Office of Public Health Louisiana Dept of Health amp Hospitals 8002562748 wwwinfectiousdiseasedhhlouisianagov Your taxes at work Isolation guidelines in Institutions are based on these CONTACT ID: 783456
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Slide1
IsolationPrecautions
Infectious Disease Epidemiology Section
Office of Public Health
Louisiana Dept of Health & Hospitals
800-256-2748
www.infectiousdisease.dhh.louisiana.gov
Your taxes at work
Slide2Isolation guidelines in Institutions are based on these
CONTACT
Direct Indirect
AIRBORNE
DROPLET
AND
Vectorborne
, Common source: Water, Food, Equipment, Rx
Main Modes of Transmission
Slide3Isolation Precaution System
for Institutions
is an expansion of
Universal Precautions
Standard Precautions
Slide4Standard Precautions
Same concept as UNIVERSAL PRECAUTIONS
Precautions should be taken for any contact with Blood and Body Fluid (UP)
AND for any contact with secretions and excretions, mucous membranes, damaged skin, contaminated environment and equipment
Slide5Handwashing
Beginning and end of day
Before & after each patient contact
Before and after gloving
Anytime after contact with
Blood & body fluid
Secretions /excretions
Mucous membranes
Damaged skin
Contaminated environment
Contaminated equipment
10-15s
Slide6Humans sheds # 300,000,000
squames
/day (4 to 25 mm) able to carry bacteria
What Does
Handwashing
Do?
RESIDENT FLORA
Survives on the skin more than 24 hours
Not easily removed, hours of scrubbing
Complete
stelirization
impossible Low virulence
Staphylococci, diphteroides,
mostly Gram + , very few Gram -
TRANSIENT FLORA
Survive on skin less than 24 hours
Easily removed with soap and water Acquired during contacts with contaminated areas mouth, nose, perineal area,genitals, anal area
catheter, bedpan, urinal, patient care casual contact May have high
virulenceð Enterobacteria, Gram - bacilli, Pseudomonas...
Slide7Patient care Activity
Seroytpe
21
Klebsiella
cultured
Hands
of nurses washed and cultured:
NO
Klebsiella
What Does
Handwashing
Do?
Activity
Number of
Klebsiella
on nurse’s handIn Colony Forming Units (CFU)
Pulse, blood pressure100-1,000Touching hand
10 - 100Touch shoulder7,0000Oral temperature
100 – 1,000Caswell & Phillips
British Med J Nov 1977: 1316
Slide8Handwashing
Slide9Hand SanitizerWashing hands with soap and water is the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations,
but sanitizers do
not
eliminate all types of germs: Not effective on spores
(particularly Clostridium difficile
) Hand sanitizers are not effective when hands are visibly dirty.
Slide10Gloves
FOR ANY CONTACT WITH
Blood and Body Fluids
Secretions & excretions
Mucous membranes
Damaged skin
Contaminated environment or equipment
GLOVES
DO NOT REPLACE
HANDWASHING
If it is wet, red or dirty
Wash, glove then wash
Slide11Eye Protection
Face Shield
RISK OF SPRAY
or SPLASH
of blood,
body
fluid,
secretion
excretion
in FACE OR EYE
Slide12Surgical Masks
STANDARD PRECAUTIONS
For personnel to protect from splashes /sprays of BBF/ S
E
DROPLET PRECAUTIONS
to prevent large droplets (>
5
m
) on/from patient
For patients
to prevent emission of droplet (large and droplet nuclei)
Slide13Gown
STANDARD PRECAUTION
To protect from splashes /sprays of large quantities of BBF/S
E
CONTACT PRECAUTION
To protect contamination of personnel clothing
Slide14Patient Placement
AIRBORNE
Private room with ventilation
control
DROPLET & CONTACT
Private room preferred
or cohort with same infection
or at least 3 feet between beds
Use common sense: do not mix in
immunocompromised
patient with infected one
Slide15Airborne Precautions
1-ROOM
WITH VENTILATION CONTROL
Negative air pressure
>6 air exchange /hour
HEPA filtered or
exshaust
out
2-PERSONAL RESPIRATOR
3-PATIENT
wears surgical mask if coughing & when transported
Small droplets (<5
m
) emitted when coughing, & performance of procedures
Use STANDARD PRECAUTIONS at
ALL times for ALL patients
Slide16Airborne
Precautions: Personal
Respirator
For Personnel
In AIRBORNE ISOLATION ONLY
To prevent inhalation of droplet nuclei
Main leak comes from poor fit around face
PAPR
Powered Air Purifying Respirators
N95 Mask
Use STANDARD PRECAUTIONS at
ALL times for ALL patients
Slide17Airborne Precautions: Signage
Use STANDARD PRECAUTIONS at
ALL times for ALL patients
Slide18Droplet Precautions
Private room
Mask when entering room
Large particle droplets (>5
m
) emitted when coughing, sneezing, talking & performance of procedures
Use STANDARD PRECAUTIONS at
ALL times for ALL patients
Slide19Respiratory Etiquette
Slide20Contact Precautions
Private room (*)
Gloves when entering room,
change glove after infectious contact
Gown when entering room if substantial contact will occur
Use STANDARD PRECAUTIONS at
ALL times for ALL patients
Slide211
Wash * Touch * Wash
If red, wet or dirty
Wash * Glove
Touch
Unglove * Wash
Know what is clean
Know what is dirty
Keep them apart
OK
3
2
Standard Precaution: Ridiculously Simple
STANDARD PRECAUTIONS
= Universal precautions: Any one may be infectious, there is no way of predicting who is infected and may transmit blood borne pathogens (HBV, HCV, HIV…) or other microorganisms (MRSA, Cdiff, MDRO…)
USE STANDARD PRECAUTIONS WITH ALL PATIENTS ALL THE TIME
Slide22AIRBORNE PRECAUTIONS
Personal Respirator: N95
Room with Ventilation Control:
Negative pressure
> 6 air exchange
Air filtrated before recirculation
or vented outside
CONTACT PRECAUTIONS
Private room or 3ft separation between patients
Gloves when entering
Gown IF extensive contact
DROPLET PRECAUTIONS
Private room or 3ft separation between patients
Mask when within 3 ft of patients
Tuberculosis, Measles, Varicella, Any suspect of TB: chronic pulmonary symptoms >3 weeks
MOST BACTERIAL & VIRAL RESPIRATORY INFECTIONS except RSV
Invasive H.influenzae, N.meningitidis, Invasive drug resistant S.pneumoniae, All serious bacterial respiratory infections spread by droplets, Diphtheria, Pneumonic Plague, Pertussis, Mycoplasma pneumoniae, Streptococcal pharyngitis, streptococcal pneumonia, scarlet fever, Adenoviral infections, Influenza, Mumps, Parvovirus 19, Rubella,
Paroxysmal cough (?Pertussis)
INFECTIONS TRANSMITTED BY CONTACT
Multi-Drug Resistant Organisms (MDRO), gastrointestinal, respiratory, skin, wound, infections or colonization with multidrug resistant bacteria, Enteric infections, enteroviral infections in infant, RSV, parainfluenza,
Infectious skin infections: HSV, impetigo, cellulitis, scabies, staphylococcal furunculosis,Viral hemorrhagic conjunctivitis, viral fevers, abscess, draining wounds that cannot be covered. Respiratory infections: bronchiolitis in infants & children.
Use STANDARD PRECAUTIONS WITH ALL PATIENTS ALL THE TIME
And these other precautions may be added
We do not use these terms any longer: Strict Isolation, Blood & body fluids,Drainage and secretions, Enteric, Respiratory, AFB
A droplet of
will fall in
100
m
10 seconds
40
m
1 minute
20
m
4 minutes
10
m
20 minutes
5-10
m
30-45 minutes
5
m
Droplet
Nuclei
Stay
suspended for hours, travels far