Follow transmission-based precautions when an illness is first suspected. Stop following these precautions only when that illness has been treated or ruled out and the room has been cleaned.
Patients should stay in their rooms as much as possible while these precautions are in place. They may need to wear a mask when they leave their rooms. Airborne precautions may be needed for germs that are so small they can float in the air and travel long distances. Droplet precautions are used to prevent contact with mucus and other secretions from the nose and sinuses, throat, airways, and lungs.
Calfee DP. Prevention and control of health care-associated infections. Goldman-Cecil Medicine. Philadelphia, PA: Elsevier; chap Centers for Disease Control and Prevention website. Isolation precautions. Updated July 22, Accessed October 22, Palmore TN. Infection prevention and control in the health care setting.
Inclusion of a ventilation system distinguishes an isolation room from a single room. Isolation is usually carried out in a single preferably en-suite room with hand washing facilities and with the door kept closed. If co-horting patients, a dedicated team of staff should care for these patients; however this can only be implemented if sufficient staff are available. The type of IPC precautions required for a patient in source isolation will depend on the mode of transmission of the organism causing the illness i.
Many infections acquired by immunocompromised patients are endogenous infections An infection caused by an infectious agent that is already present in the body, but has previously been inapparent or dormant , however transmission of infection from other patients, staff or the environment can be a risk and therefore extra precautions are required.
Where possible this room should have an ante-room, positive pressure ventilation and Hepa filtered air. Discharge air directly to the outside, away from people and air intakes, or direct all the air through HEPA filters before it is introduced to other air spaces II V.
Develop systems e. Place the patient in an AIIR as soon as possible. Personnel restrictions. Restrict susceptible healthcare personnel from entering the rooms of patients known or suspected to have measles rubeola , varicella chickenpox , disseminated zoster, or smallpox if other immune healthcare personnel are available IB V.
Infectious pulmonary or laryngeal tuberculosis or when infectious tuberculosis skin lesions are present and procedures that would aerosolize viable organisms e. Smallpox vaccinated and unvaccinated. Interim Measles Infection Control [July ] For current recommendations on face protection for measles, see Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings No recommendation is made regarding the use of PPE by healthcare personnel who are presumed to be immune to measles rubeola or varicella-zoster based on history of disease, vaccine, or serologic testing when caring for an individual with known or suspected measles, chickenpox or disseminated zoster, due to difficulties in establishing definite immunity Unresolved issue V.
Interim Measles Infection Control [July ] For current recommendations on face protection for measles, see Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings No recommendation is made regarding the type of personal protective equipment i. For patients with skin lesions associated with varicella or smallpox or draining skin lesions caused by M. Healthcare personnel transporting patients who are on Airborne Precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and infectious skin lesions are covered.
Immunize or provide the appropriate immune globulin to susceptible persons as soon as possible following unprotected contact i. Administer measles vaccine to exposed susceptible persons within 72 hours after the exposure or administer immune globulin within six days of the exposure event for high-risk persons in whom vaccine is contraindicated Administer varicella vaccine to exposed susceptible persons within hours after the exposure or administer varicella immune globulin VZIG or alternative product , when available, within 96 hours for high-risk persons in whom vaccine is contraindicated e.
Administer smallpox vaccine to exposed susceptible persons within 4 days after exposure. Protective Environment Table 4. Recommendation number, description, and category for protective environment Recommendation Category VI. IB VI. No recommendation for placing patients with other medical conditions that are associated with increased risk for environmental fungal infections e. Filter incoming air using central or point-of-use high efficiency particulate HEPA filters capable of removing Direct room airflow with the air supply on one side of the room that moves air across the patient bed and out through an exhaust on the opposite side of the room IB VI.
Monitor air pressure daily with visual indicators e. Ensure well-sealed rooms that prevent infiltration of outside air IB VI. Ensure at least 12 air changes per hour IB. Lower dust levels by using smooth, nonporous surfaces and finishes that can be scrubbed, rather than textured material e. Wet dust horizontal surfaces whenever dust detected and routinely clean crevices and sprinkler heads where dust may accumulate II VI.
Avoid carpeting in hallways and patient rooms in areas IB VI. Prohibit dried and fresh flowers and potted plants II VI. Minimize the length of time that patients who require a Protective Environment are outside their rooms for diagnostic procedures and other activities IB VI. During periods of construction, to prevent inhalation of respirable particles that could contain infectious spores, provide respiratory protection e.
No recommendation for fit-testing of patients who are using respirators. No recommendation for use of particulate respirators when leaving the Protective Environment in the absence of construction.
Unresolved issue. Use Standard Precautions as recommended for all patient interactions. IA VI. Barrier precautions, e. Implement Airborne Precautions for patients who require a Protective Environment room and who also have an airborne infectious disease e. Use an anteroom to further support the appropriate air-balance relative to the corridor and the Protective Environment; provide independent exhaust of contaminated air to the outside or place a HEPA filter in the exhaust duct if the return air must be recirculated IB VI.
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Provide administrative support, including fiscal and human resources for maintaining infection control programs. Assure that individuals with training in infection control are employed by or are available by contract to all healthcare facilities so that the infection control program is managed by one or more qualified individuals.
Determine the specific infection control full-time equivalents FTEs according to the scope of the infection control program, the complexity of the healthcare facility or system, the characteristics of the patient population, the unique or urgent needs of the facility and community, and proposed staffing levels based on survey results and recommendations from professional organizations. Include prevention of healthcare-associated infections HAI as one determinant of bedside nurse staffing levels and composition, especially in high-risk units.
Involve infection control personnel in decisions on facility construction and design, determination of AIIR and Protective Environment capacity needs and environmental assessments. Provide ventilation systems required for a sufficient number of airborne infection isolation rooms AIIR s as determined by a risk assessment and Protective Environments in healthcare facilities that provide care to patients for whom such rooms are indicated, according to published recommendations.
Involve infection control personnel in the selection and post-implementation evaluation of medical equipment and supplies and changes in practice that could affect the risk of HAI. Identify resources for performing surveillance cultures, rapid diagnostic testing for viral and other selected pathogens, preparation of antimicrobial susceptibility summary reports, trend analysis, and molecular typing of clustered isolates performed either on-site or in a reference laboratory and use these resources according to facility-specific epidemiologic needs, in consultation with clinical microbiologists.
Develop and implement policies and procedures to ensure that reusable patient care equipment is cleaned and reprocessed appropriately before use on another patient. Develop and implement processes to ensure oversight of infection control activities appropriate to the healthcare setting and assign responsibility for oversight of infection control activities to an individual or group within the healthcare organization that is knowledgeable about infection control.
Include in education and training programs, information concerning use of vaccines as an adjunctive infection control measure. Enhance education and training by applying principles of adult learning, using reading level and language appropriate material for the target audience, and using online educational tools available to the institution.
Monitor the incidence of epidemiologically-important organisms and targeted HAIs that have substantial impact on outcome and for which effective preventive interventions are available; use information collected through surveillance of high-risk populations, procedures, devices and highly transmissible infectious agents to detect transmission of infectious agents in the healthcare facility. When transmission of epidemiologically-important organisms continues despite implementation and documented adherence to infection prevention and control strategies, obtain consultation from persons knowledgeable in infection control and healthcare epidemiology to review the situation and recommend additional measures for control.
During the delivery of healthcare, avoid unnecessary touching of surfaces in close proximity to the patient to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces. When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water.
After contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings. After contact with inanimate objects including medical equipment in the immediate vicinity of the patient. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.
Develop an organizational policy on the wearing of non-natural nails by healthcare personnel who have direct contact with patients outside of the groups specified above.
Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed. Provide resources and instructions for performing hand hygiene in or near waiting areas in ambulatory and inpatient settings ; provide conveniently-located dispensers of alcohol-based hand rubs and, where sinks are available, supplies for handwashing.
Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces and persons. If laundry chutes are used, ensure that they are properly designed, maintained, and used in a manner to minimize dispersion of aerosols from contaminated laundry. Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient.
Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use.
If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile. Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients. Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space i.
Adhere to federal and state requirements for protection of healthcare personnel from exposure to bloodborne pathogens. In addition to Standard Precautions, use Transmission-Based Precautions for patients with documented or suspected infection or colonization with highly transmissible or epidemiologically-important pathogens for which additional precautions are needed to prevent transmission see Appendix A.
In acute care hospitals, place patients who require Contact Precautions in a single-patient room when available. When single-patient rooms are in short supply, apply the following principles for making decisions on patient placement:. If it becomes necessary to place a patient who requires Contact Precautions in a room with a patient who is not infected or colonized with the same infectious agent:. In long-term care and other residential settings , make decisions regarding patient placement on a case-by-case basis, balancing infection risks to other patients in the room, the presence of risk factors that increase the likelihood of transmission, and the potential adverse psychological impact on the infected or colonized patient.
In ambulatory settings , place patients who require Contact Precautions in an examination room or cubicle as soon as possible. Remove gown and observe hand hygiene before leaving the patient-care environment.
After gown removal, ensure that clothing and skin do not contact potentially contaminated environmental surfaces that could result in possible transfer of microorganism to other patients or environmental surfaces.
If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient. In acute care hospitals , place patients who require Droplet Precautions in a single-patient room when available.
Prioritize patients who have excessive cough and sputum production for single-patient room placement. Place together in the same room cohort patients who are infected the same pathogen and are suitable roommates. If it becomes necessary to place patients who require Droplet Precautions in a room with a patient who does not have the same infection:. Draw the privacy curtain between beds to minimize opportunities for close contact.
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