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Application of the updated CDC isolation guidelines for health care facilities

AORN Journal, March, 2008 by Shauna Ely Tarrac

The Centers for Disease Control and Prevention (CDC) has published updated guidelines that outline how health care workers can prevent the transmission of infectious agents to their patients as well as to one another. (1) During the past 11 years since the previous guidelines were published, (2) research has expanded, and effective interventions have been developed. (3-6) The CDC also published "Management of multidrug-resistant organisms in healthcare settings, 2006" (3) to address multidrug-resistant organisms (MDROs).

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This article highlights some of the changes in the updated "Guidelines for isolation precautions: preventing transmission of infectious agents in healthcare settings." (1) Particularly, the article guides clinicians in the appropriate application of standard precautions and prepares clinicians to incorporate respiratory hygiene/cough etiquette into infection control practices, which has been added as a component of standard precautions. It is important to note that several terms have been changed. The term nosocomial infections has been replaced with the term healthcare-associated infections (HAIs) and the term negative pressure room has been replaced with the term airborne infection isolation room.

RE-EMPHASIS ON STANDARD PRECAUTIONS

Standard precautions, previously known as universal precautions, have become one of the first-line tools for decreasing transmission of disease from patient-to-patient or patient-to-health care worker. The key elements of standard precautions include performing hand hygiene; using appropriate personal protective equipment (PPE) depending on the expected type of exposure (ie, gowns for exposure to blood or diarrheal drainage, mask and eye protection for cough-producing procedures); employing safe injection practices; and adhering to respiratory etiquette. (1)

Standard precautions are "based on the principle that all blood, body fluids, secretions, and excretions ... may contain transmissible infectious agents." (1)(p66) These infection prevention practices apply to all patients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered.

One component of standard precautions is using safe injection practices (7) These guidelines mirror the Occupational Safety and Health Administration guidelines for health care worker protection from blood and body fluid pathogens. (8) The precautions include

* using a sterile, disposable needle and syringe with a protective device for each injection and discarding all items intact in an appropriate sharps container after use;

* using single-dose medication vials, prefilled syringes, and ampules when possible;

* not using bags of IV solution as a common source of supply for multiple patients; and

* using aseptic technique to avoid contamination of sterile injection equipment.

Another concern is the potential for contamination of patient care equipment with infectious body fluids. Health care personnel must handle equipment in a manner that prevents transmission of infectious agents. Recommendations include wearing gloves during direct contact with contaminated equipment; containing heavily soiled equipment; and properly cleaning, disinfecting, and sterilizing equipment before use on another patient. (1,9)

In the surgical setting, a patient may be admitted for emergency surgery but also may be harboring an unknown bacterial or viral infection. By consistently applying standard precautions, the possibility of infection transmission is decreased greatly. These precautions may include hand hygiene and use of gloves, eye protection or a face shield, a mask, or a gown depending on the anticipated exposure. For example, when the circulating nurse assists with intubation and extubation, he or she should wear the appropriate PPE (eg, gloves, mask, eye protection).

Precautions are necessary for invasive procedures involving the insertion of catheters or injection of material into spinal or epidural spaces via lumbar puncture (eg, myelogram, spinal or epidural anesthesia). (1) Although most elements of standard precautions evolved from universal precautions that were developed for protection of health care personnel, these new elements of standard precautions focus on protection of patients. Staff members now are advised to wear masks during these invasive procedures. (10,11)

RESPIRATORY HYGIENE/COUGH ETIQUETTE

The transmission of severe acute respiratory syndrome-associated Coronavirus (SARS-CoV), a variant of the Coronavirus, in emergency departments by patients and their family members during the SARS outbreaks in 2003 highlighted the need for vigilance. Prompt implementation of infection control measures at the first point of encounter within a health care setting (eg, reception and triage areas in emergency departments and outpatient and urgent care clinics) is vital. (12-14)

The strategy to contain respiratory infectious diseases has been termed respiratory hygiene/cough etiquette (15) and should be incorporated into infection control practices as a new component of standard precautions. The strategy is targeted at patients and accompanying family members and friends with undiagnosed transmissible respiratory infections and applies to any person who enters a health care facility with signs of illness, including cough, congestion, rhinorrhea, or increased production of respiratory secretions. (16,17) The elements of respiratory hygiene/cough etiquette include educating health care personnel, patients, and visitors. This can be accomplished by posting signs in languages appropriate to the population served combined with instructions to patients and accompanying family members or friends regarding source control measures (eg, covering one's mouth and nose with a tissue when coughing, prompt disposal of used tissues).

Health Care Industry

Application of the updated CDC isolation guidelines for health care facilities

AORN Journal, March, 2008 by Shauna Ely Tarrac

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