Ref : 1nr 006_2018

POLICY AND PROCEDURE Version : 1

RSP Pages :7
Contact Isolation Last revision :
Nursing department
and Date Originated : 2015
Clinical department

I. Purpose:
1. To reduce the risk of transmission of epidemiologically important pathogens between patients, health-care employees and
others in the hospital environment and to reduce the incidence of infection among patients.
2. To contain epidemiologically important pathogens transmitted through contact by applying adequate precautions
3. To incorporate standard precautions as baseline preventive measures along with contact precautions

Application field
This policy and procedure applies in the wards.

Persons Authorized
Surgeon, medical doctor, infection control supervisor, ward supervisor, health education.

Associated Document
Infection control prevention Mr. Mohammed basil
supervisor :
Dictated By:

Clinical director Mrs. Eva

Nursing director : Mr. yahya

Approved By:

Authorization for application and dissemination for MSF staff

Date: DEC 2018

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II .Policy:

Contact transmission is the most important and frequent mode of transmission of nosocomial infections. In addition to
standard precautions, use contact precaution for specified patients, who are known or suspected to be infected, or
colonized with epidemiologically important micro-organisms that can be transmitted by direct contact with the patient
(hand or skin contact that occurs when performing patient care activities that require touching the patient’s dry skin
and wound) or indirect contact (touching) of environmental surfaces or patient care items in the patient’s
environment.

Scope
Standard precautions focus on reducing the risk of transmission of micro-organisms from recognized and
unrecognized sources of infections in patient care areas. Contact precautions are second tier precautions that should
be adopted to prevent the transmission of epidemiologically important pathogens (culture positive) such as Multi Drug
Resistant Organisms (MDRO), M RSA, ESBL and etc.

Definitions
Colonization
Microorganisms present on the host body site without evidence of infection, (fever, increased white cell count,
inflammation, and etc.)
Infection
Invasion of microorganisms into the host which survive, multiply and cause clinical signs and symptoms of disease.
Empiric contact isolation precautions
The application of precautions prior to culture confirmation is empiric isolation precautions. This applies for infected
draining wounds where the responsible organisms are not known, are without culture results

III. Procedure

Patient Placement in Contact Isolation with Multidrug Resistant Organisms (MDRO)

 The following patients will be placed in contact isolation.
o Patients with draining wounds of known or unknown organisms, patients on admission are
assumed to have potential MDRO and treated as such until cultures can be obtained. Cohorting of
patients with unknown organisms shall not occur.
o Patients with MDRO which was isolated from a wound culture.
 The physician order concerning isolation will fully describe the type of isolation and any special
considerations.
 Place the patient in a single room.
 When a private room is not available, place the patient in a room with a patient who has an active infection
with the same micro-organism but with no other infection (cohorting).and with the same sensitivity
according to culture result.
 Closed door policy shall be encouraged for all patients on contact isolation and will be required in the
following circumstances:
o Wound not well covered by dressings
o Excessive discharge where it is hard to maintain a dry dressing
o No or questionable effectiveness of antibiotic treatment

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 o All post-operative patients with a note(pus found or surgical site class 4)
o Reverse isolation such as with some burn patients, or patients with leukopenia and/or
immunosuppressed
 Patients should remain isolated for at least 2 weeks after starting antibiotics, and may be extended if there is
continued clinical signs of infection (elevated CRP, continued active pus drainage)
 Patients may be de-isolated after completing 2 weeks antibiotherapy and with closed wound, after
confirmation by Medical Activity Manager and Infection Control Nurse.
 Visitors should be limited and personal CT’s are not allowed to stay overnight in the room unless patient is a
child and/or medically indicated.
.
B. Hand Washing
 Disinfect the hands with alcohol hand rub (Manugel):
 Before contact with patient
 Before clean/aseptic
 Before clean/aseptic procedure
 After body fluid exposure risk/after removing personal protective equipment (PPE)
 After touching a patient
 After touching patient surrounding

 Regular hand washing with soap and water is advised when there is contact with blood and body fluids,
when hands are visibly dirty

C. Gown and Gloves

 Wear clean gloves (non-sterile gloves are adequate) when entering the room for having contact with the
patient or the close environment.
 Wear a disposable single use gown and gloves when entering the room before doing procedures, as well as
when you anticipate that your clothing will have substantial contact with the patient environmental surfaces,
items in the patient room, or wound drainage not contained by a dressing. Gloves are to always be worn if
using a gown is indicated.
 During the course of providing care for a patient change gloves after having contact with infective material
that may contain high concentrations of organisms from wound drainage or fecal material.
 Change gloves if it is torn.
 Remove gown and gloves before leaving the patients environment (or room) and disinfect hands with
alcohol hand rub (Manugel)
 After glove and gown removal and hand disinfection, ensure that hands do not touch potentially
contaminated environmental surfaces or items in the patient’s room to avoid the transfer of micro-organisms
to other patients or environments.
 The PPE are to be available at all times at the door step of the patient’s room.

D. Patient Transport
 If the patient is transported out of the room, ensure that precautions are maintained to minimize the risk of
transmission of micro-organisms to other patients and the contamination of environmental surfaces and
equipment.
 Limit the movement and transport of the patients from the room to essential purposes such as OT, X -Ray,
U S, O PD, physio-room, psycho-social room, external consultations and etc. Patients transported with a
wheelchair or trolley need to be covered with a clean sheet.
 Health care employees accompanying the patient have to wear PPE.

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  Mobilized patients can move in the corridors and the garden, but only if the patient has washed, the wounds
are properly dressed and with no drain. Disposable gowns do not have to be worn.
 Patients are not allowed to go to other rooms for social visits. Clean patients are not allowed to visit patients
in contact isolation.
 Patients, themselves are not allowed to take water from the shared water cooler or sink. The staff (practical
nurse) is to make sure that drinking water is available at the patient’s bedside at all times.

E. Patient Personal Hygiene

 Patients shall have daily baths either in the bathroom (shower) or assisted bed bathing done by practical
nurses.
 Patient’s oral hygiene is to be maintained daily.
 Patient’s bed linen shall be changed once a day and whenever needed, for example, when soiled with
secretions or excretions.
 Patients shall have at all times a personal hand gel disinfectant bottle, available at the bedside and shall
frequently disinfect their hands.
 Patients shall be educated about personal and environmental hygiene, contact precautions and adherence
to these precautions.

F. Patient Care Equipment

 Non-critical patient care items: urinal commodes, syringe pumps, dopplers, sphygmomanometer,
stethoscope
o Dedicate one item per patient, if possible
o If using common material among patients, clean and disinfect between patient use
o Avoid sharing items if patients are in isolation, cohort patients with the same organisms if
necessary
 Semi-critical patient care items; thermometer
o Disinfect between each patient use, preferably to have one thermometer for each patient.
 Critical patient care items: IV cannula, Foley catheters, drains, dressings
o Single use items
o Properly discard after use

G. Environmental measures
Frequently clean and disinfect all patient care areas on daily basis accordingly to cleaning schedule, starting from the
cleanest to the dirtiest.

H. Textiles and Laundry

 Don’t shake soiled laundry because this action could aerosolize infectious agents.
 Avoid contact of your body and personal clothing with the soiled items being handled.
 Contain soiled items in a laundry bag or designated bin.

I. Use of Barrier Precautions by Visitors

 Persons who are providing care or having very close patient contact (e.g. feeding, holding and etc.) could
contribute to the transmission of pathogens. They need to wear gowns when they have very close contact
with the patients. They should disinfect their hands with an alcohol hand rub before and after each contact
with the patient. They should NOT sleep in the patient’s room on a separate bed, unless. The caretaker
medically needed (authorized by Medical Director), or in case of children’s they should be instructed to not
interact with other patients.

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  Patient’s allocation in the rooms, or movement from room to another should be in consideration with the
decision of M/D and ICN.
 Health education for patients for infection control means(hand hygiene ,bathing, movement in the rooms,
and isolation precautions)will be done by health educator and/or ICN(patient briefing in the ward form)

Definitions:
Colonization:
Microorganism present on the host body site without evidence of infection (fever, increased white
blood cell count, inflammation etc.) is known as COLONIZATION.

Infection:
Invasion of microorganism into the host, survive, multiply and cause clinical signs and symptoms of
the disease is known as an INFECTION and usually requires treatment.

Donning and Removing PPE

GOWN

 Fully cover torso from neck to

knees,
Arms to end of wrist, and wrap
around the back

 Fasten in back at neck and waist

GLOVES
 Use non-sterile gloves for
contact precautions patients
 Select according to hand size
 Extend to cover wrist of
isolation gown

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 SAFE WORK PRACTICES

 Keep hands away from face

 Work from clean to dirty

 Limit surfaces touched

 Change when torn or heavily contaminated

 Perform Hand disinfection by Manugel

REMOVING PPE

GLOVES

 Outside of gloves are contaminated

 Grasp outside of gloves with opposite gloved hand:

peel off

 Hold removed glove in gloved hand

 Slide fingers of ungloved hand under remaining

glove at wrist

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 GOWN
 Gown front and sleeves are contaminated

 Unfasten neck then waist ties

 Remove gown using peeling motion: pull gown

from each shoulder toward the same hand

 Gown will turn inside out

 Hold removed gown away from body, roll into a

bundle and discard into waste receptacle

J. Removal from Contact Isolation with MDRO

1. Physician order is required for removal from contact isolation.
2. Patients under empiric contact isolation shall be removed from these precautions and placed either with
clean patients or on contact precautions according to the culture results.
3. Contact isolation shall be for a minimum of two weeks from the start of antibiotics.
4. The wound shall be closed and there be no drains or drainage.
5. A minimum of 24 hours observation period will be taken once the decision to remove from isolation is made.
K- Patients with plate, intra-medullary nail (IMN) or ORIF should not
share the same room with:
- A patient with infection or receiving antibiotic
- A patient with a wound discharging pus
- A patient with colostomy

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