Preventing transmission of infectious agents in healthcare settings 2007

The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 updates and expands the 1996 Guideline for Isolation Precautions in Hospitals. The transition of healthcare delivery from primarily acute care hospitals to other healthcare settings (e.g. home care, long-term care) prompted the need for recommendations that can be applied in all healthcare settings using common principles of infection control practice, but can be modified to reflect setting-specific needs. The successful experience with Standard Precautions, fist recommended in the 1996 guideline, has led to a reaffirmation of this approach as the foundation for preventing transmission of infectious agents in all healthcare settings.

Long-term care facilities are different from other healthcare settings in that elderly patients at increased risk for infection are brought together in one setting and remain in the facility for extended periods of time. An atmosphere of community is fostered and residents share common eating and living areas, and participate in various facility sponsored activities. Since residents interact freely with each other, controlling transmission of infection in this setting is challenging.  Residents who are colonized or infected with certain microorganisms are, in some cases, restricted to their room. However, because of the psychosocial risks associated with such restriction, it has been recommended that psychosocial needs be balanced with infection control needs.

The role of the dietary department is important in preventing transmission of infectious agents.  However, the combination of hot water and detergents used in dishwashers is sufficient to decontaminate dishware and eating utensils. Therefore, no special precautions are needed for dishware or eating utensils; reusable dishware and utensils may be used for patients requiring Transmission-Based Precautions.

Dietary employees may be exposed to respiratory hazards, blood or OPIM, if they are required to take dietary trays to patients in isolation rooms. Exposure to infectious materials may also occur when handling contaminated food trays that have come from isolation rooms, to the kitchen to be sterilized. Food trays that have come from isolation rooms should be specially marked so that employees handling these trays use the proper precautions. To minimize risk of exposure it is important that Universal Precautions are followed such as the use of gloves, masks and gowns if blood or OPIM exposure is anticipated. It is important to educate and train all exposed employees to safely enter and exit isolation rooms and to safely handle food trays coming from isolation rooms.

In the home and other communal settings, eating utensils and drinking vessels that are being used should not be shared, and consistent with good personal hygiene. If adequate resources for cleaning utensils and dishes are not available, disposable products may be used.

As foodservice personnel it is important that food safety guidelines are followed, employees are trained regarding isolation precautions, equipment is working properly, and proper personal hygiene practices are in place. Together with other healthcare personnel we can do our part to prevent transmission of infectious agents.