NURSE INNO

Contact Precautions


Contact Precautions

Contact Precautions are designed to reduce the risk of transmission of epidemiologically important microorganisms by direct or indirect contact. Direct contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person, such as occurs when personnel turn patients, bathe patients, or perform other patient-care activities that require physical contact. Direct contact transmission also can occur between two patients (e.g., by hand contact), with one serving as the source of infectious microorganisms and the other as a susceptible host. Indirect contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, in the patient’s environment. Contact Precautions apply to patients known or suspected to be infected or colonized (presence of microorganism in or on patient but without clinical signs and symptoms of infection) with epidemiologically important microorganisms that can be transmitted by direct or indirect contact.

Standard Precautions


Standard Precautions

The Standard Precautions/Transmission-Based Precautions system is designed to prevent the transmission of infectious agents. It requires the use of protective apparel for all contact with blood and body substances but uses Airborne, Droplet and Contact Precautions for patients with diseases known to be transmitted in whole or in part by those routes.

Standard Precautions synthesize the major features of Universal Precautions (Blood and Body Fluid Precautions designed to reduce the risk of transmision of bloodborne pathogens) and Body Substances Isolation (designed to reduce the risk of transmission of pathogens from moist body substances). Standard Precautions applies to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status.

Standard Precautions apply to:

blood all body fluids, secretions/excretions, except sweat (regardless of whether or not visible blood is present) nonintact skin mucous membranes


Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals.

Airborne Precautions


Airborne Precautions Patients who have or may have an infectious disease that is spread by the airborne route must be placed on Airborne Precautions in addition to Standard Precautions. Airborne Precautions (formerly respiratory isolation) applies to most infections which were previously classified as requiring “Strict,” “AFB,” and “Respiratory” isolation under the old category-specific system of isolation precautions.

Diseases Requiring Airborne Precautions

Tuberculosis, Pulmonary (or laryngeal)
-suspected or confirmed

Criteria for Using Airborne Precautions for a Patient Suspected or Confirmed to Have Pulmonary Mycobacterium Tuberculosis Varicella (chickenpox)
[requires use of Contact Precautions as well] Herpes Zoster (shingles) - in an immunocompromised patient
[requires use of Contact Precautions as well] Herpes Zoster (shingles) - disseminated
[requires the use of Contact Precautions as well] Rubeola (Measles)
Note: Airborne Precautions require a negative pressure room in addition to a private room. Negative pressure rooms are specially designed to prevent the flow of air from the room into the corridors and common areas where susceptible persons may be exposed. This is accomplished through fans and vents that direct the airflow outside of the building and/or through HEPA filters.

Droplet Precautions


Droplet Precautions

Droplet Precautions are designed to reduce the risk of droplet transmission of infectious agents. Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large particle droplets containing microorganisms generated from a person who exhibits a clinical disease or who is a carrier of the microorganism. The patient can generate these droplets from coughing, sneezing, and talking, as well as during certain procedures such as suctioning and bronchoscopy. Transmission via large droplets requires close contact (within 3 feet or less) between the source patient and the susceptible individual. Droplets (due to their large size) do not remain suspended in air and travel short distances - three feet or less. Thus, Droplet Precautions require the use of a standard surgical mask within three feet of the patient. However, it is prudent to wear a mask upon entering the room of a patient on Droplet Precautions to avoid any inadvertent exposure.


Droplet Precautions
Disease List

In addition to Standard Precautions, Droplet Precautions are required for patients known or suspected to have the following illnesses transmitted by large particle droplets.
Common organisms/diseases which require Droplet Precautions include:

Bacterial:

Invasive Hemophilus influenzae disease:
meningitis, pneumonia (in infants and small children), epiglottitis. Invasive Neisseria meningitidis disease:
meningitis, pneumonia, and bacteremia. Mycoplasma pneumonia Group A Streptococcal pharyngitis, pneumonia, or scarlet fever in infants and young children


Viral

Influenza Adenovirus
(requires Contact Precautions in addition) Mumps Parvovirus B19 Rubella
LYME disease

LYME disease

Paronychia

Paronychia

Impetigo is a superficial skin infection that occurs on open, exposed areas of  skin. This infection occurs most commonly in children but usually does  not cause serious illness. The infection starts at sites of minor skin  trauma such as insect bites or abrasions. The affected skin may develop  small (less than 5mm) fluid filled bumps that develop golden  honey-crusting when bumps burst. Usually, multiple skin lesions are  present. Impetigo is easily spread within families and close contacts.  Other  risk factors for infection include warm, humid conditions and poor  hygiene. Impetigo is most commonly caused by a bacterium called  Streptococcus, but more and more frequently, impetigo is caused by MRSA;  CA-MRSA now accounts for 7-20% of impetigo infections.[8]  Impetigo caused by Streptococcus and CA-MRSA look identical.

Impetigo is a superficial skin infection that occurs on open, exposed areas of skin. This infection occurs most commonly in children but usually does not cause serious illness. The infection starts at sites of minor skin trauma such as insect bites or abrasions. The affected skin may develop small (less than 5mm) fluid filled bumps that develop golden honey-crusting when bumps burst. Usually, multiple skin lesions are present. Impetigo is easily spread within families and close contacts.  Other risk factors for infection include warm, humid conditions and poor hygiene. Impetigo is most commonly caused by a bacterium called Streptococcus, but more and more frequently, impetigo is caused by MRSA; CA-MRSA now accounts for 7-20% of impetigo infections.[8]  Impetigo caused by Streptococcus and CA-MRSA look identical.

Herpes zoster (or simply zoster), commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox which generally occurs in children and young people. Once an episode of  chickenpox has resolved, the virus is not eliminated from the body but  can go on to cause shingles—an illness with very different  symptoms—often many years after the initial infection.
Varicella zoster virus can become latent in the nerve cell bodies and less frequently in non-neuronal satellite cells of dorsal root, cranial nerve or autonomic ganglion,[1] without causing any symptoms.[2] Years or decades after a chickenpox infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The  virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome (an area of skin supplied by one spinal nerve) causing a painful rash.[3][4] Although the rash usually heals within two to four weeks, some  sufferers experience residual nerve pain for months or years, a  condition called postherpetic neuralgia. Exactly how the virus remains latent in the body, and subsequently re-activates is not understood.[1]
Throughout the world the incidence rate of herpes zoster every year ranges from 1.2 to 3.4 cases per 1,000  healthy individuals, increasing to 3.9–11.8 per year per 1,000  individuals among those older than 65 years.[5][6][7]Antiviral drug treatment can reduce the severity and duration of herpes zoster if a  seven- to ten-day course of these drugs is started within 72 hours of  the appearance of the characteristic rash.[5][8]

Herpes zoster (or simply zoster), commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox which generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection.

Varicella zoster virus can become latent in the nerve cell bodies and less frequently in non-neuronal satellite cells of dorsal root, cranial nerve or autonomic ganglion,[1] without causing any symptoms.[2] Years or decades after a chickenpox infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome (an area of skin supplied by one spinal nerve) causing a painful rash.[3][4] Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia. Exactly how the virus remains latent in the body, and subsequently re-activates is not understood.[1]

Throughout the world the incidence rate of herpes zoster every year ranges from 1.2 to 3.4 cases per 1,000 healthy individuals, increasing to 3.9–11.8 per year per 1,000 individuals among those older than 65 years.[5][6][7]Antiviral drug treatment can reduce the severity and duration of herpes zoster if a seven- to ten-day course of these drugs is started within 72 hours of the appearance of the characteristic rash.[5][8]

Herpes simplex (Ancient Greek: ἕρπης - herpes, lit. “creeping”) is a viral disease caused by both herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever blisters, infects the face and mouth. Oral herpes is the most common form of infection. Genital herpes, known simply as herpes, is the second most common form of herpes. Other disorders such as herpetic whitlow, herpes gladiatorum, ocular herpes (keratitis), cerebral herpes infection encephalitis, Mollaret’s meningitis, neonatal herpes, and possibly Bell’s palsy are all caused by herpes simplex viruses.

Herpes viruses cycle between periods of active disease—presenting as blisters containing infectious virus particles—that last 2–21 days, followed by a remission period, during which the sores disappear. Genital herpes, however, is often asymptomatic, though viral shedding may still occur. After initial infection, the viruses move to sensory nerves, where they become latent and reside life-long. Causes of recurrence are uncertain, though some potential triggers have been identified. Over time, episodes of active disease reduce in frequency and severity.

Herpes simplex is most easily transmitted by direct contact with a lesion or the body fluid of an infected individual. Transmission may also occur through skin-to-skin contact during periods of asymptomatic shedding. Barrier protection methods are the most reliable method of preventing transmission of herpes, but they merely reduce rather than eliminate risk. Oral herpes is easily diagnosed if the patient presents with visible sores or ulcers. Early stages of orofacial herpes and genital herpes are harder to diagnose; laboratory testing is usually required.

A cure for herpes has not yet been developed. Once infected, the virus remains in the body for life. However, after several years, some people will become perpetually asymptomatic and will no longer experience outbreaks, though they may still be contagious to others. Treatments with antivirals can reduce viral shedding and alleviate the severity of symptomatic episodes. Vaccines are in clinical trials but have not demonstrated effectiveness. It should not be confused with conditions caused by other viruses in the herpesviridae family such as herpes zoster, which is caused by varicella zoster virus. The differential diagnosis includes hand, foot and mouth disease due to similar lesions on the skin.

Malignant Melanoma

Malignant Melanoma

Basal Cell & Squamous Cell Carcinoma

Basal Cell & Squamous Cell Carcinoma

ESCHAROTOMY

Full Thickness Burns

Full Thickness Burns