Isolation Guidelines

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  • Application of Expanded Precautions in Ambulatory Settings

    Although Expanded Precautions generally apply in all health care settings, exceptions exist. Management of patients colonized or infected with multi-drug resistant organisms (MDROs) may necessitate Contact Precautions in acute care hospitals, but in ambulatory care consistent use of Standard Precautions usually suffices.

    For health care settings using Contact Precautions for patients who are colonized or infected with MDROs, the duration of these precautions remains undefined. Although guidelines for VRE suggested discontinuation of Contact Precautions after three stool cultures, obtained at weekly intervals, proved negative, subsequent experiences have indicated that such screening may fail to detect colonization that may persist for >1 year. Likewise, carriers of MRSA who have negative nasal cultures after a course of systemic or topical therapy may resume shedding MRSA in the weeks that follow therapy.

    Available data indicate that colonization with VRE, MRSA, and, probably, multiple drug-resistant gram-negative bacilli (MDR-GNB) can persist for many months, especially in the presence of severe underlying disease, invasive devices and recurrent courses of antimicrobial agents.

    It is prudent to assume that MDRO carriers are colonized permanently and manage them accordingly. See also MRSA Information Sheet and VRE Information Sheet for more information regarding hospital policy for managing patients infected or colonized with these pathogens.

    All employees must follow Standard Precautions for all patients. Standard Precautions are designed to reduce the risk of transmission of micro-organisms from both recognized and unrecognized sources of infection. Simply put, Standard Precautions means putting a barrier between the health care worker and the blood of body fluid of any patient. Standard Precautions include:

    • Routine hand washing
    • Appropriate use of masks, eye protection and face shields, e.g. suctioning
    • Routine cleaning or disposal of patient-care equipment
    • Bag linen at point of use
    • Consistent and correct glove use
    • Appropriate use of gowns to prevent contamination of uniform
    • Regular cleansing of environmental surfaces
    • Strict adherence to occupational safety requirements