UNC Hospitals' Isolation Precautions

for the

Prevention of Disease Transmission

Hospital Epidemiology UNC Hospitals TABLE OF CONTENTS

Introduction CONTENTS

UNC Hospitals' Isolation Precautions Policy is based upon the latest recommendations from the Centers for Disease Control and Prevention. A simple category system is used, based upon how the infection or disease is transmitted. All healthcare workers must be familiar with the isolation precaution system in order to prevent the spread of infections to patients, coworkers, visitors, and themselves.

Infection Control Manual CONTENTS

The complete Isolation Precautions Policy is located in the Infection Control Manual. Infection Control Manuals are located at every nurses station and in all clinical areas. The policy includes an alphabetical listing of infections and the type and duration of precautions needed, an in­depth explanation of each precaution category, and a quick reference for the more frequently seen infections. All healthcare workers are encouraged to become familiar with the Isolation Precautions Policy. If help is needed, the healthcare worker may call Infection Control at 6­1636 or have the operator page the Infection Control Nurse on call.

Standard Precautions CONTENTS

Standard Precautions are the primary tool for the successful control of hospital­acquired infections. Standard Precautions are those precautions designed for the care of all patients' regardless of their diagnosis or presumed infection status. These Precautions replace the old system of "Universal Precautions" and apply to the following body substances.

. blood

· all body fluids, secretions, and excretions (except sweat)

· nonintact skin

· mucous membranes

There are several important components of Standard Precautions with the most important being good handwashing. Hands should be washed thoroughly with an antimicrobial soap (Bactoshield or Alcare foam) before and after patient care. When gloves are worn, they should be removed before leaving the patient's room and hands washed. Never leave the patient's room while still wearing gloves. Disease causing germs adhere well to glove surfaces and can then be carried to the next patient or medical equipment touched.

A second important component of Standard Precautions is the wearing of protective attire to prevent direct contact with a patient's blood or body fluids. Gloves, gown, and protective eyewear are provided by the Hospitals and can be found in all patient­care areas in personal protective equipment cabinets.

Remember, if it is wet and not yours, wear gloves!

Airborne Precautions CONTENTS

in addition to Standard Precautions, Airborne Precautions are used for those patients who have or are suspected of having infections transmitted by the airborne route. This means that the bacteria or virus causing their disease is so small that it can be suspended in the air for long periods of time and may be carried for long distances on air currents. Examples of diseases that require Airborne Precautions are tuberculosis (TB), varicella (chickenpox), zoster (shingles), and measles. The following measures are required for Airborne Precautions.

· The patient must be placed in a special isolation room. Isolation rooms are private rooms with a negative air pressure in relation to the outside corridor, have 6 air exchanges per hour, and the room air is directly exhausted to the outside. A complete listing of isolation rooms is maintained by Bed Control. Hospital Epidemiology, and the Nursing supervisors.

· All employees must wear a respirator, such as the N­95 respirator, to enter an Airborne Isolation room (a surgical mask is not an approved respirator) for patients with known or suspected tuberculosis. Respirators must also be worn when participating in cough­inducing procedures such as bronchoscopy or sputum induction with TB patients. Visitors of TB patients will wear surgical masks.

· If the patient's diagnosis is varicella, zoster, or measles, employees need not wear a respirator if they have had natural disease or have been adequately immunized. Occupational Health Service can assist you in determining your immune status if you are uncertain. Employees who are not immune to the disease should not enter the room unless absolutely necessary. If they must enter, they must wear an approved respirator such as the N­95. Visitors should be assisted by the nursing or medical staff in determining their immune status (i.e., natural disease, immunization). Immune visitors need not wear a mask. Non­immune visitors should be discouraged from entering. If visitation is essential, then the non­immune visitor must wear a surgical mask.

· Patients who require Airborne Precautions are allowed to leave the isolation room for essential purposes only (e.g., a diagnostic procedure that cannot be done in the patient's room). If the patient must be transported to another location in the hospital, the patient must wear a surgical mask and the receiving area notified that the patient requires Airborne Precautions. Both of these steps are important to prevent the transmission of disease to other patients, employees, and visitors.

Checkpoint Questions CONTENTS

Examples of diseases that require Airborne Precautions include tuberculosis, varicella, zoster, and _______________

To enter the room of a patient on Airborne Precautions who may have tuberculosis, the employee

must wear a _______________, not a surgical mask.

Protective Precautions CONTENTS

In addition to Standard Precautions, Protective Precautions are designed to protect the patient with impaired resistance to infection. These precautions will replace our former categories of Compromised Host Precautions, Transplantation Precautions, and Bone Marrow Transplant Precautions. Such patients require varying degrees of protection as determined by their attending physician. Healthcare workers and visitors should pay careful attention to the Protective Precautions card outside the patient's room to identify the precautions required. For all patients requiring Protective Precautions, the following measures are followed.

· The patient is placed in a private room with the air pressure positive in relation to the outside corridor.

· Hands should be washed thoroughly with an antimicrobial soap before entering the patient's room and before providing direct patient care.

· Only essential personnel and visitors should enter the patient's room. No one should enter who is ill or feel like they may be getting sick.

· The patient is allowed no live plants, fresh fruits or uncooked vegetables. Exceptions to fruits and vegetables may be allowed with the approval of the attending physician.

· The patient should leave their room only for essential purposes. If the patient must leave their room, they should be instructed to wear a surgical mask. Exceptions to this policy may be made by the attending physician. Notify the receiving department that the patient requires Protective Precautions

Identifyinq the patient who requires Isolation Precautions CONTENTS

As with our old system of isolation, we will continue to place an isolation precaution card in the wall plaque outside the patient's room door. Each card will clearly state the type of precautions to be observed by all employees and visitors. These cards will be colored coded as were the old cards with gold cards for Airborne and Droplet Precautions and a blue card for Contact Precautions. The Protective Precautions card will be white with red letters. Isolation Precautions cards are stocked in Central Distribution and should be available for use in all patient care areas. In order to protect the confidentiality of the patient, no disease specific or diagnostic information should be written on the card. Healthcare workers and visitors who are unsure of the correct precautions to follow should check at the nurses station for clarification.

As with all infection control measures, isolation precautions are designed to prevent the spread of infection from one person to another. The responsibility for the practice of infection control lies within the hands of every healthcare worker.

DropIet Precautions CONTENTS

In addition to Standard Precautions, use Droplet Precautions for those patients who are known or suspected of having diseases spread by the droplet route. Droplet transmission occurs when the person coughs or sneezes and releases large respiratory droplets into the air. Unlike airborne particles, these droplets are heavy and fall to surfaces rapidly, usually falling within 3 feet of the patient. These particles are too heavy to remain in the air and to be carried on air currents. Examples of infections that require Droplet Precautions are meningococcal meningitis, Respiratory Syncytial Virus (RSV), and pertussis. The following measures are required for Droplet Precautions.

· Place the patient in a private room. No special ventilation is required.

· Employees and visitors must wear a surgical mask to enter the room.

· If the patient must leave their room, notify the receiving area and have the patient wear a surgical mask when possible to minimize the dispersal of droplets.

Contact Precautions CONTENTS

In addition to Standard Precautions, use Contact Precautions for those diseases that are spread by direct or indirect contact. This means that the bacteria or virus can be acquired by either directly touching the infected site or body fluid or by touching equipment that may be contaminated with infectious material. Examples of infections that are spread by the contact route are multiply antibiotic­resistant bacteria such as methicillin­resistant S. aureus (MRSA) and vancomycin­resistant enterococcus (VRE), RSV (which also requires Droplet Precautions), and Clostridium difficile enterocolitis. The following measures are required for Contact Precautions.

· Place the patient in a private room. No special ventilation is required.

· Gloves are to be worn when entering the room. A gown should be worn if you anticipate that your clothing will become contaminated with infectious materials (e.g., wound drainage or respiratory secretions). Gown and gloves should be removed before leaving the patient's room and hands washed thoroughly.

· When possible, dedicate the use of patient­care equipment such as stethoscopes and walkers. This avoids sharing of items between patients. If use of common equipment is unavoidable, then adequately clean and disinfect the item with Vesphene 11 or alcohol before use for another patient.

· If the patient must leave their room for diagnostic tests or treatments, notify the receiving department that the patient requires Contact Precautions.

Checkpoint questions CONTENTS

A pediatric patient who is admitted with a diagnosis of RSV pneumonia would require being placed on and Precautions.

For patients who require Contact Precautions, all employees and visitors who enter the patient's room must wear


Read each statement carefully and circle whether the statement is True or False.

1. Standard Precautions mean that we wear gloves only for patients who are known

to be HIV positive or Hepatitis B positive.

True False

2. Employees and visitors who have had varicella (chickenpox) or have received

the varicella vaccine do not need to wear a respirator to enter the room of a

patient who is on Airborne Precautions for active varicella.

True False

3. Everyone who enters a Droplet Precautions room must wear a surgical mask.

True False

4. Everyone who enters a Contact Precautions room must wear clean gloves.

True False

5. The isolation precaution card that is placed outside the patient's room door

should clearly state the patient's diagnosis.

True False