Techniques for Isolation Precautions

1983 ◽  
Vol 4 (S4) ◽  
pp. 253-257 ◽  

This section contains information essential to understanding and properly using the isolation precautions that appear in the guideline and on the instruction cards. Many of the techniques and recommendations for isolation precautions are appropriate not only for patients known or suspected to be infected but also for routine patient care. For example, gowns are appropriate for patient-care personnel when soiling with feces is likely, whether or not the patient is known or suspected to be infected with an enteric pathogen, and caution should be used when handling any used needle.Handwashing is the single most important means of preventing the spread of infection. Personnel should always wash their hands, even when gloves are used, after taking care of an infected patient or one who is colonized with microorganisms of special clinical or epidemiologic significance, for example, multiply-resistant bacteria. In addition, personnel should wash their hands after touching excretions (feces, urine, or material soiled with them) or secretions (from wounds, skin infections, etc.) before touching any patient again. Hands should also be washed before performing invasive procedures, touching wounds, or touching patients who are particularly susceptible to infection. Hands should be washed between all patient contacts in intensive care units and newborn nurseries. (See Guideline for Hospital Environmental Control: Antiseptics, Handwashing, and Handwashing Facilities.)When taking care of patients infected (or colonized) with virulent or epidemiologically important microorganisms, personnel should consider using antiseptics for handwashing rather than soap and water, especially in intensive care units.

Author(s):  
Nai-Chung Chang ◽  
Michael Jones ◽  
Heather Schacht Reisinger ◽  
Marin L. Schweizer ◽  
Elizabeth Chrischilles ◽  
...  

Abstract Objective: To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. Design: For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. Setting: The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. Participants: HCWs in the STAR*ICU study units. Results: HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). Conclusions: HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.


1983 ◽  
Vol 4 (S4) ◽  
pp. 324-324

Patients requiring intensive care are usually at higher risk than other patients of becoming colonized or infected with organisms of special clinical or epidemiologic significance. Three reasons are that contacts between these patients and personnel are frequent, the patients are clustered in a confined area, and many of them are unusually susceptible to infection. Moreover, critically ill patients are more likely to have multiple invasive procedures performed on them. Because there is ample opportunity for cross-infection in the Intensive Care Unit (ICU), infection control precautions must be done scrupulously. Frequent in-service training and close supervision to ensure adequate application of infection control and isolation precautions are particularly important for ICU personnel. (See Guideline for Hospital Environmental Control: Intensive Care Units.)Most ICUs pose special problems for applying isolation precautions, hence some modifications that will neither compromise patient care nor increase the risk of infection to other patients or personnel may be necessary. The isolation precaution that will most often have to be modified is the use of a private room. Ideally, private rooms should be available in ICUs, but some ICUs do not have them or do not use them for patients who are critically ill if frequent and easy accessibility by personnel is crucial. When a private room is not available or is not desirable because of the patient's critical condition, and if airborne transmission is not likely, an isolation area can be defined within the ICU by curtains, partitions, or an area marked off on the floor with tape. Instructional cards can be posted to inform personnel and visitors about the isolation precautions in use.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Ben Rejeb ◽  
A Ben Cheikh ◽  
S Bhiri ◽  
H Ghali ◽  
M Kahloul ◽  
...  

Abstract Background The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes. Methods Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018. Results During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%). Conclusions Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital. Key messages eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.


2011 ◽  
Vol 32 (11) ◽  
pp. 1057-1063 ◽  
Author(s):  
Nisha Nair ◽  
Ekaterina Kourbatova ◽  
Katharine Poole ◽  
Charmaine M. Huckabee ◽  
Patrick Murray ◽  
...  

Background.The multicenter, cluster-randomized Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) trial was performed in 18 U.S. adult intensive care units (ICUs). It evaluated the effectiveness of infection control strategies to reduce the transmission of methicillin-resistant Staphylococcus aureus (MRSA) colonization and/or infection. Our study objective was to examine the molecular epidemiology of MRSA and assess the prevalence and risk factors for community acquired (CA)-MRSA genotype nasal carriage at the time of ICU admission.Methods.Selected MRSA isolates were subjected to molecular typing using pulsed-field gel electrophoresis.Results.Of 5,512 ICU patient admissions in the STAR*ICU trial during the intervention period, 626 (11%) had a nares sample culture result that was positive for MRSA. A total of 210 (34%) of 626 available isolates were selected for molecular typing by weighted random sampling. Of 210 patients, 123 (59%) were male; mean age was 63 years. Molecular typing revealed that 147 isolates (70%) were the USAIOO clone, 26 (12%) were USA300, 12 (6%) were USA500, 8 (4%) were USA800, and 17 (8%) were other MRSA genotypes. In a multivariate analysis, patients who were colonized with a CA-MRSA genotype (USA300, USA400, or USA1000) were less likely to have been hospitalized during the previous 12 months (PR [prevalence ratio], 0.39 [95% confidence interval (CI), 0.21-0.73]) and were less likely to be older (PR, 0.97 [95% CI, 0.95-0.98] per year) compared with patients who were colonized with a healthcare-associated (HA)-MRSA genotype.Conclusion.CA-MRSA genotypes have emerged as a cause of MRSA nares colonization among patients admitted to adult ICUs in the United States. During the study period (2006), the predominant site of CA-MRSA genotype acquisition appeared to be in the community.


2007 ◽  
Vol 37 (4) ◽  
pp. 435-452 ◽  
Author(s):  
Bernadette Longo ◽  
Craig Weinert ◽  
T. Kenny Fountain

Medical personnel in hospital intensive care units routinely rely on protocols to deliver some types of patient care. These protocol documents are developed by hospital physicians and staff to ensure that standards of care are followed. Thus, the protocol document becomes a de facto standing order, standing in for the physician's judgment in routine situations. This article reports findings from Phase I of an ongoing study exploring how insulin protocols are designed and used in intensive care units to transfer medical research findings into patient care “best practices.” We developed a taxonomy of document design elements and analyzed 29 insulin protocols to determine their use of these elements. We found that 93% of the protocols used tables to communicate procedures for measuring glucose levels and administering insulin. We further found that the protocols did not adhere well to principles for designing instructions and hypothesized that this finding reflected different purposes for instructions (training) and protocols (standardizing practice).


2021 ◽  
Vol 74 (1) ◽  
Author(s):  
Renilly de Melo Paiva ◽  
Larissa de Lima Ferreira ◽  
Manaces dos Santos Bezerril ◽  
Flavia Tavares Barreto Chiavone ◽  
Pétala Tuani Candido de Oliveira Salvador ◽  
...  

ABSTRACT Objectives: to identify and map the invasive procedures performed by nursing that can cause Healthcare-Associated Infections in patients in Intensive Care Units. Methods: this is a scoping review carried out in the first half of 2018, based on search for studies in national and international databases, in which 2,209 studies were found, of which 35 constituted the final sample. The data were analyzed and organized by simple descriptive statistics. Results: among the invasive procedures performed by nursing that provide Healthcare-Associated Infections, delayed bladder catheter was indicated in 34 (66.67%) studies, the nasogastric catheter in 10 (19.61%) and the nasoenteral catheter in two (03.92%). Conclusions: in the face of such problems, better nursing planning and guidance for care in these invasive techniques becomes relevant and thus minimizes the incidence of infections.


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