Application of the updated CDC isolation guidelines for health care facilities

AORN Journal,  March, 2008  by Shauna Ely Tarrac

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   When an infected person sneezes, coughs, or
   speaks, droplet particles can be generated, can
   stay suspended for long periods of time, and can
   be inhaled or swallowed by another person, usually
   within a distance of 3 ft. (1) (p132)

Experimental studies performed with smallpox and observations during the SARS outbreak in 2003 indicate that these two infections may be transmitted up to 6 ft from the source patient. (22) In addition, some people are considered "shedders" (ie, nasal carriers) exhibiting "cloud baby syndrome" or "cloud adult syndrome." For these syndromes, transmission of microorganisms that are not normally transmitted by the airborne route have been documented. This phenomenon has been noted in outbreak cases with the transmission of Staphylococcus aureus from colonized patients or health care workers. (23-25)

ORGANISMS OF INTEREST

"Any infectious agent transmitted in health care settings may, under defined conditions, become targeted for control." (1)(p21) Clinicians at each health care facility must monitor the endemic rate of these infections to determine a baseline threshold for that organism. Surveillance then continues, and an unexplained increase over and above the endemic rate, with or without an increase in the severity of disease, requires investigation and the institution of control measures.

MDROs. Resistant organisms refer to certain bacterial pathogens that have proven resistant to any first-line therapy medication. Any organism that is resistant to more than two antibiotics generally is considered to be an MDRO. Transmission is from patient to patient, usually via the hands of health care workers. (3) Examples of MDROs include

* bacteria with extended-spectrum beta-lactamase resistance.

* methicillin-resistant Staphylococcus aureus,

* vancomycin-resistant enterococci,

* vancomycin-intermediate Staphylococcus aureus, and

* vancomycin-resistant Staphylococcus aureus.

CLOSTRIDIUM DIFFICILE. Clostridium difficile is a spore-forming, gram-positive bacillus. It first was isolated and documented in the 1930s and was identified as a major component in the cause of pseudomembranous colitis in 1977. (26) Numerous large outbreaks in health care facilities have been documented. (27-29) This disease usually is related to recent or prolonged antibiotic therapy. In addition, a relatively new strain made its appearance in England, Canada, and the United States beginning in 2001. (30) This strain--toxinotype III, North American PFGE (pulsed-field gel electrophoresis) type 1--has been shown to produce 16 times more toxin A and 23 times more toxin B than has been observed historically with Clostridium difficile. (26,30,31)

Prevention focuses on

* instituting contact precautions for any patient with diarrhea;

* increasing the environmental cleaning of surfaces, especially patient rooms, bathrooms, and commodes; and

* ensuring consistent hand hygiene with soap and water for mechanical removal of the spores.