Patients with various conditions are placed into isolation to minimize the risk of transmission to other patients and healthcare workers. A full listing of isolation precautions can be found at the Healthcare Epidemiology Website (http://intranet.nebraskamed.com/nursing/healthcare_epidemiology_index.cfm). These recommendations are based on guidelines from the Centers for Disease Control and Prevention (CDC) (www .cdc.gov/ncidod/hip/ISOLAT/isolat.htm).

There are four major classifications of isolation precautions:

Standard Precautions

All patients should be cared for using standard precautions. All patients should be considered to potentially harbor a bloodborne pathogen. Standard precautions require adherence to hand hygiene recommendations (at a minimum, hand hygiene upon entering and leaving the patient room) and use of barrier precautions (gown, gloves, eye-protection, etc.) for contact with blood or body fluids.

Contact Precautions

Contact precautions are utilized in the care of patients infected or colonized with epidemiologically important microorganisms that can be transmitted via direct contact or indirect contact with environmental surfaces and vectors. The most common bacteria requiring contact isolation are MRSA, VRE, and C. difficile. Precautions include:

· Private room (cohorting is considered at times of limited bed availability, consult the Department of Healthcare Epidemiology)

· Strict adherence to hand hygiene

· Gloves

· Gowns if contact is anticipated between the healthcare worker’s clothing and the patient or patient-care environment

· Masks/eye protection if patient has respiratory infection and is coughing/being suctioned or has wound irrigation

· Dedicated patient care equipment (stethoscope, scale, etc.)

Droplet Precautions

Droplet precautions are used for a patient known or suspected to be infected with a pathogen transmitted by respiratory droplets. The most common organisms requiring use of droplet precautions are meningococcus, influenza, and pertussis. Precautions include:

· Private room (cohorting is considered at times of limited bed availability, consult the Department of Healthcare Epidemiology)

· Strict adherence to hand hygiene

· Mask (surgical) upon entering room

Airborne Precautions

Airborne precautions are utilized in the care of patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei (small particles that can remain suspended in the air). The most common diseases/pathogens requiring airborne precautions are pulmonary tuberculosis, chickenpox, and disseminated varicella. Precautions include:

· Private room with negative pressure and special ventilation – contact infection control or access services to get room setup

· N-95 respirators are used for care of patients known or suspected to be infected with tuberculosis or SARS patients (Healthcare workers should be fit-tested before wearing N-95 respirators or caring for patients in airborne isolation).

In addition to the 4 major transmission-based isolation categories above, immunocompromised patients may be placed into “modified protective isolation” that is designed to limit their exposure to potential pathogens. These precautions are used in OHSCU for neutropenic hosts and can be instituted in other areas of the hospital for appropriate patients.

Modified Protective Isolation

Modified protective isolation measures are designed to protect immunocompromised hosts – generally patients with neutropenia. Precautions include:

· Private room

· Strict adherence to hand hygiene

· No persons with respiratory infections or other communicable illnesses should enter

· No live plants or flowers

· No fresh fruit or vegetables