Hospital-Acquired Infections Follow-up

  • Author: Ayesha Mirza, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 5, 2012
 

Deterrence/Prevention

The Healthcare Infection Control Practices Advisory Committee (HICPAC) has developed a guideline for isolation precautions to prevent transmission of infectious agents in healthcare settings.[28, 29]

Standard precautions are to be applied to the care of all patients in all healthcare settings regardless of the suspected or confirmed presence of an infectious agent. This is the primary strategy in preventing transmission of infectious agents among patients and healthcare personnel.

Transmission-based precautions are used in addition to standard precautions when caring for patients who are infected or colonized with pathogens transmitted by airborne, droplet, or contact routes.

Airborne precautions are used to prevent transmission of airborne droplet nuclei–containing microorganisms. These droplet nuclei remain suspended in air. Precautions include use of single-patient rooms, negative air-pressure ventilation, and N95 respirator masks or higher. Organisms transmitted by airborne route include Mycobacterium tuberculosis, rubeola (measles) virus, and the varicella-zoster virus. Droplet precautions are used to prevent transmission of droplets containing microorganisms propelled less than 3 feet by coughing or sneezing by an infected person. Precautions include use of mask in the room and use of single-patient room or, if not feasible, cohorting of patients separated at least 3 feet apart.

Conditions/pathogens for which droplet precautions should be used include adenovirus, diphtheria, H influenzae type b, hemorrhagic fever viruses, influenza, mumps, M pneumoniae, Neisseria meningitidis, parvovirus B19, pertussis, plague (pneumonic), rubella, severe acute respiratory syndrome (SARS), streptococcal pharyngitis, pneumonia, or scarlet fever.

Contact precautions are used to prevent transmission of microorganisms via direct or indirect contact with infected or colonized persons. Precautions include use of single-patient room (if not feasible, cohort patients infected with the same organism), use of gowns and gloves, and hand hygiene after glove removal.

Conditions/pathogens for which contact precautions should be used include multidrug-resistant bacteria (eg, vancomycin-resistant enterococci, methicillin-resistant S aureus [MRSA], multidrug-resistant gram negative bacilli), C difficile, diphtheria, enteroviruses, E coli O157:H7 and other Shiga toxin-producing E coli, hepatitis A virus, herpes simplex virus (neonatal, mucocutaneous, or cutaneous), herpes zoster in a normal host (localized with no evidence of dissemination), impetigo, noncontained abscess, cellulitis or decubitus ulcer, parainfluenza virus, pediculosis, respiratory syncytial virus, rotavirus, scabies, Shigella, S aureus (cutaneous or draining wounds), and viral hemorrhagic fevers (eg, ebola, Lassa, Marburg).

Prevention of intravascular catheter-associated infections includes avoidance of unnecessary catheter placement, removal of catheter as soon as possible, aseptic technique during catheter insertion, and minimal manipulation of catheter. CDC guidelines address specific strategies in preventing intravascular catheter-associated infections.[30]

Prevention of healthcare-associated bacterial pneumonia includes several category IA recommendations, including education of healthcare workers about infection control procedures, thorough cleaning of devices for sterilization or disinfection, changing the breathing circuit only when it is visibly soiled, hand hygiene, and change of soiled gloves.[31]

Prevention of catheter-associated urinary tract infections includes several category I recommendations, including education of personnel in proper techniques of catheter insertion and care, catheterizing only when necessary, emphasizing handwashing, using aseptic technique for catheter insertion, securing catheter properly, maintaining closed sterile drainage, obtaining urine samples aseptically, and maintaining unobstructed urine flow.[32]

CDC highly recommends handwashing with either a nonantimicrobial soap and water or an antimicrobial soap and water when hands are visibly dirty or soiled with blood and other body fluids. If hands are not visibly soiled, alcohol-based hand rub may be used for routine decontamination of hands.[28]

 
Contributor Information and Disclosures
Author

Ayesha Mirza, MD  Assistant Professor, Pediatric Infectious Diseases, University of Florida College of Medicine Jacksonville

Ayesha Mirza, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, HIV Medicine Association of America, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Haidee T Custodio, MD  Assistant Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine

Haidee T Custodio, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David Jaimovich, MD  Chief Medical Officer, Joint Commission International and Joint Commission Resources

David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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