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ISOLATION UPDATE FOR NURSES. Department of Hospital Epidemiology and Infection Control 5-8384 Osler 425 www.hopkins-heic.org. Infection epidemic carves deadly path Poor hygiene, overwhelmed workers contribute to thousands of deaths First of three parts. - PowerPoint PPT Presentation
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Updated 4/28/03
ISOLATION UPDATE FOR NURSES
Department of Hospital Epidemiology and Infection Control
5-8384
Osler 425
www.hopkins-heic.org
Infection epidemic carves deadly pathPoor hygiene, overwhelmed workers contribute to thousands of deaths First of three parts.By Michael J. BerensTribune staff reporter
July 21, 2002
A hidden epidemic of life-threatening infections is contaminating America's hospitals, needlessly killing tens of thousands of patients each year.
Prevent infections by:
Practicing good hand hygiene
Following Standard Precautions and isolation instructions
Receiving vaccinations
Important Terms
Colonization is the presence of a pathogen in a body site without any clinical signs and symptoms. Different organisms prefer different body sites, e.g. MRSA prefers nares, VRE prefers GI tract.
An infection occurs when there are clinical signs and symptoms (fever, erythema, edema, purulent drainage, etc.)
STANDARD PRECAUTIONS
Practiced for all patients– Keep a barrier between
the HCW and the blood and/or body fluids of ALL patients
• GLOVES
• GOWNS
• MASKS
• EYEWEAR
Prevent Infections…
ISOLATION
Isolation
Isolation guidelines are based on the ways that specific organisms are spread
In order to protect patients and staff, additional isolation categories are needed to supplement Standard Precautions
Follow Isolation Directions
Follow the isolation sign on patient door/bed space
Check patient’s chart for isolation sticker
What’s New for 2003?
Nurses now have the authority to initiate isolation through a nursing order
Strict Isolation has been discontinued– Patients previously placed in Strict Isolation
will now require Airborne & Contact Precautions
• Examples: Chickenpox, Disseminated Herpes Zoster, Smallpox, SARS
What Else is New?
Airborne Isolation room requirements– Negative pressure vented to the outside
(suitable for TB)– Negative pressure room not vented to outside
but with HEPA Filter may be used if no “TB” rooms are available
Initiation of Airborne Isolation requires ID approval (not new but now encompasses more diseases)
Still More New Information
Airborne Isolation requires the use of PAPR by HCW – HCW known to be immune to chickenpox, or
measles do not need to wear PAPR when caring for patients with those diseases or disseminated Zoster
– PAPR must be worn by all HCW when caring for patient with TB, Smallpox, SARS
Airborne precautions are required for:– Tuberculosis (TB), Smallpox, Chickenpox,
Measles, SARSRequirements:– ID physician approval– Negative pressure room – Staff must wear Powered-Air Purifying
Respirators (PAPRs) and close door behind them– Staff remove PAPR prior to exiting ante-room – Sanitize hands after leaving room
Airborne Precautions
PAPRs PAPRs are obtainable
from Central Supply at x 5-8357
Hoods can be reused by the same HCW
Be sure to obtain more than one or two
Call HSE at x 5-5918 to pick up units when no longer needed
HSE will also provide training about how to use the PAPR
Contact isolation is required for:– MRSA, C. diff, Adenovirus, conjunctivitis,
decubitus ulcer infection, etc.
Requirements:– Gown and gloves for contact with patient in
room– Remove gown and gloves prior to leaving
room – Sanitize hands after leaving room
Contact Precautions
Special Precautions are required for:– VRE, VISA
Requirements:– Private room– Visitors and Healthcare Worker (HCW) must
don a gown and gloves before entering patient room
– Sanitize hands after leaving room– Dispose of gown and gloves before leaving the
room
Special Precautions
Fingers and Fomites: VRE
VRE (E faecium) can be recovered from gloved and ungloved fingertips for at least 60 minutes after inoculation
VRE recovered from bedrails (Up to 24 Hours), telephones, and stethoscopes (Up to 60 Minutes)
VRE recovered from countertops for up to 7 days after inoculation
Noskin, ICHE: 1995;16:577-581.
VISA/VRSA
VISA (Vancomycin Intermediate Staphylococcus aureus)
– 1999- now 20 cases worldwide
– Has not demonstrated transmission to health care workers
VRSA (Vancomycin Resistant Staphylococcus aureus)
– 2002- 2 cases in the United States
– In both cases, patients were co-infected with MRSA/VRE
Droplet precautions are required for:– Influenza, (adult) RSV, Parvovirus, Croup,
Mumps, Pertussis, Strept throat, etc
Requirements: – Mask, gown, gloves when within 3-6 feet of
patient – Sanitize hands after leaving room
Droplet Precautions
Pediatric Droplet
Specifically for the pediatric patient with Respiratory Syncytial Virus (RSV)– Private room preferred– Gowns and masks are required for contact– Protective attire must be removed before
leaving the room– Hand hygiene must be performed after leaving
the room
Transport of Patients Requiring Isolation
Should be limited to essential needs
Masking of patient with standard surgical mask if droplet or airborne transmission and the patient can tolerate
Notify receiving department of appropriate precautions– Make sure chart is appropriately labeled
What’s wrong with this picture?
JHH Coding Procedures If a patient presents for admission to your unit,
check his magenta plate to ensure isolation is not required.
ICO1 VRE “Special” ICO2 MRSA “Contact” ICO4 Varicella “Airborne, Contact” ICO7 Both MRSA and VRE “Special” ICO8 “Contact” for any Cystic Fibrosis
patient with Burkholderia cepacia (will not be on the same floor as other cystic fibrosis patients)
Isolation Summary
Sometimes “Standard Precautions” are not enough
“Isolation Precautions” protects patients and staff from spreading communicable diseases
Follow isolation signs and instructions posted on patients doors
Isolation policy is available on-line at www.hopkins-heic.org for further information
Hand Hygiene: Best way to Prevent Infection