2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings



TABLE OF CONTENTS
Executive Summary ……………………………………………………………………………….7
Abbreviations………………………………………………………………………………………11
Part I: Review of the Scientific Data Regarding Transmission of Infectious Agents in Healthcare Settings ............................................................ 12
I.A. Evolution of the 2007 document .................................................................12
I.B. Rationale for Standard and Transmission-Based Precautions in healthcare settings .......14
I.B.1. Source of infectious agents ...................................................................14
I.B.2. Susceptible hosts .................................................14
I.B.3. Modes of transmission ......... ...................................15
I.B.3.a. Contact transmission ............................................15
I.B.3.a.i. Direct contact transmission ...................................16
I.B.3.a.ii. Indirect contact transmission ................................16
I.B.3.b. Droplet transmission ............................................17
I.B.3.c. Airborne transmission ...........................................18
I.B.3.d. Emerging issues and controversies concerning bioaerosols and airborne transmission of infectious agents .............................19
I.B.3.d.i. Transmission from patients…………………………19
I.B.3.d.ii.
Transmission from the environment…………………20
I.B.3.e. Other sources of infection ..............................20
I.C. Infectious agents of special infection control interest for healthcare settings .....................20
I.C.1.
Epidemiologically important organisms………………………………….21
I.C.1.a. Clostridium difficile ...........................................21
I.C.1.b. Multidrug-resistant organisms(MDROs)…………………………………..…22
I.C.2. Agents of bioterrorism ...........................................23
I.C.3. Prions ..........................................................24
I.C.4. Severe acute respiratory syndrome(SARS) ........................26
I.C.5. Monkeypox ......................................................28
I.C.6. Noroviruses…………………………………………………………………28
I.C.7. Hemorrhagic fever viruses……………………………………………………………29
I.D. Transmission risks associated with specific types of healthcare settings ..........................31
I.D.1.Hospitals .........................................................31
I.D.1.a. Intensive care units ...........................................31
I.D.1.b. Burn units .....................................................32
I.D.1.c. Pediatrics .....................................................33
I.D.2. Non-acute care settings ..........................................34
I.D.2.a. Long term care .................................................34
I.D.2.b. Ambulatory care settings .......................................35
I.D.2.c. Home care ......................................................36
I.D.2.d. Other sites of healthcare delivery .............................37
I.E. Transmission risks associated with special patient populations .....38
I.E.1. Immunocompromised patients .......................................38
I.E.2. Cystic fibrosis patients .........................................39
I.F. New therapies with potential transmissible infectious agents .......39
I.F.1. Gene therapy .....................................................39
I.F.2. Infections Transmitted through Blood, Organs and Tissues .........40
I.F.3. Xenotransplantation and tissue allografts ........................40
Part II.
Fundamental Elements to Prevent Transmission of Infectious Agents in
Healthcare Settings ......................................................41
II.A.
Healthcare system components that influence the effectiveness of precautions to prevent transmission ......................................41
II.A.1. Administrative measures……………………………………………..…41
II.A.1.a. Scope of Work and Staffing Needs for Infection Control Professionals (ICP) 42
II.A.1.a.i. Infection Control Liaison Nurse…… 43
II.A.1.b.
Bedside nurse staffing……………………….……………………43
II.A.1.c. Clinical microbiology laboratory support…43
II.A.2.
Institutional safety culture and organizational characteristics………45
II.A.3.
Adherence of healthcare personnel to recommended guidelines….45
II.B. Surveillance for healthcare-associated infections (HAIs)………………..…46
II.C. Education of healthcare workers, patients, and families ...........47
II.D. Hand hygiene ...........................................49
II.E. Personal protective equipment for healthcare personnel ............49
II.E.1. Gloves ...........................................................50
II.E.2. Isolationgowns ..........................................................51
II.E.3.
Face protection: masks, goggles, face shields………………………52
II.E.3.a. Masks…………………………………………………………52
II.E.3.b. Goggles, face shields…………………………………………52
II.E.4. Respiratory protection ...........................................53
II.F. Safe work practices to prevent HCW exposure to bloodborne pathogens 55
II.F.1. Prevention of needlesticks and other sharps-related injuries
................................55
II.F.2. Prevention of mucous membrane contact ..........................56
II.F.2.a.
Precautions during aerosol-generating procedures………56
II.G. Patient placement ....... ..................................56
II.G.1. Hospitals and long-term care settings .....................56
II.G.2. Ambulatory care settings ..................................58
II.G.3. Home care .....................................................59
II.H. Transport of patients ........................................59
II.I. Environmental measures ............................................60
II.J. Patient care equipment, instruments/devices ..................61
II.K. Textiles and laundry .........................................61
II.L. Solid waste……………………………………………………………………62
II.M. Dishware and eating utensils ................................62
II.N. Adjunctive measures .........................................63
II.N.1. Chemoprophylaxis .................................................63
II.N.2. Immunoprophylaxis .............................................63
II.N.3. Management of visitors………………………………………………64
II.N.3.a. Visitors as sources of infection…………………………….64
II.N.3.b. Use of barrier precautions by visitors……………………65
Part III.
HICPAC Precautions to Prevent Transmission of Infectious Agents 66
III.A. Standard Precautions .......................................66
III.A.1.New Standard Precautions for patients……………………………………………67
III.A.1.a. Respiratory Hygiene/Cough Etiquette ......................67
III.A.1.b. Safe Injection Practices………………………………………………………. 68
III.A.1.c.
Infection Control Practices for Special Lumbar Puncture Procedures……69
III.B. Transmission-Based Precautions ..............................69
III.B.1. Contact Precautions .......................................70
III.B.2. Droplet Precautions .........................................70
III.B.3. Airborne Infection Isolation Precautions ......................71
III.C. Syndromic or empiric application of Transmission-Based Precautions 71
III.D. Discontinuation of precautions ...................................72
III.E. Application of Transmission-Based Precautions in ambulatory and home care settings .........................................................72
III.F. Protective environment (PE)................................73
Part IV
: Recommendations ....................................................... 74
Appendix A.Type and duration of precautions needed for selected infections and conditions ...................................................... 93
Tables
Table 1. Recent history of guidelines for prevention of healthcare-associated infections

..
Table 2. Clinical syndromes or conditions warranting additional empiric transmission-
based precautions pending confirmation of diagnosis………………………….........
Table 3. Infection control considerations for high-priority (CDC Category A) diseases that
Table 4. Recommendations for application of Standard Precautions for the care of all
may result from bioterrorist attacks or are considered to be bioterrorist threats

patients in all healthcare settings

Table 5. Components of a Protective Environment

Figure Sequence for donning and removing PPE

Glossary………………………………….………………………………………........................…
References

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