Isolation Policy For Certain Groups Of Organisms

 

Isolation Policy For Certain Groups Of Organisms

1.     MRSA: When MRSA is isolated in the lab the microbiologist will inform the sister-in-charge/duty doctor/head of unit.

Patient is isolated and barrier nursed. Hand washing is strictly adhered to by all concerned. Linen is changed on a daily basis. Any contamination of linen requires to be decontaminated by autoclaving before sending to the laundry

Standard Isolation

a.     Single room

Preferably with own toilet facilities. Keep door closed.

b.    Hand washing

This is the most important measure to prevent the spread of infection.  Hands must be washed and dried thoroughly after attending to the patient’s care procedure, after removing the plastic apron and before leaving the room.  Any abrasions should be covered with waterproof plasters.

c.     Disposable Plastic Aprons

To be used when required.

d.    Disposable Gloves

Non-sterile latex gloves must be worn for direct contact, helping with personal care and handling contaminated materials.  After use, place directly into clinical waste bag kept in the room.  Then wash hands thoroughly before leaving the room.

e.     Linen

It is essential that bed making should be done in such a manner that bacteria are not distributed around the room.  Soiled linen must be placed into yellow bags whilst in the room, taking care not to contaminate the outside label then taken directly to the laundry.

f.      Equipment

Once this has been taken into the room it should remain there until the patient has recovered.  It may however be necessary to decontaminate a piece of equipment for use elsewhere.

g.    Charts

The patient charts/notes must be kept outside the room.

h.    Laboratory Specimens

They should be placed in “biohazard” bags according to Health Authority procedures.

i.       Faeces/Urine

Where possible allow patients to use their own toilet facilities.  Normal daily cleaning is sufficient if the patient is continent.  Gloves and aprons must be worn when handling urinals and bedpans.  If a commode is used this must be kept for the patients sole use within their rooms.  Wear gloves and apron when emptying and cleaning.

j.       Clinical Waste

All disposable items should be discarded into a waste bag sealed before being taken out of the room to the clinical waste store.

k.     Transfers

In the event of a transfer to hospital notify the ward in advance and inform the senior infection control nurse in order that suitable facilities can be prepared.

l.       Labels

Patient’s chart and bed is to be labelled –“contact isolation”/colour coded at the bedside until the patient is cleared of the infection.

m.   Terminal disinfection of the room

The room and all surfaces should be cleaned with a disinfectant solution so that the environment is cleared of Staphylococci. Lysol 7% is recommended for the same.

n.    Visiting Restrict visitors.  Keep staff contact to a minimum.

Treatment of Carriers

a.     Colonization may be transient or may persist for weeks, or months. 

b.     Antibiotics should not be used, as local treatment includes use of skin preparation (soap or lotion) and shampoo containing chlorhexidine or hexachlorophene, and nasal ointment or spray e.g. a chlorhexidine ointment.

c.     Three consecutive swabs for culture, taken from all previously colonized sites at intervals of no less than 24 hours are necessary before clearance can be given.

Antibiotics

a.  The drug of choice for treatment of severe systemic M.R.S.A. infections is intravenous vancomycin.

b.   If an M.R.S.A. colonized patient has to undergo a surgical procedure, then it is recommended  that antibiotic prophylaxis peri-operative vancomycin (1 – 2 doses) should be used..

Cleaning Guidelines

a.     Routine cleaning of accommodation is required.

b.     Standard cleaning agents can be used for cleaning tables and floors. 

c.     Porous surfaces, benches, floors and walls likely to be contaminated should be cleaned with 0.5% sodium hypochlorite/Bacillocid 0.5% = 25 ml bacillocid in 5 liters of water.

d.     Surfaces contaminated by secretions, or areas that have been grossly soiled should be cleaned with 0.5% sodium hypochlorite

e.     Bacillocod 0.5% = 25 ml bacillocid in 5 liters of water.

f.      Sodium hypochlorite 0.5%.

 

2. Multi-resistant bacteria e.g. Imipenem resistant Acinetobacter, multi-resistant Pseudomonas aeruginosa.  The aim is to curtail the spread of such bacteria. Hence patient is to be placed on strict barrier nursing precautions irrespective of whether the organism is a coloniser or the cause of infection 

 

3.  Pulmonary tuberculosis: Masks should be used during the care of all patients with sputum positive pulmonary tuberculosis. Patient should wear mask during any movement within the hospital.

Note: Isolation precautions are to be followed until all previous culture sites are negative.

4.     HIV / HBsAg / HCV infected patients:  Standard precautions.

 

Infection control measures for MRSA and VRE or Multi drug resistant cases.

1. Isolate any patients in single room.
2. Investigate any outbreak:

·       Other patients.

·       Staff.

3. Educate staff, hand washing, skin lesions, and anti-biotic use.
4. Screen hospital transfer patients, where the hospital of transfer carries a risk of M.R.S.A. infection

Administrative Considerations

1. Patients need to be screened:

1. Patients transferred from other hospitals or Nursing home. (Duration of stay >48HRS) with any of the following.
2. Patients with open/discharging wounds.
3. Patient with ventilator.
4. Patients with central line / Foleys catheter or infected peripheral line.
5. Patients with multiple i/v antibiotics.
6. Patient with TPN/RT feed

Staff

1. Screening carried out on staff with infective dermatitis or other exfoliate skin conditions.
2. Nasal swabs – need only be carried out in the event of an outbreak.

Procedure for screening patients in the “at risk” group

1. Culture swab to be taken from Nose, axilla, and sent to lab.
2. Culture swab taken from any potentially infected lesion such as a wound, a chronic ulcer or area of diseased skin.

Isolation of patients infected with M.R.S.A/ VRE or Multi drug resistant cases.

1. All waste to be treated as “contaminated” and placed in red contaminated bag.
2. Gloves and aprons must be worn for changing the beds of incontinent patients, attending dirty wounds, changing and cleaning suction bottles.
3. Masks to be worn when doing all the procedures.
4. Plastic aprons worn when attending patient.

Solid, contaminated infectious linen to be placed directly into the red plastic bag and sealed then put into laundry bag.

 

Drainage Secretion Precautions

• For patients with infections where organisms are present in wounds or wound drainage, infectious material should be sent for autoclaving after the patient is discharged, mattresses and pillows need to be disinfected by wiping with soap and water, followed by 7% Lysol / Bacillocid / E125/ D125, and dried in sun.
• Diseases requiring drainage secretion precautions:
• Abscess
• Decubitus ulcer
• Skin or wound infection
• Conjunctivitis
• Masks are not indicated, unless splash is likely
• Gowns are indicated if soiling is likely
• Gloves are indicated for touching infected material
• Hands must be washed after touching the patient or potentially contaminated articles and before taking care of another patient
• Articles contaminated with infective material must be discarded or bagged and labelled before being sent  for decontamination and reprocessing.