Patient Isolation Precautions

Agent Infective Dose (Aerosol) Diagnostic Samples Diagnostic Assay Patient Isolation Precautions... 

Isolation Procedures Once a victim of chemical or biological agents or weapons gets to the hospital or another healthcare facility, that person may have to abide by patient isolation procedures. These include Standard Precautions, Airborne Precautions, Droplet Precautions, and Contact Precautions. These precautions are spelled out in the third edition of Medical Management Of Biological Casualties Handbook published by the U.S. Army Medical Research Institute of Infectious Disease located at Fort Detrick in Frederick, Maryland. 

Annex 4 Adapting VHF isolation precautions for a large number of patients... 

Health care workers who come in contact with patients in whom anthrax is suspected should use universal precautions at all times, including the use of rubber gloves, disposal of sharps, and frequent hand washing. No human-to-human transmission of anthrax has been reported and respiratory isolation precautions are not needed. Patients with inhalational or cutaneous anthrax should be placed on contact isolation, due to the potential for contact with open wounds or wound drainage. 

Isolate patients with suspected plague, smallpox, or viral hemorrhagic fevers, who may be highly contagious. Patient isolation is not needed for suspected anthrax, botulism, or tularemia since person-to-person transmission is not likely. However, health care workers should always use universal precautions. 

Isolation is usually not necessary, but hospital policy may require isolation procedures. Stool precautions are usually necessary. The nurse washes the hands thoroughly after all patient care and die handling of stool specimens. 

Decontamination Institute standard precautions for healthcare workers. Organisms are relatively easy to render harmless by mild heat (55 degrees Celcius for ten minutes) and standard disinfectants. Secretion and lesion precautions should be practiced, although strict isolation of patients is not required. Soap and water, or diluted sodium hypochlorite solution (0.5 percent). Secretion and lesion precautions are necessary, but strict isolation of victims is not required. 

Medical Management No specific viral therapy exists so treatment is supportive only. Treat patients with uncomplicated VEE infection with analgesics to relieve headache and myalgia. Patients who develop encephalitis could require anticonvulsants and intensive care to maintain fluid and electrolyte balance, ensure adequate ventilation, and avoid complicating secondary bacterial infections. Patients should be treated in a screened room or in quarters treated with residual insecticide for at least five days after onset, or until afebrile (without fever) to foil mosquitoes since humans may remain infectious for mosquitoes for at least seventy-two hours. Isolation and qaurantine is not required. Standard Precautions should be practiced when dealing with infection control for VEE victims as shown below ... 

If an outbreak occurs, the first step would be to properly isolate those with the disease. Health officials should be diligent regarding use of adequate isolation facilities and precautions. If they are at all uncertain about correct procedures for isolating patients, they should contact the state or local health department or CDC. All the contacts of the patients should be vaccinated as soon as possible. In the event that there are many cases in a city vaccinations may be given to the entire population of that city. 

Isolate patient(s) observe universal precautions. Report to local public health agencies (Hardin, 2002). 

Botulinum toxin is extremely poisonous to humans. Coats, gloves, face shields, and protective cabinets are recommended for handling botulism specimens. Ideally, laboratory personnel should be vaccinated with C. botulinum antitoxin. Universal precautions should be used when caring for patients suspected of botulism. Isolation is not necessary but droplet precautions should be instituted (Arnon et al., 2001). 

Biosafety Level II precautions should be used for specimens from patients suspected of Y. pestis infection. Biosafety Level III precautions are needed only if extensive work with infected specimens is expected. Strict isolation should be maintained for all patients suspected of Y. pestis infection. Gowns, gloves, masks, and eye protection should be worn for at least the first 48 hours of treatment. 

Despite its infectivity, human-to-human transmission of tularemia is not a risk, and therefore isolation is not needed. Universal precautions are recommended for patients suspected of tularemia infection. 

Patients having a febrile prodrome and either one other major criterion or at least four minor criteria are at moderate risk for smallpox. For patients at moderate risk, physicians should alert infection control and immediately institute contact precautions and respiratory isolation. If possible, they should obtain dermatology and/or infectious disease consultation and obtain digital photographs of the lesions. Given a moderate risk situation, the appropriate clinical diagnosis is essential, and physicians must rule out varicella or complication of vaccinia (smallpox vaccine). Therefore, for moderate risk patients, the history is essential, specifically the history of clinical varicella infection, history of vaccination for varicella and history of possible exposure to vaccinia (smallpox) vaccine. 

In the hospital or other health care setting, patient care requires standard precautions. Botulism patients do not require isolation, although before definitive diagnosis, those with flaccid paralysis suspected as having meningitis require droplet precautions (36). 

In either a hospital or outpatient setting, place patients suspected of having VHP in a private room and initiate standard, contact, and droplet precautions. The CDC Web site has a description of these precautions at http //www.cdc. gov/ncidod/dhqp/gl isolation.html. 

Very extensively studied, but many of the reports describe single-dose studies or multiple-dose studies in healthy subjects (only a few are cited here), which do not give a clear picture of what may be expected in diabetic patients. Those studies that have concentrated on diabetics indicate that the control of the diabetes is not usually adversely affected by calcium-channel blockers, although isolated cases with diltiazem, nicardipine and nifedipine have been reported.Similarly, there appear to be no important pharmacokinetic interactions with any of the combinations studied. However, if an otherwise unexplained worsening of diabetic control occurs it may be prudent to consider the use of a calcium-channel blocker as a possible cause. Therefore, in general, no particular precautions normally seem necessary. 

An isolated report describes a 28% reduction in valproate clearance in a patient taking valproate semisodium with propranolol 40 mg, and a 35% reduction with propranolol 80 mg. However, 12 other patients taking valproate had no changes in clearance, serum levels or half-life when given propranolol 60 or 120 mg daily for 3 weeks. This interaction would therefore not appear to be of general importance. No special precautions would seem necessary. 

The case reports of adverse interactions cited here appear to be isolated, and it is by no means certain that all the responses were in fact due to drug interactions. However, bear them in mind in the event of unexpected responses to treatment. No special precautions would normally be required during concurrent use, although a reminder that benzodiazepines may affect the performance of skilled tasks, such as driving, may be appropriate when a patient s medication is changed. Note that the manufacturer of moclobemide says that if depressed patients with excitation or agitation are first treated with moclobemide, a sedative such as a benzodiazepine should also be given for up to 2 to 3 weeks. Further study is required to find out if there are any clinically important pharmacokinetic interactions between moclobemide and any of the benzodiazepines. 

With the exception of smallpox virus and to a lesser extent plague bacteria, person-to-person transmission of these diseases rarely occurs if "universal precautions" are maintained (e.g., gloves, gown, mask, and eye protection). The majority of infected patients can be cared for without specialized isolation rooms or specialized ventilation systems. Cohort nursing with the usual practice of universal precautions will provide adequate protection. The hemorrhagic virus infections may be transmissible via a respirable aerosol of blood— respiratory protection of workers caring for these patients is required. 

Saliva contains a mixture of ionic substances and can conduct electricity. For this reason, there can be no direct electrical pathway from the ac supply to the patient. Thus use of isolation transformers should be seriously considered, especially when young children are to be measured. An alternative is the use of battery-powered units, which are especially attractive because there cannot be a stray path to ac electrical ground as long as the unit is not hooked to an electrical outlet. Although most hospitals have grounded ac outlets and ground fault interrupters, respiratory medical devices are being used in homes, clinics, and schools where such safety precautions may not be installed. 

Dietary employees can experience exposure to respiratory and bloodbome hazards when required to take dietary trays to patients. Exposure to infectious materials may also occur when handling red-bagged contaminated food trays that come from isolation rooms to the kitchen to be sterilized. Universal precautions consida aU human blood and OPIMs as infectious. The OSHA bloodbome pathogen standard requires workers exposed to blood and OPIMs to wear PPE such as gloves, masks, and gowns. 

It is essential that during the totality all moments the provision of patient treatment and care actions must take place simultaneously either in the area of prevention either in the area referent to crosstransmission microorganisms control. This set of actions and recommendations named Basic Precautions and Isolation constitute the basics of infection control and represent are the first safety barrier in health care that contributes to the prevention and cross-transmission control of HCAI implementing process for the continuous improvement of quality of care and consequently to patient safety (Pina et al., 2010). 

Contact transmission will be the chief cause of infection spread between individuals. Following universal precautions, additional contact precautions should be maintained to minimise transmission. This may include isolation of patients in private rooms where resources allow. All health workers should wear gloves and a gown for any patient contact. Face shields and eye protection should also be worn when conducting an examination or procedure that may involve aerosols or droplet formation, such as airway suctioning or the use of nebulisers. PPE should be removed between patients, with respiratory protection removed last, and disposed of appropriately in marked clinical waste bins. 

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