UTMB Isolation Precautions Policy PDF

Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topi...

Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author 01.19 – Isolation Precautions Purpose To facilitate safe care of all patients presenting themselves to The University of Texas Medical Branch (UTMB) inpatient and outpatient facilities with a known or suspected communicable disease. Audience All employees, contract workers, licensed independent practitioners, volunteers, and students who have contact with patients in isolation at UTMB. Policy Standard Precautions will be used in the care of all patients. They are based on a risk assessment and make use of common-sense practices and personal protective equipment use that protect healthcare providers from infection and prevent the spread of infection from patient to patient. This includes performing hand hygiene before and after a patient's care and wearing gloves when performing patient care. Respiratory hygiene procedures will be followed in the care of all patients with respiratory tract infections, such as wearing a face mark if recovering from an illness or covering your cough. Patients with known or suspected communicable diseases will be placed on the appropriate type of isolation precautions upon evaluation at any inpatient or outpatient facility or upon identification of a condition requiring isolation. Isolation orders may be entered by a physician or Infection Control and Healthcare Epidemiology (ICHE) personnel. If the order is placed by ICHE, an Infection Preventionist (IP) will chart the rationale in a progress note as applicable. Personal protective equipment (PPE) and supplies may be obtained from Clinical Equipment Services (CES), Materials Management, and the Laundry. Isolation carts for PPE are available from CES where applicable. Questions concerning isolation precautions during non-office hours may be referred to the IP on call at 409-643-3133. Everyone, including physicians, medical students, nurses, employees of environmental services, technicians, etc. is responsible for complying with isolation precautions and for tactfully calling observed infractions to the attention of offenders. Upon patient discharge, disposable items are either sent home with the patient or discarded. Reusable equipment will be disinfected. Refer to Appendix A for specific guidance for patient precautions for infectious diseases. Refer to Appendix B for specific discontinuation criteria related to patients in Neonatal Intensive Care Unit (NICU), Pediatric Ward, Pediatric Intensive Care Unit with confirmed or suspected respiratory viral illness. Infection Prevention Infection Preventionist (IP) will review all infection and isolation flags daily for 1 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Responsibilities appropriateness and correct all mismatches. Isolation rounds, performed by the Infection Control team will monitor isolation compliance including signage posted on the patient’s door and personal protective equipment (PPE) availability. The IP will ensure patient education has been documented in the patient’s chart. Nursing Implement appropriate isolation precautions for patients who are admitted Responsibilities with an isolation precautions flag in EPIC. Contact ICHE for questions. The Department of ICHE should be contacted before Airborne Precautions are discontinued. If a patient is to be transported to another location (OR, Radiology, etc.) nursing should notify the Transportation Department and the receiving department prior to transport, that the patient is on a particular type of isolation precautions. The appropriate isolation sign is placed at the patient’s door and the patient’s EPIC record is flagged.  Hospital personnel should instruct visitors about precautions to be taken while visiting or attending patients in isolation. All patients in isolation will be reviewed daily by the nurse in charge and responsible physician(s) to determine the need for change in isolation status or for discontinuing isolation. Findings will be noted in the patient’s medical record. Transportation Transport patients by the most direct routes to their destination. Avoid Department contact with employees and visitors as much as possible. Responsibilities Disinfect wheelchairs and stretchers with a hospital-grade disinfectant after use for a patient on isolation and prior to returning the wheelchair/stretcher to service. Cleaning of wheelchairs will be focused on the seat, arm rest, and back rest. The metal portion of the wheelchair will be inspected for contamination with blood and other body fluids and once removed, all surfaces will be decontaminated with a hospital grade disinfectant. Cleaning of the stretchers will focus on the upper and lower surfaces of the stretcher pad. The metal portion of the stretcher will be inspected for contamination with blood and body fluids and once removed, all surfaces decontaminated with a hospital grade disinfectant except for C. difficile in which case a 1:10 dilution of sodium hypochlorite (bleach) will be used. Patient Compliance In the event a patient is non-compliant with the isolation precautions the and Education following steps will be taken:  The nurse and or physician will explain the isolation precautions to the patient and encourage the patient’s compliance with the precautions (i.e. 2 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author staying in the room, wearing a mask). Continued non-compliance will be reported to the higher-level supervisor.  The nurse will document isolation education provided to the patient and family within the patient’s chart. Isolation Guidelines for specific types of isolation are listed below, and include: Precautions Airborne, All Barrier, Droplet, Contact, Extended Contact Precautions, Extended Respiratory and Extremely Drug Resistant Organisms Precautions (XDRO). Airborne Airborne Precautions will be used for patients known or suspected to be Precautions infected with microorganisms transmitted by airborne droplet nuclei (small- particle residue [3-5µm in size] of evaporated droplets containing microorganisms that remain suspended in the air and that can be dispersed widely by air currents within a room or over a long distance). Airborne Precautions include placement in an airborne infection isolation room (AIIR) meeting the following criteria: Private Room: necessary for all patients in this category.  Monitored negative air pressure in relation to the surrounding areas.  Twelve (12) air changes per hour, and  Appropriate discharge of air outdoors or monitored high-efficiency filtration of room air before the air is recirculated to other areas in the hospital. o If an AIIR is not available, ICHE, upon consultation with Property Services, will recommend an alternate method of managing airborne droplet nuclei. Respiratory Protection: A fit tested particulate respirator (N-95) will be worn when entering the room for all patients in this category. Use of a powered air purifying respirator (PAPR) is also acceptable. PAPRs require a fit test, equipment acquisition and training. The facility will provide respiratory protection, no personal items are allowed for use.  Persons susceptible to measles (Rubeola) or chickenpox (Varicella Zoster Virus) will not enter the room of patients known or suspected to have measles or chickenpox if other immune caregivers are available.  For chickenpox, a gown and gloves will also be worn (Airborne + Contact Precautions).  For pulmonary tuberculosis: All patients requiring work up for pulmonary tuberculosis, will have MTB PCR, AFB smear, and AFB cultures performed on adequately collected sputum samples. In general, infectiousness can be determined accurately by MTB PCR. All patients require AFB smears and cultures regardless of PCR results. Negative PCR but positive AFB smear usually indicates non-tuberculous mycobacteria. o For patients with suspected pulmonary TB, airborne precautions will continue until the patient has one negative PCR on sputum samples, and after considering all other clinically relevant information. In some cases, results of additional PCR, AFB smears and culture results may be required before discontinuing airborne precautions; this decision 3 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author may be guided by infectious disease specialists. o For patients with MTB PCR or culture confirmed pulmonary TB: Airborne precautions should continue until symptoms improve, the patient has complied with an adequate TB treatment regimen for at least 2 weeks, and patient has two negative PCR or 3 negative smears on sputum samples which are obtained at least 8 hours apart. Extrapulmonary tuberculosis: evaluate for concomitant pulmonary infection. Door: Keep the room door closed and the patient in the room. Place an Airborne Precautions sign on the patient’s door. Hands: Will be washed with an antimicrobial soap or an alcohol hand rub will be applied before entering and after leaving the room. Food Trays: Patients will be served meals on regular food trays. Patient Transport: Limit the movement and transport of the patient from the room to essential purposes only. If transport is necessary, place a surgical mask on the patient during transport. A mask is not necessary for the transporter. In addition to Standard Precautions, Extended Respiratory Precautions will be Extended used for patients known or suspected to be infected with microorganisms that Respiratory transmit primarily through large particle droplets and contact. Some Precautions treatments may cause aerosolization of droplets to the extent that a higher level of protection is required. In addition, eye protection is required. Diseases requiring the use of Extended Respiratory Precautions include COVID-19, SARS, and MERS. Room placement:  Private room  Airborne infection isolation room (negative pressure room) is ONLY required for prolonged or frequent aerosol-generating procedures.  Door should be kept closed PPE Required:  Respiratory protection o An N95 respirator will be worn for all patient care activities o An N95 respirator (PAPR for those who cannot be fit-tested for N95 and who must participate in care) will be worn to perform aerosol- generating procedures. (These include, but are not limited to: intubating the patient, extubating the patient, suctioning, use of CPAP.)  Eye protection – The following are acceptable forms of eye protection, but must function well with the respiratory protection worn: o Isolation masks with attached face shields o Disposable safety glasses or face shields o Reusable hard plastic safety glasses, goggles, or face shields  Contact precautions: 4 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author o Isolation or fluid-resistant gown o Gloves that cover the cuff of the gown Food Trays: Patients will be served meals on regular food trays. Patient Transport: Limit the movement and transport of the patient from the room to essential purposes only. The patient will don a clean gown, will wear a surgical mask, will practice hand hygiene and will be covered by a clean sheet whether transported by stretcher or wheelchair. For most EIDs, the transporter will clean hands and don PPE prior to entering the room, will retain PPE until the patient is placed on the stretcher or in a wheelchair, and then will remove the PPE and clean hands. For some EIDs, the transporter will be required to wear a surgical mask during transport. Patient Care Equipment: Dedicate the use of patient-care equipment when possible. If equipment must leave the patient’s room, the healthcare worker will remove the equipment (removing PPE as previously instructed). All surfaces of the equipment will be cleaned with a hospital grade disinfectant. All Barrier Precautions will be used for patients known or suspected to have All Barrier an Emerging Infectious Disease (EID) due to high consequence or special Precautions for high pathogens when both contact and airborne transmission are important. A consequence and separate, detailed ICHE policy (04.01 – Infection Control for the Care of special pathogens Patients with suspected or Diagnosed High Consequence Pathogens, Viruses of Special Concern or Emerging Infectious Diseases) addresses the institutional response. The policy includes (i) screening of patients for symptoms and travel history at all points of entry to care which is activated in the electronic medical records when a special alert is issued by health authorities; (ii) guidance on isolation precautions; (iii) informing public health authorities and key hospital staff; and (iii) disposal of waste. Following is a brief summary of the isolation precautions for these pathogens. Note: for some high-consequence infections (e.g. Ebola virus disease), the Biocontainment Critical Care Unit (BCCU) will be activated. Limit movement of patient to extent possible. If the BCCU is activated, BCCU-specific protocols will be followed. All Barrier Precautions for other inpatient areas include: Private Room: necessary for all patients in this category.  Monitored negative pressure in relation to the surrounding areas.  Twelve (12) air exchanges per hour, and  Appropriate discharge of air outdoors or monitored high-efficiency filtration of room air before the air is recirculated to other areas in the hospital. Personal Items: All rings, watches, bracelets, pagers, or any other personal items should be removed prior to donning personal protective equipment (PPE) as described below. Respiratory Protection: A fit tested particulate respirator (N-95) will be worn 5 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author when entering the room for all patients in this category.  Healthcare workers who enter the room must have been previously fit tested for the N-95 mask. If not, the healthcare worker must not enter the room.  PAPRs may be required for care in the BCCU and may be utilized for entry into any room where a patient in Airborne Precautions is housed if the staff member cannot be fit-tested for an N95 respirator. Protective Eyewear: Wear protective eyewear when entering the room unless a PAPR or face shield is worn. Faceshield: Wear faceshield over the N-95 mask and gown when performing aerosol-generating procedures unless a PAPR is worn. Gloves: Wear gloves (clean, nonsterile gloves are adequate) when entering the room. Gowns: Wear a gown when entering the room. Hands: Will be washed with a hospital approved antimicrobial soap or an alcohol hand rub applied before entering and after leaving the room. Donning PPE Sequence:  Don gown  Don fit tested N-95 mask  Don goggles (eyeglasses do not replace the need for goggles)  Don gloves  Make sure gown is secured behind the neck and with the tie behind the back  Pull gloves up over gown sleeve cuffs Doffing PPE Sequence:  Remove gloves  Remove protective eyewear  Remove gown  Exit room and WASH HANDS WITH AN ANTIMICROBIAL SOAP or APPLY AN ALCOHOL HAND RUB; then remove the N-95 mask and WASH HANDS WITH AN ANTIMICROBIAL SOAP OR APPLY AN ALCOHOL HAND RUB again.  Note: if transmission of the infection is by contact, clean hands after removing gloves and between removing each item of PPE.  See http://www.utmb.edu/hce/ or Healthcare Epidemiology under Clinical on the UTMB home page. Powered Air Purifying Respirator (PAPR): may be worn in lieu of a N-95 mask during aerosol-generating procedures such as bronchoscopy, endotracheal intubation, endotracheal tube suctioning, etc when not using a closed system. A PAPR may be required for care of the patient in the BCCU (see BCCU department protocols). 6 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Door: Keep the room door closed and the patient in the room. Place an All- Barrier Precautions sign on the patient’s door. Trash and Linen: Trash and linen will be handled the same as for any isolation room. Food Trays: Trays will be delivered on disposable plates with disposable cutlery. Patient Transport: Limit the movement and transport of the patient from the room to essential purposes only. The patient will don a clean gown, will wear a surgical mask, will practice hand hygiene, and will be covered by a clean sheet whether transported by stretcher or wheelchair. For most EIDs, the transporter will clean hands and don PPE prior to entering the room, will retain PPE until the patient is placed on the stretcher or in a wheelchair, and then will remove the PPE and clean hands. For some EIDs, the transporter will be required to wear a surgical mask during transport. Patient Care Equipment: Dedicate the use of patient-care equipment when possible. If equipment must leave the patient’s room, the healthcare worker will remove the equipment (removing PPE as previously instructed). All surfaces of the equipment will be cleaned with a hospital grade disinfectant. Outpatient Clinics: No personal protective equipment is required for the registration of patients. Patients may be required to wear a facemask. Gowns and gloves are required for invasive procedures. Hand hygiene (handwashing with an antimicrobial soap and water or application of an alcohol handrub to hands) is required before and after contact with all patients. Droplet Precautions Droplet Precautions will be used for patients known or suspected to be infected with microorganisms transmitted by droplets (large-particle droplets [larger than 10µm in size]) that can be generated by the patient during coughing, sneezing, talking, or during the performance of cough-inducing procedures). Droplet Precautions include: Private Room: necessary for all patients in this category. When Private Room is NOT available: Place the patient in a room with a patient who has an infection with the same microorganism, (same species) unless otherwise recommended, but with no other infection (cohorting).  When cohorting is not achievable, maintain spatial separation of >3 feet between the infected patient and other patients and visitors. (Special air handling and ventilation are not necessary). Respiratory Protection: Don a surgical mask prior to entering the patient’s room. 7 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Door: May remain open. Place Droplet Precautions sign on the patient’s door. Hands: Will be washed with an antimicrobial soap or an alcohol hand rub applied before entering and after leaving the room. Food Trays: Patients will be served meals on regular food trays. Patient Transport: Limit the movement and transport of the patient from the room to essential purposes only. If transport is necessary, place a surgical mask on the patient prior to transport. A mask is not necessary for the transporter. Contact Precautions Contact Precautions will be used for specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact that occurs when performing patient-care activities that require touching the patient’s dry skin) or indirect contact (touching) with environmental surfaces or patient care items in the patient’s environment. Private Room: necessary for all patients in this category. Gloves: Wear gloves (clean, nonsterile gloves are adequate) when entering the room.  Change gloves after having contact with infective material such as blood and body fluids.  Remove gloves before leaving the patients environment Hands will be washed with an antimicrobial soap or an alcohol hand rub applied before entering and after leaving the room.  Gowns: Wear a gown when entering the room.  Remove the gown before leaving the patient’s environment.  After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces. Food Trays: Patients will be served meals on regular food trays. Extended Contact Extended Contact Precautions will be used for specified patients known or Precautions suspected of being colonized or infected with Clostridium difficile or Norovirus. This microorganism may be transmitted to patients by the contaminated hands or clothing of healthcare workers or by contact with contaminated inanimate or environmental surfaces. Private Room: necessary for all patients in this category. When Private Room is NOT Available:  Consultation with the Department of Healthcare Epidemiology will be necessary before patient placement. Gloves: Wear gloves (clean, nonsterile gloves are adequate) when entering 8 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author the room.  Change gloves after having contact with infective material such as blood and body fluids.  Remove gloves before leaving the patients environment and wash hands immediately with an antimicrobial soap and water. DO NOT use alcohol hand rub for this type of isolation. Alcohol will not kill C. difficile spores or Noroviruses. Gowns: Wear a gown when entering the room.  Remove the gown before leaving the patient’s environment.  After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces. Door: Place an Extended Contact Precautions sign on the patient’s door. Food Trays: Patients will be served meals on regular food trays. Patient Transport: Limit the movement and transport of the patient from the room for essential purposes only. If the patient is transported, ensure that isolation precautions are maintained to minimize the risk of transmission of microorganisms to other patients and contamination of environmental surfaces or equipment. Patients on Extended Contact Precautions must be transported on a stretcher or wheelchair covered with a sheet or other physical barrier. Gown or gloves should not be worn during transport. The transporter should wear a gown and gloves to assist the patient in and out of the wheelchair/stretcher at each destination. Hands must be washed with an antimicrobial soap after gloves are removed. Do not use an alcohol hand rub after patient contact or upon entering the patient’s care space. Alcohol will not kill C. difficile spores or Noroviruses. Patient Care Equipment: When possible, dedicate the use of non-critical patient-care equipment to a single patient to avoid sharing between patients. If use of common equipment or items is unavoidable, then clean and disinfect them before use on another patient. Outpatient Clinics: No personal protective equipment is required for the registration of patients. Gowns and gloves are required for invasive procedures. Hand hygiene (handwashing with an antimicrobial soap and water or application of an alcohol hand rub) is required before and after contact with all patients. Extremely Drug- XDRO precautions will be used for bacteria or fungi that are classified as Resistant Organism epidemiologically significant due to their resistance to all first-line Precautions (XDRO) antimicrobials. They are also species that has been identified as causes of outbreaks in healthcare facilities. Private Room: necessary for all patients in this category. Gloves: Wear gloves (clean, nonsterile gloves are adequate) when entering 9 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author the room.  Change gloves after having contact with infective material that may contain high concentrations of microorganisms (fecal material)  Remove gloves before leaving the patients environment Hands will be washed with an antimicrobial soap or an alcohol hand rub applied before entering and after leaving the room Gowns: Wear a gown when entering the room.  Remove the gown before leaving the patient’s environment.  After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces. Protective Eyewear: Wear protective eyewear when performing droplet generating procedures such as suctioning of respiratory secretions, intubation/extubation. Food Trays: Patients will be served meals on regular food trays. Patient Transport: Limit the movement and transport of the patient from the room to essential purposes only. Patients on XDRO Precautions must be transported on a stretcher or wheelchair covered with a sheet or other physical barrier. Gown or gloves should not be worn during transport. The transporter should wear a gown and gloves to assist the patient in and out of the wheelchair/stretcher at each destination. Patient Care Equipment: When possible, dedicate the use of non-critical patient-care equipment to a single patient to avoid sharing between patients. If use of common equipment or items is unavoidable, then clean and disinfect them before use on another patient. Physicians and other healthcare workers may not take a personal stethoscope, cell phone or iPad into the room unless they are covered by the gown and not removed from under gown while in the room. Environmental cultures will be conducted as needed at the discretion of the ICHE department. See policy 01.22- Control of Multi-Durg Resistant Organisms (MDRO) for more information. 10 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author APPENDIX A Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution Abscess  Draining, major Contact DI Until drainage stops or can be contained by dressing  Draining, minor or limited Standard If dressing covers and contains drainage Acquired immunodeficiency Standard Postexposure chemoprophylaxis for some syndrome blood exposures Actinomycosis Standard Not transmitted from person to person Adenovirus infection (see agent- specific guidance under Gastroenteritis, Conjunctivitis, Pneumonia) Amebiasis Standard Person-to-person transmission is rare. Transmission in settings for the mentally challenged and in a family group has been reported. Use care when handling diapered infants and mentally challenged persons. Anthrax Standard Infected patients do not generally pose a transmission risk.  Cutaneous Standard Transmission through non-intact skin contact with draining lesions possible, therefore use Contact Precautions if large amount of uncontained drainage. Handwashing with soap and water preferable to use of waterless alcohol- based antiseptics since alcohol does not have sporicidal activity.  Pulmonary Standard Not transmitted from person to person.  Environmental contaminant: Until Until decontamination of environment aerosolizable spore containing environment complet. Wear respirator (N95 mask or powder or other substance completely PAPRs), protective clothing; decontaminate decontaminate persons with powder on d them (Notice to Readers: Occupational Health Guidelines for Remediation Workers at Bacillus anthracis- Contaminated Sites — United States, 2001–2002 (https://www.cdc.gov/mmwr/preview/mmw rhtml/mm5135a3.h tm accessed September 2018).) Hand hygiene: Handwashing for 30-60 seconds with soap and water or 2% chlorhexidine gluconate after spore contact (alcohol handrubs inactive against spores.) Postexposure prophylaxis following environmental exposure: 60 days of antimicrobials (either doxycycline, ciprofloxacin, or levofloxacin) and Postexposure vaccine under IND. 11 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution Antibiotic-associated colitis (see Clostridiodes difficile) Arthropod-borne Standard Not transmitted from person to person  viral encephalitis (eastern, except rarely by transfusion, and for western, Venezuelan equine West Nile virus by organ transplant, encephalomyelitis; St Louis, breastmilk or transplacentally. Install California encephalitis; West Nile screens in windows and doors in Virus) and viral fevers (dengue, endemic areas. Use DEET-containing yellow fever, Colorado tick fever) mosquito repellants and clothing to cover extremities. Ascariasis Standard Not transmitted from person to person. Aspergillosis Standard Contact Precautions and Airborne if massive soft tissue infection with copious drainage and repeated irrigations required Avian influenza (see Influenza, Avian below) Babesiosis Standard Not transmitted from person to person, except rarely by transfusion. Blastomycosis, North American, Standard Not transmitted from person to person. cutaneous or pulmonary Botulism Standard Not transmitted from person to person. Bronchiolitis (see respiratory Contact + Duration of Use mask according to Standard infections in infants and young Standard Illness Precautions children) Brucellosis (undulant, Malta, Standard Not transmitted from person to person, Mediterranean fever) except rarely via banked spermatozoa and sexual contact. Provide antimicrobial prophylaxis following laboratory exposure. Campylobacter gastroenteritis (see gastroenteritis) Candidiasis other than infection Standard caused by C. auris, all forms including mucocutaneous Candida auris Extremely Drug Resistant Cat-scratch fever (benign Standard Not transmitted from person to person. inoculation lymphoreticulosis) Cellulitis, uncontrolled drainage Contact Duration of illness Chancroid (soft chancre) Standard Transmitted sexually from person to (H.ducreyi) person. Chickenpox (see varicella) Chlamydia trachomatis  Conjunctivitis Standard  Genital (lymphogranuloma Standard venereum)  Pneumonia (infants < 3 mos of Standard age) Chlamydia pneumoniae Standard Outbreaks in institutionalized populations reported, rarely. 12  Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution Cholera (see gastroenteritis) Closed-cavity infection  Open drain in place; limited or Standard Contact Precautions if there is copious minor drainage uncontained drainage.  No drain or closed drainage Standard system in place Clostridiodes difficile (C diff) Extended Duration of Contact + Illness Standard Clostridium: see list below  C. botulinum Standard Not transmitted from person to person.  C.perfringens (Food poisoning) Standard Not transmitted from person to person.  C.perfringens (Gas gangrene) Standard Transmission from person to person rare; 1 outbreak in a surgical setting reported. Use Contact Precautions if wound drainage is extensive. Coccidioidomycosis (valley fever)  Draining lesions Standard Not transmitted from person to person except under extraordinary circumstances, because the infectious arthroconidial form of Coccidioides immitis is not produced in humans.  Pneumonia Standard Not transmitted from person to person except under extraordinary circumstances, (e.g., inhalation of aerosolized tissue phase endospores during necropsy, transplantation of infected lung) because the infectious arthroconidial form of Coccidioides immitis is not produced in humans. Colorado tick fever Standard Not transmitted from person to person. Congenital rubella Contact + Until 1yr of age Standard Precautions if nasopharyngeal Standard and urine cultures repeatedly negative after 3 mos. of age. Conjunctivitis  Acute bacterial Standard  Chlamydia Standard  Gonococcal Standard  Acute viral (acute hemorrhagic) Contact + Duration of Adenovirus most common; enterovirus 70, Standard illness Coxsackie virus A24 also associated with community outbreaks. Highly contagious; outbreaks in eye clinics, pediatric and neonatal settings, institutional settings reported. Eye clinics should follow Standard Precautions when handling patients with conjunctivitis. Routine use of infection control measures in the handling of instruments and equipment will prevent the occurrence of outbreaks in this and 13  Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution other settings. Coronavirus  Common strains (e.g. HKU1, NL63, 229E, OC43)  Adults-not Standard immunocompromised  Adults immunocompromised Droplet Duration of illness  Children Contact Duration of illness  Neonatal (NICU) Contact + Duration of Droplet illness  Covid-19 Contact + Eye Protection required Droplet + Extended Until cleared by ICHE. See Emerging Respiratory Infectious Disease Protocol.  MERS, SARS (also see middle Extended Until cleared by ICHE. See Emerging eastern respiratory syndrome and Respiratory Infectious Disease Protocol. severe acute respiratory syndrome) Coxsackievirus disease (see enteroviral infection) Creutzfeldt-Jakob disease (CJD, Standard Use disposable instruments or special yCJD) sterilization/disinfection for surfaces, objects contaminated with neural tissue if CJD or vCJD suspected and has not been R/O; No special burial procedures. Croup (see respiratory infections in infants and young children) Crimean – Congo Fever (see Viral Standard Hemorrhagic Fever) Cryptococcosis Standard Not transmitted from person to person, except rarely via tissue and corneal transplant Cryptosporidiosis (see gastroenteritis) Cysticercosis Standard Not transmitted from person to person. Cytomegalovirus infection, neonatal Standard No additional precautions for pregnant or immunosuppressed HCWs. Decubitus ulcer, (see Pressure ulcer) Dengue Fever Standard Not transmitted from person to person. Diarrhea, acute - infective etiology suspected (see gastroenteritis) Diphtheria  Cutaneous Contact + Until off Until 2 cultures taken 24 hours apart Standard antimicrobial negative. treatment and culture-negative  Pharyngeal Droplet + Until off Until 2 cultures taken 24 hours apart 14 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution Standard antimicrobial negative. treatment and culture-negative Ebola virus (see Viral Hemorrhagic Ebola Virus Disease for Healthcare Fevers) Workers : Updated recommendations for healthcare workers can be found at Ebola: for Clinicians (https://www.cdc.gov/vhf/ebola/clinicians/ind ex.html accessed September 2018). Echinococcosis (hydatidosis) Standard Not transmitted from person to person. Echovirus (see enteroviral infection) Encephalitis or encepalomyelitis (see specific etiologic agents) Endometritis Standard Enterobiasis (pinworm disease, Standard oxyuriasis) Enterococcus species (see multidrug-resistant organisms if epidemiologically significant or vancomycin resistant) Enterocolitis, C. difficile (see Gastroenteritis, C. difficile) Enteroviral infections  Adults Standard  Infants and young children Contact Use Contact Precautions for diapered or incontinent children for duration of illness and to control institutional outbreaks Epiglottitis, due to Haemophilus Droplet + Until 24 hours See specific disease agents for epiglottitis influenzae, type b Standard after initiation due to other etiologies. of effective therapy Epstein-Barr virus infection, Standard including infectious mononucleosis Erythema infectiosum (also see Parvovirus B19) Escherichia coli gastroenteritis (see gastroenteritis) Extremely drug resistant organisms Extremely Contact ICHE for discontinuation (XDRO) Drug requirements Resistant Organism Food poisoning  Botulism Standard Not transmitted from person to person.  Clostridium perfringens or welchii Standard Not transmitted from person to person.  Staphylococcal Standard Not transmitted from person to person. Furunculosis - staphylococcal Standard Contact if drainage not controlled. Follow institutional policies if MRSA.  Infants and young children Contact + Duration of Standard illness (with 15 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution wound lesions, until wounds stop draining) Gangrene (gas gangrene) Standard Not transmitted from person to person. Gastroenteritis: see specific agents Standard Use Contact Precautions for diapered or below incontinent persons for the duration of illness or to control institutional outbreaks for gastroenteritis caused by all of the agents below.  Adenovirus Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.  Campylobacter species Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.  Cholera Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.  Clostridium difficile Contact + Duration of Discontinue antibiotics if appropriate. Do Standard illness not share electronic thermometers; ensure consistent environmental cleaning and disinfection. Hypochlorite solutions may be required for cleaning if transmission continues. Handwashing with soap and water preferred because of the absence of sporicidal activity of alcohol in waterless antiseptic handrubs  Cryptosporidium species Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.  Escherichia coli Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks. o Enterohemorrhagic 0157:H7 Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks. o Diapered or incontinent Contact + Use Contact Precautions for diapered or Standard incontinent persons for the duration of illness or to control institutional outbreaks. o Other species Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.  Giardia lamblia Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.  Norovirus Extended Use Extended Contact Precautions for a Contact minimum of 48 hours after the resolution of symptoms or to control institutional outbreaks. Persons who clean areas heavily contaminated with feces or vomitus may benefit from wearing masks since virus 16 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution can be aerosolized from these body substances; ensure consistent environmental cleaning and disinfection with focus on restrooms even when apparently unsoiled. Hypochlorite solutions may be required when there is continued transmission. Alcohol is less active, but there is no evidence that alcohol antiseptic handrubs are not effective for hand decontamination. Cohorting of affected patients to separate airspaces and toilet facilities may help interrupt transmission during outbreaks. Gastroenteritis, Noroviruses Precaution Update [May 2019]: The Type of Precaution was updated from “Standard” to “Contact + Standard” to align with Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings (2011)  Rotavirus Contact + Duration of Ensure consistent environmental cleaning Standard illness and disinfection and frequent removal of soiled diapers. Prolonged shedding may occur in both immunocompetent and immunocompromised children and the elderly  Salmonella species (including S. Standard Use Contact Precautions for diapered or typhi) incontinent persons for the duration of illness or to control institutional outbreaks. o Diapered or incontinent Contact + Use Contact Precautions for diapered or Standard incontinent persons for the duration of illness or to control institutional outbreaks.  Shigella species Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks. o Diapered or incontinent Contact + Use Contact Precautions for diapered or Standard incontinent persons for the duration of illness or to control institutional outbreaks.  Vibrio parahaemolyticus Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.  Viral (if not covered elsewhere) Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks.  Yersinia enterocolitica Standard Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks. German measles (see Rubella; see Congenital Rubella) 17 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution Giardiasis (see gastroenteritis) Gonococcal ophthalmia neonatorum (gonorrheal opthalmia, Standard acute conjunctivitis of newborn) Gonorrhea Standard Granuloma inguinale (donovanosis, Standard granuloma venereum) Guillain-Barré syndrome Standard Not an infectious condition Haemophilus influenzae (see disease-specific recommendations) Hand, foot, and mouth disease (see enteroviral infection) Hansen’s Disease (see Leprosy) Hantavirus pulmonary syndrome Standard Not transmitted from person to person. Helicobacter pylori Standard Hemorrhagic fevers (see viral hemorrhagic fevers) Hepatitis, viral  Type A Standard Provide hepatitis A vaccine postexposure as recommended. o Diapered or incontinent patients Contact + Maintain Contact Precautions in infants Standard and children 14 yrs. of age for 1 week after onset of symptoms  Type B - HBsAg positive Standard See specific recommendations for care of patients in hemodialysis centers.  Type C and other unspecified non- Standard See specific recommendations for care of A, non-B patients in hemodialysis centers.  Type D (seen only with hepatitis B) Standard  Type E Standard Use Contact Precautions for diapered or incontinent individuals for the duration of illness.  Type G Standard Herpangina (see enteroviral infection) Herpes simplex (Herpesvirus hominis)  Encephalitis Standard  Neonatal Contact + Until lesions Also, for asymptomatic, exposed infants Standard dry and crusted delivered vaginally or by C-section and if mother has active infection and membranes have been ruptured for more than 4 to 6 hours until infant surface cultures obtained at 24-36 hours of age negative after 48 hours incubation. 18 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution  Mucocutaneous, disseminated or Contact + Until lesions primary, severe Standard dry and crusted  Mucocutaneous, recurrent (skin, Standard oral, genital) Herpes zoster (varicella-zoster) (Shingles)  Disseminated disease in any Airborne + Duration of Susceptible HCWs should not enter room patient Contact + illness if immune caregivers are available; no  Localized disease in Standard recommendation for protection of immune immunocompromised patient until HCWs; no recommendation for type of disseminated infection ruled out protection (i.e. surgical mask or respirator) for susceptible HCWs.  Localized in patient with intact Standard Until lesions Susceptible HCWs should not provide immune system with lesions that dry and crusted direct patient care when other immune can be contained/covered caregivers are available. Histoplasmosis Standard Not transmitted from person to person. HIV (see human immunodeficiency virus) Hookworm disease Standard (ancylostomiasis, uncinariasis) Human immunodeficiency virus Standard Postexposure chemoprophylaxis for some (HIV) infection3 blood exposures Human metapneumovirus Contact + Duration of HAI reported, but route of transmission Standard illness not established. Assumed to be Contact transmission as for RSV since the viruses are closely related and have similar clinical manifestations and epidemiology. Wear masks according to Standard Precautions. Impetigo Contact + Until 24 hours Standard after initiation of effective therapy Infectious mononucleosis Standard Influenza, seasonal Droplet + 7 days except See Prevention Strategies for Seasonal Standard DI in Influenza in Healthcare Settings immunocompro (https://www.cdc.gov/flu/professionals/inf mised persons ectioncontrol/health caresettings.htm accessed September 2018). [Current version of this document may differ from original.] for current seasonal influenza guidance. Influenza, Swine All Barrier 7 days from onset of symptoms or until afebrile for 24 hours, whichever is longer except DI in immunocompro mised persons 19 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution Influenza, Avian (e.g., H5N1, H7, H9 Droplet + See strains) Standard https://www.cdc.gov/flu/avianflu/novel-flu- infection-control.htm accessed September 2018 for current avian influenza guidance. Influenza, Pandemic Influenza (also Droplet + See a human influenza virus) Standard https://www.cdc.gov/flu/avianflu/novel-flu- infection- control.htm accessed September 2018 for current pandemic influenza guidance. Kawasaki syndrome Standard Lassa fever (see Viral Hemorrhagic All Barrier BCU protocol Fevers) Legionnaires’ disease Standard Not transmitted from person to person. Leprosy Standard Leptospirosis Standard Not transmitted from person to person. Lice  Head (pediculosis) Contact + Until 24 hours See Standard after initiation https://www.cdc.gov/parasites/lice/ of effective index.html accessed September 2018 therapy  Body Standard Transmitted person-to-person through infested clothing. Wear gown and gloves when removing clothing; bag and wash clothes according to CDC guidance Parasites – Lice (https://www.cdc.gov/parasites/lice/ind ex.html accessed September 2018).  Pubic Standard Transmitted person-to-person through sexual contact. See CDC's Parasites – Lice (https://www.cdc.gov/parasites/lice/index.h tml accessed September 2018). Listeriosis Standard Person-to-person transmission rare; cross- transmission in neonatal settings reported. Lyme disease Standard Not transmitted from person to person. Lymphocytic choriomeningitis Standard Not transmitted from person to person. Lymphogranuloma venereum Standard Malaria Standard Not transmitted from person to person, except through transfusion rarely and through a failure to follow Standard Precautions during patient care. Install screens in windows and doors in endemic areas. Use DEET- containing mosquito repellants and clothing to cover extremities. Marburg virus disease (see Viral All Barrier BCU Protocol Hemorrhagic Fevers). 20 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution Measles (rubeola), all presentations Airborne + 4 days after Interim Measles Infection Control Standard onset of rash; [July 2019] duration of illness in See Interim Infection Prevention and immune Control Recommendations for compromised Measles in Healthcare Settings (https://www.cdc.gov/infectioncontrol/gu idelines/measles) Susceptible healthcare personnel (HCP) should not enter room if immune care providers are available; regardless of presumptive evidence of immunity, HCP should use respiratory protection that is at least as protective as a fit- tested, NIOSH- certified N95 respirator upon entry into the patient's room or care area. For exposed susceptibles, postexposure vaccine within 72 hours or immune globulin within 6 days when available. Place exposed susceptible patients on Airborne Precautions and exclude susceptible healthcare personnel. Melioidosis, all forms Standard Not transmitted from person to person. Meningitis  Aseptic (nonbacterial or viral Standard Contact for infants and young children. meningitis [also see enteroviral infections])  Bacterial, gram-negative enteric, in Standard neonates  Fungal Standard  Haemophilus influenzae, type b Droplet + Until 24 hours known or suspected Standard after initiation of effective therapy  Listeria monocytogenes (see Standard Listeriosis)  Neisseria meningitidis Droplet + Until 24 hours See Meningococcal Disease below. (meningococcal) known or Standard after initiation suspected of effective therapy  Streptococcus pneumoniae Standard  M. tuberculosis Standard Concurrent, active pulmonary disease or draining cutaneous lesions may necessitate addition of Contact and/or Airborne. For children, Airborne Precautions until active tuberculosis ruled out in visiting family members (see Tuberculosis below).  Other diagnosed bacterial Standard Meningococcal disease: sepsis, Droplet + Until 24 hours Postexposure chemoprophylaxis for pneumonia, Meningitis Standard after initiation household contacts, HCWs exposed to 21 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution of effective respiratory secretions; postexposure therapy vaccine only to control outbreaks. Middle Eastern respiratory Extended See Emerging Infectious Disease Protocol. syndrome (MERS) Respiratory Molluscum contagiosum Standard Monkeypox (mpox) Airborne + A - until Contact monkey pox See CDC’s Monkeypox website confirmed and (https://www.cdc.gov/poxvirus/monkeypox/cli smallpox nicians/infection excluded; -control-healthcare.html accessed May C - until lesions 2022) for information on infection crusted prevention and control. Mucormycosis Standard Multidrug-resistant organisms Contact + See MDR policy-some highly resistant (MDROs), infection or colonization Standard organisms may require additional (e.g., MRSA, VRE, VISA/VRSA, precautions ESBLs, resistant S. pneumoniae)  Gastrointestinal Contact + Standard  Respiratory Contact + Standard  Pneumococcal Standard  Skin, wound, or burn Contact + Standard  Methicillin-resistant Contact + Staphylococcus aureus (MRSA)- Standard infection (clinical isolate)  Vancomycin-resistant enterococci Contact + (VRE) Standard Mumps (infectious parotitis) Droplet + Until 5 days Mumps Update [October 2017]: The Standard after the onset Healthcare Infection Control Practices of swelling Advisory Committee (HICPAC) voted to change the recommendation of isolation for persons with mumps from 9 days to 5 days based on a 2008 MMWR report: Updated Recommendations for Isolation of Persons with Mumps. (https://www.cdc.gov/mmwr/preview/mmwr html/mm5740 a3.htm accessed September 2018). After onset of swelling, susceptible HCWs should not provide care if immune caregivers are available. The below note has been superseded by the above recommendation update. Note: (Recent assessment of outbreaks in healthy 18-24 year olds has indicated that salivary viral shedding occurred early in the course of illness and that 5 days of isolation after onset of parotitis may be 22 Section: UTMB On-line Documentation 01.19 - Policy Subject: Infection Control & Healthcare Epidemiology Policies and Procedures 6.25.24 - Revised Topic: 01.19 – Isolation Precautions 1981- Author Infection/Condition Type of Duration of Precautions/Comments Precaution Precaution appropriate in community settings; however the implications for healthcare personnel and high- risk patient populations remain to be clarified.) Mycobacteria, nontuberculosis (atypical)  Pulmonary Standard  Wound Standard Mycoplasma pneumonia Droplet + Duration of Standard Illness Necrotizing enterocolitis Standard Contact Precautions when cases clustered temporally. Nocardiosis, draining lesions or Standard Not transmitted person-to-person. other presentations Norovirus gastroenteritis (see viral gastroenteritis) Orf Virus (Sore Mouth Infection) Standard Parainfluenza virus infection, Contact + Duration of Viral shedding may be prolonged in respiratory in infants and young Standard illness immunosuppressed patients. Reliability of children antigen testing to determine when to remove patients with prolonged hospitalizations from Co