Isolation Guidelines


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  • Tables and Figures

     

    Contact
    Precaution

    Droplet
    Precaution

    Airborne
    Precaution

    Contact
    /Droplet
    Precaution

    Contact
    /Airborne
    Precaution

     Cart
    /cabinet
    storage area

    Yes

    Yes 

    Yes

    Yes

    Yes

    Private room

    Preferred

    Preferred

    Preferred

    Preferred

    Preferred

    Door closed

    No

    No 

    Yes

    No

    Yes

    Mask/eye
    protection

    No unless organism in sputum

    If within 3 feet of patient

    To enter room

    If within 3 feet of patient

    Yes

    Gown

    For contact with patient's infectious secretions

    For contact with patient's infectious secretions

    No

    For contact with patient's infectious secretions

    For contact with patient's infectious secretions

    Gloves

    For contact with infective material

    For contact with infective material

    No

    For contact with infective material

    For contact with infective material

    Large reusable items

    Wash with approved germicide

    Wash with approved germicide

    Wash with approved germicide

    Wash with approved germicide

    Wash with approved germicide

    One-to-one nursing

    No

    No

    No

    No

    No

    Linen

    Leak-resistant bag at bedsideLeak-resistant bag at bedside

    No

    Leak-resistant bag at bedside

    Leak-resistant bag at bedside

    Dedicated thermometer

    Preferred

    Preferred

    No

    Preferred

    Preferred

    Dedicated B/P apparatus

    Preferred

    Preferred

    No

    Preferred

    Preferred

    Special transport

    Patient in clean sheets

    Patient in face mask and clean linens

    Patient in face mask

    Patient in face mask and clean linens

    Patient in face mask and clean linens

    Disposable meal tray

    No

    No

    No

    No

    No

    Change cubicle curtains at discharge

    No

    No

    No

    No

    No

    Procedures not done in room should be done at end of day

    Preferred

    Preferred

    Preferred

    Preferred

    Preferred

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    Components of a protective environment (PE)

    • Patients: Allogeneic hematopoeitic stem cell transplant (HSCT) only
      • Maintain in PE room except for required diagnostic or therapeutic procedures that cannot be performed in the room, e.g. radiology, operating room.
      • Respiratory protection, e.g., N95 respirator, for the patient when leaving PE during periods of construction.
    • Standard and expanded precautions
      • Hand hygiene observed before and after patient contact.
      • Gown, gloves, mask NOT required for HCWs or visitors for routine entry into the room.
      • Use of gown, gloves, mask by HCWs and visitors according to Standard Precautions and as indicated for suspected or proven infections for which expanded precautions are recommended.
    • Engineering
      • Central or point-of-use HEPA (99.97% efficiency) filters capable of removing particles 0.3 µ m in diameter for supply (incoming) air.
      • Well-sealed rooms.
      • Proper construction of windows, doors, and intake and exhaust ports.
      • Ceilings: smooth, free of fissures, open joints, crevices.
      • Walls sealed above and below the ceiling.
      • If leakage detected, locate source and make necessary repairs.
      • Ventilation to maintain >12 ACH.
      • Directed air flow: air supply and exhaust grills located so that clean, filtered air enters from one side of the room, flows across the patient’s bed, exits on opposite side of the room.
      • Positive room air pressure in relation to the corridor.
      • Pressure differential of >2.5 Pa [0.01” water gauge].
      • Monitor and document results of air flow patterns daily using visual methods (e.g., flutter strips, smoke tubes).
      • Self-closing door on all room exits
      • Maintain back-up ventilation equipment (e.g., portable units for fans or filters) for emergency provision of ventilation requirements for PE areas and take immediate steps to restore the fixed ventilation system.
      • For patients who require both a PE and Airborne Infection Isolation, use an anteroom to ensure proper air balance relationships and provide independent exhaust of contaminated air to the outside or place a HEPA filter in the exhaust duct. If an anteroom is not available, place patient in an AII room and use portable ventilation units, industrial-grade HEPA filters to enhance filtration of spores.
    • Surfaces
      • Daily wet-dusting of horizontal surfaces using cloths moistened with EPA-registered hospital disinfectant/detergent.
      • Avoid dusting methods that disperse dust.
      • No carpeting in patient rooms or hallways.
      • No upholstered furniture and furnishings.
    • Other
      • No flowers (fresh or dried) or potted plants in PE rooms or areas.
      • Use vacuum cleaner equipped with HEPA filters when vacuum cleaning is necessary.

    Table 2

    Clinical syndromes or conditions warranting additional empiric precautions to prevent transmission of epidemiologically important pathogens pending confirmation of diagnosis

    Clinical syndrome or condition

    Potential pathogen

     

    Potential pathogen  

     

    Diarrhea

    Acute diarrhea with a likely infectious cause in an incontinent or diapered patient

    Enteric pathogens

     

    Standard plus Contact (pediatric and adult)

    Meningitis  

     

    Neisseria meningitidis  

    Enterovirus

    Droplet for first 24 hours of antimicrobial therapy; mask and face protection for intubation

    Contact for infants and children

    Rash or exanthems, generalized, etiology unknown

    Petechial/ecchymotic with fever 

    Neisseria meningitidis

    Droplet for first 24 hours of antimicrobial therapy

    Vesicular

    Varicella, smallpox, or vaccinia virus

    Airborne Infection Isolation plus Contact; Contact if vaccinia

    Maculopapular with cough, coryza and fever

    Rubeola (measles) virus

    Airborne Infection Isolation

    Respiratory infections

    Cough/fever/upper lobe pulmonary infiltrate in an HIV-negative patient or a patient at low risk for HIV

    M. tuberculosis ; severe acute respiratory syndrome virus (SARS-CoV)

    Airborne Infection Isolation; add Contact plus eye protection if history of SARS exposure, travel

    Cough/fever/pulmonary infiltrate in any lung location in an HIV-infected patient, or high risk for HIV

    M. tuberculosis 

     

    Airborne Infection Isolation

    Respiratory infections, particularly bronchiolitis and pneumonia, in infants and young children

    Respiratory syncytial virus, parainfluenza virus, adenovirus, influenza virus, Human metapneumovirus

    Contact plus Droplet; Droplet may be discontinued when adenovirus and influenza have been ruled out

    Skin or wound infection

    Abscess or draining wound that cannot be covered

    Staphylococcus aureus, 

    group A streptococcus

    Contact