What infection control measures are required for patients with the following conditions admitted to the ICU? Justify your answers.
a) Neutropenic sepsis
This patient requires standard precautions in the ICU. These include:
• Handwashing before and after every patient contact
• Gloves, gown, eye protection on direct patient bedside care
• Use of above when removing soiled linen and clothing
HOWEVER the patient is at risk from staff and other patients. Consider
Positive pressure room.
Isolation away from overtly infected patients or visitors especially children,
Limiting staff contact. (e.g. limiting number of bedside ward rounds or staff entering room)
b) Neisseria meningitidis
Infection control is required to address droplet precautions. In addition to standard precautions:
• Private room preferred, cohort if necessary
• Wearing of a mask (normal surgical mask OK) within 1m of patient.
• Mask of patient (normal surgical mask OK) during transport (although keep transport of patient to a minimum.)
• Limitation of staff to high-risk procedures e.g. intubation.
• Notifiable disease to public health.
• Contact tracing and prophylaxis
c) SARS,
Infection control is targeted to address airborne routes of transmission In addition to standard precautions:
• Negative pressure room with room exhaust filtration.
• Use of an airborne filtering mask (N95) not just a surgical mask on entering room
• Patient N95 masked on transport (minimize transport)
• Notifiable disease to public health.
• Contact tracing and isolation.
d) Norovirus.
Norovirus is a highly infectious virus
It is spread predominantly via the fecal oral route AND via airborne route.
It is able to exist on environmental surfaces for weeks and contact precautions are essential. Infection control measures are required to manage these two routes.
Standard precautions include:
• Handwashing HOWEVER norovirus has no lipid capsule therefore alcohol-based rubs are not recommended. Soap and water especially if hands visibly contaminated.
Contact precautions in addition to above-
• Private room and cohorting of multiple cases if necessary.
• Gloves on entering room and changing after contact with contaminated secretions
• Gown on entering room in case of touching environmental surfaces as well as patient
• Minimize patient transport around hospital unless necessary.
• Use of dedicated non-essential equipment. I.e. stethoscopes.
• Limitation of staff to high-risk procedures i.e. intubation.
• Notifiable disease to public health.
• Contact tracing and isolation.
AND managing airborne routes with an N95 mask for staff especially with active vomiting or high-risk procedures such as intubation. Similar to SARS.
This question could very well have been worded, "describe what is meant by standard precautions, contact precautions, droplet precautions and airborne precautions". The examiners gave scenarios which are essentially and example of each barrier method.
Neutropenic patients require reverse barrier protective measures:
Neisseria meningitidis: From the NSW Health page on Meningococcal disease:
SARS: From the NSW Health page on SARS coronavirus (SARS-CoV)
Norovirus:
Eggimann, Philippe, and Didier Pittet. "Infection control in the ICU." Chest 120.6 (2001): 2059-2093.
CDC Guidelines for Isolation Precautions
NSW Health PHU disease control guidelines