Isolation-Task

Task items replaced iTISS as a sampler of specific "nursing workload" items that the medicine program continues to track as QA indicators.

PDF of Hospital Policy Manual for Infection Control

Only mark a task as performed if it was done during a patients stay on your ward. If a task was done prior to patient coming to your ward or after patient is transferred to another ward, it should be marked as no or none during the stay on your ward.

These items are included in: S_AllDiagnoses table which is in CCMDB.mdb.

Isolation Task

Possible entries for Isolation task:

• 100500 - Isolation None (If no isolation is charted', or only a mask was required, collect it as none)
• 100501 - Isolation Total (gloves,gown,masks) (gloves, gown, mask);hence, there should only be a few patients with this task marked
• 100502 - Isolation (gloves and gown)

Collection Rationale

• This element is collected not only for nursing work load but also as a quality indicator to facilitate future work on infection control.

• We decided not to code mask only isolation because it is both very common, doesn't relevantly correlate with anything, and takes very little time.

Date Glove and Gown added

options changed June 5.09--TOstryzniuk 17:35, 5 June 2009 (CDT))

• use to only collect total isolation (Glove, gown, mask)prior to this date therefore very few marked with this task.

Test data

see Test data

Data Integrity Rules

Since we are coding what is actually charted, no integrity checks can be done on this. However, it would be interesting to run a report on the corellation between diagnoses and the charting of isolation sometime to see what it shows.

MSRA VRE

• Contact Precautions: Glove and Gown

Reason why MSRA or VRE patient may not be on isolation

1. Awaiting results takes 2 – 3 days. In the interim, the patient would not be known to be positive for VRE or MRSA and would not be on Contact Precautions. Could of been discharged or transfered out of ward before +ve results obtained.
2. VRE Modified (Alert) may be considered if a VRE +ve patient does not have loose stool, diarrhea, fecal/urinary incontinence, VRE infection and is capable of practicing good hand hygiene. This is done in consultation with IP & C, in which case, the patient is monitored for continued ability to meet the criteria. These patients may be managed on Routine Practices, not Contact Precautions.
3. If a staff member is performing a task which they do not anticipate contact with the VRE, or MSRA +ve patient or their environment a gown is not required. Because this includes most care, gowns are normally worn for care of patients on Contact Precautions. Strictly speaking, according to Infectious Disease's IP & C Manual, they are only required:

• if clothing or forearms will have direct contact with the patient
• if it is anticipated clothing or forearms will be in direct contact with frequently touched environmental surfaces or objects, and there is an increased risk of the environment being contaminated

Site comments

• • HSC-H4 - Yes I have had admissions that had swabs taken during their stay on the unit and then were found to be MRSA or VRE positive but got transfered before isolation was established. Gail Hall
  • On my 2 units @HSC B3&D5 MRSA will always be isolated, VRE will be isolated if the pt is having diarrhea and is confused, but if the pt is Oriented x3 and up and about and no isolation rooms around they will not isolate and ID is ok with this--PStein 07:48, 20 October 2010 (CDT)
  • HSC A4 isolates these patients (glove & gown). If they are up & about they wear isolation gowns & gloves themselves.--CMarks 08:05, 20 October 2010 (CDT)
  • STB.5B will always isolate MRSA and VRE +ve.
  • STB E6 does not isolate if...Patient Alert and oriented 3 and ad lib., or both patients in the room are +ve. Sometimes task is missed for gown and glove as culture results are not back before the patient is discharged/transfered. Lack of isolation carts in the hallway and a list of isolation patients does not help.ENagy 13:01, 20 October 2010 (CDT)
  • SBGH E5 According to the crn on my ward, there is not a simple answer to the question. In regards to isolating MRSA or VRE positive patients, each case on this ward is determined with infection control input. If they are culture proven positive, they are generally put on "contact" precautions. Having said that, there are many factors that they consider when deciding whether or not to isolate someone. Some of those factors are strain of MRSA/VRE, whether or not they are going to be eradicated, and whether they are culture positive, or just suspect. The short answer would be, not every MRSA/VRE positive patient is put on isolation.DPageNewton
  • HSC D4 - Does gown and glove isolation for MRSA and VRE, so I mark this isolation all the time--FLindell 14:37, 20 October 2010 (CDT)

Template:Discussion

• Just to clarify - the table attached below are the frequency for HSC only. In 2007 and 2008, we are only collecting TOTAL Isolation, is 3 out of 159 cases in 2007 and 1 out of 163 cases in 2008 be possible? I find it really very very low. Before 2007, when we have the ITISS form, total isolation cases were 52, 87 and 48 respectively in 2004, 2005 and 2006. There is a study which aims to find if isolation at HSC is effective in reducing the risk of infection specifically MRSA/VRE - can the database helps in answering the goal of this study with the data we have? What are the other diagnoses that requires isolation? I would really like to have a data quality check for isolation (i.e. able to distinguish the missed entry from incorrect value). JMojica 10:31, 26 October 2010 (CDT)

Year	Number of MRSA or VRE +ve in Admit or acquired DX	Number with task- Isolation (glove, gown) marked	Comments
2007-HSC	159	3
2008-HSC	163	1
2009-HSC	234	119		Glove and gown added to task on June 5. 2009. Prior to this only TOTAL isolation task item was available.
2010-HSC	271	239

Tuberculosis-Isolation

• Airborne Precautions

For patients with suspect /confirmed Infectious TB they are placed in AIIR (Airborne Infection Isolation Room) on Airborne precautions until they are no longer considered infectious.

• • For anyone entering the room they are required to wear an N-95 mask.
  • If the patient leaves the AIIR they are required to wear a procedure mask.
  • No gloves or gown is required.

• Patients are no longer considered infectious if:
  • An alternate diagnosis is made based on mircobiology results, radiological results and patient presentation.
  • Patient was smear negative at time of diagnosis and has completed 14 days of anti-tuberculin medication,
  • Patient was smear positive at diagnosis, has completed 14 days of anti-tuberculin medication and has converted to smear negative.--Information provided by Infection Disease team, TB ICP (infection control program).--TOstryzniuk 17:31, 8 November 2010 (CST)