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TG273 IC excerpts - IAFF Main

EXCERPT FROM: USACHPPM TECHNICAL GUIDE 273 1 2 STANDARD PRECAUTIONS AND ISOLATION PROCEDURES 3 4 5 To aid in the fight against nosocomial transmission of infectious agents, a combination of 6 standard precautions and isolation procedures has been established. The following is a 7 summarization of the basic guidelines advocated by the CDC as an effective strategy to reduce 8 the incidence of nosocomial infections in health care settings. A basic premise of these 9 guidelines is that all patients, regardless of their diagnosis, are to be treated so as to minimize the 10 transmission of microorganisms from patient to health care worker (HCW), HCW to patient, and 11 patient to HCW to another patient. These guidelines describe the use of a two-tiered approach: 12 1) Standard precautions must be used when caring for all patients.

1 2 Indications for Standard and Isolation Precautions Precaution category Condition Standard All patients Airborne Pulmonary or laryngeal …

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Transcription of TG273 IC excerpts - IAFF Main

1 EXCERPT FROM: USACHPPM TECHNICAL GUIDE 273 1 2 STANDARD PRECAUTIONS AND ISOLATION PROCEDURES 3 4 5 To aid in the fight against nosocomial transmission of infectious agents, a combination of 6 standard precautions and isolation procedures has been established. The following is a 7 summarization of the basic guidelines advocated by the CDC as an effective strategy to reduce 8 the incidence of nosocomial infections in health care settings. A basic premise of these 9 guidelines is that all patients, regardless of their diagnosis, are to be treated so as to minimize the 10 transmission of microorganisms from patient to health care worker (HCW), HCW to patient, and 11 patient to HCW to another patient. These guidelines describe the use of a two-tiered approach: 12 1) Standard precautions must be used when caring for all patients.

2 Standard precautions 13 entail a list of basic hygiene procedures that are designed to prevent contact with moist body 14 surfaces and thereby reduce the risk of transmission of bloodborne pathogens. 15 2) When caring for patients with highly transmissible or epidemiologically important 16 pathogens or with poor hygiene, extra barrier or isolation precautions may be necessary. 17 These precautions will help in interrupting contact, droplet, or airborne transmission of these 18 pathogens. There may be instances when more than one extra barrier precaution will need 19 to be implemented. 20 21 Standard Precautions 22 These precautions apply when contact is possible with ruptured skin or mucous membranes, 23 blood, all body fluids, secretions, or excretions except sweat.

3 Hand hygiene among HCWs is the 24 most effective means of preventing nosocomially transmitted infections. Hand hygiene consists 25 of washing hands when soiled or disinfecting hands when possibly contaminated, irrespective of 26 whether gloves were worn. These actions should take place immediately after gloves are 27 removed, before and between patient contacts, and any time secretions, excretions, blood, or 28 body fluids or contaminated items or equipment are handled. Gloves should be worn if touching 29 mucous membranes, broken skin, contaminated objects, blood, body fluids, secretions, or 30 excretions. These gloves must be changed between patients and before touching clean sites on 31 the same patient. During procedures that are likely to result in splashing of blood, body fluids, 32 secretions or excretions, the HCW should wear a mask, eye protection and a gown to protect 33 mucous membranes, skin and clothing.

4 All visitors, patients and HCWs must not be exposed to 34 contaminated materials or equipment. This means that all reusable equipment must be cleaned 35 and sterilized before reuse. Soiled linen should be transported in a double bag. HCWs must be 36 careful when handling sharp instruments such as needles. This will minimize the risk of 37 bloodborne contamination. Never recap needles. If recapping is unavoidable, use a mechanical 38 device or the one-handed technique. HCWs must ensure that puncture-resistant containers are 39 designated and used for all used sharps instruments. Patient and treatment rooms, cubicles, and 40 bedside equipment should be appropriately cleaned. The hot water and detergents in hospitals 41 are sufficient to decontaminate food service materials therefore no special precautions are 42 needed.

5 43 44 The tables below list examples of conditions necessitating isolation precautions and summarize 45 the measures to be taken for the different isolation precautions. 46 1 2 Indications for Standard and Isolation Precautions Precaution category Condition Standard All patients Airborne Pulmonary or laryngeal (suspected) tuberculosis, measles, varicella; disseminated zoster Contact Hemorrhagic fever such as Ebola, Lassa, and Marburg, (risk for) colonization or infection with multiresistant bacteria, Clostridium difficile infection, acute diarrhea in incontinent patient, RSV infection, croup or bronchiolitis in young infants, skin infections like impetigo , major abcess, cellulites or decbiti, staphylococcal furonculosis, pediculosis, scabies or cutaneous infections with Corynebacterium diphtheriae, Herpes simplex virus, zoster Droplet Meningitis, (suspected) invasive infection with Haemophilus influenzae type B or Neisseria meningitides, diphtheria, M.

6 Pneumoniae, pertussis, influenza, adenovirus, mumps, Parvovirus B19, rubella, streptococcal pharyngitis, pneumonia, scarlet fever in young children 3 Summary of Transmission-based Precautions Precaution Contact Droplet Airborne Patient room Private Private Private with specific ventilation requirements Gloves Before entering room Standard precautions Hand hygiene Standard precautions, with hand antisepsis Gown If direct contact with patient or environment Standard precautions Masks Standard precautions Within 1 meter of patient Before entering room special requirements Other Limit patient transport 4 Excerpted from: Wenzel, Richard P., Timothy F. Brewer and Jean-Paul Butzler, (editors).

7 5 A Guide to Infection Control in the Hospital, 3rd Edition. International Society for Infectious 6 Diseases. Boston, Massachusetts. 2004. pp. 38-42. 7 8 RESISTANT BACTERIA / IN-THEATER NOSOCOMIAL INFECTIONS 1 2 Increasing bacteria resistance is noted throughout the world. Multi-drug resistant bacteria 3 (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae) have been 4 recognized among casualties returning from OIF/OEF. Although resistance is often associated 5 with nosocomial infections, the recognition of bacteria from the community with innate resistance 6 is increasingly being reported. Community-acquired methicillin resistant Staphylococcus aureus 7 (CA-MRSA) is a well known example. 8 9 CA-MRSA 10 Colonizes approximately 3% of healthy soldiers.

8 11 Often carries a gene that is associated with more aggressive and invasive infections. 12 Rarely recognized in cultures of battlefield wounds near the time of injury. 13 Typically remains susceptible to trimethoprim-sulfamethoxazole, clindamycin, tetracycline, 14 rifampin, and fluoroquinolones. 15 Prevention 16 Routine personal hygiene. 17 Consider as the infectious etiology if skin and soft tissue infections do not respond to 18 traditional therapy (cefazolin, cephalothin, nafcillin, dicloxacillin, 19 amoxicillin/clavulanate). 20 If infection likely, recommend therapy with trimethoprim-sulfamethoxazole or clindamycin. 21 Consider decontamination 22 Nasal mupirocin ointment (2%) BID for 5-7 days. 23 Chlorhexidine-based soap shower for 5-7 days.

9 24 25 Multi-drug resistant bacteria 26 Recognized among casualties injured in OIF/OEF. 27 Etiology unknown but includes 28 Skin colonization - colonization with these bacteria has been described but resistance to 29 multi-drugs is not usually present. 30 Inoculation at the time of injury - possible colonization of wound occurs at the time of the 31 injury but preliminary work from wound cultures and evaluation of infections upon 32 return to CONUS medical facilities implies this less likely. 33 Horizontal transmission - increasing data supports this as the likely source of infection. 34 Prevention 35 Minimize empiric broad spectrum antibiotics (such as carbapenems) in the empiric 36 therapy of battlefield wounds or other infections that occur in theater.

10 37 Infection Control 38 Minimal interventions include frequent hand washing, frequent use of alcohol hand 39 gel, and/or wearing surgical gloves with changing them between patients. 40 Equipment that comes into direct contact with a patient should be cleaned between 41 patients. 42 Consider cohorting those patients undergoing long-term in-hospital care. 43 44 In-theater nosocomial infections 45 Personnel receiving prolonged medical care in echelon III MTFs are at risk of developing 46 nosocomial infections. A nosocomial infection is defined as a new infectious syndrome, such as 47 pneumonia, bacteremia, or urinary tract infection, after 72 hours of hospitalization. These 48 infections often involve multi-drug resistant bacteria (Acinetobacter baumannii, Pseudomonas 49 aeruginosa, Klebsiella pneumoniae, MRSA).


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