CDC issues new patient isolation guidelines
It's official: 'Nosocomial' has left the building
[Editor's note: The Centers for Disease Control and Prevention has posted its long-awaited (OK, long, long-awaited) new isolation guidelines at www.cdc.gov. Look for a complete analysis of key changes and additions along with ICP comments and reactions in a special report in the next issue of Hospital Infection Control. For immediate reference, the executive summary of the guidelines is summarized below.]
The "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007" updates and expands the "1996 Guideline for Isolation Precautions in Hospitals." The document's executive summary notes that the following developments led to revision of the 1996 guideline:
- The transition of health care delivery from primarily acute care hospitals to other health care settings (e.g., home care, ambulatory care, free-standing specialty care sites, long-term care) created a need for recommendations that can be applied in all health care settings using common principles of infection control practice, yet can be modified to reflect setting-specific needs. Accordingly, the revised guideline addresses the spectrum of health care delivery settings. Furthermore, the term "nosocomial infections" is replaced by "health care-associated infections" (HAIs) to reflect the changing patterns in health care delivery and difficulty in determining the geographic site of exposure to an infectious agent and/or acquisition of infection.
- The emergence of new pathogens (e.g., SARS-CoV associated with the severe acute respiratory syndrome [SARS], avian influenza in humans), renewed concern for evolving known pathogens (e.g., C. difficile, noroviruses, community-associated MRSA [CA-MRSA]), development of new therapies (e.g., gene therapy), and increasing concern for the threat of bioweapons attacks, established a need to address a broader scope of issues than in previous isolation guidelines.
- The successful experience with Standard Precautions, first recommended in the 1996 guideline, has led to a reaffirmation of this approach as the foundation for preventing transmission of infectious agents in all health care settings. New additions to the recommendations for Standard Precautions are Respiratory Hygiene/Cough Etiquette and safe injection practices, including the use of a mask when performing certain high-risk, prolonged procedures involving spinal canal punctures (e.g., myelography, epidural anesthesia). The need for a recommendation for Respiratory Hygiene/Cough Etiquette grew out of observations during the SARS outbreaks where failure to implement simple source control measures with patients, visitors, and health care personnel with respiratory symptoms may have contributed to SARS coronavirus (SARS-CoV) transmission. The recommended practices have a strong evidence base. The continued occurrence of outbreaks of hepatitis B and hepatitis C viruses in ambulatory settings indicated a need to reiterate safe injection practice recommendations as part of Standard Precautions. The addition of a mask for certain spinal injections grew from recent evidence of an associated risk for developing meningitis caused by respiratory flora.
- The accumulated evidence that environmental controls decrease the risk of life-threatening fungal infections in the most severely immunocompromised patients (allogeneic hematopoietic stem cell transplant patients) led to the update on the components of the Protective Environment (PE).
- Evidence that organizational characteristics (e.g., nurse staffing levels and composition, establishment of a safety culture) influence health care personnel adherence to recommended infection control practices, and therefore are important factors in preventing transmission of infectious agents, led to a new emphasis and recommendations for administrative involvement in the development and support of infection control programs.
- Continued increase in the incidence of HAIs caused by multidrug-resistant organisms (MDROs) in all health care settings and the expanded body of knowledge concerning prevention of transmission of MDROs created a need for more specific recommendations for surveillance and control of these pathogens that would be practical and effective in various types of health care settings.
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