University of Pennsylvania Medical Center Guidelines for Antibiotic Use

GUIDELINES FOR INFECTION CONTROL ISOLATION SYSTEMS

I. STANDARD PRECAUTIONS (formerly known as Universal Precautions)

Standard Precautions are designed to reduce the risk of transmission of microorganisms from recognized and unrecognized sources of infection.

Use Standard Precautions for care of ALL patients, regardless of their diagnosis.

1Standard Precautions applies to:

Blood

All body fluids, secretions, and excretions except sweat regardless of whether they contain visible blood

Non-intact skin

Mucous membranes

Gloves will be worn whenever contact with these fluids is anticipated. Gloves will be changed between patients, between tasks, or when torn.

Hand washing between patients and after contact with blood/body fluids is essential. Wash hands after removing gloves.

If aerosolization or splattering of blood/body fluids is likely, additional barriers must be worn (gowns, splash shields, goggles, masks).

II. AIRBORNE PRECAUTIONS

To reduce the risk of airborne transmission of infectious agents.

Use Airborne Precautions for patients known or suspected to have infections transmitted by droplet nuclei (particles 5 microns or smaller in size).

2Illnesses include:

Tuberculosis

Measles

Varicella (chickenpox), including disseminated Zoster

Patients must be placed in a room with negative air pressure ventilation to prevent transmission of droplet nuclei. Without negative pressure ventilation, infectious droplet nuclei can remain suspended in air for long periods of time.

Doors and windows in negative pressure isolation rooms must be kept closed at all times.

Hospital personnel and visitors entering an Airborne isolation room must wear the N95 TB respirator.

For patients isolated with chickenpox or measles - persons immune to chickenpox/measles may enter an Airborne isolation room without a mask.

Patients in Airborne isolation must remain in their room. Patients should leave their room only for essential studies. Patients must wear a paper surgical mask when leaving their room.

1Please refer to Appendix A in the Infection Control Manual for a complete listing of infections and conditions pertaining to Standard Precautions (S).

2Please refer to Appendix A in the Infection Control Manual for a complete listing of infections and conditions pertaining to Airborne Precautions (A).

GUIDELINES FOR INFECTION CONTROL

INFECTION CONTROL ISOLATION SYSTEM

III. DROPLET PRECAUTIONS

To reduce the risk of droplet transmission of infectious agents.

Involves contact of the conjunctivae, or mucous membranes of the nose or mouth of a susceptible person with large droplets (greater than 5 microns in size) containing microorganisms from a person who has clinical disease or is a carrier of the microorganism.

1Illnesses include:

Diphtheria

Influenza

Rubella

Pertussis

Mumps

Invasive N. meningitidis disease

Invasive H. influenzae disease, etc..

Droplets are generated during sneezing, coughing, talking, and during certain procedures such as suctioning or bronchoscopy.

Close contact (usually 3 feet or less) to the infectious person is required for transmission of the disease. Large droplets travel only short distances and do not remain suspended in the air.

Hospital personnel and visitors entering a Droplet isolation room must wear a paper surgical mask.

IV. CONTACT PRECAUTIONS

To reduce the transmission of epidemiologically important infectious agents spread by direct or indirect contact.

Direct Contact - skin to skin contact, the physical transfer of microorganisms.

Indirect Contact - contact with a contaminated intermediate object from the patient's environment.

2Contact precautions apply to patients who are actively infected or colonized with epidemiologically important organisms, including :

Multi-Drug Resistant Bacteria (MRSA, VRE, etc.)

Enteric infections with a low infective dose or prolonged survival in the environment (C. difficile, etc.)

Skin infections that are highly contagious (scabies, major abscesses, impetigo, Herpes Simplex, Zoster, etc.)

Hospital personnel and visitors entering a contact isolation room must wear gloves and gowns.

Disinfection of non-disposable, reusable patient equipment must be performed before leaving the contact isolation room and before reuse with another patient. When possible, dedicate equipment to the contact isolation room.

HAND WASHING

Hand washing is the single most important step you can perform to reduce the transmission of infectious agents from person to person or from one site to another.

Wearing gloves does not replace the need to wash your hands!!!

1Please refer to Appendix A in the Infection Control Manual for a complete listing of infections and conditions pertaining to Droplet Precautions (D).

2Please refer to Appendix A in the Infection Control Manual for a complete listing of infections and conditions pertaining to Contact Precautions (C).

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