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Isolation precautions in hospitals covid19

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Dr. Satti M. Saleh
Infectious Diseases Director
Deputy medical director
CBAHI SIT Member
Meeqat General Hospital Complex
Madina .KSA

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Isolation precautions in hospitals covid19

  1. 1. Dr. Satti M. Saleh Infectious Diseases Director Deputy medical director CBAHI SIT Member Meeqat General Hospital Complex Madina .KSA
  2. 2. ISOLATION PRECAUTIONS IN HOSPITAL Rationale for precautions Infection Transmission Requires : Organism Source Mode of Transmission Host
  3. 3. SOURCE Patient , personnel , visitors . Acute cases in incubation . Colonized Patients . Endogenous Flora . Inanimate Environment ( contaminated ) eg; water , food , equipment .
  4. 4. ISOLATION PRECAUTIONS IN HOSPITALs HOST Age Underlying disease Treatment : 1 -Antimicrobial. 2 – Corticosteroids. 3 – Immunosuppressive agents. Weak in first line of defense mechanisms eg; Surgical operations . Anesthesia . Catheters .
  5. 5. ISOLATION PRECAUTIONS IN HOSPITALS Transmission Its main routes :  Contact a -Direct contacts. b - Indirect contacts. c - Droplet transmission ( 3 feet ).  Common vehicle transmission Water equipment devices.  Airborne transmission. Airborne droplet nuclei ( 5 micrometers or small ) Evaporated droplets or dust particles eg TB , Measles , chickenpox.  Vector borne.
  6. 6. ISOLATION PRECAUTIONS IN HOSPITALS  Interruption of transmission of micro-organisms is directed primarily at transmission. Disadvantages of isolation.  Special equipment, environmental modification , more cost.  Patient care may be affected.  Deprives patient of normal social relationship.  Disadvantages to be weighed against prevention values . Early isolation practices .
  7. 7. ISOLATION PRECAUTIONS IN HOSPITALS  1877 Separate facilities.  1910 Cubical system, separate gown , wash hands, disinfect objects.  1950 Infectious disease hospital begin to close.  1960 T.B Hospitals decreased.  1970 CDC Isolation manual.  1983 CDC Guidelines. 1 - Category specific isolation. Disease specific isolation. Use guidelines to develop a system . 2- Encourage personnel to make decision on what precautions to be taken. 3 – Encourage personnel to make decision about the likelihood of exposure to reduce costs.
  8. 8. ISOLATION PRECAUTIONS IN HOSPITALS CATEGORY SPCIFIC ISOLATION  Strict isolation  Contact isolation.  Respiratory isolation  T.B isolation.  Enteric precaution  Drainage , secretion precautions.  Blood & body fluid precautions.  Protective isolation. DISEASE SPECIFIC ISOLATION
  9. 9. ISOLATION PRECAUTIONS IN HOSPITALS  Consider epidemiology of each infectious disease. Highly educated. To be updated.  Universal precautions ( 1985 ) :  Applying blood & body fluid precautions universally to all people.  Prevention of needle stick injuries.  Traditional barriers e.g gloves .  Eye coverings in certain procedures . Amniotic ,CSF, semen, & vaginal secretions.  Not to feces, nasal secretions, sputum, sweat, &tears.
  10. 10. ISOLATION PRECAUTIONS IN HOSPITALS  Body substance isolation ( 1987 ):  Isolation of all moist &potentially infectious body substances ( blood, urine, feces, sputum, saliva, wound drainage, other body fluids regardless of their presumed infection status ).  Stop sign alert (( airborne )). DISADVANTAGES :  Added costs.  Overprotection of personnel.  Difficulty in maintaining routine application.  Lack of hands washing after gloves removal.  Droplet infection.
  11. 11. ISOLATION PRECAUTIONS IN HOSPITALS New Isolation Guidelines ( 1990 ) :  Problem of multi-drug resistance T.B.  Multi-drug resistant of micro organisms.  New guidelines should : 1- Be epidemiologically sound . 2- Recognize importance of all body secretions. 3- Adequate precautions of airborne, droplets contact routes. 4- Simple. 5- Use new terms to avoid confusions. 6- In expensive
  12. 12. New Isolation Precautions, 1996 ‘’ Standard’’ And ‘’ Transmission – Based Precautions’’
  13. 13. STANDARD PRECAUTIONS  Consider all patients and their bodily fluids (except sweat) to be potentially infectious  Use appropriate barrier precautions when there is a risk of exposure to blood, body fluids, secretions, excretions, mucous membranes and non-intact skin.  Patients with known or suspected infections are NOT to have their medical records labeled as “infectious”.  Specimens of patients with known or suspected infections are NOT to be labeled as “infectious”. All specimens are to be treated in the same safe manner .  Used needles and sharps should be disposed of safely ( in puncture proof sharp boxes ) .  Needles should NOT be recapped .  All Health care workers should receive the HBV vaccine .
  14. 14. Transmission-Based Precautions . Three categories of Transmission-based Precautions : - Contact Precautions . - Droplet Precautions . - Airborne Precautions .
  15. 15. Contact transmission  Examples of organisms spread by contact:  Multi-drug-resistant organisms in the gastrointestinal tract, sputum, or wounds (MRSA, MDR Gram –ve, VRE).  Clostridium difficile.  Herpes simplex virus (mucocutaneous).  Scabies.
  16. 16. Contact precautions . Wash hands with antimicrobial soap before leaving the patient's room . . Minimize risk or environmental contamination during patient transport (e.g. patient can be placed in a gown ). . Patient’s care devices ( e.g. thermometer , BP cuffs , stethoscopes ) should be dedicated to use for a single patient if possible , otherwise, they should be rigorously cleansed and disinfected before use for other patients .
  17. 17. Contact precautions . Private room preferred; cohorting allowed if necessary . . The door of the room may remain open . . Gloves : - upon entering room . - change gloves after contact with contaminated secretions . - should be removed before leaving the room . . Gown: - if clothing may come into contact with the patient or environmental surfaces . - should be removed before leaving the room .
  18. 18. DROPLET TRANSMISSION  Respiratory droplets are large particles (>5 micron) expelled during . - Coughing . - Sneezing . - Talking. - During procedures such as suctioning and bronchoscope .  Droplets travel < 1,5 meter from the source patient .  Example : • Neisseria meningitides . • Haemophilus influenza type b ( invasive ) . • Streptococcus pyogenes (group A Streptococcus) . • Mycoplasma pneumonia .
  19. 19. DROPLET PRECAUTIONS  Private room preferred; cohorting allowed if necessary.  Special air handling and ventilation are unnecessary .  The door of the room may remain open .  Wear a mask when within 1 meter of the patient .  Mask the patient during transport .
  20. 20. AIRBORNE TRANSMISSION  Airborne spreads upon aerosolization of small particles (=< 5 micron) of the infectious agent that can then travel over long distances through the air .  Most common nosocomial pathogens transmitted by this route : - Mycobacterium tuberculosis . - Varicella-zoster virus (chickenpox) . - Measles . - Smallpox. - ? SARS .
  21. 21. AIRBORNE PRECAUTIONS  Place the patient in a negative pressure room with at least 6 – 12 air exchanges per hour .  Room exhaust must be appropriately discharged outdoors or passed through a HEPA ( high – efficiency particulate aerator ) filter before recirculation within the hospital .  The door of the room should be kept closed .
  22. 22. Hand Hygiene . Hand hygiene is the single most important practice to reduce the transmission or infectious agents in healthcare settings . . The term “Hand hygiene” includes :  -Hand washing with either plain or antiseptic containing soap and water . - Use or alcohol-based products ( gals, rinses, foams) containing an emollient that do not require the use of water.
  23. 23. RATIONALE TRANSIENT FLORA (Contaminating or non – colonizing)  Attached to the superficial layer of skin.  Microbes isolated from skin not consistently present in hajority of persons associated with HCAI . RESIDENT FLORA  Attached to deeper layer of the skin persistently isolated from skin of most persons (cons, diptheriods )
  24. 24. TRANSMISSIONRequires 1) Pt’s Hands of health care workers . 2) Survive for several minutes . 3) Non or Inadequate hand hygiene . 4) Contaminated Hands Pt’s
  25. 25. TYPE OF HAND HYGIENE 1) Intensity of contact . 2) Degree of contamination . 3) Susceptibility of patient to infection . 4) Prove dure to be performed .
  26. 26. HAND WASHING Health care infection control practices advisory committee (HICPAC) former recommendations  Plain soap and water was recommended for routine hand washing.  Antimicrobial soaps (e.g. : chlorhexidine) was recommended for : - Patients under contact precautions . - During instances of epidemic or hyperendemic spread of infections.
  27. 27. HAND HYGIENE  In the absence of visible soiling of hands, approved alcohol-based products for hand disinfection are preferred over hand washing with water and antimicrobial or plain soap because of their superior microbiocidal activity, reduced drying of the skin, and convenience.
  28. 28. When to wash hands  Before and immediately after patient contact (examination, feeding, bathing, carrying out aseptic and/or invasive procedures… etc ).  Between different procedures on the same patient .  After contact with mucous membranes, blood and body fluids, secretions and excretions.  After removing gloves.  After touching objects or surfaces contaminated with blood or body fluids.  Before preparing or serving food.
  29. 29. GOWNS AND OTHER PROTECTIVE APPAREL (eg-aprons)  Indications .  If contact with blood and body fluid is likely .  For patients under contact precautions .
  30. 30. HAND WASHING STUDY IN RIYADH MEDICAL COMPLEX- GENERAL HOSPITAL  Overall frequency of hand washing .  23.7% after patient contact .  6.7% before patient contact .
  31. 31. HAND WASHING STUDY IN RIYADH MEDICAL COMPLEX-GENERAL HOSPITAL Frequency of hand washing by profess ion .  Medical students : 70,0%  Interns : 69,2%  Nurses : 18,8%  Residents : 12.5%  Consultants : 9,1%
  32. 32. HAND WASHING STUDY IN RIYADH MEDICAL COMPLEX- GENERAL HOSPITAL  Frequency of wearing gloves (when indicated) : 75,5%  Frequency of hand washing after removing gloves : 48.8%
  33. 33. Precautions Needed for Cases  Condition Type Duration  Pulmonary TB S+A Till sputum Negative  Chicken Pox S+A Till rash crusted  M-meningitis S+D 24 Hrs  HIV S Duration of stay Clinical Syndromes: Empiric precautions as per clinical presentation
  34. 34. THANK YOU Dr. Satti Mohammed
  • AlaaNagy6

    May. 30, 2021
  • RabieAlhabeeb

    Jul. 7, 2020
  • IdrisAlnoor1

    Mar. 23, 2020

Dr. Satti M. Saleh Infectious Diseases Director Deputy medical director CBAHI SIT Member Meeqat General Hospital Complex Madina .KSA

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