Isolation

Regard all patient blood, excretions and secretions as potentially infectious and institute appropriate precautions to minimise risks of transmission.

Wear gloves that are clean at the time of use for contact with mucous membranes and nonintact skin of all patients.

Decontaminate hands between each patient contact.

Decontaminate hands promptly after touching infective material (e.g., blood, body fluids, secretions, or excretions), infected patients or their immediate environment, and contaminated articles used for patient care. Waterless hand antiseptics are efficient unless the hands are visibly soiled in which case they should be washed first. (See the chapter on hand hygiene)

Use no touch technique when possible to avoid touching infective material.

Wear gloves when in contact with blood, body fluids, secretions, excretions and contaminated items. Wash hands immediately after removing gloves. If gloves are not readily available, wash hands thoroughly as soon as patient safety permits.

Dispose of faeces, urine, and other patient secretions via designated sinks. Clean and disinfect bedpans, urinals and other containers appropriately (see chapter on cleaning, disinfection and sterilization).

Clean up spills of infective material promptly (see chapter on cleaning, disinfection and sterilization). General disinfection of floors and walls is then not necessary.

Ensure that patient-care equipment, supplies, and linen contaminated with infective material are disinfected or sterilized between each patient use (See chapter on cleaning, disinfection and sterilization).

If no washing machine is available for linen soiled with infective material the linen can be boiled.

Used dressings and other medical waste should be disposed of in sealed, labeled plastic bags and preferably incinerated or deeply buried.

Dysentery including cholera with unmanageable diarrhoea

Methicillin-resistant S. aureus, particularly if there is likely to be considerable contamination of articles in the room

Infected large burns

In high risk areas, patients infected or colonised with multidrug resistant pathogens

Hand hygiene after handling secretions, excretions or contaminated items from any patient.

Isolation in a single room, if available, for airborne or particularly hazardous infections, and for situations in which a patients soil the room environment with secretions or excretions.



6. Isolation Precautions

Introduction Organisms causing hospital-acquired infections can be transmitted from infected and colonised patients both to other patients and to staff. Appropriate isolation precautions for all patients, including those who are infected and colonised reduce the risk of transmission. Transmission of infection Organisms can be spread by several routes which are listed in the chapter on occupational health. These routes include direct person-to-person contact, indirect contact via an intermediate object, and airborne transmission. Patient-to-patient transmission via staff hands is regarded as the most important route; therefore proper hand hygiene is an important means of preventing spread of infection in the hospital. (See additional information in the chapter on hand hygiene). Standard Precautions for All Patients In all patient care, transfer of potentially harmful microorganisms between patients and staff must be avoided. For this reason, the following general precautions are used: Regard all patient blood, excretions and secretions as potentially infectious and institute appropriate precautions to minimise risks of transmission. Wear gloves that are clean at the time of use for contact with mucous membranes and nonintact skin of all patients. Decontaminate hands between each patient contact. Decontaminate hands promptly after touching infective material (e.g., blood, body fluids, secretions, or excretions), infected patients or their immediate environment, and contaminated articles used for patient care. Waterless hand antiseptics are efficient unless the hands are visibly soiled in which case they should be washed first. (See the chapter on hand hygiene) Use no touch technique when possible to avoid touching infective material. Wear gloves when in contact with blood, body fluids, secretions, excretions and contaminated items. Wash hands immediately after removing gloves. If gloves are not readily available, wash hands thoroughly as soon as patient safety permits. Dispose of faeces, urine, and other patient secretions via designated sinks. Clean and disinfect bedpans, urinals and other containers appropriately (see chapter on cleaning, disinfection and sterilization). Clean up spills of infective material promptly (see chapter on cleaning, disinfection and sterilization). General disinfection of floors and walls is then not necessary. Ensure that patient-care equipment, supplies, and linen contaminated with infective material are disinfected or sterilized between each patient use (See chapter on cleaning, disinfection and sterilization). If no washing machine is available for linen soiled with infective material the linen can be boiled. Used dressings and other medical waste should be disposed of in sealed, labeled plastic bags and preferably incinerated or deeply buried. Gowns and Aprons Gowns and aprons are frequently recommended to prevent transmission of infectious agents, however they are of less importance than hand hygiene and are costly. They could be of benefit in situations where soiling of staff clothing is likely when dealing with patients with infected or discharging wounds or when cleaning soiled material. Masks Thin, surgical type masks provide minimal protection against airborne pathogens. High efficiency, respirator type masks, may offer additional protection, however these are costly and may not be available for use. When masks are required to stop spread of airborne-spread microbes, a high-efficiency mask should be worn whenever available. For patients with childhood communicable diseases, limiting staff contact to those who are already immune is important as is immunization of susceptible staff. Shoe covers and protective headgear Shoe covers and hats or caps do not prevent transmission of infectious agents and are costly. They should not be used. Additional Precautions for Some Infected Patients Single Rooms In addition to Standard Precautions, some patients, particularly those infected with pathogens transmitted by the airborne route, need to be placed in single rooms. These rooms should be physically separated from other patients to reduce the risk of transmission. If appropriate ventilation is provided for these rooms, the air should be extracted to the outside of the building and away from entrances or areas where people are standing or gathering. Patients with the same infection can be placed together in the same room. Single rooms are also desirable for patients whose infections result in gross soiling or contamination of the environment, such as occurs with large wounds with heavy discharge, massive uncontrolled bleeding or diarrhoea, or heavy dispersal of skin scales (burn patients). Dressings, secretions and excretions, contaminated linen, gloves, or other barrier items should be disposed of in bags within the room before being removed for incineration or disinfection. After patients are discharged, the room, bed, and equipment should be cleaned before the admission of a new patient. Patients who may require single room isolation include those with the following infections: Dysentery including cholera with unmanageable diarrhoea Methicillin-resistant S. aureus, particularly if there is likely to be considerable contamination of articles in the room Tuberculosis Infected large burns In high risk areas, patients infected or colonised with multidrug resistant pathogens SARS Precautions for Family Members Providing Care to Patients in Hospitals It is very important that family members providing care to patients in hospitals be educated by the staff to use good hygiene and appropriate precautions to prevent spread of infections to themselves and to other patients. The precautions for family members may need to be the same as those used by staff. Minimal Requirements Hand hygiene after handling secretions, excretions or contaminated items from any patient. Isolation in a single room, if available, for airborne or particularly hazardous infections, and for situations in which a patients soil the room environment with secretions or excretions. Bibliography Standard Principles for preventing hospital-acquired infections. Journal Hospital Infection 2001;47(Suppl):S21-S37. HICPAC. Guideline for Isolation Precautions in Hospitals. American Journal Infection Control 1996;24:24-52.