2.5 Isolation Precautions & Biohazard Spill Response

2.5 Isolation Precautions & Biohazard Spill Response

CDC Transmission-Based Precautions

Transmission-Based Precautions are second-tier infection control measures applied to patients with known or suspected highly transmissible pathogens, used in addition to Standard Precautions.

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|              CDC TRANSMISSION-BASED PRECAUTIONS SUMMARY                 |
+-------------------------------------------------------------------------+
| Category | Key Pathogens           | Room Type        | Mandatory PPE   |
+----------+-------------------------+------------------+-----------------+
| Airborne | TB, Measles (Rubeola),  | AIIR Negative    | N95 Respirator  |
|          | Varicella (Chickenpox)  | Pressure (6-12ACH| or PAPR (donned |
|          | Disseminated Zoster     | HEPA filtration) | before entry)   |
+----------+-------------------------+------------------+-----------------+
| Droplet  | Influenza, Pertussis,   | Standard private | Surgical Mask   |
|          | N. meningitidis, Mumps, | room (door may   | within 3-6 ft;  |
|          | Rubella, Adenovirus     | remain open)     | Eye protection  |
+----------+-------------------------+------------------+-----------------+
| Contact  | MRSA, VRE, CRE, ESBL,   | Standard private | Isolation Gown  |
|          | Scabies, RSV, Wounds    | room or cohort   | and Gloves      |
+----------+-------------------------+------------------+-----------------+
| Contact  | C. difficile spores,    | Standard private | Gown + Gloves;  |
| Enteric  | Norovirus, Rotavirus    | room (dedicated) | Soap & water;   |
|          |                         |                  | Bleach clean    |
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1. Airborne Precautions

• Target Pathogens: Mycobacterium tuberculosis (active pulmonary/laryngeal TB), Measles virus (Rubeola), Varicella-Zoster virus (chickenpox, disseminated shingles).
• Engineering Requirements: Patient must be placed in an Airborne Infection Isolation Room (AIIR) with continuous negative air pressure relative to hallways, a minimum of 6 to 12 air changes per hour (ACH), and direct external air exhaust or HEPA filtration. The door must remain tightly closed at all times.
• PPE Protocol: Healthcare personnel must don a fit-tested NIOSH-approved N95 particulate respirator or PAPR before entering the room. The respirator must remain on until after exiting the room and closing the door.
• Phlebotomy Workflow: Bring only necessary collection tubes and equipment into the room; never bring the full phlebotomy tray into an airborne isolation room.

2. Droplet Precautions

• Target Pathogens: Influenza virus, Bordetella pertussis (whooping cough), Neisseria meningitidis (meningococcal meningitis/septicemia), Mycoplasma pneumoniae, Mumps virus, Rubella virus, Adenovirus, Group A Streptococcus pharyngitis.
• Transmission: Large respiratory droplets (>5 µm) propelled through coughing, sneezing, or suctioning, traveling up to 3 to 6 feet.
• PPE Protocol: Don a fluid-resistant surgical/procedure mask upon room entry or when working within 3 to 6 feet of the patient. Add eye protection (face shield or goggles) if specimen handling or close patient proximity creates spray risk. Special air handling or negative pressure is not required; the door may remain open.

3. Contact Precautions

• Target Pathogens: Multidrug-Resistant Organisms (MDROs) including MRSA, Vancomycin-Resistant Enterococcus (VRE), Carbapenem-Resistant Enterobacteriaceae (CRE), extended-spectrum beta-lactamase (ESBL) producers; uncontrolled wound drainage, scabies, and lice.
• PPE Protocol: Don an isolation gown and medical examination gloves upon entering the room. Remove and discard PPE before leaving the patient room, and perform immediate hand hygiene.
• Equipment Protocol: Use dedicated single-patient or single-use disposable equipment (e.g., disposable tourniquets). Disinfect any reusable equipment (e.g., blood glucose meters) with an EPA-registered disinfectant before removing it from the room.

4. Contact Enteric Precautions

• Target Pathogens: Clostridioides difficile (C. diff), Norovirus, and Rotavirus.
• Specific Mandates:
  1. Hand Hygiene: Mechanical soap and water handwashing is strictly mandatory. Alcohol-based hand rubs are ineffective against C. diff bacterial endospores and non-enveloped norovirus capsids.
  2. Environmental Disinfection: Surfaces must be disinfected with sodium hypochlorite (household bleach dilution) or an EPA-registered sporicidal chemical. Quaternary ammonium compounds do not kill C. diff spores.

Biohazard Spill Cleanup Protocol

Accidental blood spills occurring on laboratory countertops, phlebotomy chairs, or clinical floors require systematic containment and disinfection.

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|                  BIOHAZARD SPILL CLEANUP WORKFLOW                       |
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| 1. Secure Area    | Restrict traffic, alert coworkers, isolate spill    |
| 2. Don PPE        | Gloves, fluid-resistant gown, goggles/face shield   |
| 3. Remove Sharps  | Use tongs/forceps/dustpan; NEVER use gloved hands   |
| 4. Cover Spill    | Place absorbent paper towels over entire spill      |
| 5. Apply Bleach   | Saturate with 1:10 sodium hypochlorite dilution     |
| 6. Contact Time   | Allow 10 to 20 minutes contact/kill time            |
| 7. Wipe & Discard | Wipe up debris into red biohazard waste bag         |
| 8. Final Wipe     | Re-clean perimeter with fresh disinfectant, air dry |
| 9. Doff & Wash    | Remove PPE, discard, wash hands with soap & water   |
+-------------------------------------------------------------------------+

Step-by-Step Spill Cleanup Procedure

1. Secure the Area: Immediately alert nearby colleagues, isolate the spill perimeter, and prevent foot traffic across the contaminated zone.
2. Don Appropriate PPE: Put on medical examination gloves and a fluid-resistant isolation gown or lab coat. If the spill is large or splashing/splattering is possible, don protective goggles or a full-face shield.
3. Remove Broken Glass and Sharps Mechanically: If broken collection tubes or sharps are present in the spill, NEVER pick them up with bare or gloved hands. Use mechanical tools such as plastic tongs, forceps, or a disposable cardboard dustpan and scraper. Discard all collected sharps directly into a rigid biohazard sharps container.
4. Cover with Absorbent Paper Towels: Place absorbent paper towels or biohazard spill pillows gently over the spill, working from the outside perimeter inward to absorb liquid and prevent liquid spreading.
5. Apply Disinfectant: Saturate the paper towels and surrounding area with an EPA-registered hospital disinfectant or a freshly prepared 1:10 dilution of 5.25% household sodium hypochlorite (bleach), which provides ~5,000 ppm available chlorine.
6. Observe Contact Time (10 to 20 Minutes): Allow the disinfectant solution to remain wet on the contaminated surface for the full manufacturer-recommended contact time, typically 10 to 20 minutes, to ensure complete destruction of resilient bloodborne viruses (HBV, HCV, HIV).
7. Wipe and Dispose in Biohazard Waste: Wipe up the saturated towels and contaminated debris, working from the outside inward. Place all materials into a heavy-duty red biohazard waste bag labeled with the biohazard symbol.
8. Re-Clean and Disinfect the Area: Spray or wipe the area with fresh disinfectant, allow it to air dry, and dispose of used cleaning cloths in the biohazard bag.
9. Doff PPE and Wash Hands: Remove PPE in the correct sequence (gloves, eye protection, gown), discard into biohazard waste, and perform thorough mechanical hand hygiene with soap and water.