1 Isolation at Risk of Spread of Infection

Infection type

Isolation type

Personal protective equipment—PPE

1.

All gastroenteritis cases

CA

Gloves

Gown, mask, capa,b

 

Clostridium difficile a

C(A)

Gloves

Gown, mask, capa,b

 

Salmonella, Shigella, Yersinia, Campylobacter

C(A)

Gloves

Gown, mask, capa,b

 

Campylobacter, Cholerae, intestinal-pathogenic E. coli

C(A)

Gloves

Gown, mask, capa,b

 

Entero-haemorrhagic E. coli—EHEC

C + A

Gloves

Gown, mask, capa,b

 

Virus gastroenteritis (Noro, Rota, sapo, etc.)a,b

C + A

Gloves

Gown, mask, capa,b

2.

Hepatitis A or E

C + B

Gloves

Gownb

3.

Staphylococcus aureus in wounds or eczema

C

Gloves

Gownb

4.

Streptococcus group A in the throat, skin or wounds

C

Gloves

Gownb

5.

Skin and wound infections, moderate secretion

C

Gloves

Gownb

6.

Gram-negative Bacilli with copious secretion from respiratory tract or wounds

C

Gloves

Gownb

7.

Corynebacterium jeikeium, Staphylococcus haemolyticus (only during nosocomial epidemics)

C

Gloves

Gownb

8.

Poliomyelitis

C(A)

Gloves

Gownb

9.

Untreated scab and lice

C

Gloves

Gownb

10.

Other diseases which are transmitted through contact (e.g. tuberculosis in the intestines, urinary tract or in wounds or fistula)

C

Gloves

Gownb

11.

HIV/AIDS uncomplicated and other blood-borne infectious viruses such as HTLV I and II and parvovirus B19

B + C(wound/mucosa)

Gloves

Gownb

12.

Hepatitis, acute (unknown cause)

C + B

Gloves

Gownb

 

Hepatitis, chronic (unknown cause)

B

Gloves

Gownb

 

Hepatitis A, B, C, D, E, G

B + C

Gloves

Gownb

13.

Malaria falciparum, Brucella, yellow fever

B

Gloves

Gownb

14.

Suspected active pulmonary tuberculosis

A + C

Gloves

Gown,b resp., cap, shoesa

15.

Ornithosis, tularemi

A + C

Gloves

Gownb, resp., cap, goggles/visor

16.

Pneumonia caused by Staphylococcus aureus

A + C

Gloves

Gown,b mask, cap

17.

RSV, influenza and other airborne viruses

A + C

Gloves

Gown,b mask, cap

18.

Varicella-zoster, measles, parotitis, rubella, pertussis

A + C

Gloves

Gown,b resp., cap

19.

Herpes simplex in newborns, in child and maternity wards

A + C

Gloves

Gown,b mask, cap

20.

Systemic infection with: Meningococci, group A Streptococci, Pneumococci; first 24 hours after initial effective treatment

A + C

Gloves

Gown,b mask, cap

21.

Imported patientsc (suspected MRSA or other resistant microbes until test results are negative)c

A + C

Gloves

Gown,b mask, cap

22.

Methicillin-resistant Staphylococcus aureus—MRSA (recently or in the last year)

A + C

Gloves

Gown,b mask, cap

23.

Other multiresistant bacteria (penicillin-resistant pneumococci, multiresistant enterococci, some multiresistant, gram-negative bacteria: Acinetobacter, Burkholderia cepacia, ESBL—E. coli mm). Airborne transmission isolation is determined in relation to the infection type and symptomsd

Ad+C

Gloves

Gown,b mask, cap

24.

Multidrug-resistant tuberculosis, open cavern and expectoration (first 14 days after initial treatment and on resistance—3 months or more)

SI

Gloves

Microbe impermeable gown,b resp., cap, shoesa

25.

Rare severe diseases (diphtheria, rabies, plague, anthrax, viral haemorrhagic fever, SARS, MERS, avian influenza—See also special guidelines)

SI

Gloves

Microbe impermeable gown,b resp., cap, hood, goggles, shoesa

Any other contagious and very serious diseases that may be transmitted by contact and air (including droplet)

  

PPE—Emergency boxe

  1. NB. Contact infection control personnel in case of suspicion or questions
  2. aRoom-bound shoes are recommended; changed in the sluice, washed in a special shoe-washing machine or use single-use shoe or shoe-leg covers
  3. bWhen risk of splashing, vomiting, cough, blood splatter and uncontrolled secretion, evaluate the use of cap, mask and visor or goggles, regardless of the type of isolation
  4. cImported patients from abroad or in other ways may be exposed to resistant microbes
  5. dAirborne transmission may be dependent on symptoms of the patient and viability of the bacteria in the environment. The choice between use of surgical mask and respirator may depend on microbial agent, transmission rate, severity and symptoms
  6. ePPE—emergency box; see PPE

1.1 Isolation Type (See Also Separate Regimes)

  • C = contact isolation; isolate or single room.

  • B = blood-borne and tissue transmission; single room preferred.

  • A = airborne transmission, including droplets and contact transmission. (A) may be airborne in certain situations with excessive spills, vomiting, uncontrolled secretion, etc. Isolate with sluice and a separate bathroom (entrance from the patients room) with decontaminator machine. Defined and controlled negative air pressure—separate air supply and hepafiltered exhaust. If shortage: a single room with anteroom and a separate bathroom.

  • SI = strict isolation; air + droplets + contact + blood. Isolate with sluice and a separate bathroom (entrance from the patient’s room) with decontaminator or autoclave (throughput). Defined and controlled negative pressure relative to the corridor, separate air supply and hepafiltered exhaust.

1.2 PPE:—Most Used—with Different Combinations, According To Isolation Type

  • Gloves: high-quality gloves with long “cuff” to cover the wrists (often use of double).

  • Gown with cuff (water preventing coat) or microbe impermeable, waterproof gown or coverall with hood (barrier against most bacteria and virus and water impermeable for a defined period).

  • Cap- surgical cap that covers hair and ears; always use cap if wearing mask/respirator.

  • Mask—surgical; always use together with cap.

  • Visor—large (against direct splatter); always use together with cap.

  • Respirator—resp. mask: P3, N95, waterproof, with hepafilter against airborne and droplet transmission.

  • Shoe/leg covers or room-bound waterproof shoes (that can be decontaminated at 85 °C or autoclaved or single use).

  • Goggles: large (tight-sitting); placed outside the surgical cap or the hood (can be decontaminated).

  • Hood—microbe impermeable that covers the surgical cap and the respirator mask on place and covers the neck down to shoulders (P3 level).

P3—level of protection: tight-fitting, waterproof respirator mask with hepafilter, eventually portable respirator and PPE corresponding to the isolation type.

PPE—emergency box: equipment for two to eight persons, stored at certain acute-care areas.

The box is pre-packed and contains respirator mask (P3), cap, hood, gown with cuffs (or coveralls with hoods), large goggles, waterproof shoe covers/overshoes and two pairs of high-quality gloves with long cuffs. Use only after consultation with hospital infection control personnel. Regular control and upgrading of the boxes, see chapters concerning high-risk infectious disease preparedness.

Prion disease is not included—see separate section Chap. 55.