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Volume: 24S3 - July 1998
Guidelines for the Control of Diphtheria in Canada
APPENDIX D
Isolation Precautions for Hospitalized Diphtheria Cases*
A Standard precautions
These are universal precautions designed for the care of all hospitalized
patients to reduce the risk of transmission of micro-organisms from both
recognized and unrecognized sources of infection. Standard precautions
include the techniques listed below.
- Hand washing after touching blood, body fluids, secretions,
excretions, and contaminated items, whether or not gloves are worn.
Hands should be washed immediately after removing gloves, between patient
contacts, and when otherwise indicated to avoid transfer of microorganisms
to other patients or environments.
- Gloves should be worn when touching blood, body fluids, secretions,
excretions, and items contaminated with these fluids. Clean gloves should
be used before touching mucous membranes and nonintact skin. Gloves
should be promptly removed after use, before touching noncontaminated
items and environmental surfaces, and before going to another patient.
- Masks, eye protection, and face shields should be worn to protect
mucous membranes of the eyes, nose, and mouth during procedures and
patient-care activities likely to generate splashes or sprays of blood,
body fluids, secretions, or excretions.
- Nonsterile gowns will protect skin and prevent the soiling
of clothing during procedures and patient-care activities likely to
generate splashes or sprays of blood, body fluids, secretions, or excretions.
Soiled gowns should be promptly removed.
- Patient-care equipment that has been used should be handled
in a manner that prevents skin and mucous membrane exposure and contamination
of clothing.
- Linen soiled with blood and body fluids, secretions, or excretions
should be handled, transported, and processed in a manner that prevents
skin and mucous membrane exposure and contamination of clothing. [All
articles in direct contact with the patient and articles soiled by discharges
from the patient should be disinfected. Disinfection procedures should
follow routine hospital linen management. The immediate environment
of the patient should be wiped down with a hospital grade germicide
following housekeeping service procedures.]
- Blood-borne pathogen exposure should be avoided by taking all
precautions to prevent injuries when using, cleaning, and disposing
of needles, scalpels, and other sharp instruments and devices.
- Mouthpieces, resuscitation bags, and other ventilation devices
should be readily available in all patient-care areas and used instead
of mouth-to-mouth resuscitation.
B Droplet precautions
Droplet precautions should be used in addition to standard precautions
for all cases of respiratory diphtheria. Specific recommendations for
droplet precautions are
- Private room (preferred)
- Use of a mask if within three metres of the patient.
C Contact precautions
Contact precautions should be used in addition to standard precautions
for all cases of cutaneous diphtheria. Specific recommendations for contact
precautions are
- Private room (preferred; cohorting permissible)
- Gloves at all times
- Hand washing with an antimicrobial agent after glove removal
- Gowns at all times.
* Modified from American Academy of Pediatrics. Infection control
for hospitalized children. In: Peter G, ed. 1997 Red Book: Report
of the Committee on Infectious Diseases. 24th ed. Elk Grove, IL: American
Academy of Pediatrics; 1997:100-07.
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