Wednesday, October 19, 2011


The most important defense against nosocomial transmission of viruses and other infectious agents is continuous education of staff and strict adherence to infection control policies. The doctor, nurse, or medical student, who may have rapid contact with a succession of patients of varying degrees of vulnerability, provides a vector to virus carriage and transmission. All involved in patient care should be aware of the following (Aitken and Jeffries, 2001):
- The potential dangers to patients of continuing to work while suffering form a respiratory infection, cold sores, or other viral disease.
- Adequate hand washing after examining every patient must be emphasized.
- As must the potential risks to the workers, and patients, of breaks in hygienic practice such as eating, drinking, smoking, applying cosmotics, or inserting contact lenses in clinical or laboratory areas and from touching their mouth or eyes during the course of work.
- All health care workers should have an access to an employee health (occupational health) department or infection control nurse in addition to immediate access to a clinical virologist or microbiologist to provide advice and emergency coverage after normal working hours.
- By providing this infrastructure, the immune states of employees can be checked and when appropriate, supplemented by Immunization.
- In addition, specific advice in emergency situations e.g., recommendations for postexposure prophylaxis, can be provided, as well as specialist advice on individual patient management in controlling nosocomial infections.

In most hospitals, the committee directs the infection control activities are already responsible for other hospital functions; usually do not have the time or the skill to perform the day-to-day duties of infection control. In the 1960s, infection control programs were begun in U.S. hospitals, the infection control practitioner (ICP), was introduced; include nurses, medical technologists or respiratory therapists. Physician hospital epidemiologists, who serve as medical directors of the infection control program, particularly in larger hospitals, are growing in number and have their own professional organization. To be effective, nosocomial infection programs must include the following (i) organized surveillance and control activities, (ii) adequate number of trained infection control staff.
General Isolation Precaution Guidelines for Hospital
The isolation guidelines issued by CDC involve a two-level approach: Standard Precautions, which apply to all clients and patients attending healthcare facilities, and Transmission-Based Precautions, which apply to hospitalized patients. There are three sets of Transmission-Based Precautions (air, droplet or contact). In all situations, whether used alone or in combination, Transmission-Based Precautions must be used in conjunction with the Standard Precautions (Garner and HICPAC, 1996).

Airborne Precautions
Table 4 : Airborne Precautions
Used in addition to Standard Precautions for a patient known or suspected to be infected with microorganisms transmitted by the airborne route.
• Private room.
• Door closed.
• Room air is exhausted to the outside (negative air pressure) using fan or other filteration system.
• If private room not available, place patient in room with patient having active infection with the same disease, but with no other infection (cohorting).
• Check all visitors for susceptibility before allowing them to visit.
• Wear surgical mask.
• If TB known or suspected, wear particulate respirator if available
• If chicken pox or measles:
- Immune persons—no mask required.
- Susceptible persons—do not enter room.
• Remove mask after leaving the room and place in a plastic bag or waste container with tight-fitting lid.
• Limit transport of patient to essential purposes only.
• During transport, patient must wear surgical mask.
• Notify area receiving patient.
ETNA Communications, 2000
These precautions are designed to reduce the nosocomial transmission of 5 µm particles or less that can remain in the air for several hours and be widely dispersed. Microorganisms spread wholly or partly by the airborne route e.g. tuberculosis, chicken pox, measles.
Droplet Precautions
These precautions reduce the risks for nosocomial transmission of pathogens spread wholly or partly by droplets larger than 5 µm e.g. Influenza, Mumps and Rubella viruses (Table 5). The droplets remain in the air only for a short time and travel only a few feet; therefore, contact with the source must be close for a susceptible host to become infected.
Contact Precautions
These precautions reduce the transmission of organisms from infected patient through direct contact with the patient or indirect contact with environmental surfaces or patient care items (Table 6) e.g., HAV, herpes simplex, herpes zoster and hemorrhagic fever viruses.

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