Transmission-based precautions and signs:
Isolation signs and what they mean:
Contact Precautions:
Droplet-Contact Precautions:
- Abscesses, draining, major, until draining stops or can be contained by a dressing
- Bed Bugs: The room itself should be on contact precautions for cleaning purposes. The patient should be moved to a clean room ASAP, given a shower, and be given a fresh hospital gown and fresh linens. The room should sit for 1-2 hours prior to cleaning. All patient belongings should be double-bagged.
- Blepharitis (eye), if there is copious drainage
- Bronchiolitis, for the duration of the illness
- Congenital rubella, also known as "German measles"
- Conjunctivitis, acute viral
- Diphtheria, cutaneous, until off antimicrobial treatment and cultures are negative
- Furunculosis, staphylococcal (boils), duration of illness or until wound lesions stop draining
- Hepatitis A, viral
- Herpes Simplex Virus (HSV), mucocutaneous disseminated or primary, severe, until lesions are dry and crusted
- Herpes Simplex Virus, Neonatal
- Herpes Zoster (Varicella-zoster, Shingles), disseminated in any patient, localized in immunocompromised patient until disseminated infection is ruled out (along with airborne and standard contact), duration of illness
- Human metapneumovirus, duration of illness
- Impetigo, until 24 hours after initiation of effective therapy
- Lice (pediculosis), until 24 hours after effective therapy
- MRSA: active infection or history of colonization, until IP rules out that criteria for removal has been met (1 negative swab if it has been 18 months or greater since last colonization; 2 negative swabs if <18 months; 2 negative cultures if it was from an infection prior)
- MDRO's
- VRE history
- ESBL history
- Resistant S. pneumoniae (community-acquired pneumonia)
- Parainfluenza virus (duration of illness)
- Pneumonia associated with Burkholderia cepacia in CF patients, including respiratory tract colonization
- Poliomyelitis
- Pressure ulcer, decubiti, pressure sore, infected major, duration of illness
- Respiratory infectious diseases, acute, duration of illness, if not covered elsewhere
- Respiratory syncytial virus (RSV)
- Human metapneumovirus (it is in the same family as RSV)
- Scabies (until 24 hours after therapy is initiated)
- Scalded skin syndrome (staphylococcal), duration of illness
- Staphylococcal disease, wounds, skin, burns, major, until drainage stops or can be contained by dressing
- Vaccinia: vaccination site care following an adverse event following vaccination, until lesions dry and are crusted and scabs are separated
- Wound infections, major: until drainage stops or can be contained by dressing
Droplet-Contact Precautions:
- Adenovirus with pneumonia, duration of illness
- Covid-19, for 10 days for inpatients, until a provider requests removal
- If a patient has a droplet precaution and is colonized with MRSA or has an active MRSA infection simultaneously
- Streptococcal disease, Group A Strep (pharyngitis, "Strep Throat")
- Streptococcal disease, major skin, wound or burn, until 24 hours after initiation of effective therapy
- Viral hemorrhagic fevers
- Coxsackie Virus (Hand-Foot-and-Mouth Disease): Use in hospital to prevent institutional outbreaks
Droplet Precautions:
Airborne Precautions:
- Influenza virus A, B or pandemic influenza (7 days)
- Diphtheria, Pharyngeal (until off antimicrobial treatment and 2 cultures are negative)
- Epiglottitis, due to Haemophilus influenzae type b (until 24 hours after initiation of effective therapy)
- Meningitis, known or suspected (bacterial Neisseria meningitidis), until 24 hours after initiation of effective therapy
- Meningococcal disease: sepsis, pneumonia, meningitis (until 24 hours after initiation of effective therapy) (bacterial, viral, fungal, parasite)
- Mumps (infectious parotitis), until 5 days after the onset of swelling
- Mycoplasma spp (walking pneumonia), duration of illness
- Parvovirus B19, Erythema infectiosum
- Pertussis (Whooping Cough), until 5 days after initiation of effective antibiotic therapy
- Plague (Y. pestis)
- Pneumonia (Haemophilus influenzae, meningococcal, Group A Strep)
- Rhinovirus
- Rubella (German Measles)
- Streptococcal Disease (Group A Strep) Pneumonia, Invasive Disease, Bloodstream Bacteremia
Airborne Precautions:
- Measles (rubeola), until 4 days after the onset of the rash and duration of the illness in the immune compromised
- Tuberculosis, pulmonary or laryngeal disease, confirmed or suspected
Airborne-Contact Precautions:
Enteric Contact Precautions:
- Herpes zoster (varicella-zoster): shingles (disseminated in any patient; localized in immunocompromised patient), until lesions are dry and crusted
- SARS, along with droplet precautions, for duration of illness plus 10 days after resolution of fever
- Smallpox (variola)
- Tuberculosis, extrapulmonary, draining lesion
- Varicella zoster (chicken pox)
Enteric Contact Precautions:
- Gastroenteritis, duration of illness
- Norovirus
- Suspected or confirmed C. difficile
- Rotavirus
https://www.cdc.gov/infectioncontrol/pdf/guidelines/Isolation-guidelines-H.pdf
Donning and doffing of ppe:
Donning: Putting on PPE
Doffing: Removing PPE
PPE: Personal Protective Equipment
Read the sign on the door to see what type of PPE is needed before you go into the room.
DONNING: GMEG
DOFFING: GGEM
Doffing: Removing PPE
PPE: Personal Protective Equipment
Read the sign on the door to see what type of PPE is needed before you go into the room.
DONNING: GMEG
- Perform Hand Hygiene First
- Remember GMEG for Donning PPE
- G: Put on the gown first, slowly, inserting your arms into the sleeves and thumbs through the thumb holders, if present.
- If the neck is in a loop, place it over your head.
- If the neck has Velcro, fasten it next.
- Tie the tie around the back or waist to secure it, depending upon the type of gown you have.
- M: Put on the mask next.
- N95: If you are using an N95 mask, hold the mask in one hand, and lean forward slightly and carefully place both straps over your head over your nose, mouth and chin, securing the first one (top) to the back of the head at the top, and lower the second one (bottom) below your ears at your neck. Make sure they are not tangled. Fit the nosepiece around the bridge of your nose to create a seal.
- Surgical mask: Carefully loop the ear loops around the ears. Mold the nosepiece to your nose. Lower the base under the chin.
- E: Put on eye protection next over your eyes, if the transmission precaution calls for it (goggles, eye protection or face shield).
- Perform hand hygiene again.
- G: Lastly, carefully put on your gloves, making sure to cover the ends of the sleeves with the gloves. You are now ready to enter the patient care area.
DOFFING: GGEM
- You are going to remove your gloves first, or at the same time as the gown, removing them inside out (gloves). Do not touch the outside of the gloves. This part is considered to be contaminated.
- With your non-dominant hand, pinch the inside of the opposite glove and carefully pull over the glove to make it come off inside-out as you peel it away from your hand. Wad this glove up in your other gloved hand.
- With your dominant hand, carefully place your finger inside the wrist of this glove to pull it away and down so that you pull it off inside out over the wadded up glove in the hand. Discard the gloves. Some people learn to do this simultaneously while removing their gown.
- Use your arms and body to slide the gown. Release the tie of the gown. Move the shoulders and arms up through the gown until it slides off the body. Turn it inside out into a ball and discard.
- Perform hand hygiene.
- Remove eye protection carefully over the head. Dispose of or clean them with a sani wipe or alcohol pad.
- Remove the mask carefully away from the face, removing the loops from the ears, and discard it.
- If it is an N95 mask, wear out until you leave the room before you take it off. Dispose of or reuse it according to your facility's protocol.
Bedbugs, lice, scabies, and carpet beetles
cleaners and types
Disinfectants: reduce the level of microbes to safer levels on surfaces an on fomites (nonliving things, including surfaces, linens, bedding, clothing, etc...) and destroy most viruses
- Bleach solutions
- Bleach wipes
- Disinfecting wipes
- Many household and hospital cleaners
- Vinegar-based
- Ammonia-based (Windex, Glass Cleaners)
- Baking soda
- Essential oils
- Chlorhexidine or chlorhexidine solutions
- Chlorhexidine-isopropyl solutions
- Chlorhexidine prep swabs and baths (pre-surgical)
- Iodine
- Surgical scrubs
- Phenol
- Hydrogen peroxide
- 70% or 90% isopropyl alcohol solutions or wipes
- Sanitizing wipes
- Sanitizing hand wipes
- Ethanol-alcohol
- Methanol blue (in toilet bowl sanitizers or cleaners; also a stain used to stain some bacteria)
- UV light
- Sterilants (chemical) for scopes
- Autoclaves: destroy microbes at 120 degrees Celsius at 120 lbs of pressure for at least 15-20 minutes
- Soap (foam, liquid, bar, dish soap)
- Detergents (laundry detergents, dishwashing pods/powders/liquids)
- Bacteriocides: kill bacteria
- Fungicides: kill fungi
- Virucides: kill viruses
- Germicides: kill all microbe types
- Bacteriostatic: reduces the level of bacteria
- Fungistatic: reduces the level of fungi
- Virustatic: reduces the level of viruses
signs versus symptoms of infection:
What is a sign? A sign is a manifestation of infection or disease that healthcare providers see. A symptom is a manifestation of infection or disease perceived, felt or experienced by the patient.
Common Signs:
Symptoms:
Common Signs:
- Vital signs: Temperature, Blood Pressure, Respiration Rate, Pulse, Heart Rate
- Inflammation: Redness, Warmth, Edema/Swelling, Pain
- Cyanosis (blue lips, blue nailbeds)
- Jaundice (yellowish skin, yellowing of eye whites)
- Cuts, bruises, wounds, scars, tumors, swellings
- Lab Test Results: increases/decreases in certain blood cells or metabolites, positives or negatives for common viral, bacterial, fungal or parasite infections, increases/decreases in kidney function
- Scan Results: fractures, breaks, rips, tears, arthritis, cysts, spurs
- Swollen glands
- Auscultations and changes in sounds of the lungs or abdomen
- Skin changes, mole changes
- Weight gain or loss
- Pus or discharge and type and color
- Hematuria
- Changes in gait
- Changes in the nail beds: discoloration, pale, blue, splintering, spoon nails, ridges, spots
- Changes in skin turgor: edema or dehydration, sunken eyes, puffy eyes
- Changes in awareness or consciousness or mental status
- Person is eating less or more
- Scabbing
- Peeling
- Blisters
- Lesions
- Rashes and type
- Changes in the type and color of stool
- Changes in the frequency, urgency, color of urine
- White patches on the back of the throat
- Swollen eustachian tube or tympanic membrane
- Discharge from the ear and color
- Petechiae
- Purpura
- Exudates
- Halitosis
- Koplik's spots
- Janeway lesions
- Osgood lesions
- Pink eye due to conjunctivitis
- Stye
- Scaling
- Uremia or uremic frost
- Dandruff
- Sores
- Ulcers
- White patches on the insides of the cheeks
- Strawberry tongue
- Tachycardia
- Bradycardia
- Arrhythmia
- Changes on the EKG
- Raspberry tongue
- Swollen tongue
- Swelling in the back of the throat
- Drop in blood pressure
- Shock
- Nodules
- Anemia
- Seizures
- Pale or red skin
- Acidosis
- Alkalosis
- O & P in the stool
- Electrolyte imbalances
- Atrophy
- Cloudy lens
- Unequal pupils
- Pupils that are too small or too large
- Tetany
- Blood clots
- Clogged vessels
- Diverticula
- Aneurysm
- Effusion
- Abscess
- Roth's spots
- Gingivitis
- Periodontitis
- Necrosis
- Gangrene
- Pale, cold, sweaty appearance
- Agitation
- Warm skin, hands, feet
- Burns
- Blue fingertips, toes
- Creaking or popping sounds
- Decreased range of motion measurements
- Bacteremia, viremia, fungemia, or parasitemia
- Patches
- Curved bones
- Erosion
- Fluid
- Effusion
- Sclerosis
- Scleritis
- Red cheeks
- Butterfly rash on cheeks
- Yellow, green, or blood-stained sputum
- Rapid, shallow breathing
- Skin pallor
- Prolonged bleeding time
- Lowered bleeding time
- Failure to thrive
- Inability to feed properly
- Recurrent infections
- Persistent infections
- Changes in levels of vitamins, minerals
- Changes on the CBC/WBC panel
- Hypertension
- Hypotension
- Hyperglycemia
- Hypoglycemia
- Facial drooping/sagging
- Eye drooping/sagging (Ptosis)
- Incontinence
- Slurring of words or not making sense
- Ascites
- Stones
- Calculi
Symptoms:
- Pain
- Nausea
- Vomiting
- Diarrhea
- Headache
- Earache
- Sore throat
- Difficulty breathing or shortness of breath
- Dizziness
- Blurry vision
- Fatigue
- Malaise
- Chills
- Body aches
- Joint pain and aches
- Congestion
- Bleeding
- Burning
- Runny nose
- Coughing
- Sneezing
- Tightness
- Pressure
- Weakness
- Watery eyes
- Runny nose
- Sore throat
- Itching and scratching
- Pins and needles
- Numbness
- Lack of energy
- Loss of taste, smell, appetite
- Muffled hearing
- Loss of balance
- Difficulty walking
- Urinating more or less
- Increased or decreased thirst
- Eye pain and watering and itching due to conjunctivitis
- Discomfort
- Anxiety
- Depression
- Sadness
- Emptiness
- Pain on a scale of 1-10 and type
- Deafness
- Tenderness
- Increased or decreased salivation
- Sensation of rapid heart beat
- Sensation of low heart beat
- Sensation of heart skipping a beat
- Loss of consciousness
- Syncope
- Breathlessness
- Cramping (abdominal, pelvic, muscular)
- Confusion
- Delusions, hallucinations
- Neck pain and stiffness
- Constipation
- Chest pain
- Dry mouth
- Feeling agitated
- Restricted movement
- Stiffness
- Restricted airways
- Wheezing
- Rales
- Crackles
- Coughing that sounds like whoops
- Coughing that sounds like a seal's bark
- Burning skin
- Pleurisy
- Brittle hair
- Hair that falls out easily
- Muscle twitches
- Muscle flaccidity
- Muscle tetany and cramping
- Loss of taste
- Loss of smell
- Sore, cracked tongue
- Tiredness
- Rigors
- Forgetfulness
- Difficulty finding words
- Loss of bladder or bowel function
- Weakness on one side of the body
- Headaches
- Double vision
- Dysphagia
- Dysarthria
- Falls
- Heartburn