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<td height="30px"><span class="title"><a name="h1" id="h1"></a>Development of Models for Emergency Preparedness </span></td>
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<td><div id="centerContent"><p><strong>Public Health Emergency Preparedness</strong></p> <div class="headnote">
<p>This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.</p>
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<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
<h3>Table 1. CDC Hospital Infection Control Practices
Advisory Committee (HICPAC) Recommendations Related to Standard
and Transmission-based Infection Control Practices</h3>
<p><strong>Recommendations</strong></p>
<p>The recommendations are limited to the topic of isolation precautions.
Therefore, they must be supplemented by hospital policies and
procedures for other aspects of infection and environmental control,
occupational health, administrative and legal issues, and other
issues beyond the scope of this guideline.<2E> The
recommendations presented below are categorized as follows:</p>
<ul>
<li> <strong>Category IA.</strong> Strongly recommended
for all hospitals and strongly supported by well-designed experimental
or epidemiologic studies.</li>
<li><strong>Category IB.</strong> Strongly recommended for all hospitals and
reviewed as effective by experts in the field and a consensus of
HICPAC based on strong rationale and suggestive evidence, even
though definitive scientific studies have not been done.</li>
<li><strong>Category II.</strong> Suggested for implementation in many hospitals.
Recommendations may be supported by suggestive clinical or epidemiologic
studies, a strong theoretical rationale, or definitive studies
applicable to some, but not all, hospitals.</li>
<li><strong>No recommendation; unresolved issue.</strong> Practices for which
insufficient evidence or consensus regarding efficacy exists.</li>
</ul>
<table border="1" cellspacing="0" cellpadding="3" width="99%">
<tr valign="top">
<td colspan="2">
<p><strong>Administrative
Controls</strong></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Education</p>
</td>
<td width="75%">
<p>Develop
a system to ensure that hospital patients, personnel, and visitors
are educated about use of precautions and their responsibility
for adherence to them. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Adherence to Precautions</p>
</td>
<td width="75%">
<p>Periodically
evaluate adherence to precautions and use findings to direct improvements. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td colspan="2">
<p><strong>Standard
Precautions:</strong> Use Standard Precautions, or the equivalent, for the care of all
patients. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row" rowspan="3">
<p>Hand Washing</p>
</td>
<td width="75%">
<p>Wash
hands after touching blood, body fluids, secretions, excretions,
and contaminated items, whether or not gloves are worn. Wash hands
immediately after gloves are removed, between patient contacts,
and when otherwise indicated to avoid transfer of microorganisms
to other patients or environments. It may be necessary to wash
hands between tasks and procedures on the same patient to prevent
cross-contamination of different body sites. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="75%">
<p>Use
a plain (nonantimicrobial) soap for routine hand washing. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="75%">
<p>Use
an antimicrobial agent or a waterless antiseptic agent for specific
circumstances (e.g., control of outbreaks or hyperendemic infections),
as defined by the infection control program. <em>Category IB</em> (See
Contact Precautions for additional recommendations on using antimicrobial
and antiseptic agents.)</p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Gloves</p>
</td>
<td width="75%">
<p>Wear
gloves (clean, nonsterile gloves are adequate) when touching blood,
body fluids, secretions, excretions, and contaminated items. Put
on clean gloves just before touching mucous membranes and nonintact
skin. Change gloves between tasks and procedures on the same patient
after contact with material that may contain a high concentration
of microorganisms. Remove gloves promptly after use, before touching
noncontaminated items and environmental surfaces, and before going
to another patient, and wash hands immediately to avoid transfer
of microorganisms to other patients or environments. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Mask, Eye Protection, Face Shield</p>
</td>
<td width="75%">
<p>Wear
a mask and eye protection or a face shield to protect mucous membranes
of the eyes, nose, and mouth during procedures and patient-care
activities that are likely to generate splashes or sprays of blood,
body fluids, secretions, and excretions. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Gown</p>
</td>
<td width="75%">
<p>Wear
a gown (a clean, nonsterile gown is adequate) to protect skin and
to prevent soiling of clothing during procedures and patient-care
activities that are likely to generate splashes or sprays of blood,
body fluids, secretions, or excretions. Select a gown that is appropriate
for the activity and amount of fluid likely to be encountered.
Remove a soiled gown as promptly as possible, and wash hands to
avoid transfer of microorganisms to other patients or environments. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient-Care Equipment</p>
</td>
<td width="75%">
<p>Handle
used patient-care equipment soiled with blood, body fluids, secretions,
and excretions in a manner that prevents skin and mucous membrane
exposures, contamination of clothing, and transfer of microorganisms
to other patients and environments. Ensure that reusable equipment
is not used for the care of another patient until it has been cleaned
and reprocessed appropriately. Ensure that single-use items are
discarded properly. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Environmental Control</p>
</td>
<td width="75%">
<p>Ensure
that the hospital has adequate procedures for the routine care,
cleaning, and disinfection of environmental surfaces, beds, bedrails,
bedside equipment, and other frequently touched surfaces, and ensure
that these procedures are being followed. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Linen</p>
</td>
<td width="75%">
<p>Handle,
transport, and process used linen soiled with blood, body fluids,
secretions, and excretions in a manner that prevents skin and mucous
membrane exposures and contamination of clothing, and that avoids
transfer of microorganisms to other patients and environments. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row" rowspan="2">
<p>Occupational Health and Bloodborne Pathogens</p>
</td>
<td width="75%">
<p>Take
care to prevent injuries when using needles, scalpels, and other
sharp instruments or devices; when handling sharp instruments after
procedures; when cleaning used instruments; and when disposing
of used needles. Never recap used needles, or otherwise manipulate
them using both hands, or use (any other technique that involves
directing the point of a needle toward any part of the body; rather,
use either a one-handed &quot;scoop&quot; technique or a mechanical
device designed for holding the needle sheath. Do not remove used
needles from disposable syringes by hand, and do not bend, break,
or otherwise manipulate used needles by hand. Place used disposable
syringes and needles, scalpel blades, and other sharp items in
appropriate puncture-resistant containers, which are located as
close as practical to the area in which the items were used, and
place reusable syringes and needles in a puncture-resistant container
for transport to the reprocessing area. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="75%">
<p>Use
mouthpieces, resuscitation bags, or other ventilation devices as
an alternative to mouth-to-mouth resuscitation methods in areas
where the need for resuscitation is predictable. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient Placement</p>
</td>
<td width="75%">
<p>Place
a patient who contaminates the environment or who does not (or
cannot be expected to) assist in maintaining appropriate hygiene
or environmental control in a private room. If a private room is
not available, consult with infection control professionals regarding
patient placement or other alternatives. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td colspan="2">
<p><strong>Airborne Precautions:</strong> In addition to Standard Precautions, use Airborne Precautions,
or the equivalent, for patients known or suspected to be infected
with microorganisms transmitted by airborne droplet nuclei (small-particle
residue [5 &micro;m or smaller in size] of evaporated droplets
containing microorganisms that remain suspended in the air and
that can be dispersed widely by air currents within a room or
over a long distance). <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient Placement</p>
</td>
<td width="75%">
<p>Place
the patient in a private room that has 1) monitored negative air
pressure in relation to the surrounding areas, 2) 6 to 12 air changes
per hour, and 3) appropriate discharge of air outdoors or monitored
high-efficiency filtration of room air before the air is circulated
to other areas in the hospital.(23) Keep the room door closed and
the patient in the room. When a private room is not available,
place the patient in a room with a patient who has active infection
with the same microorganism, unless otherwise recommended,(23)
but with no other infection. When a private room is not available
and cohorting is not desirable, consultation with infection control
professionals is advised before patient placement. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Respiratory Protection</p>
</td>
<td width="75%">
<p>Wear
respiratory protection (N95 respirator) when entering the room
of a patient with known or suspected infectious pulmonary tuberculosis.(23,81)
Susceptible persons should not enter the room of patients known
or suspected to have measles (rubeola) or varicella (chickenpox)
if other immune caregivers are available. If susceptible persons
must enter the room of a patient known or suspected to have measles
(rubeola) or varicella, they should wear respiratory protection
(N95 respirator).(81) Persons immune to measles (rubeola) or varicella
need not wear respiratory protection. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient Transport</p>
</td>
<td width="75%">
<p>Limit
the movement and transport of the patient from the room to essential
purposes only. If transport or movement is necessary, minimize
patient dispersal of droplet nuclei by placing a surgical mask
on the patient, if possible. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td colspan="2">
<p><strong>Droplet Precautions:</strong> In addition to Standard Precautions, use Droplet Precautions,
or the equivalent, for a patient known or suspected to be infected
with microorganisms transmitted by droplets (large-particle droplets [larger than 5 &micro;m in
size] that can be generated by the patient during coughing, sneezing,
talking, or the performance of procedures). <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient Placement</p>
</td>
<td width="75%">
<p>Place
the patient in a private room. When a private room is not available,
place the patient in a room with a patient(s) who has active infection
with the same microorganism but with no other infection (cohorting).
When a private room is not available and cohorting is not achievable,
maintain spatial separation of at least 3 ft between the infected
patient and other patients and visitors. Special air handling and
ventilation are not necessary, and the door may remain open. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Mask</p>
</td>
<td width="75%">
<p>In addition
to wearing a mask as outlined under Standard Precautions, wear
a mask when working within 3 ft of the patient. (Logistically,
some hospitals may want to implement the wearing of a mask to enter
the room.) <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient Transport</p>
</td>
<td width="75%">
<p>Limit
the movement and transport of the patient from the room to essential
purposes only. If transport or movement is necessary, minimize
patient dispersal of droplets by masking the patient, if possible. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td colspan="2">
<p><strong>Contact Precautions:</strong> In addition to Standard Precautions, use Contact Precautions,
or the equivalent, for specified patients known or suspected
to be infected or colonized with epidemiologically important
microorganisms that can be transmitted by direct contact with
the patient (hand or skin-to-skin contact that occurs when performing
patient-care activities that require touching the patient's dry
skin) or indirect contact (touching) with environmental surfaces
or patient-care items in the patient's environment. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient Placement</p>
</td>
<td width="75%">
<p>Place
the patient in a private room. When a private room is not available,
place the patient in a room with a patient(s) who has active infection
with the same microorganism but with no other infection (cohorting).
When a private room is not available and cohorting is not achievable,
consider the epidemiology of the microorganism and the patient
population when determining patient placement. Consultation with
infection control professionals is advised before patient placement. <em>Category
IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Gloves and Hand Washing</p>
</td>
<td width="75%">
<p>In addition
to wearing gloves as outlined under Standard Precautions, wear
gloves (clean, nonsterile gloves are adequate) when entering the
room. During the course of providing care for a patient, change
gloves after having contact with infective material that may contain
high concentrations of microorganisms (fecal material and wound
drainage). Remove gloves before leaving the patient's room and
wash hands immediately with an antimicrobial agent or a waterless
antiseptic agent.(72,94) After glove removal and hand washing,
ensure that hands do not touch potentially contaminated environmental
surfaces or items in the patient's room to avoid transfer of microorganisms
to other patients or environments. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Gown</p>
</td>
<td width="75%">
<p>In addition
to wearing a gown as outlined under Standard Precautions, wear
a gown (a clean, nonsterile gown is adequate) when entering the
room if you anticipate that your clothing will have substantial
contact with the patient, environmental surfaces, or items in the
patient's room, or if the patient is incontinent or has diarrhea,
an ileostomy, a colostomy, or wound drainage not contained by a
dressing. Remove the gown before leaving the patient's environment.
After gown removal, ensure that clothing does not contact potentially
contaminated environmental surfaces to avoid transfer of microorganisms
to other patients or environments. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient Transport</p>
</td>
<td width="75%">
<p>Limit
the movement and transport of the patient from the room to essential
purposes only. If the patient is transported out of the room, ensure
that precautions are maintained to minimize the risk of transmission
of microorganisms to other patients and contamination of environmental
surfaces or equipment. <em>Category IB</em></p>
</td>
</tr>
<tr valign="top">
<td width="25%" scope="row">
<p>Patient-Care Equipment</p>
</td>
<td width="75%">
<p>When
possible, dedicate the use of non-critical patient-care equipment
to a single patient (or cohort of patients infected or colonized
with the pathogen requiring precautions) to avoid sharing between
patients. If use of common equipment or items is unavoidable, then
adequately clean and disinfect them before use for another patient. <em>Category
IB</em></p>
</td>
</tr>
</table>
<p class="size2"><a href="devmodel2.htm#Tab1">Return to Document</a></p>
<p>&nbsp;</p>
<div class="footnote">
<p> The information on this page is archived and provided for reference purposes only.</p></div>
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