ࡱ> y &;bjbj D{{2=86TMN(vvvv0 J V $M&M&M&M&M&M&M$OORJM^  "0 ^ ^ JMvv_Mv$v$v$^ vv$Mv$^ $Mv$v$2CHvP̄|!RG.MuM0MGT!ZT\HTH^ ^ v$^ ^ ^ ^ ^ JMJM(#N^ ^ ^ M^ ^ ^ ^ T^ ^ ^ ^ ^ ^ ^ ^ ^  : Isolation Categories of Transmission-Based Precautions  DOCPROPERTY Author \* MERGEFORMAT H5MAPL0437HighlightsPolicy StatementStandard Precautions shall be used when caring for residents at all times regardless of their suspected or confirmed infection status. Transmission-Based Precautions shall be used when caring for residents who are documented or suspected to have communicable diseases or infections that can be transmitted to others. The facility shall make every effort to use the least restrictive approach to managing individuals with potentially communicable infections. Transmission-Based Precautions shall only be used when transmission cannot be reasonably prevented by less restrictive measures. Policy Interpretation and ImplementationTransmission-Based Isolation Precautions Types of Transmission-Based Isolation Precautions Airborne Precautions Examples of Infections Requiring Airborne Precautions Resident Placement During Airborne Precautions Respiratory Protection During Airborne Precautions Resident Transport During Airborne Precautions Resident-Care Equipment During Airborne Precautions Signs to Use to Alert Staff of Airborne Precautions Contact Precautions Examples of Infections Requiring Contact Precautions Resident Placement During Contact Precautions Gloves and Handwashing During Contact Precautions Gowns During Contact Precautions Resident Transport During Contact Precautions Resident-Care Equipment During Contact Precautions Signs Used to Alert Staff of Contact Precautions Droplet Precautions Examples of Infections Requiring Droplet Precautions Resident Placement During Droplet Precautions Masks During Droplet Precautions Resident Transport During Droplet Precautions Resident-Care Equipment During Droplet Precautions Signs Used to Alert Staff of Droplet Precautions Transmission-Based Precautions will be used whenever measures more stringent than Standard Precautions are needed to prevent or control the spread of infection. Based on CDC definitions, three types of Transmission-Based Precautions (airborne, droplet and contact) have been established. Airborne Precautions In addition to Standard Precautions, implement Airborne Precautions for anyone who is documented or suspected to be infected with microorganisms transmitted by airborne droplet nuclei (small-particle residue [5 microns or smaller in size] of evaporated droplets containing microorganisms that remain suspended in the air and can be widely dispersed by air currents within a room or over a long distance). If the facility does not have an Airborne Infection Isolation (AII) room, Airborne Precautions cannot be provided. Any resident suspected of having an Airborne Infectious Disease shall be masked and transported to a facility with an AII room. If the facility does have an Airborne Infection Isolation Room the following will be applied: Examples of infections requiring Airborne Precautions include, but are not limited to: Measles Varicella (including disseminated zoster) Tuberculosis Resident Placement If necessary and if such a room is available, place the resident in a private room that meets the following criteria: Monitored negative air pressure in relation to the surrounding areas; Six (6) to twelve (12) air changes per hour; Appropriate discharge of air outdoors or monitored high efficiency filtration of room air before the air is circulated to other areas of the facility. Keep the room door closed and the resident in the room. If there is not a room in the facility that meets these criteria, then cohort the individual with someone else who is infected with the same microorganism. continues on next page If isolation in a negative pressure room is essential to prevent transmission of the illness (for example, with active TB), transfer the individual to a setting that can provide the appropriate kind of isolation room. If facility does not have a negative air pressure room and if a resident has positively been confirmed as having TB, the resident will be masked and placed in a room with the door closed until the resident can be transferred to acute care setting. Respiratory Protection All individuals must wear approved respiratory protection when entering the room. Anyone who is susceptible (i.e., not immune) to measles (rubeola) or varicella (chickenpox) may not enter the room of someone who has, or is suspected of having, these infections. Resident Transport The resident should only leave an isolation room when absolutely essential. Someone who is on Airborne Precautions, should wear a mask when leaving the room or coming into contact with others. Depending on the organism, a special filtration mask may be necessary. If the resident is transported to another unit within the facility or to another facility, the Infection Preventionist (or designee) will notify the unit or facility of the type of precautions the resident is on and the residents suspected or confirmed type of infection. The facility is also responsible for notifying transport staff of residents that require special care due to infectious conditions. Resident-Care Equipment When possible, dedicate the use of non-critical resident-care equipment items such as a stethoscope, sphygmomanometer, bedside commode, or electronic rectal thermometer to a single resident (or cohort of residents) to avoid sharing between residents. If use of common items is unavoidable, then adequately clean and disinfect them before use for another resident. Signs The facility will implement a system to alert staff to the type of precaution resident requires. This facility utilizes the following system for identification of Airborne Precautions ________________________________________________. The facility will also ensure that the residents care plan and care specialist communication system indicates the type of precautions implemented for the resident. Contact Precautions In addition to Standard Precautions, implement Contact Precautions for residents known or suspected to be infected with microorganisms that can be transmitted by direct contact with the resident or indirect contact with environmental surfaces or resident-care items in the residents environment. The decision on whether precautions are necessary will be evaluated on a case by case basis. continues on next page Examples of infections requiring Contact Precautions include, but are not limited to: Infections with multi-drug resistant organisms (determined on a case by case basis); Diarrhea associated with Clostridium difficile; Enterohemorrhagic Escherichia coli 0157:H7; Shigella; Hepatitis A; Diarrhea associated with Rotavirus; Heavily draining wounds with noncontained drainage; Pediculosis; Scabies; Resident Placement Place the individual in a private room if possible. If a private room is not available, the Infection Preventionist will assess various risks associated with other resident placement options (e.g., cohorting, placing with a low risk roommate). Gloves and Handwashing In addition to wearing gloves as outlined under Standard Precautions, wear gloves (clean, non-sterile) when entering the room. While caring for a resident, change gloves after having contact with infective material (for example, fecal material and wound drainage). Remove gloves before leaving the room and perform hand hygiene. After removing gloves and washing hands, do not touch potentially contaminated environmental surfaces or items in the residents room. Gown Wear a disposable gown upon entering the Contact Precautions room or cubicle. After removing the gown, do not allow clothing to contact potentially contaminated environmental surfaces. Resident Transport For individuals with skin lesions, excretions, secretions, or drainage that is difficult to contain, maintain precautions to minimize the risk of transmission to other residents and contamination of environmental surfaces or equipment. If the resident is transported to another unit within the facility or to another facility, the Infection Preventionist (or designee) will notify the unit or facility of the type of precautions the resident is on and the residents suspected or confirmed type of infection. The facility is also responsible for notifying transport staff of residents that require special care due to infectious conditions. continues on next page Resident-Care Equipment When possible, dedicate the use of non-critical resident-care equipment items such as a stethoscope, sphygmomanometer, bedside commode, or electronic thermometer to a single resident (or cohort of residents) to avoid sharing between residents. If use of common items is unavoidable, then adequately clean and disinfect them before use for another resident. Signs The facility will implement a system to alert staff to the type of precaution resident requires This facility utilizes the following system for identification of Contact Precautions for staff and visitors:____________________________ ________________________________________________________. The facility will also ensure that the residents care plan and care specialist communication system indicates the type of precautions implemented for the resident. Droplet Precautions In addition to Standard Precautions, implement Droplet Precautions for an individual documented or suspected to be infected with microorganisms transmitted by droplets (large-particle droplets [larger than 5 microns in size] that can be generated by the individual coughing, sneezing, talking, or by the performance of procedures such as suctioning). Examples of infections requiring Droplet Precautions include, but are not limited to: Invasive Haemophilus influenzae type B disease including meningitis, pneumonia and epiglottitis; Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis; Mycoplasma pneumonia; B. pertussis; Influenza; Mumps; Rubella. Resident Placement Place the resident in a private room if possible. When a private room is not available, residents with the same infection with the same microorganism but with no other infection may be cohorted. When a private room is not available and cohorting is not achievable, use a curtain and maintain at least 3 feet of space between the infected resident and other residents and visitors. Special air handling and ventilation are unnecessary and the door to the room may remain open. Masks In addition to Standard Precautions, put on a mask when entering the room or cubicle. continues on next page Resident Transport Limit movement of resident from the room to essential purposes only. If transport or movement from the room is necessary, place a mask on the infected individual and encourage the resident to follow respiratory hygiene/cough etiquette to minimize dispersal of droplets. If the resident is transported to another unit within the facility or to another facility, the Infection Preventionist (or designee) will notify the unit or facility of the type of precautions the resident is on and the residents suspected or confirmed type of infection. The facility is also responsible for notifying transport staff of residents that require special care due to infectious conditions. If the resident can tolerate a mask and control respiratory secretions, some activities outside the room may be acceptable. Resident-Care Equipment When possible, dedicate the use of non-critical resident-care equipment items such as a stethoscope, sphygmomanometer, bedside commode, or electronic rectal thermometer to a single resident (or cohort of residents) to avoid sharing between residents. If use of common items is unavoidable, then adequately clean and disinfect them before use for another resident. Signs The facility will implement a system to alert staff and visitors to the type of precaution the resident requires. This facility utilizes the following system for identification of Droplet Precautions __________________________________________________. The facility will also ensure that the residents care plan and care specialist communication system indicates the type of precautions implemented for the resident.ReferencesOBRA Regulatory Reference Numbers483.65(b); CDC Guideline for Isolation Precautions (See Centers for Disease Control and Preventions website at:  HYPERLINK "http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html" http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.htmlSurvey Tag NumbersF441Related DocumentsIsolation Initiating Transmission-Based Precautions Isolation Notices of Transmission-Based PrecautionsPolicy RevisedDate:________________ By:__________________ Date:________________ By:__________________ Date:________________ By:__________________ Date:________________ By:__________________     2001 MED-PASS, Inc. 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