What's new in the isolation precautions?

Here are some highlights from the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007:

  • Respiratory hygiene/cough etiquette: The severe acute respiratory syndrome (SARS) epidemic pointed out the need for better source control among patients, visitors and health care workers with respiratory infections. Patients should be asked to "cover their cough" with a tissue or, if possible, coughing patients should be masked. Health care workers with respiratory infections should avoid direct patient contact or should wear a mask. Hand hygiene should occur after contact with respiratory secretions.
  • Droplet spread: The SARS outbreak demonstrated that droplets could travel 6 feet or more from the source patient. Droplet spread depends on such factors as the velocity and method they are propelled (coughing vs. talking, for example), humidity, and infectivity of the organism. "It may be prudent to don a mask when within 6 to 10 feet of the patient or upon entry into the patient's room, especially when exposure to emerging or highly virulent pathogens is likely."
  • Multiple means of spread: While some organisms are primarily spread through direct contact with mucous secretions, the guidelines note that some, such as Staphylococcus aureus and noroviruses, may become aerosolized and could be spread over short distances.
  • A new way to label transmission: Aerosol transmission could be considered: 1) obligate: under natural conditions, disease occurs following transmission of the agent only through inhalation of small-particle aerosols (e.g., tuberculosis); 2) preferential: natural infection results from transmission through multiple routes, but small-particle aerosols are the predominant route (e.g. measles, varicella); and 3) opportunistic: agents that naturally cause disease through other routes, but under special circumstances may be transmitted via fine particle aerosols.
  • SARS, avian and pandemic influenza: The guidelines refer health care personnel to the CDC web site for current recommendations. However, they note that CDC currently recommends the use of N95 respirators when caring for patients with SARS, and the use of respiratory protection during aerosol-generating procedures such as intubation, bronchoscopy, and suctioning of patients with SARS, avian or pandemic influenza.
  • Safety culture: A commitment to a culture of safety leads to greater adherence to hand hygiene and other infection control measures. A culture of safety occurs through 1) the actions management takes to improve patient and worker safety; 2) worker participation in safety planning; 3) the availability of appropriate protective equipment; 4) influence of group norms regarding acceptable safety practices; and 5) the organization's socialization process for new personnel.
  • Masks: Recommends masks and goggles or the use of face shields to protect health care workers from splashes and sprays of respiratory secretions as a part of Standard Precautions.
  • Respiratory protection: The guidelines state that "The subject of respiratory protection as it applies to preventing transmission of airborne infectious agents, including the need for and frequency of fit-testing is under scientific review …" Respirators may be reused by the same health care worker for tuberculosis "providing the respirator is not damaged or soiled, the fit is not compromised by change in shape, and the respirator has not been contaminated with blood or body fluids. There are no data on which to base a recommendation for the length of time a respirator may be reused."
  • Sharps safety: The prevention of sharps injuries is an "essential element" of Standard Precautions.