Guideline for isolation precautions preventing transmission of infectious agents in healthcare settings, 2007

Jane D. Siegel, Emily Rhinehart, Marguerite Jackson, Linda Chiarello; the Healthcare Infection Control Practices Advisory Committee.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 following developments led to revision of the 1996 guideline: 1. The transition of healthcare delivery from primarily acute care hospitals to other healthcare 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 healthcare 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 healthcare delivery settings. Furthermore, the term \u201cnosocomial infections\u201c is replaced by \u201chealthcare associated infections\u201d (HAIs) to reflect the changing patterns in healthcare delivery and difficulty in determining the geographic site of exposure to an infectious agent and/or acquisition of infection. 2. 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. 3. 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 healthcare 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 healthcare 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 re-iterate 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. 4. 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). 5. Evidence that organizational characteristics (e.g., nurse staffing levels and composition, establishment of a safety culture) influence healthcare 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. 6. Continued increase in the incidence of HAIs caused by multidrug-resistant organisms (MDROs) in all healthcare 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 healthcare settings.This document is intended for use by infection control staff, healthcare epidemiologists, healthcare administrators, nurses, other healthcare providers, and persons responsible for developing, implementing, and evaluating infection control programs for healthcare settings across the continuum of care. The reader is referred to other guidelines and websites for more detailed information and for recommendations concerning specialized infection control problems.Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007.Infectious DiseasePrevention and ControlSupersededHICPACEBeltrami/JHageman\u200eMarch \u200e26, \u200e2014

Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)

Since 1989, a rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) has been reported by U.S. hospitals. This increase poses important problems, including a) the lack of available antimicrobial therapy for VRE infections, because most VRE are also resistant to drugs previously used to treat such infections (e.g., aminoglycosides and ampicillin), and b) the possibility that the vancomycin-resistant genes present in VRE can be transferred to other gram-positive microorganisms (e.g., Staphylococcus aureus). An increased risk for VRE infection and colonization has been associated with previous vancomycin and/or multiantimicrobial therapy, severe underlying disease or immunosuppression, and intraabdominal surgery. Because enterococci can be found in the normal gastrointestinal and female genital tracts, most enterococcal infections have been attributed to endogenous sources within the individual patient. However, recent reports of outbreaks and endemic infections caused by enterococci, including VRE, have indicated that patient-to-patient transmission of the microorganisms can occur either through direct contact or through indirect contact via a) the hands of personnel or b) contaminated patient-care equipment or environmental surfaces. This report presents recommendations of the Hospital Infection Control Practices Advisory Committee for preventing and controlling the spread of vancomycin resistance, with a special focus on VRE. Preventing and controlling the spread of vancomycin resistance will require coordinated, concerted efforts from all involved hospital departments and can be achieved only if each of the following elements is addressed: a) prudent vancomycin use by clinicians, b) education of hospital staff regarding the problem of vancomycin resistance, c) early detection and prompt reporting of vancomycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and d) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE.September 22, 1995.These guidelines were prepared for publication by the following CDC staff: Ofelia C. Tablan, Fred C. Tenover, William J. Martone, Robert P. Gaynes, William R. Jarvis, Martin S. Favero, J. Shaw, Hospital Infections Program, National Center for Infectious Diseases in collaboration with the Subcommittee on Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals .Includes bibliographical references (p. 10-13)

Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. [pt. II-III

"This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided." - p. 1"This report consists of Parts II and III of a three-part document and contains the consensus HICPAC recommendations for the prevention of the following infections: bacterial pneumonia, Legionnaires disease, pertussis, invasive pulmonary aspergillosis (IPA), lower respiratory tract infections caused by RSV, parainfluenza and adenoviruses, and influenza. Part III provides suggested performance indicators to assist infection-control personnel in monitoring the implementation of the guideline recommendations in their facilities. Part I of the guideline provides the background for the recommendations and includes a discussion of the epidemiology, diagnosis, pathogenesis, modes of transmission, and prevention and control of the infections. Part I can be an important resource for educating health-care personnel. Because education of health-care personnel is the cornerstone of an effective infection-control program, health-care agencies should give high priority to continuing infection-control education programs for their staff members." - p. 2Introduction -- Key Terms Used In the Guideline -- Abbreviations Used In the Guideline -- -- [Part II]: Categorization of Recommendations -- Prevention of Health-Care-Associated Bacterial Pneumonia -- Prevention and Control of Health-Care-Associated Legionnaires Disease -- Prevention and Control of Health-Care-Associated Pertussis -- Prevention and Control of Health-Care-Associated Pulmonary Aspergillosis -- Prevention and Control of Health-Care-Associated Respiratory Syncytial Virus, Parainfluenza Virus, and Adenovirus Infections -- Prevention and Control of Health-Care-Associated Influenza -- Severe Acute Respiratory Syndrome -- Part III: Performance Indicators -- Referencesprepared by Ofelia C. Tablan, Larry J. Anderson, Richard Besser, Carolyn Bridges, Rana Hajjeh.Parts 2 and 3 of a larger (179 p.) work with the same title, published on the Web at: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/CDCpneumo%5Fguidelines.pdf."March 26, 2004."Cover title."The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Division of Healthcare Quality Promotion, Denise M. Cardo, M.D., Director, and the Division of Bacterial and Mycotic Diseases, Mitchell L. Cohen, M.D., Director."Also available via the World Wide Web.Includes bibliographical references (p. 23-35)

Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/ODSS Hand Hygiene Task Force

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.prepared by John M. Boyce, Didier Pittet."October 25, 2002.""The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Director; and the Division of Healthcare Quality Promotion, Steve Solomon, M.D., Acting Director." - p. 1Published also as: American journal of infection control, v. 30, no. 8, suppl 1; and in: Infection control and hospital epidemiology, v. 23, no. 12, suppl.Title from title.Includes bibliographical references (p. 34-44)

Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

Introduction -- Key Terms Used In the Guideline -- Abbreviations Used In the Guideline -- -- Part I. Background -- Health-care-associated bacterial pneumonia -- Health-care-associated legionnaires disease -- Health-care-associated pertussis -- Health-care-associated aspergillosis -- Health-care-associated viral infections -- Health-care-associated respiratory syncytial virus infection -- Health-care-associated parainfluenza infection -- Health-care-associated adenovirus infection -- Health-care-associated influenza -- Severe acute respiratory syndrome -- -- [Part II]: Categorization of Recommendations -- Prevention of Health-Care-Associated Bacterial Pneumonia -- Prevention and Control of Health-Care-Associated Legionnaires Disease -- Prevention and Control of Health-Care-Associated Pertussis -- Prevention and Control of Health-Care-Associated Pulmonary Aspergillosis -- Prevention and Control of Health-Care-Associated Respiratory Syncytial Virus, Parainfluenza Virus, and Adenovirus Infections -- Prevention and Control of Health-Care-Associated Influenza -- Severe Acute Respiratory Syndrome -- Part III: Performance Indicators -- Referencesprepared by Ofelia C. Tablan, Larry J. Anderson, Richard Besser, Carolyn Bridges, Rana Hajjeh.Title from title screen (viewed Aug. 14, 2006).Parts II and III also published as:MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports ; v. 53, no. RR-3. March 16, 2004."The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Division of Healthcare Quality Promotion, Denise M. Cardo, M.D., Director, and the Division of Bacterial and Mycotic Diseases, Mitchell L. Cohen, M.D., Director."System requirements: Adobe Acrobat Reader.Mode of access: Internet from the CDC web site. Address as of 08/14/06: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/CDCpneumo%5Fguidelines.pdfElectronic book.Includes bibliographical references (p. 96-178)

Cloxacillin versus vancomycin for presumed late-onset sepsis in the Neonatal Intensive Care Unit and the impact upon outcome of coagulase negative staphylococcal bacteremia: a retrospective cohort study

BACKGROUND: Coagulase negative staphylococcus (CONS) is the main cause of late-onset sepsis in Neonatal Intensive Care Units (NICU). Although CONS rarely causes fulminant sepsis, vancomycin is frequently used as empiric therapy. Indiscriminate use of vancomycin has been linked to the emergence of vancomycin resistant organisms. The objective of this study was to compare duration of CONS sepsis and mortality before and after implementation of a policy of selective vancomycin use and compare use of vancomycin between the 2 time periods. METHODS: A retrospective study was conducted of infants ≥4 days old, experiencing signs of sepsis with a first positive blood culture for CONS, during two 12-month periods. Late-onset sepsis was treated empirically with vancomycin and gentamicin during period 1, and cloxacillin and gentamicin during period 2. The confidence interval method was used to assess non-inferiority of the outcomes between the two study groups. RESULTS: There were 45 episodes of CONS sepsis during period 1 and 37 during period 2. Duration of sepsis was similar between periods (hazard ratio of 1.00, 95%CI: 0.64, 1.57). One death during period 2 was possibly related to CONS sepsis versus none in period 1. Vancomycin was used in 97.8% of episodes in period 1 versus 81.1% of episodes in period 2. CONCLUSION: Although we failed to show non-inferiority of duration of sepsis in the cloxacillin and gentamicin group compared to the vancomycin and gentamicin group, duration of sepsis was clinically similar. Restricting vancomycin for confirmed cases of CONS sepsis resistant to oxacillin appears effective and safe, and significantly reduces vancomycin use in the NICU

Nasal decontamination for the prevention of surgical site infection in Staphylococcus aureus carriers (Protocol)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are S aureus carriers undergoing surgery, treated in any setting

Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP)

"This report summarizes recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning influenza vaccination of health-care personnel (HCP) in the United States. These recommendations apply to HCP in acute care hospitals, nursing homes, skilled nursing facilities, physician's offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. The recommendations are targeted at health-care facility administrators, infection-control professionals, and occupational health professionals responsible for influenza vaccination programs and influenza infection-control programs in their institutions. HICPAC and ACIP recommend that all HCP be vaccinated annually against influenza. Facilities that employ HCP are strongly encouraged to provide vaccine to their staff by using evidence-based approaches that maximize vaccination rates- p. 1Introduction -- Summary Recommendations -- Background -- Transmission of Influenza in Health-Care Settings -- Strategies for Improving HCP Vaccination Rates -- Recommendations for Using Inactivated Influenza Vaccine and LAIV Among HCP -- Recommendations for Prioritization of Influenza Vaccination During the 2005-06 Influenza Season -- Side Effects and Adverse Reactions Associated with Vaccination -- Additional Information Regarding Influenza Infection Control in Health-Care Settings -- Referencesprepared by Michele L. Pearson, Carolyn B. Bridges, Scott A. Harper."February 24, 2006."Cover title.The material in this report originated in the National Center for Infectious Diseases, Rima F. Khabbaz, MD, Director; Division of Healthcare Quality Promotion, Denise M. Cardo, MD, Director; Division of Viral and Rickettsial Diseases, Steve Monroe, PhD, Acting Director; and National Immunization Program, Anne Schuchat, MD, Director; Epidemiology and Surveillance Division, Alison Mawle, PhD, Acting DirectorAlso available via the World Wide Web.Includes bibliographical references (p. 12-15)

Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee

"Embargoed until Monday, February 28, 2005 at 12:30 pm."Since 2002, 4 states have enacted legislation that requires health care organizations to publicly disclose health care-associated infection (HAI) rates. Similar legislative efforts are underway in several other states. Advocates of mandatory public reporting of HAIs believe that making such information publicly available will enable consumers to make more informed choices about their health care and improve overall health care quality by reducing HAIs. Further, they believe that patients have a right to know this information. However, others have expressed concern that the reliability of public reporting systems may be compromised by institutional variability in the definitions used for HAIs, or in the methods and resources used to identify HAIs. Presently, there is insufficient evidence on the merits and limitations of an HAI public reporting system. Therefore, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has not recommended for or against mandatory public reporting of HAI rates. However, HICPAC has developed this guidance document based on established principles for public health and HAI reporting systems. This document is intended to assist policymakers, program planners, consumer advocacy organizations, and others tasked with designing and implementing public reporting systems for HAIs. The document provides a framework for legislators, but does not provide model legislation. HICPAC recommends that persons who design and implement such systems 1) use established public health surveillance methods when designing and implementing mandatory HAI reporting systems; 2) create multidisciplinary advisory panels, including persons with expertise in the prevention and control of HAIs, to monitor the planning and oversight of HAI public reporting systems; 3) choose appropriate process and outcome measures based on facility type and phase in measures to allow time for facilities to adapt and to permit ongoing evaluation of data validity; and 4) provide regular and confidential feedback of performance data to healthcare providers. Specifically, HICPAC recommends that states establishing public reporting systems for HAIs select one or more of the following process or outcome measures as appropriate for hospitals or long-term care facilities in their jurisdictions: 1) central-line insertion practices; 2) surgical antimicrobial prophylaxis; 3) influenza vaccination coverage among patients and healthcare personnel; 4) central line-associated bloodstream infections; and 5) surgical site infections following selected operations. HICPAC will update these recommendations as more research and experience become available.Also published as: McKibben L, Horan T, Tokars JI, Fowler G, Cardo DM, Pearson ML, Brennan PJ. Guidance on public reporting of healthcare-associated infections: recommendations of the healthcare infection control practices advisory committee. Infect Control Hosp Epidemiol. 2005 Jun;26(6):580-7.Includes bibliographical references (p. 28-30).1587701