15. INFECTION CONTROL IN THE INPATIENT SETTING
This
section is meant to guide health facilities who would be admitting patients
suspected to have SARS or with Probable SARS.
15.1. PHYSICAL REQUIREMENTS OF SARS
ISOLATION ROOM/WARD
·
All DOH-designated SARS referral hospitals should
identify rooms or wards beforehand, which will be dedicated solely for SARS
in-patients.
·
In choosing the rooms or wards for the purpose of
SARS in-patient care, consider transport route from the ER to these designated
rooms (i.e. need to use elevators). The
shortest possible route should be taken.
·
The door of isolation rooms must be closed at all
times.
·
SUSPECT SARS must be admitted ONLY TO SINGLE
ISOLATION ROOMS.
·
PROBABLE SARS should preferably be admitted to
single isolation rooms also.
·
If single private rooms will not be possible,
cohort placement (putting several patients with the same diagnosis in one area)
of Probable SARS in one room is an acceptable alternative. Place a screen or other forms of barriers
between patients.
·
Do not mix SARS suspects and Probable SARS patients
in the same room.
·
Do not cohort SARS Suspects together as some
suspects may be reassessed as non-SARS after work-up.
·
The designated single rooms or wards for SARS
should be equipped with negative-pressure devices. If negative-pressure rooms are not available, single air-supply
or air-conditioning unit with independent exhaust is acceptable. If still not possible, well-ventilated
private rooms with windows that open away from public areas should suffice. Exhaust
and windows must not open to any area with public access. The single isolation rooms and wards must
have their own sink and bathrooms.
· A separate area strategically located within the isolation room or ward must be designated to serve as an area for HCWs to change and dispose PPE (i.e. changing room).
15.2. PERSONNEL REQUIREMENTS OF SARS
ROOM/WARD
·
If possible, only HCWs with defined patient
care-related activities should be allowed to enter these areas.
·
All persons entering the room should wear an N95
mask. Observe standard precautions
(hand hygiene) as well as airborne (masks), droplet (masks and gloves) and
contact (gloves, gowns, eye protection) precautions.
·
Paramedical staff such as X-ray technicians,
janitors, food tray handlers and the like must be equally protected with PPE
when they enter these rooms.
15.3.
CONTAINMENT
PROCEDURES FOR SARS ROOM/WARD
·
Exposure to the SARS-infected patient must be kept
to the absolute minimum according to the level of care required.
·
HCWs must disinfect hands and change PPE in the
designated areas within the Isolation Room/Ward before moving to the next
patient.
·
Hand washing with soap and water should be
practiced after contact with any SARS suspect.
Alcohol-based hand rubs can also be used.
·
Solely the patient should use utilities used by the
SARS patient. These include eating utensils, thermometers, BP cuff, tourniquet
and the like.
·
Discard wastes soiled with body fluids of SARS
patients including facial tissues, gloves and surgical masks in the yellow
(Infectious wastes) trash bags.
·
Trained personnel must collect the linen with the minimum
handling, shaking or sorting to minimize generation of contaminated
aerosols. Used linen must be properly
put into yellow plastic bags before transport to the laundry area. Linen used
by SARS patients must be disinfected with 0.1% sodium hypochlorite for at least
30 minutes before washing with soap and water.
Other SARS patients can reuse disinfected and washed linen.
15.4.
ROUTINE
AND TERMINAL CLEANING OF SARS ISOLATION ROOMS
OR WARDS
·
The personnel assigned to do cleaning and
disinfecting tasks in SARS-designated areas must be properly trained and
supervised.
·
The recommended PPE must be worn and includes gown,
apron, utility gloves, eye protection and N95 masks.
·
If the volume of patients is high, the hospital may
consider dedicating cleaning personnel for these areas alone.
·
Daily routine cleaning should include all
horizontal surfaces such as floors, tables and nightstands; and all surfaces
that are frequently touched by the patient and the HCWs such as bedrails, call
buttons, telephones, and the toilet and lavatory in the bathroom.
·
Terminal cleaning after patient discharge or
transfer must include:
o
All of the horizontal surface covered in routine
cleaning PLUS
o
Obviously soiled vertical surfaces
o
Surfaces frequently touched by the patient or HCWs
such as doorknobs,switches
o
All other durable equipments in the room such as
bed, wheelchair, commode.
·
Equipment such as mechanical ventilators, pulse
oximeter and BP cuff must be
cleaned
and disinfected according to manufacturer’s instructions.
·
There is no need to disinfect walls, window drapes
and other vertical surfaces unless
obviously
soiled.
·
Disinfectant solutions for this purpose are
chemical germicides used in hospital
infection
control, which provide low to intermediate level disinfection of hospital
equipment. These agents include 0.1%
sodium hypochlorite (1part bleach in 100 parts water) or phenolic agents.
·
Discard all leftover solutions used for cleaning
the SARS-designated areas and do
not
use anymore in other hospital areas.
The housekeeping equipment such as mops and rugs must be washed
thoroughly and allowed to dry.