Infection Control - inpatient isolation precautions
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Isolation precautions for inpatients with Cystic Fibrosis (CF)
Children and young people with CF should be admitted to a single room. Only people with CF who live in the same household may share a hospital room. If a single room is not possible there should be no more than one child or young person with CF in each shared room. Roommates should be selected carefully to ensure that risk of exposure to respiratory infections is low.
Children and young people with CF should also be separated from those with non-CF bronchiectasis / chronic cough/respiratory infections.
All children and young people with CF should have an identified toilet/bathroom on the ward that other patients with CF do not use.
Children and young people with CF on ward at the same time should not be looked after by the same nurse. Contact Precautions will be necessary for patients if this is not possible.
Children and young people with CF should be discouraged from waiting around in corridors on the ward and/or sitting or waiting around the nurse's station, including during the evenings.
To prevent transmissible pathogens occurring between children and young people with CF, healthcare workers should observe an appropriate combination of practices (e.g. hand hygiene and disinfection) and barrier precautions (e.g. gown, mask, gloves) based on the anticipated exposure when they care for a patient.
Masks should be worn, as follows:
- Surgical masks (or mask as per local hospital policy) are to be worn by healthcare personnel caring for any patient under Droplet Precaution with suspected or confirmed pathogens that are transmitted by the droplet route (e.g. adenovirus, rhinovirus, influenza virus or Mycoplasma pneumonia)
- Masks and eye protection should be worn by healthcare personnel if splashes or sprays of respiratory tract secretions are anticipated as per Standard Precautions.
- It is recommended that all people with CF, while in hospital, perform all respiratory interventions (e.g. nebulisers, airway clearance, and collection of respiratory tract cultures) in the patient's room. If 2 people with CF who live in the same house are sharing a room, these procedures should be performed when the second person is not in the room, whenever possible.
There should be rigid adherence to infection control policies by physiotherapists when carrying out airway clearance:
- Physiotherapists should have access to records of individual's microbiological status.
- If more than one child or young person with CF on the ward, then they should be seen in order of least risk → highest risk of transmission/resistance (E.g. those with multi-resistant bacteria, MRSA or B. cepacia complex seen last).
- Physiotherapists should take all reasonable precautions to reduce the risk of cross-infection - rigorous hand hygiene, wearing of single-use long-sleeved wrap-around gowns and decontamination of pulse oximeters and exercise equipment between patients.
It is recommended that people with CF are evaluated on a case-by-case basis for participation in activities outside their hospital room (e.g. going to the play/activity room, physiotherapy department, or school room) only when no other person with CF is present and under the supervision of a trained staff member.
Considerations include the capability of a person with CF to contain his or her respiratory tract secretions, age, pathogens, and adherence to the following practices:
- Perform hand hygiene and put on a mask immediately before leaving hospital room
- After a person with CF has left the hospital play/activity/school room, clean surfaces and touched items with hospital standard disinfectant/detergent.
If the child is coughing/expectorating copious secretions there may be significant contamination of the environment. Consideration should then be given to providing activities in the child's room. Children or young people with MRSA and/or B. cepacia complex should not use shared play/activity or school rooms.
- Cystic Fibrosis, Australia (2012). Infection Control Guidelines for Cystic Fibrosis Patients and Carers. Available from: http://www.cysticfibrosis.org.au/media/wysiwyg/CFAustralia/PDF_files/02_CFA_InfectionControlGuidelines_LowRez.pdf
- Cystic Fibrosis Foundation Guideline (2014). Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update. Available from: http://www.jstor.org/stable/10.1086/676882?origin=JSTOR-pdf
- Royal Brompton & Harefield, NHS Foundation Trust (2014). Clinical Guidelines: Care of Children with Cystic Fibrosis. Available from: www.rbht.nhs.uk/childrencf
Information last reviewed: October 2016
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