Isolation-Task

Legacy Content

This page contains Legacy Content.

• Explanation: discontinued as part of move to ICD10/CCI.
• Successor: Isolation, infectious

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The Isolation task encodes whether or not a medicine patient was in isolation. It is stored in the Diagnosis tab in CCMDB.accdb because that is the only way we could store it when we started to collect it.

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.

PDF of Hospital Policy Manual for Infection Control

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) - Referred to as Contact and Airborne precautions. There should only be a few patients with this task marked
• 100502 - Isolation (gloves and gown) - Referred to as Contact Precautions.

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.

Possible change

Dr Garland confirmed with both Dr Hajidiacos for Medicine and Dr Paunovic for Critical Care that this data is not really needed. We need to discuss whether collection should continue. Furthermore, after talking to MA Lynch, we will continue to collect isolation, BUT we'll do away with the different subsets of it and it'll be just Y or N, and Yes will include ANY/ALL types of isolation to include: gloves only, glove+gown, negative pressure room, etc

• In new system we'll code this as 1 thing, in CCI using Isolation, infectious
• emailed Trish to find out when and how to make the change. Ttenbergen 13:46, 2018 May 8 (CDT)

Date Glove and Gown added

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

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

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.

MRSA or VRE Isolation

• 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. Elaine Nagy 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)

other reasons for isolation

• 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)
  • did we ever address this? Should it be fanned out to collectors? Is the question still relevant? Ttenbergen 18:22, 2012 September 6 (CDT) Ttenbergen 17:36, 2014 October 2 (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

Pulmonary Tuberculosis-Isolation

Airborne Precautions - No gloves or gown is required.

• Accommodation
  • For patients with suspect /confirmed Infectious TB they are placed in Single room with negative pressure ventilation in relation to surrounding area,(AIIR (Airborne Infection Isolation Room))until they are no longer considered infectious.
  • NOTE: When a negative pressure isolation room is not available, or in the event of an outbreak or exposure where large numbers of patients require Airborne Precautions, consult Infection Prevention and Control before patient placement to determine room placement and/or cohorting of patients.
  • 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.

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 & Prevention program).--TOstryzniuk 17:31, 8 November 2010 (CST)

Data Structure

the list of options is in s_AllDiagnoses table and the actual data is stored in L_Dxs.

Legacy

Task items replaced iTISS December 15, 2006.