue abscess, blood stream infections,
pneumonia, endocarditis (heart valves, inner lining ofpneumonia, endocarditis (heart valves, inner lining of
the heart), and toxic shockthe heart), and toxic shock
on MRSAon MRSA

 MRSA is spread by worker hands that pick up theMRSA is spread by worker hands that pick up the
bacteria from skin-to-skin contact with abacteria from skin-to-skin contact with a
colonized or infected patient, then care forcolonized or infected patient, then care for
another patient without first performinganother patient without first performing
adequate hand hygieneadequate hand hygiene
 Contact with contaminated substances or itemsContact with contaminated substances or items
such as computer keyboards, bedrails, or medicalsuch as computer keyboards, bedrails, or medical
equipment can also lead to transmissionequipment can also lead to transmission
 MRSA may survive for weeks to months onMRSA may survive for weeks to months on
various surfaces!various surfaces!
on MRSAon MRSA

on VREon VRE
 Enterococci bacteria are normally found in theEnterococci bacteria are normally found in the
human intestines, the female genital tract, andhuman intestines, the female genital tract, and
the environment and may not cause diseasethe environment and may not cause disease
 Vancomycin is a drug commonly used to treatVancomycin is a drug commonly used to treat
enterococci infections. In some instances theenterococci infections. In some instances the
bacteria is resistant to the drug and is thereforebacteria is resistant to the drug and is therefore
called vancomycin-resistant entercocci (VRE)called vancomycin-resistant entercocci (VRE)
 Patients can be colonizedPatients can be colonized oror have an activehave an active
infection involving the urinary tract, blood streaminfection involving the urinary tract, blood stream
or woundsor wounds

 Risk factors for developing VRE include: personsRisk factors for developing VRE include: persons
previously treated with vancomycin or combinations ofpreviously treated with vancomycin or combinations of
other drugs, persons receiving prolonged antibioticother drugs, persons receiving prolonged antibiotic
therapy, weak immune system, surgery to abdomen ortherapy, weak immune system, surgery to abdomen or
chest, and use of indwelling catheterschest, and use of indwelling catheters
 VRE is spread by direct contact with infected stool,VRE is spread by direct contact with infected stool,
urine, or blood containing VREurine, or blood containing VRE
 Can also spread indirectly by hands or via contaminatedCan also spread indirectly by hands or via contaminated
environmental surfacesenvironmental surfaces
on VREon VRE

II - Airborne PrecautionsII - Airborne Precautions

Airborne PrecautionsAirborne Precautions
 Airborne PrecautionsAirborne Precautions apply to diseases transmittedapply to diseases transmitted
by the airborne routeby the airborne route
 Bacteria or viruses are released into the air whenBacteria or viruses are released into the air when
an infected patient talks, coughs, or sneezesan infected patient talks, coughs, or sneezes
 These droplets float on air currents and/or remain inThese droplets float on air currents and/or remain in
the air for long periods of timethe air for long periods of time
 A susceptible person who does not wear respiratoryA susceptible person who does not wear respiratory
protection can breathe in the droplets and potentiallyprotection can breathe in the droplets and potentially
become infectedbecome infected

1. Pulmonary Tuberculosis (TB)1. Pulmonary Tuberculosis (TB)
2. Measles2. Measles
3. Chicken Pox3. Chicken Pox
Unusual bioterrorism agents and others such as …Unusual bioterrorism agents and others such as …
- Smallpox (Bioterrorism)- Smallpox (Bioterrorism)
- Viral hemorrhagic fevers- Viral hemorrhagic fevers (Bioterrorism)(Bioterrorism)
- SARS- SARS
 Patients are placed on droplet precautions when any of thesePatients are placed on droplet precautions when any of these
diseases are suspecteddiseases are suspected oror confirmedconfirmed

N-95 RespiratorsN-95 Respirators
 ALLALL STAFFSTAFF providing care to patients onproviding care to patients on
Airborne PrecautionsAirborne Precautions mustmust wear anwear an
N-95 respiratorN-95 respirator!!!!
 N-95 respirators must be fit tested annually–N-95 respirators must be fit tested annually–
your mask size can change over timeyour mask size can change over time

 Patients should be placed in negative pressure roomsPatients should be placed in negative pressure rooms
AIIR while on their designated floor/unitAIIR while on their designated floor/unit
 Keep the door closed!!!Keep the door closed!!!
 Limit transport of patient from room except forLimit transport of patient from room except for
essential purposesessential purposes
 Have the patient wear a regular surgical mask anyHave the patient wear a regular surgical mask any
time they are transported from their roomtime they are transported from their room
 Inform the receiving department of the patient’sInform the receiving department of the patient’s
isolation statusisolation status prior to transferring the patientprior to transferring the patient

III - Droplet PrecautionsIII - Droplet Precautions

Droplet PrecautionsDroplet Precautions
 Applies to diseases transmitted by closeApplies to diseases transmitted by close
contact with respiratory secretionscontact with respiratory secretions
 Infectious droplets are expelled when aInfectious droplets are expelled when a
patient coughs or sneezespatient coughs or sneezes
 Droplets remain airborne for about 3 feet,Droplets remain airborne for about 3 feet,
then fall to the floorthen fall to the floor

Droplet PrecautionsDroplet Precautions
 InfluenzaInfluenza
 Pertussis (Whooping Cough)Pertussis (Whooping Cough)
 MumpsMumps
 Meningitis caused byMeningitis caused by H. influenzaeH. influenzae oror N.N.
meningiditismeningiditis
 Fifth Disease (Parvovirus B-19)Fifth Disease (Parvovirus B-19)
 Patients are placed on droplet precautions when any of thesePatients are placed on droplet precautions when any of these
diseases are suspecteddiseases are suspected oror confirmedconfirmed

More onMore on Droplet PrecautionsDroplet Precautions
 Wear gloves when handling itemsWear gloves when handling items
contaminated with respiratory secretionscontaminated with respiratory secretions
 Wash hands after removing glovesWash hands after removing gloves

More onMore on Droplet PrecautionsDroplet Precautions
 the room can be cleaned with the standard germicidalthe room can be cleaned with the standard germicidal
agentagent
 Patients should be placed in private rooms while onPatients should be placed in private rooms while on
their designated floor/unit, but negative pressuretheir designated floor/unit, but negative pressure
rooms are unnecessaryrooms are unnecessary
 During transport, patients wear a regular surgicalDuring transport, patients wear a regular surgical
maskmask

Questions or Concerns?Questions or Concerns?
ContactContact
Infection Control & PreventionInfection Control & Prevention
Phone: 260Phone: 260

Isolation precautions in clinical practice

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