Confusion regarding isolation guidelines in the healthcare setting is frequently brought up as an issue among workers. A solid foundation of knowledge regarding the proper precautions to take is imperative to maintaining patient wellbeing. The Centers for Disease Control (CDC) has published a set of recommendations structured to help prevent the transmission of infectious agents among patients, families, visitors, and healthcare workers in all settings where healthcare is delivered. In today’s blog post a summary of these recommendations will be provided.
There are two tiers of basic infection control: standard precautions and transmission-based precautions. Standard precautions include a set of customary measures that should be taken for all providers such as washing hands before and after each patient encounter.1-3 The particular condition an individual presents with will influence if further, transmission-based isolation precautions need to also be taken. The three categories of transmission-based precautions are contact, droplet, and airborne precautions.1
Contact Precautions1-4
- When to use: for patients with known or suspected infections, diseases, or germs that are spread by touching the patient or items in the room.
- Examples: MRSA, VRE, diarrheal illnesses, open wounds
- Patient placement: a single-patient room is the preferred placement. If this is not available, spatial separation of at least 3 feet between beds is recommended to reduce the chance for contaminated items to be inadvertently shared.
- Source control: the patient does not have to wear a mask.
- Personal protective equipment: gown and gloves should be worn while in the patient’s room, and removed before leaving the room.
- Patient transport and movement: limit transport unless essential, and ensure precautions are taken to prevent or reduce contamination of surfaces and equipment.
- Visitors need to check with nurses before taking anything into or out of the room.
Droplet Precautions1-4
- When to use: for patients with known or suspected infection spread by tiny respiratory droplets generated when a patient coughs, talks, or sneezes.
- Examples: pneumonia, influenza, whooping cough, bacterial meningitis
- Patient placement: a single-patient room is the preferred placement. If this is not available, spatial separation of at least 3 feet with a curtain drawn is recommended.
- Source control: a mask should be placed on the patient any time they must be transported outside of their room if tolerated.
- Personal protective equipment: a mask should be donned for close contact with an infectious patient.
- Patient transport and movement: limit transport for essential purposes only. Ensure the patient is wearing a mask.
Airbone Precautions1-4
- When to use: for patients with known or suspected infection transmitted by
- Examples: Measles, SARS, Varicella (chickenpox), tuberculosis
- Patient placement: an airborne infection isolation room (AIIR) is the preferred placement. This type of room is a single-patient room equipped with ventilation capacity that allows for monitored negative pressure. If this type of room is unavailable, the patient should be masked and placed in a single-person room with the door closed. (CDC long article)
- Source control: a mask should be placed on the patient.
- Personal protective equipment: a mask and/or respirator should be donned prior to room entry depending on the disease-specific recommendations.
- Patient transport and movement: Limit transport for essential purposes only. Ensure the patient is wearing a mask.
Now that you are familiar with standard precautions and the 3 categories of transmission-based precautions, you should be able to better understand the potential types of precautions necessary to protect you and your patient as well as determine whether or not the appropriate precautionary measures were administered. Failure to follow these measures could potentially lead to infection spreading to other patients, healthcare workers, family members and friends, and other hospital visitors.
References:
- Centers for disease control. Transmission-based precautions. Cdc.gov. https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html. Reviewed January 7, 2016. Accessed April 30, 2019.
- Centers for disease control. Isolation Precautions Guideline. gov. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html. Published 2007. Accessed April 30, 2019.
- Protect your patients: Follow all posted precaution signs. Professionals.site.apic.org. http://professionals.site.apic.org/protect-your-patients/follow-the-rules-for-isolation-precautions/. Accessed April 30, 2019.
- Siegel JD, Rhinehart E, Jackson M, Chiarello L. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Published 2007. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html. Accessed April 30, 2019/