Question

precautions required in the hospital setting of the following disease HIV MRSA Varicella zoster Hepatitis B Pertussis Pulmonary Tuberculosis Seasonal Influenza Clostridium difficile

Answer 1

Precautions required in the hospital setting of the following disease.

A) HIV

1) All health workers should routinely use appropriate barrier precautions to prevent skin and mucous-membrane exposure when contact with blood or other body fluids of any patient is anticipated.

2) Gloves should be worn for touching blood and body fluids, mucous membranes, or non-intact skin of all patients, for handling items or surfaces soiled with blood or body fluids, and for performing venipuncture and other vascular access procedures. Gloves should be changed after contact with each patient.

3) Masks and protective eyewear or face shields should be worn during procedures that are likely to generate droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes. Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.

4) Hands and other skin surfaces should be washed immediately and thoroughly if             contaminated with blood or other body fluids.

5) Hands should be washed immediately after gloves are removed.

6) All health-care workers should take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices during procedures; when cleaning used instruments; during disposal of used needles; and when handling sharp instruments after procedures.

7) Disposable syringes and needles, scalpel blades, and other sharp items should be placed in puncture-resistant containers for disposal; the puncture-resistant containers should be located as close as practical to the use area.

8) Although saliva has not been implicated in HIV transmission, to minimize the need for emergency mouth-to-mouth resuscitation, mouth- pieces, resuscitation bags, or other ventilation devices should be available for use in areas in which the need for resuscitation is predictable.

9) Health-care workers who have exudative lesions or weeping dermatitis should refrain from all direct patient care and from handling patient-care equipment until the condition resolves.

10) Pregnant health-care workers should be especially familiar with and strictly adhere to precautions to minimize the risk of HIV transmission.

Source: CDC (www.cdc.gov)

B) MRSA

1) HCP should clean their hands with soap and water or an alcohol-based hand sanitizer before and after caring for every patient.

2) Carefully clean hospital rooms and medical equipment.

3) Use Contact Precautions when caring for patients with MRSA (colonized, or carrying, and infected).

Contact Precautions mean:

· Whenever possible, patients with MRSA will have a single room or will share a room only with someone else who also has MRSA.

· Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with MRSA.

· Visitors might also be asked to wear a gown and gloves.

· When leaving the room, healthcare providers and visitors remove their gown and gloves and clean their hands.

· Patients are asked to stay in their hospital rooms as much as possible. They should not go to common areas, such as the gift shop or cafeteria. They may go to other areas of the hospital for treatments and tests.

4) Test some patients to see if they have MRSA on their skin. This test involves rubbing a cotton-tipped swab in the patient’s nostrils or on the skin.

5) Apply topical medicines and antiseptics to try to decrease the amount of staph on a person’s body (also called decolonization).

Source: CDC (www.cdc.gov)

C) Varicella zoster

1) Have documented evidence of immunity for all healthcare personnel readily available at the healthcare personnel’s work location

2) Alert healthcare personnel without evidence of immunity to varicella about the risks of possible infection and offer those without evidence of immunity 2 doses of varicella vaccine, administered 4 to 8 weeks apart, when they begin employment

3) Establish protocols and recommendations for screening and vaccinating healthcare personnel and for managing healthcare personnel after exposures in the work place

Source: CDC (www.cdc.gov)

D ) Hepatitis B

1) immunizations against hepatitis B

2) Universal Precautions

· Wear gloves, aprons, lab coats and other protective clothing as needed.

· Wear goggles or face shields to protect against splashing of blood or body   fluids into eyes or mouth or onto broken skin or skin rashes.

· Use mouthpieces for resuscitation.

· Wash all body surfaces exposed to blood or body fluids with soap and water as soon as possible after contact.

· Dispose of used needles and other contaminated sharp instruments and tools in puncture-resistant containers.

· Place materials soiled with blood or body fluids in leak-proof, appropriately labeled waste bags/containers.

· Clean all potentially contaminated or contaminated surfaces, such as floors, walls, beds and large equipment, with a 1:10 solution of household bleach.

· Use routine autoclaving when sterilizing contaminated instruments that can tolerate moisture and heat.

Source: CDC (www.cdc.gov) and CCOHS (www.ccohs.ca)

E) Pertussis

1) Patient Isolation

2) In addition to standard precautions, droplet precautions are needed for 5 days after starting effective therapy or for 3 weeks after onset of cough if appropriate therapy was not given.

3) Identification of exposed individuals and implementation of the following:

· Completion of primary immunization if not completed or administration of a booster vaccine if the last vaccine dose has been given >3 years.

· Monitor exposed individuals for 21 days after exposure for evidence of disease.

· Macrolide (azithromycin, erythromycin, or clarithromycin) or TMP-SMX (trimethoprim/sulfamethoxazole; contraindicated for <2 months of age) to close contacts regardless of immunization (vaccine induced protection is not absolute and wanes with time and there is no booster given after 7 years of age).

Source: ISID (www.isid.org)

F) Tuberculosis

Administrative Controls, Environmental Controls and Respiratory Controls

Administrative Controls

The first and most important level of the hierarchy, administrative controls, are management measures that are intended to reduce the risk or exposure to persons with infectious TB. These control measures consist of the following activities:

• Assigning someone the responsibility for TB infection control in the health care setting;
• Conducting a TB risk assessment of the setting;
• Developing and implementing a written TB infection-control plan;
• Ensuring the availability of recommended laboratory processing, testing, and reporting of results;
• Implementing effective work practices for managing patients who may have TB disease;
• Ensuring proper cleaning, sterilization, or disinfection of equipment that might be contaminated (e.g., endoscopes);
• Educating, training, and counseling health care workers, patients, and visitors about TB infection and disease;
• Testing and evaluating workers who are at risk for exposure to TB disease;
• Applying epidemiology-based prevention principles, including the use of setting-related TB infection-control data;
• Using posters and signs to remind patients and staff of proper cough etiquette (covering mouth when coughing) and respiratory hygiene; and
• Coordinating efforts between local or state health departments and high-risk health-care and congregate settings.

Environmental Controls

The second level of the hierarchy is the use of environmental controls to prevent the spread and reduce the concentration of infectious droplet nuclei. This includes two types of environmental control.

• Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation (e.g., hoods, tents, or booths) and diluting and removing contaminated air by using general ventilation.
• Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source airborne infection isolation (AII) rooms; and cleaning the air by using high efficiency particulate air (HEPA) filtration, or ultraviolet germicidal irradiation.

Respiratory Controls

The third level of the hierarchy is the use of respiratory-protection control. It consists of the use of personal protective equipment in situations that pose a high risk of exposure to TB disease.

Use of respiratory protection equipment can further reduce risk for exposure of health care workers to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease. The following measures can be taken to reduce the risk for exposure:

• Implementing a respiratory protection program;
• Training health care workers on respiratory protection; and
• Educating patients on respiratory hygiene and the importance of cough etiquette procedures.

Source: CDC (www.cdc.gov), ISID (www.isid.org) and WHO (www.who.int)

G) Seasonal Influenza

In addition to Standard precautions there are Adhere to Droplet precautions.

A) Standard Precautions include:

1) Hand Hygiene

2) PPE

B) Adhere to Droplet precautions include:

• Droplet precautions should be implemented for patients with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer, while a patient is in a healthcare facility.
• Place patients with suspected or confirmed influenza in a private room or area. When a single patient room is not available, cohorting could be adopted.
• HCP should don a facemask when entering the room of a patient
• If a patient under droplet precautions requires movement or transport outside of the room:

o Have the patient wear a facemask, if possible, and follow respiratory hygiene and cough etiquette and hand hygiene.

C) Use Caution when Performing Aerosol-Generating Procedures

• Only performing these procedures on patients with suspected or confirmed influenza if they are medically necessary and cannot be postponed.
• Limiting the number of HCP present during the procedure to only those essential for patient care and support.

Source: CDC (www.cdc.gov)

H) Clostridium difficile

1) Clean their hands with soap and water or an alcohol-based hand rub before and after caring for every patient. This can prevent C. diff and other germs from being passed from one patient to another on their hands.

2) Carefully clean hospital rooms and medical equipment that have been used for patients with C. diff. •

3) Use Contact Precautions to prevent C. diff from spreading to other patients.

Contact Precautions mean:

· Whenever possible, patients with C. diff will have a single room or share a room only with someone else who also has C. diff.

· Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with C. diff.

· Visitors may also be asked to wear a gown and gloves. o When leaving the room, hospital providers and visitors remove their gown and gloves and clean their hands

· Patients on Contact Precautions are asked to stay in their hospital rooms as much as possible.

Source: CDC (www.cdc.gov) and NHS (www.nhft.nhs.uk)