Isolation Precautions in Healthcare

Protective Measures (I): Isolation Precautions

• Protective measures for different transmission modes are discussed.
• A two-tier system is employed for isolation precautions in hospitals and communities.
• The first tier, Standard Precautions (SP), applies to all patients regardless of their diagnosis.
• SP aims to prevent the transmission of microorganisms through contact with blood, body fluids, secretions, excretions, mucous membrane and non-intact skin.
• The second tier, Transmission-Based Precautions, is used in addition to SP when Standard Precautions are insufficient to prevent infection.
• Examples include respiratory infections needing additional precautions.

Learning Objectives

• Students will compare isolation precautions for diseases with different transmission modes.
• Students will describe special precautions for multidrug-resistant organisms (MDROs).
• Students will describe the criteria for clearance of MRSA carriage.
• Students will devise a plan for isolation precautions for specific communicable diseases.

Isolation Precautions in Hong Kong

• A two-tier system is used: Standard Precautions and Transmission-Based Precautions.
• Standard Precautions apply to all patients, regardless of their diagnosis, to prevent transmission of microorganisms through contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin.
• Transmission-Based Precautions are used in addition to Standard Precautions for specific diseases where standard precautions are not enough to prevent infection.

1. Standard Precautions

• Standard precautions apply to all patients, regardless of diagnosis.
• They cover situations involving contact with blood, body fluids, excretions, secretions, and non-intact skin (excluding sweat).
• Standard precautions include hand hygiene, use of Personal Protective Equipment (PPE), patient placement, handling of used equipment, environmental control, and linen management.
• Precaution measures also include prevention of needlesticks and sharps injuries, safe injection practices, and respiratory hygiene/cough etiquette in healthcare settings.

1.1 Hand Hygiene

• Hand hygiene (hand washing/handrub) is performed between direct patient, resident and client contacts.
• It's done after touching body fluids, excretions, secretions, mucous membranes and contaminated items.
• Alcoholic handrub is prioritized if hands are not visibly soiled.
• Facilities for hand hygiene should always be available and accessible to residents and visitors.
• Education on hand hygiene should be provided to all patients.

1.2 Use of Personal Protective Equipment (PPE)

• Gloves are used when contact involves blood, body fluids, secretions, excretions, mucous membrane and non-intact skin.
• Gloves are removed after completing the procedure.
• Masks, eye protection and face shields are used when splashes of blood, body fluids, excretions, or secretions are anticipated or likely.
• Gowns/aprons are used to protect clothing from contamination.

1.3 Patient Placement

• Patients at high risk of transmitting infection or poor hygiene should be in single rooms or physically separated locations.
• Spatial separation of at least 1 meter is needed for droplet precautions.

1.4 Handling of Used Equipment

• Handle used equipment to prevent skin and mucous membrane exposure and contamination.
• Contaminated reusable equipment should be cleaned and disinfected before use by another patient.

1.5 Environmental Control

• Areas near patients (bed rails, bedside tables, etc.) should be cleaned more often than other areas.
• Terminal cleaning and disinfection of patient areas should be performed upon discharge.

1.6 Linen Management

• Used linen should be handled and processed correctly to avoid contaminating people and the environment.
• Bulky soiled material (e.g., feces) should be removed from linen before placing it in laundry bags.

1.7 Prevention of Needlesticks and Sharps Injuries

• Use safe needle alternatives whenever possible.
• Avoid practices that increase injury risk.
• Use a one-handed "scoop" or mechanical recapping device when recapping is unavoidable.
• Put used needles in a puncture-resistant container.

1.8 Safe Injection Practices

• Use sterile, single-use needles and syringes for each injection.
• Single-dose vials are preferred over multiple-dose vials.
• Needles/cannulas and syringes must be sterile if using multi-dose vials.

1.9 Respiratory Hygiene/Cough Etiquette

• Alert patients to respiratory hygiene/cough etiquette.
• Mask and separate individuals with respiratory symptoms.
• Observe droplet precautions.

2. Transmission-Based Precautions

• Additional precautions for highly transmissible pathogens.
• Includes contact, droplet, and airborne precautions.
• Used in addition to standard precautions.

2.1 Contact Precautions

• Used for patients with or suspected of infections transmitted by direct or indirect contact.
• Includes placing patients in single rooms, minimizing environmental contamination during transport and using appropriate PPE when handling equipment.

2.2 Droplet Precautions

• Used for patients with or suspected of infections transmitted by large particle droplets (e.g., coughing, sneezing).
• Includes placing patients in single rooms with one-meter separation, using surgical masks when working within one meter of the patient, and transporting patients only for necessary purposes, using a surgical mask.

2.3 Airborne Precautions

• Used for airborne infections transmitted via small-particle residues in the air.
• Includes placing patients in negative pressure rooms and using respirators when entering the room.
• Additional precautions should be taken for patients with measles or chickenpox.

3. Precautions for Multidrug-Resistant Organisms (MDROs)

• MDROs are germs that have adapted to antibiotics.
• Examples include MRSA and VRE.
• Colonization: Presence of the germ on or in the body without illness.
• Infection: Illness resulting from germ presence and invasion.
• Precautions include using single rooms, minimizing the number of people entering the room, frequent cleaning, and using dedicated non-critical items.
• Transferring patients should be avoided if possible, otherwise, the receiving department should be notified.
• Patient risk of spreading MDROs should be evaluated and appropriate precautions implemented.

3. Precautions for Clearance of MRSA Carriage

• Two consecutive screening cultures with negative results.
• Swabs taken from specified areas with a 48-hour interval.
• Patients must take baths with a chlorhexidine solution, and apply a povidone-iodine ointment to the nostrils for several days to decolonize.
• Patients who take antimicrobials for MRSA should be screened 48 hours after completing their treatment to ensure the results aren't skewed.

4. Handling of Dead Bodies

• Avoid direct contact with body fluids.
• Wear appropriate PPE.
• Wounds should be covered.
• Do not touch eyes, mouth, or nose.
• Place the body in opaque, leak-proof plastic bags.
• Label the body bag with proper identification.
• Remove PPE and wash hands afterwards.