Isolation Guidelines


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  • Principles of Isolation and Categories

    Standard precautions

    Assume that every person is potentially infected or colonized with an organism that could be transmitted in the health care setting and apply the following infection control practices during delivery of health care:

    • Indications for handwashing and hand antisepsis
      • When hands are visibly dirty or contaminated with proteinaceous material or visibly soiled with blood or other body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water.
      • If hands are not visibly soiled, use an alcohol-based hand rub for routinely. decontaminating hands in all other clinical situations described. Alternatively, wash hands with an antimicrobial soap and water.
      • Decontaminate hands in the following circumstances, whether or not gloves are worn:
        • Before having direct contact with patients
        • After contact with blood, body fluids or excretions, mucous membranes, non-intact skin or wound dressings
        • After contact with a patient’s intact skin (e.g. when taking a pulse or blood pressure or lifting a patient)
        • If hands will be moving from a contaminated-body site to a clean-body site
        • After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient
        • After removing gloves
      • Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if contact with spores (e.g, Bacillus spp. or C. difficile) is anticipated. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors and other antiseptic agents have poor activity against spores.
      • Do not wear artificial fingernails or extenders when having direct contact with patients at high risk for infection (e.g., those in ICUs or operating rooms)
    • Personal protective equipment (see figures Donning PPE and Removing PPE )
      • Observe the following principles of use:
        • Wear personal protective equipment (PPE) when the nature of the anticipated patient interaction indicates that contact with blood or body fluids may occur.
        • During the delivery of health care, avoid touching surfaces in close proximity to the patient.
        • Prevent contamination of clothing and skin during the process of removing PPE (www.cdc.gov/ncidod/sars).
        • Before leaving the patient’s room or cubicle, remove and discard gowns and gloves.
      • Gloves
        • Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially colonized intact skin (e.g., of a patient with diarrhea), could occur.
        • Wear gloves with fit and durability appropriate to the task.
          • Wear disposable medical examination gloves for providing direct patient care.
          • Wear disposable medical examination gloves or reusable utility gloves for cleaning the environment or medical equipment.
        • Remove gloves after contact with a patient and/or the surrounding environment (including medical equipment), using proper technique to prevent hand contamination. Do not wear the same pair of gloves for the care of more than one patient. Do not wash gloves for reuse with different patients.
        • Change gloves during patient care if the hands will move from a contaminated body site (e.g., perineal area) to a clean body site (e.g., face).
      • Gowns and other PPE attire
        • Wear a gown, apron or other PPE attire appropriate to the task, to protect skin and prevent soiling of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions or excretions is anticipated.
          • Wear a gown for direct patient contact if the patient has uncontained secretions or excretions.
          • Remove gown, apron or other PPE attire and perform hand hygiene before leaving the patient’s environment.
      • Mouth, nose, eye protection
        • Use PPE to protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. Masks, goggles, face shields and combinations of each should be selected according to the task performed.
        • During procedures that generate sprays of respiratory secretions (e.g., bronchoscopy, suctioning and intubation), wear gloves, gown and either a face shield that fully covers the front and sides of the face, or a mask and goggles. Use an N95 or higher respirator instead of a surgical mask if the patient has a suspected or proven infection that is likely to be transmitted by the airborne route. (www.cdc.gov/ncidod/sars).
    • Respiratory hygiene/cough etiquette
      • Educate staff on the importance of source control measures to contain respiratory secretions and prevent droplet and fomite transmission of respiratory pathogens, especially during seasonal outbreaks of viral respiratory tract infections (e.g., Severe Acute Respiratory Syndrome (SARS), influenza, RSV, adenovirus, Parainfluenza (www.cdc.gov/ncidod/sars).
      • Implement the following measures to contain the source of respiratory secretions in patients and accompanying individuals who have signs and symptoms of respiratory tract infection, beginning at the point of initial encounter in a health care setting (e.g., triage, reception and waiting areas in emergency departments, ambulatory clinics, health care provider offices):
        • Post signs in ambulatory and inpatient settings with instructions to patients and other persons with symptoms of a respiratory infection entering the facility to cover their mouths/noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after hands have been in contact with respiratory secretions.
        • Provide tissues and no-touch receptacles (i.e. ideally by foot pedal operated lid or open waste baskets) for disposal of used tissues
        • Provide resources and instructions for performing hand hygiene in or near waiting areas in ambulatory and inpatient settings; provide conveniently located dispensers of alcohol-based hand rubs and, where sinks are available, supplies for handwashing
        • During periods of increased rates of respiratory infections in the community (e.g., as indicated by increased school absenteeism), offer masks to coughing patients and other persons (e.g., symptomatic persons who accompany ill patients) with suspected respiratory tract infection upon entry into common waiting areas and encourage them to maintain spatial separation, ideally a distance of at least 3 feet, from others in common waiting areas (www.cdc.gov/ncidod/sars).
    • Patient placement
      • Include the potential for transmission of infectious agents in patient-placement decisions. Place patients who pose a risk for transmission to others (e.g., uncontained secretions, excretions or wound drainage or infants with suspected viral respiratory tract or gastrointestinal tract infections) in a single-patient room when available.
      • Determine patient placement based on the following principles:
        • Route(s) of transmission of the infectious agent
        • Risk factors for transmission in the infected patient
        • Risk factors for adverse outcomes resulting from health care-associated infection in other patients in the area
        • Availability of single-patient rooms
        • Patient options for room sharing (e.g., cohorting patients with the same infection)