4812-volume-10-transmission-based-precautions-isolation-guidelines.pdf

Canterbury DHB

Volume 10 – Infection Prevention and Control Transmission-Based Precautions (Isolation Guidelines)

1 Transmission-Based Precautions (Isolation Guidelines)

1.1 Transmission-based Precautions (Isolation Guidelines)

Transmission-based Precautions are applied to patients suspected or confirmed to be infected with microorganisms transmitted by the contact, droplet or airborne routes. In these instances the route(s) of transmission of the micro-organism is/are not completely interrupted using Standard Precautions. There are four categories of precautions that can be implemented in the CDHB

1. Contact Precautions 2. Droplet Precautions 3. Airborne Precautions 4. Protective (Environment) Precautions

Depending on the route of transmission, transmission-based precautions involves a combination of the following precautions (Refer 1.1.5 Summary Chart for Transmission-based Precautions)

a. Allocation of single rooms or cohorting of patients b. Appropriate air handling requirements c. Appropriate use of PPE d. Patient dedicated equipment e. Enhanced cleaning and disinfection of the patient environment

• Transmission-based Precautions are always used in addition to Standard Precautions.

• Some diseases have multiple routes of transmission and several categories of Transmission-based Precautions may be combined, e.g. Chickenpox may require airborne and contact precautions.

• All staff members must comply with Transmission-based Precautions. • Extend duration of Transmission-based Precautions for immunosuppressed

patients with viral infections due to the prolonged shedding of viral agents that may be transmitted to others.

• It is important to advise the patient’s family, whanau and significant others regarding Transmission-based Precautions rationale and procedures.

• Ensure that the patient receives the information pamphlet: “Why am I being Nursed in Isolation” (Ref. 0106) available from Supply Department or download from the IP&C intranet site

• Contact the Infection Prevention and Control Service to arrange staff education sessions as required on the ward.

• Where single room accommodation is not available a risk assessment in consultation with IP&C is required.

Authorised by Issue 6: June 2012 Ref: 4812 of 29 Review Date: June 2014

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1.1.1 Contact Precautions

Contact Precautions are intended to prevent transmission of (known or suspected) infectious agents including epidemiologically important micro-organisms, which are spread by direct or indirect contact with the patient or the patient’s environment or patient care items, e.g. multi-drug resistant organisms, scabies, excessive wound drainage, drainage of body fluids causing extensive environmental contamination, and gastrointestinal tract pathogens such as Norovirus, Clostridium difficile and Rotavirus.

1.1.2 Droplet Precautions Droplet Precautions are intended to prevent transmission of (known or suspected) infectious agents including epidemiologically important micro-organisms, which are spread by close respiratory or mucous membrane contact with respiratory secretions, e.g. influenza, Pertussis (whooping cough), meningococcal meningitis (for first 24 hours of effective antimicrobial therapy).

1.1.3 Airborne Precautions Airborne Precautions are intended to prevent transmission of (known or suspected) infectious agents that remain infectious over long distances when suspended in the air and are transmitted person to person by inhalation of airborne particles, e.g. chicken pox, measles, pulmonary tuberculosis.

NB Refer to separate section on care of patients with pulmonary tuberculosis and use of negative pressure rooms for airborne isolation.

1.1.4 Protective (Environment) Precautions A protective environment is most commonly used for stem cell transplant patients to minimise fungal spore counts in the air and reduce the risk of invasive environmental fungal infections; this usually requires HEPA filtered positive pressure rooms such as those in the Bone Marrow Transplant Unit (BMTU).

Dependant on neutrophil count, only patients considered to be sufficiently immunosuppressed by their clinical team should be placed in protective (environment) precautions. Generally there is no evidence to support the need for special diets for those in protective environments and general good hygiene practice must be observed. Refer to local dietician and NZ Food Safety Authority guidelines for advice. Staff with upper respiratory tract infections should not enter a room in Protective (Environment) precautions.


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1.1.5 Summary Chart for Transmission-based Precautions

Action Contact Precautions Droplet Precautions Airborne Precautions Protective (Environment) Precautions

Single Room with ensuite facilities

Yes, or cohort If single room not available risk assessment necessary in consultation with IP&C

Yes, or cohort Yes Yes

No ensuite facilities available

Designate toilet/shower and label clearly for individual room number OR use individually assigned commode in patient’s room. Shower last and terminally clean afterwards.

Patient to wear surgical mask while transferring to WC/Shower OR use individually assigned commode in patient’s room. Shower last, if possible.

Non applicable as should have ensuite/dedicated bathroom.

Designate toilet/shower and label clearly for individual room number OR use individually assigned commode in patient’s room. Shower in freshly cleaned shower.

Negative Air Pressure No No Yes No – positive pressure hepa filtered Door May be open. Closed during dust/aerosol

generating procedures, e.g. bed making. May be open Closed at all times Closed at all times in positive pressure

room. Equipment Dedicated equipment or disinfect between use.

Limit equipment and furniture to wipeable/impermeable only. Keep supplies in room to a minimum. Patient’s records outside room.

Dedicated equipment or disinfect between use. Limit equipment and furniture to wipeable /impermeable only. Keep supplies in room to a minimum. Patient’s records outside room.

As per Standard Precautions Ensure equipment is clean before being taken into room.

Hand Hygiene Antimicrobial liquid soap or alcohol-based handrub for multi-drug resistant bacteria. Plain liquid soap or alcohol-based handrub for other infections. N.B. Hand washing with liquid soap is required for Clostridium difficile infection NOT alcohol-based handrub.

Plain liquid soap or alcohol-based handrub.

Plain liquid soap or alcohol-based handrub.

Liquid soap or alcohol-based handrub before any contact with patient.

Gloves For contact with patient or environment. Remove before leaving room then perform hand hygiene.

As per Standard Precautions As per Standard Precautions Clean gloves and no-touch technique when handling high risk sites e.g. CVC lines

Gowns/aprons Wear gown when close physical contact, e.g. manual handling is anticipated. Wear plastic apron when limited contact with patient or environment is planned. Remove and dispose of before leaving room avoiding contact with outer surface.

As per Standard Precautions As per Standard Precautions As per Standard Precautions

Mask Not generally indicated. May be required in Surgical mask when entering the Particulate Respirator (N95) on No mask required. Staff or visitors with


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Action Contact Precautions Droplet Precautions Airborne Precautions Protective (Environment) Precautions

some circumstances, e.g. bed making or if patient has respiratory infection with MDRO.

patient’s room. Remove at exit to the room. Handle by the ties or earloops.

entering room (sized and fitted correctly). Remove outside room.

upper respiratory tract infection should not be visiting or care for patient.

Goggles/Face shield As per Standard Precautions, i.e. if procedure involves splash risk.

As per Standard Precautions, i.e. if procedure involves splash risk.



Linen Place in red linen bag with water soluble liner. No label required.

Place in red linen bag with water soluble liner. No label required.

No special precautions for linen. No special precautions for linen.

Waste As per infectious/medical waste disposal. Dispose of inside room.

As per infectious/medical waste disposal. Dispose of inside room.

Disposal as per infectious/medical waste Dispose of inside room.

No special requirements, Follow CDHB Waste Disposal policy.

Crockery/Utensils/Meal Trays

Sanitise in approved dishwasher. Bagging not required. Perform hand hygiene after delivering or collecting meal trays.

Sanitise in approved dishwasher. Bagging not required. Staff wear appropriate mask when delivering or collecting meal trays.

Sanitise in approved dishwasher. Bagging not required .Staff wear appropriate mask when delivering or collecting meal trays.

Sanitise in approved dishwasher. Staff performs hand hygiene on entry to room.

Visitors Perform hand hygiene. Not required to wear PPE. See additional information.

Perform hand hygiene. Not required to wear PPE. Discourage visiting whilst patient actively symptomatic. See 1.2.4.

Perform hand hygiene. Not required to wear N95 if they have been in contact prior to identification of causative organism. Visitors may need to be restricted.

Perform hand hygiene. Do not visit if unwell.

Transfer to other departments/ hospitals

Limit to essential transportation only. Ensure receiving area is aware of status of Contact Precautions prior to transfer. Patient to wear surgical mask only if respiratory symptoms present.

Limit to essential transportation only. Ensure receiving area is aware of status of Droplet Precautions prior to transfer. Patient to wear surgical mask.

Limit to essential transportation only. Ensure receiving area is aware of status of Airborne Precautions prior to transfer. Patient to wear surgical mask.

Limit to essential transportation only. Ensure receiving area is aware of status of Protective Environment prior to transfer. Patient to wear surgical mask or N95 mask (risk assess).


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1.2 Additional General Information

1.2.1 Points to Consider when Working in Transmission-Based Precautions 1. Minimise the frequency of entrances into the room by collecting all the

equipment required before entering the room. 2. Have the minimum amount of people in the room. 3. Have minimum amount of equipment in the room. When admitting into

an isolation room, remove surplus equipment where possible. 4. Spend a minimum amount of time in the room if the person is acutely

unwell with an infectious disease such as Norovirus. 5. When patients are placed in transmission-based precautions due to an

infection or colonisation with an MDRO, efforts should be made to ensure patients continue to receive adequate medical and nursing care to counteract potential psychological adverse effects such as anxiety and depression and feeling of stigmatisation.

6. Consider nominating a buddy or runner who can assist staff working in Transmission-Based Precautions, e.g. collecting and removing supplies or equipment.

1.2.2 Use of PPE in Isolation Rooms

Make sure that neither the environment outside isolation room, nor other persons can be contaminated from the used PPE.

• Generally, PPE should be removed inside the room, hand hygiene performed then room exited.

• Remove PPE in a manner that prevents self-contamination or self-inoculation with contaminated PPE or hands – see 1.2.3.

• Discard disposable items immediately into a foot controlled lidded rubbish bin.

• Remove the most heavily contaminated items first, i.e. gloves. • Hand hygiene must be performed immediately after glove removal. • If wearing full PPE, the last item to be removed should be the mask

and hand hygiene must be repeated. • Do NOT remove PPE prior to leaving a room when transporting blood

or body fluid substance to the sluice for disposal e.g. a bedpan. Go directly to the sluice and remove PPE in the sluice after completion of task.

Disposable Particulate Respirator (N95) Masks • This is a protective tight fitting device worn on the face which covers the nose

and the mouth and protects the wearer from inhaling hazardous/infectious airborne particles by filtering the air before it reaches the wearer.


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• Used respirators are considered contaminated and must be discarded following a patient episode of care DO NOT REUSE

• The respirator mask should be worn by staff performing aerosol generating procedures with patients with respiratory infection

• Do not touch the front of the mask once fitted on the face to avoid contamination of the hands

• Remove the respirator mask by the elastic • Mask fit testing of staff is no longer a routine requirement. However, staff

must ensure that the mask worn forms a tight seal around nose/mouth before entering isolation room.


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1.2.3 Sequence for Putting on and Removing PPE


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1.2.4 Visitors Visitors wishing to see other inpatients are requested to do so prior to

visiting the patient in transmission-based precautions.

Visitors, especially children, should consider delaying their visiting for patients in the acute phase of highly transmissible diseases such as Norovirus, Rotavirus, Influenza, Mumps and Measles.

Visitors must not be discouraged from visiting patients with MDRO/MRSA.

Prior to entering a transmission-based precautions room, visitors require instructions on performing hand hygiene.

Visitors generally do not need to wear PPE (Refer Summary Chart for Isolation Precautions). There may be exceptions to this based on risk assessment e.g. TB – discuss with Infection Prevention and Control or Charge Nurse Manager.

Visitors should not use ward toilets or enter staff areas.

Visitors should not visit if they have symptoms of an infectious disease in the last two days.

All visitors must wash their hands or use alcohol-based hand rub prior to leaving a transmission based precautions room.

1.2.5 Cohort Isolation (Sharing Rooms) When a single room is not available, an infected or colonised patient

may be placed with another patient who is infected with the same micro-organism provided that:

Neither patient is infected with other potentially transmissible micro-organisms.

The likelihood of re-infection with the same micro-organism is minimal.

Ensure the patients are physically separated.

Change PPE and perform hand hygiene between contact with patients in the same room.

It is important to be certain of the mode of transmission of the known or suspected pathogens. Contact the Infection Prevention and Control Service if cohorting of patients is being considered.

1.2.6 Laboratory Specimens All human blood and body substances must be treated as if they are

infected or contaminated with infectious agents; therefore there is no need to label as infectious.


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Care should be taken when collecting specimens to avoid contamination

of the outside of the container. Ensure specimen container is closed securely.

1.2.7 Deceased Patients and Infectious Diseases Body bags are only required in the following circumstances:

The body is:

• Leaking body fluids which are not containable or where gross external contamination of blood is present, OR

• Deemed to be at high risk of leaking body fluids by nature of condition, e.g. oedema, aspiration, extensive burns, trauma, OR

The patient:

• Had or was suspected of having a Viral Haemorrhagic Fever, OR • Has confirmed/suspected Emerging New Infectious Disease (ENID)

which may have resulted in death. Body bags are available from Mortuary or Undertaker and can be requested via the Mortuary staff or orderlies out-of-hours.

• The ward staff must advise the Mortuary if a patient is known or strongly suspected of having one of the following infectious diseases. However, a body bag is not necessary unless any of the criteria above are present.

• Spongiform encephalitis, e.g. Creutzfeld Jacob disease • Hepatitis B • HIV/AIDS • Hepatitis C • Tuberculosis • Typhoid/paratyphoid • Meningococcal meningitis/septicaemia (if death occurs before 48

hours of suitable antibiotics given). • Invasive Beta-haemolytic Streptococcus Group A disease (if death

occurs before 24 hours of suitable antibiotics given).


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1.3 Transmission-Based Precautions Cleaning and Disinfection

1.3.1 Daily Cleaning

• Clean room last. • No special cleaning solutions are required for daily cleaning of room. • Disposable cloths must be used. • Focus on frequently touched surfaces and equipment such as bed rails,

over bed tables, commodes, door knobs, call bells. • Protective clothing is worn by cleaning staff in accordance with

Transmission-Based Precautions sign outside room. • Launder mop head after use.

1.3.2 Terminal Cleaning Terminal Cleaning occurs on patient discharge from Contact Precautions. Refer to A to Z for conditions requiring Contact Precautions.

• Nurse-in-Charge contacts cleaning services to arrange. • Privacy, window, shower curtains (if applicable) require removing

prior to terminal clean. • Curtains to be sent to laundry in black laundry bags. • Clean surfaces using a disinfectant as follows:

Options for Disinfection (refer to disinfection chart):

Viral- Sodium hypochlorite (Presept/Chlorwhite) 1000ppm

Bacterial- Phenolic (Prephen) NOTE: not to be used on infant’s incubators/bassinettes

70% alcohol wipes NOTE: not to be used on display panels of electronic equipment

Steam cleaning

1.3.3 Bed Space Disinfection The disinfection of the bed space follows the identification of an infectious patient in a multi bed room and their subsequent transfer to a single room or discharge. The multi bed room in these instances is not in Contact Precautions.

• Transfer or Discharge – privacy curtains are removed for laundering – bed, locker, chair and equipment transferred to a single room – horizontal and touch points disinfected


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References Department of Labour (2000) Managing Health and Safety Risks in New Zealand Mortuaries, Occupational Safety and Health Service, Wellington Guidelines for the Control of Multidrug-resistant Organisms in New Zealand, 2007 MOH http://www.moh.govt.nz/moh.nsf/indexmh/guidelines-for-the-control-of-multidrug-resistant-organisms-in-nz

Guidelines for the Control of methicillin-resistant Staphylococcus aureus in New Zealand, 2002. MOH http://www.moh.govt.nz/moh.nsf/pagesmh/1804?Open

Guidelines for preventing the transmission of mycobacterium tuberculosis in healthcare settings (2005) MMWR, 54, RR-17, 1-141.

Management of Multi Drug resistant Organisms in Healthcare settings, 2006 CDC

Hannum D et al (1996)

The effect of respirator training on the ability of healthcare workers to pass a qualitative fit test. Infect Control Hosp Epidemiology, 17, 636-40

Health and Safety Executive (2005) Controlling the risks of infection at work from human remains - A guide for those involved in funeral services (including embalmers) and those involved in exhumation Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. WHO Interim Guidelines2007 http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html

Occupational Safety and Health Service of the Department of Labour (2000) Managing Health and Safety Risks in New Zealand Mortuaries. Guideline to promote safe working conditions.

Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Prevention and Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007 http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf


http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf

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1.4 Alphabetical List of Diseases See also www.cdc.gov for a comprehensive, detailed and continuously updated A – Z Index. Disease Mode of Transmission Recommended Precautions Precaution Duration Acquired Immunodeficiency Syndrome (HIV)

Blood & body fluids Standard

Adenovirus infection in infants and young children

Respiratory secretions and infections

Contact and Droplet Duration of illness

Amebiasis (Dysentery) Faeces Standard

Anthrax

− Cutaneous Pus Standard

− Pulmonary Environmental/soil Standard

Antibiotic-associated colitis (see Clostridium difficile)

Arthropod borne Viral Fevers (see Dengue Fever, Yellow Fever, Ross River Virus)

Blood

Standard

Aspergillosis Environmental Standard Botulism (Clostridium botulinum) Food Standard

Bronchiolitis Respiratory Secretions Contact (Paediatrics) Standard (adults)

Duration of illness

Brucellosis (undulant, Malta, Mediterranean fever)

Body fluid Standard

Campylobacter (see Gastroenteritis) Candidiasis, all forms including mucocutaneous

Skin and mucous membrane Standard

Cellulitis

• Uncontrolled drainage Serous ooze Contact Until drainage contained

• Controlled drainage Serous ooze Standard

Chancroid (soft chancre) Pus Standard


http://www.cdc.gov/

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Disease Mode of Transmission Recommended Precautions Precaution Duration Chickenpox (Varicella) Respiratory and direct contact with

lesion. Airborne and Contact if non immune staff. Susceptible HCW’s should not enter room if immune caregivers are available.

Maintain precautions until all lesions are crusted. If immunoglobulin required for susceptible exposed individuals, egg. neonates, discuss with Microbiology or Infectious Diseases staff.

Chlamydia trachomatis

• Conjunctivitis Pus Standard

• Genital Genital Discharge Standard

• Pneumonia (infants < 3 mths of age) Respiratory secretions Standard

Cholera (see Gastroenteritis)

Clostridium

• C. botulinum Foodborne Standard

• C. difficile Faeces Contact – with dedicated toilet/commode. Discontinue antibiotics if appropriate. Ensure consistent environment cleaning and disinfection. Handwashing with liquid soap and water instead of alcohol -based hand rub.

Duration of clinical symptoms + 48 hrs asymptomatic. Note: No further specimens required once asymptomatic

• C. perfringens

Food poisoning Food Standard Gas Gangrene Environment (e.g. soil) Standard

Congenital rubella Respiratory secretions Contact and Droplet Until 1 yr of age Standard precautions if nasopharyngeal and urine cultures repeatedly negative > 3 months of age.

Conjunctivitis Acute bacterial Purulent exudate Standard Chlamydia Purulent exudate Standard Gonococcal Purulent exudate Standard Viral (e.g. adenovirus) Purulent exudate Contact Duration of illness


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Disease Mode of Transmission Recommended Precautions Precaution Duration Coxsackievirus disease - Hand, Foot & Mouth (see Enteroviral infections)

Faeces and respiratory secretions

Creutzfeldt-Jakob disease (see CJD guidelines on IP&C intranet for further information)

CNS or neurological tissue Standard Use disposable instruments or special sterilisation/disinfection for surfaces, objects contaminated with neural tissue if CJD or vCJD suspected.

Duration of illness

Croup Respiratory secretions Presumed by inhalation.

Contact and droplet Duration of clinical illness

Cryptococcosis Standard Cryptosporidiosis (see Gastroenteritis) Cytomegalovirus infection, neonatal or immunosuppressed

Mucosal contact with infectious tissue, secretions (urine) and excretions

Standard

Dengue Fever Blood via bite from infected mosquito.

Standard

Diarrhoea acute - Infective etiology suspected (see Gastroenteritis) Adult with history of recent antibiotic use (see Clostridium difficile)

Diphtheria

• Cutaneous Lesions Contact Until two cultures taken at least 24 hours apart are negative.

• Pharyngeal Respiratory secretions Droplet

Encephalitis or encephalomyelitis (see specific etiologic agents)

Endometritis (see also Group A Streptococcus)

Vaginal Discharge Standard

Enterobiasis (pinworm disease, oxyuriasis) Faecal/oral Standard Enterococcus species (see multidrug-resistant organisms if epidemiologically significant or vancomycin resistant)


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Disease Mode of Transmission Recommended Precautions Precaution Duration Enteroviral infections, i.e. Group A and B Coxsackieviruses and echo viruses. Excludes polio virus)

Adults Faeces Standard Infants and young children (in nappies) Faeces Contact Duration of clinical illness Epiglottitis, due to Haemophilus influenzae, Type B

Respiratory secretions Droplet 24hrs after start of effective treatment

Epstein-Barr virus infection, including infectious mononucleosis (glandular fever)

Respiratory secretions including saliva

Standard

Erythema infectiosum (See Parvovirus B19)

Food poisoning Botulism Clostridium botulinum Food

Food Food

Standard Standard Standard

Clostridium perfringens Staphylococcal Furunculosis – Staphylococcal (adults) Infants and young children

Contact with lesions Contact with lesions

Contact Contact

Duration of illness Duration of illness

Gastroenteritis

• Campylobacter species Faeces Standard - with dedicated toilet/commode Contact Precautions for diapered or incontinent children and adults.

Duration of clinical symptoms.

• Cholera Faeces Standard. Contact Precautions for diapered or incontinent children and adults.


• Clostridium difficile See Clostridium previously listed

• Cryptosporidium species Faeces Standard - with dedicated toilet/commode Contact Precautions for diapered or incontinent children and adults.


• Escherichia coli

Enterohemorrhagic O157:H7 Faeces Standard - with dedicated toilet/commode Contact Precautions for diapered or incontinent children and adults.



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Disease Mode of Transmission Recommended Precautions Precaution Duration

• Giardia lamblia Faeces Standard - with dedicated toilet/commode Contact Precautions for diapered or incontinent children and adults.


• Norovirus (see Norovirus Guidelines on IP&C Intranet for further information)

Faeces/Vomit Contact and Droplet with dedicated toilet/commode

Duration of clinical symptoms and until asymptomatic for at least 48-72 hours. Prolonged shedding may occur in immunocompromised children and the elderly.

• Rotavirus Faeces/Vomit Contact and Droplet with dedicated toilet/commode

Duration of clinical symptoms and until asymptomatic for at least 48 hours. Prolonged shedding may occur in immuno compromised children and the elderly.

• Salmonella species (including S. typhi, S.paratyphi)

Faeces Standard - with dedicated toilet/commode Contact Precautions for diapered or incontinent children and adults.


• Shigella species Faeces Standard - with dedicated toilet/commode Contact Precautions for diapered or incontinent children and adults.


• Vibrio parahaemolyticus Faeces Standard Contact Precautions for diapered or incontinent children and adults.


• Viral (if not covered elsewhere) Faeces Standard - with dedicated toilet/commode Contact Precautions for diapered or incontinent children and adults.


• Yersinia entercolitica Faeces Standard Contact Precautions for diapered or incontinent children and adults.


German measles (see Rubella)

Gonococcal ophthalmia neonatorum (gonorrheal ophthalmia, acute conjunctivitis of newborn)

Mucous membranes & pus Standard

Gonorrhea Mucous membranes/sexual contact Standard


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Disease Mode of Transmission Recommended Precautions Precaution Duration Guillain-Barré syndrome Respiratory secretions/faeces

Not person to person spread Standard

Haemorrhagic fevers (eg. Ebola, Lassa Fever, Marburg)

Blood and body fluid and respiratory secretions.

Contact and Airborne including protective eyewear. Negative air pressure room during infectious period. Notify Infection Prevention and Control for further advice. Notify Medical Officer of Health.

Duration of illness

Hand, foot and mouth disease (see Enteroviral infection)

Hantavirus pulmonary syndrome Rodents/ blood Standard Duration of illness

Helicobacter pylori Faecal/oral Standard Duration of illness

Hepatitis, viral For one week of jaundice. Maintain precautions

− In infants & children <3 yrs of age for duration of hospitalisation.

− In children 3-14yrs, until 2 weeks after onset of symptoms

− In others until one week after onset of symptoms.

• Type A Faeces Standard - with dedicated toilet/commode Diapered or incontinent patients Faeces Contact

• Type B (HBSAG Positive) Blood/body fluids Standard

• Type C and other non-specified (non-A, non-B)

Blood/body fluids Standard

• Type D (co infection with Type B) Blood/body fluids Standard

• Type E – see Type A Faeces Standard - with dedicated toilet/commode

• Type G Standard


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Disease Mode of Transmission Recommended Precautions Precaution Duration Herpes simplex (cold sore) Encephalitis Lesions & mucous membranes Standard Neonatal Exposure Lesion secretions Standard

Contact

For asymptomatic, exposed infants delivered vaginally or by C-section to mother with active infection and membranes which have been ruptured for more than 4 to 6 hours, monitor closely for signs of infection. For symptomatic infants contact precautions until lesions dry.

Mucotaneous, disseminated or primary severe

Lesion secretions Contact Until all lesions crusted

Mucotaneous, recurrent (skin, oral, genital) Lesion secretions Standard Herpes zoster (varicella-zoster/shingles)

• Disseminated (wide spread) usually in immuno compromised patients

Lesion secretions Contact and Airborne Until all lesions crusted. Avoid contact unless immune to chickenpox

• Area cannot be contained by an occlusive dressing

Lesion secretions Contact Until all lesions crusted. Avoid contact unless immune to chickenpox

• Localised in normal patient and area covered by occlusive dressing

Lesion secretions Standard Avoid contact unless immune to chickenpox

HIV (Human immunodeficiency virus) Blood borne virus – direct contact with blood or body substances

Standard

Impetigo Lesions Contact Until 24hrs after effective treatment

Infectious mononucleosis Respiratory secretions and saliva Standard

Influenza (see Influenza Guidelines on IP&C intranet for further information)

Respiratory secretions Droplet 5 days from onset of illness without chemoprophylaxis. Duration of clinical illness in immunocompromised persons

Kawasaki syndrome No known person-to-person spread Standard

Legionnaires' disease Contaminated water from environment, aspirated/inhaled. Not person to person transmission

Standard

Leprosy Long term close contact Standard


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Disease Mode of Transmission Recommended Precautions Precaution Duration Leptospirosis Not person to person transmission Standard Lice (Pediculosis) – head lice pubic lice body lice

Head to head Sexual/intimate contact Clothing

Standard Standard Standard

Person not infectious to close contacts 24 hours after effective treatment

Listeriosis Contaminated foods Standard

Lyme Disease Ticks Standard

Malaria Mosquito Standard Measles (Rubeola, Morbilli) Airborne spread Airborne

4 days after onset of rash. Duration of clinical illness for immune compromised. Avoid contact unless immune.

Meningitis

• Aseptic nonbacterial or viral meningitis (also see enteroviral infections)

Faeces/oral Standard

• Bacterial, gram-negative enteric, in neonates

Standard

• Fungal Inhalation from environmental after aerosolation

Standard

• Haemophilus influenzae, known or suspected

Respiratory secretions Droplet Until 24hrs after initiation of effective treatment See meningococcal disease below

• Listeria monocytogenes Food or faecal/oral Standard

• Neisseria meningitidis (meningococcal) known or suspected

Respiratory secretions Droplet Until 24 hrs after initiation of effective treatment

• M.Tuberculosis Respiratory secretions Standard Patient should be examined for evidence of current (active) pulmonary tuberculosis. If evidence exists, see Tuberculosis

• Other diagnosed bacterial Depends on organism Standard

Meningococcal pneumonia or sepsis (Meningococcemia)

Blood/Respiratory secretions Droplet Until 24hrs after initiation of effective therapy. Post exposure chemoprophylaxis may be required for HCWs. Contact the Infection Prevention and Control Service.


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Disease Mode of Transmission Recommended Precautions Precaution Duration Molluscum contagiosum

Close contact/lesions Standard

Multidrug-resistant organisms, infection or colonisation (e.g. MRSA, VRE, VISA/VRSA, ESBL’s, resistant S. pneumoniae

As per site identified. Multi site colonisation cannot be excluded

Contact On advice from IP&C team/Infectious Diseases

Mumps (infectious parotitis) Saliva Droplet For 9 days after onset of swelling. Avoid contact unless immune.

Mycobacteria, nontuberculosis (atypical) Not person to person transmission Pulmonary Respiratory secretions Standard Wound Drainage Standard

Mycoplasma pneumonia

Respiratory secretions Droplet and contact Duration of illness

Necrotizing enterocolitis Faeces Standard Contact Precautions when cases temporarily clustered. Norovirus gastroenteritis (see Gastroenteritis)

Parainfluenza virus infection, respiratory in infants and young children

Respiratory secretions Contact Duration of illness Viral shedding may be prolonged in immunosuppressed patients.

Parvovirus B19 (erythema infectiosum) Respiratory secretions Droplet Pregnant staff should avoid caring for these patients.

Maintain precautions for duration of hospitalisation when chronic disease occurs in an immunocompromised patient. For patients with transient aplastic crisis or red cell crisis, maintain precautions for 7 days

Pertussis (whooping cough)

Respiratory secretions Droplet Until 5 days after effective treatment

Pharyngitis Respiratory secretions Contact and Droplet until aetiology known

Until aetiology known

Pinworm infection (See Enterobiosis)

Plague

• Bubonic Pus Standard

• Pneumonic Respiratory infections Droplet Until 48 hours after initiation of effective treatment


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Disease Mode of Transmission Recommended Precautions Precaution Duration Pneumonia

• Adenovirus Respiratory secretions Droplet and Contact Duration of illness

• Bacterial not listed elsewhere (including gram negative bacteria)

Respiratory secretions Standard

• Burkholderia cepacia in cystic fibrosis (CF) pts including respiratory tract colonisation

Respiratory secretions Contact Avoid exposure to other CF patient. Persons with CF who visit or provide care and are not infected or colonised with B. cepacia may elect to wear a mask when within a metre of a colonised or infected patient.

• Chlamydia Respiratory secretions Standard

• Fungal Respiratory secretions Standard

• Haemophilus influenzae Type B Adults Infants & children any age

Respiratory secretions Respiratory secretions

Standard Droplet

Until 24hrs after initiation of effective therapy.

• Legionella (See Legionnaires’ Disease)

• Meningococcal Respiratory secretions Droplet Until 24hrs after initiation of effective therapy.

• Multi-drug resistant bacteria (see Multidrug resistant organism)

• Mycoplasma (primary atypical pneumonia)

Respiratory secretions Droplet and Contact Duration of illness

• Pneumococcal pneumonia Standard

• Pneumocystis carinii Respiratory secretions Standard Do not place in room with immunocompromised patient.

• Staphylococcus aureus Respiratory secretions Standard


Canterbury DHB



• Streptococcus, Group A Adults Infants & young children

Respiratory secretions Respiratory secretions

Droplet Droplet

24 hours after start of effective therapy

• Viral Respiratory secretions Standard

Poliomyelitis Faeces Contact Duration of illness Psittacosis (ornithosis) Zoonoses

Not transmitted person to person Standard

Rabies Respiratory secretions Standard

Respiratory syncytial virus infection Respiratory secretions

• Adult Standard/Risk Assessment Discuss with Infection Prevention and Control Service.

• Child or imunocompromised adults Contact Duration of clinical symptoms.

Rheumatic fever (Group A Streptococcal) Not person-to-person transmission Standard

Rhinovirus Respiratory secretions Standard Respiratory hygiene and cough etiquette encouraged.

Ringworm (dermatophytosis, dermatomycosis, tinea)

Lesions

Standard

Roseola infantum (exanthem subitum)

Oral secretions

Standard

Rotavirus infection (see Gastroenteritis) Rubella (German measles; also see congenital rubella)

Respiratory secretions

Droplet Non immune staff should avoid caring for these patients.

Until 7 days after onset of rash. Susceptible case who has known exposure - precautions for 7 days or until rash appears then 7 days after onset of rash.

Rubeola (see measles) Salmonellosis (see Gastroenteritis)

Scabies Skin contact Contact Until 24hrs after initiation of effective therapy. Scalded skin syndrome staphylococcal (Ritters disease)

Lesion drainage

Contact

Duration of clinical symptoms

Schistosomiasis (bilharziasis)

Environmental (water)

Standard


Canterbury DHB


Disease Mode of Transmission Recommended Precautions Precaution Duration Severe Acute Respiratory Syndrome (SARS) Probable or confirmed case

Respiratory Secretions Faecal /Oral Blood/Body Fluids Environmental

Airborne and Contact including protective eyewear

Duration of illness plus 10 days after resolution of fever, provided respiratory symptoms are absent or improving (and discuss with Infectious Diseases Physician).

Shigellosis (see Gastroenteritis) Shingles (see Herpes Zoster) Staphylococcal disease (S.aureus)

• Skin, wound or burn

Major (No dressing or dressing does not contain drainage adequately)

Pus/exudate Contact Until drainage contained

Minor (dressing covers and contains drainage adequately)

Pus/exudate Standard

• Entercolitis Faeces Standard Contact Precautions for diapered or incontinent children for duration of illness

• Multi-drug resistant Pus/exudate Contact Duration of illness but reassess risk as required Discuss with Infection Prevention and Control.

• Pneumonia Respiratory secretions Standard

• Scalded Skin Syndrome (not MRSA) Lesion, drainage Contact Duration of illness

• Toxic Shock Syndrome (not MRSA) Vaginal discharge or pus Standard Duration of illness

Streptococcal disease (Group A Streptococcus)

N.B. Ensure disinfection of articles likely to have been contaminated by lesions/secretions

• Skin, wound or burn


Pus/exudate Contact Until 24 hours after initiation of effective therapy and drainage contained



• Endometritis (puerperal sepsis) Vaginal discharge Standard

• Pharyngitis in infants, young children Respiratory secretions Droplet Until 24 hours after initiation of effective therapy

• Pneumonia Respiratory secretions Droplet Until 24 hours after initiation of effective therapy


Canterbury DHB



• Scarlet fever in infants, young children Respiratory secretions Droplet Until 24 hours after initiation of effective therapy

• Serious invasive disease Droplet Plus Contact if draining wound

Until 24 hours after initiation of effective therapy

Streptococcal disease (not group A or B) unless covered elsewhere

Lesions/secretions Standard

Syphilis Skin and mucous membrane, including congenital, primary, secondary

Lesion secretions and blood Standard

Latent (tertiary) and seropositivity without lesions

Blood Standard

Tapeworm Disease Hymenolepis nana Ingestion of parasite from

undercooked meat Standard

Taenia solium (pork) Standard Other Standard

Tetanus Environmental via skin injury Standard Tinea (fungus infection dermatophytosis, dermatomycosis, ringworm)

Direct skin-to-skin contact or indirect contact from infected fomites from people or animals.

Standard

Toxoplasmosis

Cat faeces, undercooked meat Standard. No restrictions for pregnant staff.

Toxic Shock syndrome (see Staphylococcal disease, Streptococcal disease)

Standard If Group A streptococcus likely then Droplet Precautions Until 24 hours after initiation of effective therapy.

Trachoma (acute) Purulent exudate Standard

Tuberculosis (refer also to Care of Patients with Pulmonary Tuberculosis, CDHB Policies, Volume 10, IP&C)

Extra pulmonary, draining lesion (including scrofula)

Pus/Exudate Standard Contact for wound care Airborne for wound care that may involve aerosol, e.g. irrigation.

Discontinue precautions when drainage has ceased.

Extra pulmonary and meningitis Drainage from infected area Standard

Patients should be examined for evidence of current (Active) pulmonary TB.


http://www.cdhb.health.nz/Hospitals-Services/Health-Professionals/CDHB-Policies/documents/4814-Volume-10-Care-of-Patients-with-Pulmonary-Tuberculosis.pdf



Canterbury DHB


Disease Mode of Transmission Recommended Precautions Precaution Duration Pulmonary or laryngeal disease confirmed Airborne, Droplet nuclei Airborne Until all of the following has been met:

The patient has had a minimum of 2 weeks effective chemotherapy

The patient has stopped coughing Patient is infected with a fully sensitive strain of

Mycobacterium tuberculosis The patient is responding well to treatment At least 2 of the patient’s sputum specimens are

smear-negative or the patient remains smear-positive but is culture negative.

Pulmonary or laryngeal disease suspected Airborne, Droplet nuclei Airborne When likelihood of infectious TB disease deemed

negligible and either: 1. There is another diagnosis that explains the clinical

syndrome OR 2. The results of two consecutive sputum specs are smear

negative on separate days. (at least one of these should be an early morning specimen)

Typhoid (Salmonella typhi) (see Gastroenteritis)

Varicella (see Chickenpox)

Vibrio parahaemolyticus (see Gastroenteritis)

Whooping cough (see Pertussis) Wound/Skin Infection/Abscess/Decubitus Ulcer


Pus/exudate Contact Until drainage contained.



Yersinia enterocolitica gastroenteritis (see Gastroenteritis)


Canterbury DHB


References

Heymann D: Control of Communicable Disease Manual, 18th Edition, 2004.

Ministry of Health Tuberculosis Control in New Zealand http://www.moh.govt.nz/cd/tbcontrol

Siegel, J.D., Rhinehart, E., Jackson, M., Chiarello, L. and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007 http://www.cdc.gov/ncidod/dhqp/gl_isolation.html

Policy Owner CDHB Infection Prevention & Control Service

Date of Authorisation 11 June 2012


http://www.moh.govt.nz/cd/tbcontrol

Canterbury DHB


1.5 Notifiable Diseases in New Zealand (includes suspected cases)*

Policy All diseases identified in this document must be notified to the Medical Officer of Health. This includes suspected cases.

Scope All Canterbury DHB staff

Notifiable Infectious Diseases under the Health Act 1956 Section A – Infectious Diseases Notifiable to Medical Officer of Health and Local Authority Acute gastroenteritis** Cholera Giardiasis Legionellosis Meningoencephalitis – primary amoebic Shigellosis Yersiniosis

Campylobacteriosis Cryptosporidosis Hepatitis A Listeriosis Salmonellosis Typhoid and paratyphoid fever

Section B – Infectious Diseases Notifiable to Medical Officer of Health Acquired Immunodeficiency Syndrome (AIDS) Arboviral diseases Creutzfeldt-Jakob Disease and other Spongiform encephalopathies Enterobacter sakazakii invasive disease Hepatitis B Hepatitis (viral) – not otherwise specified Hydatid disease Leptospirosis Measles Neisseria meningitidis invasive disease Plague Rabies Rickettsial diseases Severe Acute Respiratory Syndrome (SARS) Viral haemorrhagic fevers

Anthrax Brucellosis Diphtheria Haemophilus Influenzae b Hepatitis C Highly pathogenic Avian Influenza (HPAI) Invasive pneumococcal Disease Leprosy Malaria Mumps Non-seasonal influenza (capable of being transmitted between human beings) Pertussis Poliomyelitis Rheumatic Fever Rubella Tetanus Yellow Fever

Notifiable to Medical Officer of Health Cysticercosis Taeniasis Trichinosis Decompression sickness Lead absorption equal to or in excess of 10mcg/dl (0.48mcmol/L)*** Poisoning arising from chemical contamination of the environment

Notifiable Diseases under the Tuberculosis Act 1948 Notifiable to the Medical Officer of Health Tuberculosis (all forms)

* During times of increased incidence, practitioners may be requested to report, with informed consent, to their local Medical Officer of Health of cases of other communicable diseases not on this list.


Canterbury DHB


** Not every case of acute gastroenteritis is necessarily notifiable – only those where there is a suspected

common source or from a person in a high risk category (e.g. food handler, child care work, etc.) or single cases of chemical, bacterial, or toxic food poisoning such as botulism, toxic shellfish poisoning (any type) and disease caused by verocytotoxic E.coli.

*** Blood lead levels to be reported to the Medical Officer of Health, i.e. 10mcg/dl (0.48mcmol/L) are for environmental exposure. Where occupational exposure is suspected, please notify OSH through the NODS network.

References Ministry of Health, Schedule of Notifiable Diseases, 2009. Accessed 23rd July 2012

http://www.health.govt.nz/our-work/diseases-and-conditions/notifiable-diseases


http://www.health.govt.nz/our-work/diseases-and-conditions/notifiable-diseases

Canterbury DHB


1.5.1 Notifiable Disease Fax Form


4812-volume-10-transmission-based-precautions-isolation-guidelines.pdf

Documents

contact precautions

airborne precautions

categories of precautions

standard precautions

following precautions

categories of transmission

route of transmission

duration of transmission