Standard Precautions

1
Standard PrecautionsIsolation Procedures
July 21, 2004 Susan Neufeld RN, MN
2
What Was SARs?

• Severe Acute Respiratory Syndrome
• SARS is a type of viral pneumonia
• Death may result from progressive respiratory
  failure due to alveolar damage.
• The typical clinical course of SARS involved an
  improvement in symptoms during the first week of
  infection, followed by a worsening during the
  second week.
• Most likely from the healthy masked palm civet
  from the province of Guangdong
• http//www-micro.msb.le.ac.uk/3035/Coronaviruses.h
  tml

Corona Virus
http//news.nationalgeographic.com/news/2003/04/04
09_030409_sars.html
http//www.lioncrusher.com/images/Paguma_larvata.j
pg
3
SARs or Acute Respiratory Infection

• Non-outbreak Screening
• Question all clients at first encounter to a
  health care institution.
• 1) Shortness of breath?
• 2) Fever/chills?
• 3) Have you been to China, Taiwan, Hong Kong in
  last 14 days?
• 4) Contact with sick person that has travelled
  in last 14 days?
• If Yes
• Don surgical mask and consider eye protection
• PT company to don mask wash hands
• Move pt to separate area

4
SARs or Acute Respiratory Infection
Outbreak Screening Question all clients at first
encounter to a health care institution. 1)
Shortness of breath? 2) Fever/chills? If
Yes Don N95 respirator and consider eye
protection PT company to don mask wash
hands Move pt to separate area ask 3) Have
you been to China, Taiwan, Hong Kong in last 14
days? 4) Contact with sick person that has
travelled in last 14 days? On admission repeat
the above and add Are you a health care
worker? Have you worked, visited, or been
admitted to a hospital that has SARs pts?
5
Post SARs What Did We Learn?
The focus during this period  is on vigilant
surveillance for severe respiratory illness of
unknown etiology, stringent infection control
practices and efficient communication between all
stakeholders. (PPHB, 2004). 

• Enhanced Surveillance
• Improve Public Health Response
• Timely Laboratory Testing

6
Evolution of Standard Precautions

• 1870s- Pts with ID Separate Facilty
• 1910s- Cubicle system separate gowns,
  handwashing disinfecting
• 1950/60s-Single pt. isolation rooms in hospitals
• 1970s CDC Isolation Techniques in Hospital.
• Seven Categories of Isolation
• Strict
• Respiratory
• Protective
• Enteric
• Wound and Skin
• Discharge
• Blood

7
Evolution Continued

• 1983 CDC revised again to include category or
  disease specific remove protective isolation.
• 1985 HIV Blood Body fluid precautions
  (Universal Precautions)
• 1987 Body substance isolation all body fluids
  simple to implement but neglected droplet or
  airbourne transmission.
• 1990s AROs, confusion need for simplification
  Standard Precautions Route of Transmission

8
Standard Precautions

• Apply to all clients regardless of ID status.
• Wash Hands
• Wear Gloves
• Mask/Eye Protection
• Gown
• Patient Care Equipment
• Environmental Control
• Linen http//www.uvsystems.co.uk/assets/gfx/hand
  -wash.jpg
• Needles
• Occupational Health Bloodborne Pathogens
• CPR

9
Masks

• Wear within 1m of coughing patient.
• Surgical Masks for filtration of particles gt5
  microns.
• N95 Masks filter particles 1 micron in size, have
  a 95 filter efficacy, and provide a tight seal.
• Read manufacture instructions.
• Remove carefully using straps so you do not
  contaminate yourself.
• Discard crushed or if in contact with secretions.
• Wash hands after removal.

10
Gloves

• Not a substitute for HANDWASHING
• Wash hands before donning and after removal.
• Must wear for contact with mucus membranes, non
  intact skin, rashes, blood collection, as per
  isolation protocols.
• Cover gown cuffs with gloves
• Never wash or reuse
• Meant to be used for specific tasks and then
  discarded NOT for routine activities. If worn for
  long periods of time get holes and tears.

11
Eye Protection

• Dont touch your eyes during patient care.
• Wear safety glasses, goggles or face shield if
  there is a POTENTIAL for splatter
• In pediatric patients because they have limited
  manners (shown to prevent RSV Adenovirus which
  are transmitted by large droplets).
• Over prescription glasses
• Clean between use
• Wash hands after removing

12
Route of Transmission Precautions

• Contact
• Droplet
• Airborne

http//students.washington.edu/grant/random/sneeze
.jpg
13
Contact Precautions

• Transmission through
• Direct Contact
• Indirect Contact through contaminated
• Hands to new client
• Equipment
• Environmental surfaces
• C. diff, Rotavirus, Hep A, Herpes, RSV, MRSA,
  VRE, Serratia, ESBLs (extended spectrum
  betalactamases ie. e-coli klebsiella)

14
Droplet Precautions

• Released from coughing, sneezing, suctioning
• Micro organisms bound to particles gt5 microns
  settle to surfaces where they survive (up to
  12hrs for RSV on nonporous surface)
• Can inhale if within 3 feet of cough otherwise
  falls to the ground.
• Pertussus, Neisseria Mennigitis, Group A strep,
  Mumps, Influenza virus, RSV, Rubella

http//www.mja.com.au/public/issues/176_08_150402/
bea10248_fm-1.jpg
15
Back to SARs

• Droplet transmission
• Why N95 Masks?
• Who knows?
• Philosophy Better to overprotect than
  underprotect?

16
Airborne Transmission

• Micro organisms transmitted through coughing,
  sneezing, laughing
• Trapped in particles lt5microns in size
• Can be suspended in air up to 8hrs
• Can drift to unsuspecting hosts
• Need air filtration and N95 masks
• TB, Chicken Pox, Red Measles

http//www.med.sc.edu85/fox/myc-tub-dk.jpg (SEM
x40,000)
17
Issues In Pediatrics

• Family visitation
• Feelings of Fear Loneliness
• Need for social interaction
• NICU/PICU proximity
• Client teaching compliance

18
Protection of Clients who areImmuno- compromised

• Proper handwashing most important thing!
• Separate oncology/transplant units in pediatrics.
• Filtered/positive pressure air rooms for
  neutropenic clients.
• Practices vary among institutions but limited
  evidence of need for isolation.

19
Long-Term Care Facilities

• What are the issues?
• it is the residents home
• cognitive impairment is common
• difficult to diagnose
• epidemiology of infection unclear (ie. AROs
  common but pneumonia causes morbidity)
• fewer resources, private vs public
• Limited evidence of effectiveness of
• Infection Control in LTCFs

20
What Works in LTCFs?

• HAND WASHING
• Immunization

Smith PW et al. AJIC 199725488-512
21
References

• Health Canada (2003). Infection control
  precautions for respiratory infections
  transmitted by large droplet and contact.
• PPHB (2004). Severe Respiratory Illness in the
  SARs Post-Outbreak Period. http//www.hc-sc.gc.ca/
  pphb-dgspsp/sars-sras/sri.html.
• Smith, P.W. et al. Infection prevention and
  control in the longterm care facility. AJIC
  199725 488-512
• Vancouver Island Health Authority (2001).
  Handwashing and gloves.