Isolation Frequently Asked Questions

What personal protective equipment (PPE) do visitors need to wear when visiting patients on isolation?

For patients on Contact Precautions, visitors do not need to wear any PPE unless they are assisting with direct patient care duties (e.g., wound care, suctioning). For patients on Droplet or Airborne Precautions, visitors should wear a regular surgical mask while in the patient’s room. They do not need to wear an N-95 respirator for patients on Airborne Precautions. For all patients, visitors should wash their hands or use the alcohol hand gel before and after visiting any of our patients.

Why aren’t visitors required to wear a gown and gloves when visiting a patient on Contact Precautions?

Visitors are not a major source of infection or spread of infection from patient-to-patient because they do not have contact with multiple patients. Therefore, we do not require visitors to wear gowns or gloves for Contact Precautions patients like we do for our healthcare workers unless they are assisting with any direct patient care activities. We do ask that they wash their hands or use the alcohol hand gel upon room entry and when leaving the patient room.

Why do I have to “gown up, etc.” when I enter an isolation room if I’m just observing and do not intend to touch the patient?

Studies have shown that over 90% of the time a healthcare worker enters the room, they touch either the patient or objects in the patient’s environment. This may be due to unexpected issues that arise once the healthcare worker enters the room (such as an alarming ventilator or IV device). Thus, VUMC policy is to wear the required PPE regardless of how much contact with either the patient or the patient’s environment is anticipated.

How do I get more supplies when the cart is empty?

Contact your unit’s service center for more supplies. In addition, many units have their own stock of PPE that may be used to replenish the carts.

How do I know what precautions are needed?

There are several ways to know what type of precautions are needed for isolation patients: 1) Look at the sign on the door to the patient’s room – it will indicate exactly what type of isolation precautions and personal protective equipment you must wear before entering the room, 2) refer to the Department of Infection Prevention’s website, or 3) review the information in the patient’s eStar chart (i.e., the Infection and Isolation flags).

Does a patient with HIV, HCV, or HBV need isolation precautions?

Patients with HIV/HCV/HBV do not need to be placed on isolation precautions because of their bloodborne pathogen infection. There may be circumstances where such patients need isolation based on their specific clinical presentation.  For example, if the HIV+ patient has respiratory symptoms (i.e., cough, shortness of breath, coughing up blood, chest pain, etc.) they need to be placed on Airborne Precautions until an alternative diagnosis can be confirmed. HIV patients do not manifest typical symptoms of pulmonary tuberculosis, so the suspicion index should be high.

Do I need to wash my hands if I wear gloves when performing patient care?

YES! Because bacteria can pass through tiny invisible holes in gloves and because your hands can become contaminated when gloves are being removed, you still must remove your gloves and wash your hands or use alcohol hand gel after patient contact. Also DO NOT REUSE gloves between patients, as this can spread germs from one patient to another.

How do I refill the alcohol hand gel dispenser? What if the dispenser is empty or broken?

Fortunately, each unit has an ample supply of dispensers, so you should still be able to perform hand hygiene with another dispenser nearby. But we also want to make sure that the dispensers stay filled. As a part of routine room cleaning, Environmental Services will check the status of gel for each room and replace those that are empty. But we must all be responsible for making sure an empty dispenser is addressed. Each unit has supplies to refill the gel dispensers. If you find a dispenser that is empty, please notify the patient’s nurse or the unit charge nurse, who should restock the dispenser. If you find a broken dispenser, please notify the unit charge nurse. The charge nurse should record the details of the broken dispenser into the unit’s maintenance log. Plant services will replace the broken dispenser promptly.

What is the policy regarding isolations patients leaving the room to smoke?

Although smoking is not considered a medical necessity for leaving the floor while on Contact Precautions, some patients may demand to leave. For infection prevention purposes, request the patient perform hand hygiene up to the elbows before leaving, put on a clean hospital cover gown and request patient only go to the designated smoking area.

Should disposable food trays be used for patients on isolation?

No, disposable food trays are not needed. A dietary tray is brought into the patient’s room by unit staff wearing appropriate PPE. Removing a tray from an isolation room should be done by two persons. The first staff member brings the food cart to the room door and opens the cart door. The second caregiver in PPE enters the room, obtains the tray, and places the used tray directly into the food cart. The cart containing used trays is taken directly to the kitchen area and appropriate cleaning and disinfection is done to dishes, tray and the transport cart. Do not place used dishes/trays from an isolation room into a biohazard bag. The items will be destroyed if placed in a biohazard bag.

How do I pass medications to a patient on Contact Isolation Precautions?

Medications are administered utilizing barcode-assisted medication administration (BCMA), whenever possible. A bar code scanner may be placed into a plastic bag and taken to patient to scan the armband. Do not scan an armband not attached to the patient. The scanner should be removed from the plastic bag at the room door and cleaned with a disinfectant wipe.

How do I take equipment into and out of an isolation room?

Use disposable or dedicated patient care equipment (e.g., blood pressure cuff, thermometer, stethoscope) when possible. When multi-use equipment cannot be dedicated to isolation patients, wipe down all contact surfaces with a hospital-approved disinfectant or disinfectant wipes after each use. Some equipment may be placed in disposable plastic cover bags for use with the isolation patient and cleaned per aforementioned instructions between patients. Do not place used equipment from an isolation room into a biohazard bag. The items will be destroyed if placed in a biohazard bag.

How do I take supplies into and out of an isolation room?

1)           Take only enough supplies needed to complete a specific task into an isolation room. Do not take excess supplies into the room (e.g., excess blood products, disposable medical supplies).

2)           Discard all disposable medical supplies present in the patient room at the time of discharge.

How do I administer blood products to a patient on isolation?

Used blood products that need to be returned to the Blood Bank are bagged in a biohazard bag prior to return to the Blood Bank. Blood products are not to enter the isolation room until time of use is indicated.

How do I obtain a lab specimen when a patient is on isolation?

Don PPE. Obtain and label the specimen. Call for assistance and stand at the door. Another healthcare worker holds open a biohazard bag at the doorway. The garbed person inside the room, drops the specimen into the biohazard bag and the helper seals the bag. Taping the lab on door leaves residual adhesive that cannot be easily cleaned. By working with a peer, labs can be sent on for processing and not delayed until the nurse finished the care and doffs PPE.

How do I administer a multidose medication when it cannot be secured in an isolation room?

• Glucometer check: Don PPE and enter the room with the glucometer. Perform the glucose check. Ask a peer to hand the insulin to you with a syringe(s) if it is needed.
• Double Check of the medication: With a nurse at the door, verify the “rights” of medication administration in the doorway allowing the second nurse to verify.
• Multidose Medications: Don PPE, enter the room with the medication. Scan the medication and administer. Hand the multidose medication out to a peer to be wiped down with alcohol wipes.
• Controlled Substances: Don PPE. Administer medication. Call for assistance and stand at door. Another healthcare worker holds open a biohazard bag at the doorway. Drop the specimen into the biohazard bag and the helper seals the bag. Doff PPE and exit room. Don clean gloves and waste medication appropriately. Doff gloves and perform hand hygiene.

What precautions should sitters take with isolation patients?

When inside the patient’s room, sitters should wear all appropriate PPE for the patient’s infection.

If the patient is positive for a respiratory illness such as COVID-19 or influenza, non-essential staff will not be in the room for AGPs; sitters will be considered non-essential since the provider will be directly managing these activities.  If an isolation patient meets the criteria for a virtual sitter, this would be preferred.

How do I obtain signed paper documents from an isolation room?

Obtain document, a “single use” pen and ask another staff member to remain on standby with an envelope. Don PPE and discuss documents with patient. Ask patient to perform hand hygiene. Give the patient the single use pen and have them sign the paper with as little contact as possible. Leave the pen inside the room. At the doorway, the person in PPE drops the paper into the envelope held open by the other staff member. The envelope can either be delivered to medical records or scanned by the unit for usual processing.     

How do I clean items from isolation rooms?

When cleaning items from an isolation room, be sure to keep the soiled/isolated items segregated from any clean items. This can be accomplished by utilizing Clean and Dirty Areas (outlined below).

While this process can be useful, be mindful of high traffic areas and limit standing “dirty” items/spaces. Always clean items in accordance with the manufacturer’s instructions, using appropriate VUMC disinfectant products for that item.

• Clean Area:
  • Designate a “clean” area that will be used only to place clean items to dry after being cleaned
• Dirty Area:
  • An area near the “clean” area may used as a “dirty” space to place dirty items (such as eye protection, glucometer, etc.) while doffing PPE. Once PPE is doffed, items should be cleaned immediately with an appropriate disinfectant and then moved to the “clean” space to allow for disinfectant to dry
  • If a non-porous surface is used, the surface should be wiped after each encounter with an approved disinfectant
  • An absorbent pad may also be used and then discarded after each use
  • If an absorbent pad is not labeled “clean,” it should be assumed “dirty” and discarded

How do I remove a patient with MRSA from Contact Precautions?

The isolation flag will automatically be removed 90 days from the last detection of MRSA. To remove a patient from precautions earlier than that, the patient must be off MRSA-specific antibiotics for 72 hours and have no evidence of continued colonization with MRSA, as evidenced by negative nasal (anterior nares) cultures at day 0 and day 7. In addition, a culture from all draining wounds must be negative for MRSA x 1. Finally, cultures from the original site of isolation of MRSA, if obtainable without increased risk for substantial patient morbidity (e.g., tracheal aspirate culture in patient with tracheostomy is easily obtained; however, collection of pleural fluid for sole intent of removal off isolation precautions would not be required), should be negative x 1. 

How do I remove a patient with VRE from Contact Precautions?

The isolation flag will automatically be removed 90 days from the last detection of VRE. To remove a patient from precautions earlier than that, the patient must be off VRE-specific antibiotics for 72 hours and have no evidence of continued colonization with VRE, as evidenced by negative rectal or stool cultures at day 0, day 7 and day 14. In addition, cultures from the original site of isolation of VRE, if obtainable without increased risk for substantial patient morbidity (see above), should be negative x 1. 

How do I remove a patient with C. difficile infection from Contact Precautions? 

All patients for whom a C. difficile test is ordered are placed on empiric Contact Precautions.

(-) If a test for C. difficile is ordered, and the patient is negative for C. difficile toxin gene by PCR (first part of the test) and an alternative diagnosis for the diarrheal symptoms is documented by the patient’s provider, then Contact Precautions may be discontinued.

(+, +: C. difficile INFECTION) If a patient is positive for C. difficile toxin gene by PCR, AND positive for C. difficile toxin by antigen detection, the patient can be removed from contact isolation per current VUMC guidelines as outlined below: 

• The patient remains on contact isolation until the patient returns to his/her normal stooling pattern for minimum of 48 hours AND
• Patient is off of C. difficile-specific treatment
• Discharge or transfer from room so that all surfaces in room may be cleaned thoroughly
• Patient must be bathed,
• Place patient in a clean gown, and
• Place patient in a clean bed if transferred to a new room

NOTE: A negative test is NOT required (and should not performed) for removal from isolation. 

(+, -: C. difficile COLONIZATION) If a test for C. difficile is ordered, and the patient is positive for C. difficile toxin gene by PCR (first part of the test), BUT negative for C. difficile toxin by antigen detection (second part of the test), the following guidelines apply for removing contact isolation precautions: 

• The patient remains on contact isolation until the patient returns to his/her normal stooling pattern for minimum of 48 hours.
• Discharge or transfer from room so that all surfaces in room may be cleaned thoroughly
• Patient must be bathed,
• Place patient in a clean gown, and
• Place patient in a clean bed if transferred to a new room

NOTE: A negative test is NOT required (and should not performed) for removal from isolation

How do I remove a patient with a multidrug-resistant (MDR) Gram-negative organism (such as MDR Acinetobacter baumannii, CRE, and ESBL+ organisms) from Contact Precautions?

Patients with non-carbapenemase producing CRE and ESBL+ organism infection or colonization remain on Contact Precautions until the following are met:

1. At least 3 months (ESBL+)/6 months (CRE) have elapsed since the last positive culture for the organism, OR
2. The patient has negative rectal swab samples for the specific organism x 2 obtained at least 1 week apart.

Patients with carbapenemase-producing CRE or extensively-resistant gram-negative or other organism infection or colonization must stay on Contact Precautions indefinitely due to the high concern for nosocomial transmission of these agents and the limited number of antibiotics available to treat such pathogens.

How do I remove a patient with Candida auris from Contact Precautions?

Patients with C. auris infection or colonization must stay on Contact Precautions indefinitely due to the high concern for nosocomial transmission of this pathogen.

How do I remove a patient from Airborne Precautions/TB isolation?

Removal from Airborne Precautions must be made in consultation with the Department of Infection Prevention. Specific information regarding the patient’s clinical symptoms, history, and lab data will be used to determine appropriateness for removal. Please click here for details on the Department of Infection Prevention’s process for removal from Airborne Precautions.

Should patients who have a history of infection of colonization with a resistant organism during a prior hospitalization be placed on isolation upon readmission to VUMC?

If the patient is readmitted within 90 days (MRSA, VRE if has draining wound unable to be covered or if admitted to 10T3, OTU, NICU, PCICU, PHO and PCARD), 180 days (ESBL+ or non-carbapenemase-producing CRE) from the prior hospitalization, the patient should be placed on empiric isolation. For those presenting greater than the noted period since the prior hospitalization, isolation status will be determined by the Department of Infection Prevention. For patients with a history of carbapenemase-producing CRE or extenstively-resiatnt pathogen infection/colonization (including Candida auris), the patient is placed back into Contact Precautions regardless of the time since detection.

Who has to wear personal protective equipment (PPE) into an isolation OR room?

Everyone who enters the isolation OR room MUST wear the appropriate PPE upon room entry. For Airborne Precautions, this means wearing the N-95 respirator until the patient is intubated and then after the patient is extubated. For Droplet Precautions, wear a surgical mask until patient is intubated and then after the patient is extubated. For Contact Precautions, wear gown and gloves upon room entry for the entire duration of the case. 

Which isolation cases must be boarded in the OR for the end of the day?

Any patient on Airborne Precautions (for example, those with known or suspected tuberculosis, varicella [chickenpox], measles, smallpox, or SARS).

What about breaks or relief staffing?

As staff from the isolation OR room need to leave for breaks, they must remove PPE and perform hand hygiene upon leaving the room. Relief staff must don appropriate PPE and perform hand hygiene before entering the room. No exceptions.

Why do we have to reduce traffic in the ORs?

It is recommended to reduce traffic in all operating rooms to reduce the incidence of surgical site infections. Isolation OR rooms have the added burden of contamination that must not be transported by personnel from room to room.

Do we have to wear PPE once a patient on Contact Precautions in the OR is draped?

Yes. Every person entering the room must wear the appropriate PPE. They must remove the PPE if they exit the room. Should they need to re-enter the room, PPE must be donned again.