CDC issues updated isolation guideline
By Carina Stanton, MA
The U.S. Centers for Disease Control and Prevention (CDC) has released the first major revision to its isolation guideline, recommending greater administrative support to maintain nurse staffing and adherence to infection-control programs, as well as expanded recommendations on Standard Precautions, with added emphasis on respiratory hygiene/cough etiquette and safe injection practices.
The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 updates and replaces the CDC's 1996 guideline for isolation precautions in hospitals. This revision reflects current infection-control concerns associated with the changes that have occurred in healthcare delivery, including the need for infection-control recommendations that can be tailored to facilities beyond the hospital setting.
"This updated guideline puts infection control in the framework of patient safety with recommendations that promote a culture of safety across the healthcare community to prevent healthcare-associated infections (HAIs)," said Jane Siegel, MD, a pediatrics professor at the University of Texas Southwestern Medical Center who co-authored the updated guidelines with other invited authors of CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) and CDC's Division of Healthcare Quality Promotion.
Evidence-based research and observations during occurrence of outbreaks were considered by the committee as it worked to revise the guideline, Siegel noted. Revisions based on a review of this new scientific information include:
- Additions to Standard Precautions, with recommendations to promote respiratory cough/hygiene etiquette and to wear a fit-tested N95, or higher, respirator, in addition to eye and face protection during such aerosol-producing procedures as endotracheal intubation and bronchoscopy. This recommendation applies when such procedures are performed on patients suspected or proven to be infected with an agent transmitted by respiratory aerosols, such as severe acute respiratory syndrome (SARS).
- Increased observation of current safe injection practices in all settings because of continued outbreaks of hepatitis B and hepatitis C viruses in ambulatory settings that result from not following recommended practices.
- New discussions in the section on transmission addressing bioaerosols and increased concern for transmission associated with aerosol-generating procedures
- A change to the process of donning protective equipment when caring for patients on "contact precautions" or "droplet precautions" that now recommends that healthcare personnel don gowns, gloves and masks "upon entry into the patient's room."
- A new definition of "epidemiologically important organisms" developed to assist in identifying clusters of infections, such as multidrug-resistant organisms or susceptible bacteria or viruses that are being transmitted among patients
With increased transmission of such emerging and re-emerging pathogens as SARS, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA), "this new definition serves as a starting point for organizations to be aware of transmission of these organisms, which could be a tip-off to a potential outbreak," Siegel advised. The guideline also includes an updated section on multidrug-resistant organisms, which the CDC pre-released last year.
Siegel stressed the importance of recommending senior-level administrative support for infection-control programs. "An increase in the complexity and vulnerability of patient populations and impending requirements to report healthcare-associated infection rates to state health departments and to the public means that infection-control professionals have a vastly increased workload. So there is a greater need for senior administration to appropriate personnel and other resources that will enable organizations to carry out infection-control recommendations and meet the expectations of regulatory agencies and the public."
Perioperative Nursing Specialist Joan Blanchard, RN, MSS, CNOR, CIC, encourages all practitioners to review the new CDC guideline and speak with infection-control officers to ensure that new recommendations are being followed. "The new CDC Isolation Guideline supports the prevention and control of infections that safeguard patients in all phases of their care in healthcare facilities," she said. Blanchard serves as a HICPAC liaison for AORN.
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