Infection Control Manual

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2007 Source Isolation Policy (92 kB)

 

 

 

 

 

 

 

 

Source Isolation

Key Points
Do a risk assessment and prepare the room & patient Plan equipment for the room Print out a Contact Precautions (Source Isolation) Notice to stick on the door SOURCE ISOLATION PROCEDURE: Use plastic aprons (yellow / pink depending on your local hospital practice) and gloves Clean hands or gloves before you touch the patient Discard protective clothing into the yellow sack in the room Clean hands when you leave Arrange special cleaning of the room or bed space INFORM THE INFECTION CONTROL TEAM Check if the disease needs to be notified (See Notifiable Diseases)

 

Planning for Source Isolation

Do a risk assessment to decide whether it is necessary to source isolate a patient for the protection of others. Record this in the patient's notes and clearly state the reasons. You may ask for and the patient may request a visit from a member of the Infection Control Team for a more complete explanation.

Risk Assessment for Source Isolation

If the number of side rooms is limited, then the following hierarchy of risk should be used when deciding who should go into a side room:

• Fever of unknown origin from sub-Saharan Africa (See Section on Viral Heamorrhagic Fever)
• Tuberculosis, chickenpox, measles, mumps and rubella (See Sections on Tuberculosis, Varicella-zoster Virus, Rubella)
• Diarrhoea (See Sections on Outbreak Management and Food Poisoning)
• Patients with Alert Organisms (MRSA, Streptococcus pyogenes in wounds and respiratory tract)
• Patients with undiagnosed rash illness, cellulitis, PUO

It may be necessary to cohort nurse all patients with a particular condition (e.g. diarrhoea) in a section of the ward or whole ward. A decision then has to be made as to whether to close a ward because of an unacceptable risk to new admissions.

Source Isolation Procedure

Prior to moving the patient into a single room:

• Explain the need for isolation to the patient
• Remove all unnecessary equipment from the room
• Ensure that mattresses and pillows have protective covers
• Place a Source Isolation notice on the door of the room
• Consider whether people entering the room should be immune to the patient's disease (important for rubella, chickenpox and tuberculosis)
• Record in the nursing care plan the reason for isolation, the date started and any special precautions necessary to prevent the spread of infection
• Inform the Infection Control Team
• If appropriate, inform household and catering departments

Equipment required for source isolation:

Outside room:

• Coat hook
• Source Isolation notice (yellow) or equivalent
• Disposable aprons (yellow / pink depending on your local hospital practice)
• Patient's charts (except ICU)
• Clear / red (depending on your local hospital practice) plastic bags (for double-bagging linen)
• Alcohol gel or alcoholic chlorhexidine hand rub

Inside room:

• Unsterile disposable gloves
• Skin disinfectant for handwashing (e.g. chlorhexidine gluconate in a proper dispenser)
• Paper towels
• Yellow plastic bag for all waste in a foot-operated sack holder
• Red alginate-stitched plastic bags (for linen)
• "Sharps" disposal box, preferably wall-mounted
• Dedicated cleaning equipment (if space available)

Note: for some diseases (e.g. viral haemorrhagic fever) all waste and linen will be put into disposable sealable bins for incineration

In the ward:

• Have available on the ward the appropriate chemical disinfectant for decontamination of equipment and for dealing with spillages (e.g. chlorine-releasing agent)
• Contact domestic / patient support staff for designated cleaning equipment

 

Staff Responsibilities

Before entering the room, staff members should:

• Remove white coats or outside clothing (preferably leave on hook outside room)
• Remove wristwatch and jewellery and roll up sleeves
• Put on a yellow / pink (depending on your local hospital practice) apron

Inside the room (or visiting bed space):

• If the patient is to be examined or before any procedure, wash and dry hands thoroughly or, if hands are clean, use alcohol gel and put on non-sterile examination gloves
• Perform patient task (change disposable gloves if they become soiled during the procedure)
• Do not touch the patient or anything else in the room unnecessarily
• Do not sit on the bed
• Sharps must be disposed of in the sharps box inside the isolation room

Before leaving the room or bed space:

• Remove gloves and apron and discard into yellow bag
• Bag linen in red / clear alginate bag
• Wash hands in antiseptic hand wash and dry thoroughly

Outside the room:

• Close the door after leaving the room
• Place alginate linen bag into red / clear plastic bag
• Wash hands again in antiseptic hand wash, OR
• Rub hands using alcohol gel, alcoholic chlorhexidine hand rub or equivalent

 

Visitors of Patients in Source Isolation

The risks to visitors should be assessed (low risk for MRSA, high risk for chickenpox). If in doubt, ask the Infection Control Team before allowing visits. Visits by children should be discouraged. The following actions should be followed if a visitor is allowed to see a patient in source isolation:

• Visitors should be reassured by staff as to the risks of catching infection
• Visitors should remove outdoor clothing before entering the room
• There is usually no need for visitors to wear protective clothing
• Visitors should not sit on the patient's bed
• Visitors should not eat in the patient's room
• Visitors should be encouraged to wash their hands or use alcohol gel before leaving the room and not to do tasks for other patients

 

Decontamination of Equipment

If equipment is removed from the room it must be decontaminated according to the disinfection policy. If it is to be serviced, a Permit to Work certificate is required to ensure safety of the maintenance staff members.

 

Decontamination of the Room

The nursing staff should consider the following points when decontaminating the room after a patient has been in source isolation:

• Deal with spillages of blood and body fluid, and clean and remove used equipment
• Discard any rubbish, disposables into a yellow sack
• Patient support (Domestic) staff can then proceed with cleaning

 

Domestic Cleaning of the Room

Domestic staff membes should wear protective clothing (yellow plastic apron and domestic rubber gloves).

Daily cleaning

Daily cleaning should be done by ward domestic staff members after cleaning the rest of the ward. Disposable cloths will be used and discarded. Domestic staff members should use Marigold gloves or equivalent, not clinical gloves.

The following points should be kept in mind:

• If it is necessary to remove equipment, this should be wiped down with general purpose detergent and then with disinfectant
• If it is necessary, strip the bed of all linen. Linen should be placed in an alginate stitched bad and tied, before being brought out of the room and 'double bagged' in a red plastic bag
• Surfaces, ledges, furniture and bed locker will be damp-dusted using hot water and general purpose detergent; room surfaces should be done first, then bathroom fittings, then toilets
• Vacuum cleaning may be necessary to remove dust from behind fixtures and fittings (e.g. pipes and radiators)
• The floor should be damp-cleaned with detergent solution using a mop with a head which can be discarded or laundered
• Carpeted areas should be vacuum cleaned after surfaces have been dusted

 

Additional Action on Discharge of the Patient

Special Disinfection

After discharge of patients harbouring methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci (GRE) and Streptococcus pyogenes or other diseases at discretion of the Infection Control Team, special cleaning will be performed.

Curtains will be taken down and sent for laundering in an alginate bag. Paper curtains will be disposed of in a yellow sack.

When the surfaces have been cleaned with detergent, all hard surfaces must be wiped with fresh chlorine-releasing solation at 10,000 ppm free chlorine and allowed to dry.

On completion of the cleaning, the bucket must be cleaned and the mop head disposed of or sent for laundering. The domestic should then remove the plastic apron and discard it into the yellow bag. The bag must be secured before sending for incineration.

Domestic rubber gloves should be washed whilst sill wearing them and then placed with the mop bucket. Throw them away if they are perforated. Thorough handwashing should then be carried out before leaving the room and again after disposing of the yellow bag. Later, return and replenish soap, paper towels, replace curtains, etc. Inform local nursing staff and supervisor that the task is complete.

For further details, see Section on Cleaning Areas Used for Source Isolation and the domestic cleaning policies held in local domestic cleaning departments. If a room is carpeted, seek advice from the Infection Control Team.