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					                      Isolation of Service Users with an Infection Policy




      Isolation of Service Users with an Infection Policy



Document Reference:      Doris Thomson
Ratifying Group:         Infection Control Group
Status:                  Final
Reference No             IC19
Date of Issue            October 2007
Date of review           October 2008




Signed: ___________________________________________

      Claire Murdoch. Chief Executive




Signed: ___________________________________________

      Dr Alex Lewis, Medical Director




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                       Isolation of Service Users with an Infection Policy




            Isolation of Service Users with an Infection

1.   Introduction
Current scientific thinking recognises the evidence of many years’ experience that
the isolation of service users with suspected or proven infection is effective in
reducing transmission. While the risk of transmission differs between types of
infection, the need to separate infected service users from the general patient
population still applies. The aim of isolation is to confine organisms and block routes
of spread is just one aspect of an organisation-wide strategy to reduce and prevent
HCAIs and requires an overall corporate commitment.

Source isolation involves protecting the community from an individual who is an
infection risk, whereas protective isolation is used when the community itself is an
infection risk to the individual. Methods implemented to prevent the spread of
infection are an extension of hygiene measures used in caring for patients, but
everyone who has contact with the patient, day and night must meticulously follow
the specified precautions. Only one person is required to make a mistake to spread
the infection.


2.   Principles
a)   Hand Hygiene
Hand washing is the single most effective measure in the prevention of spread of
infection. Hands must be washed immediately before entering isolation area, after
contact with patient or equipment, and before leaving the isolation area (See Hand
Hygiene Procedure).

b)   Infection Control Team
Inform the Infection Control Team of any patients in isolation. This will ensure
appropriate investigative measures are implemented to identify infection, block
routes of transmission, and prevent cross infection.

c)   Side Rooms
A single room is the most effective form of isolation. To fully isolate service users
due to the nature of their primary diagnosis may be very difficult to do but every effort
must be made. If there are single rooms available, this should always be the first
choice for placement of an infected service user. The room with the door shut is
used to prevent the transmission of organisms ensuring gross environmental
contamination is kept to the absolute minimum.

This functions in reverse in protective isolation and protects the patient from
organism contamination.

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                       Isolation of Service Users with an Infection Policy


d)   Gloves and Aprons
Gloves and aprons should be worn by staff when giving care. Wash hands before
and after using gloves. The use of gloves does not remove the necessity for hand
washing.

This functions in reverse for protective isolation and protects the patient from carers’
normal or transient flora. Friends and relatives do not need to wear protective
clothing and gloves when they visit. However, they must wash hands on entering
and leaving the room and they should not visit any other patient. Visitors should be
asked not to eat or drink in the isolation room.

e)   Equipment
Disposable equipment should be used whenever possible. The use of plastic plates
and cups is not necessary. For further information contact Infection Control Team.
            Fans should not be used to control the patient’s temperature.
N.B Flower vases should not be taken into protective isolation patients due to the
potential bacterial growth in stagnant water.

f)   Spillages
See Spillage Policy.

g)     Linen should be treated as infected
See Linen Policy.

h)   All waste should be categorised as hazardous waste and disposed of in line
     with national guidance
See Waste Policy.

i)   Notes and charts should be kept outside the room/bay/area.
j)   Transfer and Transportation of service Users
This should remain at absolute minimum. If considered essential the appropriate
ward, department, transportation and portering services must be informed of
relevant precautions prior to movement of the Service User can be put into place.
The equipment used to transfer the patient, e.g. trolley, must be decontaminated
after use.

k)   Protective Isolation
Staff and visitors who are unwell e.g. cold, sore throats, herpes simplex, diarrhoea,
infected skin lesions or non-immune staff who have had recent infectious disease
contact must not enter the protective isolation room.

l)   Visitors
The number of visitors should be kept to a minimum, especially children. Visitors
should report to the person in charge prior to entering the isolation room. If they are

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                          Isolation of Service Users with an Infection Policy


in any way unwell, they must inform the person in charge. Staff must instruct visitors
on hand washing procedure and appropriate protective clothing.

m)     Staff Immunity
Non-immune staff should not care for patients who are known to have Chicken
Pox/Shingles, Measles, Mumps, Tuberculosis, Diphtheria, Poliomyelitis and Rubella.
Further information and advice is available from the Occupational Health
Department.


3.     Guidelines
a)     Source and Protective Isolation
        Prior to placing a service user into isolation

 Action                                                    Rationale
 i)    Explain the necessity for isolation                 i)    To obtain the patient's consent
                                                                 and co-operation
 ii)   Remove any unnecessary equipment ii)                      To minimise contamination
       from the room
 iii) Ensure pillows and mattresses have iii) To minimise contamination
      protective covering
 iv) Ensure source/protective isolation iv) To advise staff and visitors of
     notice is placed on outside of the door appropriate precautions



b)     Source Isolation
        Equipment Required - OUTSIDE ROOM

 Action                                                    Rationale
 i)    Disposable gloves
 ii)   Disposable aprons                                   i-v) These essential items are
                                                                necessary      for    immediate
 iii) Black plastic bags
                                                                implementation prior to entering
 iv) Clear plastic bags                                         isolation room
 v)    Alcohol hand gel


        Equipment Required - INSIDE ROOM

 Action                                                    Rationale

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                       Isolation of Service Users with an Infection Policy



Action                                                  Rationale
i)    Skin disinfectant e.g. Hibiscrub and
      Alcohol gel
ii)   Paper towels
iii) Yellow clinical waste bag and foot i-v) These essential items are
     operated sack holder                    necessary      for    immediate
                                             implementation prior to entering
iv) Clinical waste other than hand towels
                                             isolation room
     should be removed from the room
v)    Red infected linen bag and holder. Any
      foul linen should be removed from the
      room

       Before Entering the Room

Action                                                  Rationale
i)    Before entering the room, staff and i)       To reduce the risk of cross
      visitors should remove outer clothing, contamination
      i.e. suit jackets , outside clothing.
ii)   Staff   should    not     be        wearing i)          Rings and wristwatches         can
      wristwatches or jewellery                               harbour micro-organisms
iii) Wash and dry hands thoroughly                      ii)   Handwashing is the single most
                                                              effective   measure       in    the
                                                              prevention of spread of infection
iv) Don gloves and apron if care or iii) To prevent contamination of skin
    treatment to be given                and clothing

       Inside the Room

Action                                                  Rationale
i)    Perform tasks, changing gloves and i)                   To reduce the risk of cross
      handwashing between tasks and when                      contamination
      soiling of gloves occurs
ii)   Linen should be placed in a red bag ii)                 This confines organisms and
      then double bagged into a clear plastic                 ensures recognition by hospital
      bag before removal from the room                        personnel of infected linen


       Before Leaving the Room




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                        Isolation of Service Users with an Infection Policy




 Action                                                  Rationale
 i)    Remove aprons and gloves discard i)                     This will be sent for incineration
       into yellow clinical waste bag
 ii)   Wash and dry hands thoroughly                     ii)   Handwashing is the single most
                                                               effective   measure       in    the
                                                               prevention of spread of infection
 iii) Leave the room shutting the door iii) To    prevent                           environmental
      behind you                            contamination
 iv) Use alcohol hand rub gel outside the iv) To reduce the risk of cross
     room                                     contamination



c)     Protective Isolation
        Equipment Required – OUTSIDE ROOM if not possible to leave outside
         room personal hand gel dispenser must be worn and yellow sack kept in
         dirty utility room.

 Action                                                  Rationale
 i)    Yellow plastic bag and foot operated i)                 These essential items are
       sack holder                                             necessary     for     immediate
                                                               implementation prior to entering
                                                               the room
 ii)   Alcohol hand rub gel                              ii)   To reduce the risk of cross
                                                               contamination

        Equipment Required – INSIDE ROOM

 Action                                                  Rationale
 i)    Disposable Aprons
 ii)   Sterile gloves for invasive procedures
                                                         i-v) These essential items will
 iii) Unsterile disposable gloves
                                                              minimise necessity for leaving
 iv) Black plastic bag and foot operated                      the isolation room.
     sack holder
 v)    Appropriate clinical equipment

        Before Entering the Room




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                       Isolation of Service Users with an Infection Policy



 Action                                                 Rationale
 i)    Wash and dry hands thoroughly                    i)    Handwashing is the single most
                                                              effective  measure    in   the
                                                              prevention of the spread of
                                                              infection

        Inside the Room

 Action                                                 Rationale
 i)    Don gloves and apron if the intention i)               To prevent contamination of the
       is to have direct patient contact                      patient with normal or transient
                                                              flora
 ii)   Perform tasks, using appropriate ii)                   To reduce the risk of cross
       gloves, changing gloves and washing                    contamination
       hands between tasks and when soiling
       of gloves occurs
 iii) On completion of tasks, remove iii) To reduce the risk from potential
        clinical waste and linen from the bacterial contamination
      room

        On Leaving the Room

 Action                                                 Rationale
 i)    Leave the room shutting the door i)                    To       prevent         external
       behind you                                             contamination entering the room
 ii)   Remove apron and gloves discard into ii)               This will be sent for incineration
       yellow clinical waste bag
 iii) Wash and dry hands thoroughly                     iii) Handwashing is the single most
                                                             effective  measure    in   the
                                                             prevention of the spread of
                                                             infection

4.    Cleaning procedures should be rigorously applied. There should be
procedures for enhanced and terminal cleaning must be followed.

Source Isolation Rooms must be cleaned daily and last by Domestic staff.

Protective Isolation Rooms must be cleaned daily and first by Domestic staff.

Individual coloured coded cleaning equipment must be used for every isolation room
e.g. yellow mop bucket, cloths, gloves, aprons etc.



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                           Isolation of Service Users with an Infection Policy


Following the discharge of a patient and after a room is cleaned, it should be
thoroughly aired and a new patient should not be admitted to the room in less than
one hour.

       Further detailed cleaning schedules are available from CNWL Facilities
        Manager based at Trust Headquarters


References

Department of Health (2006) Saving Lives: Isolating patients with HAI

Coia JE, Duckworth GJ, Edwards DI et al. (2006) Guidelines for the control and prevention of
meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities, Journal of Hospital
Infection, 635: S1–S44


Department of Health (2003) Winning Ways: Working together to reduce healthcare associated
infection in England, London: DH. Available at
www.dh.gov.uk/en/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/DH_40646
82

Department of Health (2006) The Health Act 2006: Code of practice for the prevention and control of
healthcare associated infections, London: DH. Available at
www.dh.gov.uk/en/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/Publication
sPolicyandGuidance/DH_4139336

Pratt RJ, Pellowe CM, Wilson JA et al. (2007) epic2: National evidence-based guidelines for
preventing healthcare-associated infections in NHS hospitals in England, Journal of Hospital Infection,
65: S1–S64. Available at www.epic.tvu.ac.uk/PDF%20Files/epic2/epic2-final.pdf

National Patient Safety Agency (2007) The national specifications for cleanliness in the NHS, London:
NHS/NPSA. Available at
www.npsa.nhs.uk/health/currentprojects/nutrition/cleaning

Department of Health (2006) Health Technical Memorandom 07-01: Safe Management of Healthcare
Waste, London: DH.
Available at
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_063274

Department of Health (2004) The NHS Healthcare Cleaning Manual, London: DH. Available at
http://patientexperience.nhsestates.gov.uk/clean_hospitals/ch_content/cleaning_manual/introduction.
asp




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INFECTION CONTROL POLICY                                        Page 9 of 10




               SOURCE ISOLATION
                    TO CONFINE ORGANISMS AND BLOCK
                        ROUTES OF TRANSMISSION


           ALL PERSONNEL MUST BE ADVISED BY PERSON IN
             CHARGE BEFORE ENTERING ISOLATION ROOM.
 VISITORS DO NOT NORMALLY NEED TO WEAR GLOVES AND APRONS BUT
           THEY SHOULD CHECK WITH THE NURSE IN CHARGE

                           BEFORE ENTERING THE ROOM:


                   1. WASH AND DRY HANDS THOROUGHLY


                              2. PUT ON AN APRON


       3. PUT ON GLOVES (IF DIRECT PATIENT CONTACT INTENDED)


                           BEFORE LEAVING THE ROOM:


         1. DISCARD GLOVES AND APRON INTO A YELLOW CLINICAL
                             WASTE BAG


                   2. WASH AND DRY HANDS THOROUGHLY


          3. LEAVE THE ROOM SHUTTING THE DOOR BEHIND YOU

                       4. USE ALCOHOL HAND RUB GEL

                   FOR MORE IN DEPTH INFORMATION SEE
                      INFECTION CONTROL POLICIES



                 PLEASE PRINT OUT ON YELLOW CARD AND LAMINATE



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INFECTION CONTROL POLICY                                       Page 10 of 10




                           PROTECTIVE
                            ISOLATION

                   TO PREVENT EXOGENOUS ORGANISMS
                       ENTERING ISOLATION ROOM



             ALL PERSONNEL MUST BE ADVISED BY PERSON IN
              CHARGE PRIOR TO ENTERING ISOLATION ROOM.
             VISITORS SHOULD CHECK WITH NURSE IN CHARGE

                           BEFORE ENTERING THE ROOM:


                   1. WASH AND DRY HANDS THOROUGHLY



                             ON LEAVING THE ROOM:


                       1. SHUT THE DOOR BEHIND YOU


              2. DISCARD GLOVES AND APRON INTO A YELLOW
                          CLINICAL WASTE BAG


                   3. WASH AND DRY HANDS THOROUGHLY




                   FOR MORE IN DEPTH INFORMATION SEE
                           INFECTION CONTROL POLICIES



                  PLEASE PRINT OUT ON BLUE CARD AND LAMINATE




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