Developing infection control interventions: isolation

Introduction

An important component of infection control interventions in healthcare settings is represented by the use of isolation of patients and the application of contact precautions (CP). These infection control measures are used to prevent and limit the spread of multidrug-resistant organisms (MDRO) and other important nosocomial pathogens such as Clostridium difficile in healthcare settings.

Rationale for the isolation of MDRO patients

MDRO can colonize the skin, oropharyngeal region, respiratory tract and digestive tract of hospitalised patients. MDRO are also able to survive in the environment for a long period of time. Although exact modes of nosocomial transmission for MDRO are difficult to prove, molecular microbiologic and epidemiologic evidence suggest spread among hospitalised patients. Transmission can occur through direct contact with patients colonised or infected or through indirect contact via the hands of healthcare workers (HCWs) or via contaminated patient care equipment or environmental surfaces.

Consequently, strategies to increase and monitor adherence to hand hygiene, contact precautions and patient isolation, environmental and equipment cleaning and to improve the accurateness and promptness of recognition of infected/colonized patients are important components of the attempt to control the spread of these organisms.

Once MDRO infection or carriage is detected in hospitalised patients, most international guidelines recommend the application of CP and isolation to these patients.

Isolation and contact precautions

CP include: wearing a gown and gloves upon room entry of a patient colonized or infected with epidemiologically targeted bacteria and using disposable single-use or patient-dedicated noncritical care equipment (such as blood pressure cuffs and stethoscopes).

There are multiple ways of implementing such CP with different types of isolation of patients. The efficacy of CP can be optimized through an effective and consistent approach to screening cultures, not only in order to identify all carriers but also to monitor the success of any isolation or infection prevention measure.

Alert code of previously known MDRO positive patients and pre-emptive CP could help in reducing the spread of MDRO. No consensus exists on when CP and patient isolation may be discontinued.

It’s essential to bear in mind that CP and isolation should be applied in the contest of a multifaceted strategy to limit the emergence and spread of MDRO. Importantly these strategies must be applied for MDRO colonized and infected patients.

References

• Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003 May; 24(5):362-86.
• Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Jul; 35(7):772-96.
• Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014 Jan; 20 Suppl 1:1-55.

Contributors

• Original contribution from: Maria Adriana Cataldo and Nicola Petrosillo, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy.

Other contributors:

• Adriana Cataldo
• Vladimir Prikazsky