Healthcare-Associated Infections _ ______________________________________________________________
TYPE AND DURATION OF PRECAUTIONS REQUIRED FOR INFECTIONS WITH POTENTIAL FOR OUTBREAKS (Continued)
Infection/Condition Precaution Type Precaution Duration Notes Tuberculosis, pulmonary or laryngeal disease (confirmed) Airborne —
Only when therapy is effective, patient is clinically improving, and the cultures of 3 consecutive sputum smears, collected on different days, are negative
Tuberculosis, pulmonary or laryngeal disease (suspected)
Airborne
Only when the likelihood of infectious disease is negligible and the cultures of 3 consecutive sputum smears, collected on different days, are negative
—
Tuberculosis, latent (skin-test positive with no evidence of current pulmonary disease)
Standard
Ongoing
—
Varicella zoster (chickenpox)
Airborne, Contact
Until all lesions are crusted (10 to 21 days) Susceptible healthcare staff should not enter the room if immune caregivers are available.
Whooping cough (pertussis)
Droplet, Standard
Until 5 days after initiation of effective therapy
—
Source: [25; 339]
Table 21
Legionella The source of HAI with Legionella pneumonia is usually con- taminated water [89]. Implementation of Standard Precautions for the patient is sufficient [25]. Laboratory-based surveillance for nosocomial Legionella should be performed, and samples of tap water should be obtained for culture. If the culture is positive, it is best to obtain cultures from patients who have healthcare-associated pneumonia. There are more than 40 known types of Legionella species, but most outbreaks are caused by Legionella pneumophila serotypes 1 and 6. Antibiotic-Resistant Micro-Organisms Outbreaks of antibiotic resistance have involved MRSA, VRE, and, most recently, vancomycin-resistant S. aureus [344]. In such outbreaks, it is important to identify patients with colo- nization or infection early and isolate them or cohort them. Contact Precautions should be implemented and carried out until antibiotic therapy has been completed and cultures are negative [25]. The importance of adhering to proper hand hygiene and other elements of Contact Precautions should be emphasized. Healthcare workers who were involved with patients before isolation should be evaluated for colonization and infection and treated appropriately.
Potential Outbreaks The following are overviews of selected potential outbreaks. Identification and early action in the case of any of these outbreaks will limit the adverse effects. Group A Streptococci Most outbreaks of group A streptococci involve surgical wounds, and the source can usually be traced to an asymptom- atic carrier in the operating room or on the wound care team [89; 342]. Standard Precautions are sufficient if the wound is minor; if it is major, Contact Precautions should be instituted and followed for 24 hours after initiation of effective therapy [25]. The healthcare worker should receive antimicrobial therapy as appropriate and leave the setting until completion of therapy. Pulmonary Tuberculosis Dealing with pulmonary tuberculosis involves prompt iden- tification of the disease and determining the susceptible individuals who were exposed to the patient before isolation [89]. Airborne Precautions should be instituted and remain in place until the patient is receiving effective therapy, is improv- ing clinically, and the culture results for three consecutive sputum specimens, collected on different days, are negative. Comprehensive information is available in the CDC guidelines for preventing the transmission of tuberculosis in healthcare facilities [343].
114
EliteLearning.com/Dental
Powered by FlippingBook