Canterbury DHB

Protective Isolation

Purpose

To prevent opportunistic infections among neutropenic patients. This includes patients receiving intensive treatment for ALL, AML, NHL, myeloma, and autologous and allogeneic bone marrow transplantation.

In Aplastic Anaemia, neutropenia may be prolonged, and isolation impracticable. See Initial Supportive Care - Aplastic Anaemia section.

Associated Documents

Canterbury DHB Infection Prevention & Control Policies and Procedures

Definitions

Neutropenia – neutropenia exists when the neutrophil count falls below 1.9x10⁹/L. When the neutrophil count falls below 0.5x10⁹/L, the patient is severely neutropenic and many protective measures are started at this time.

Intensive chemotherapy – any schedule that is likely to lead to severe neutropenia lasting for more than a few days. For example, CHOP chemotherapy usually only causes transient neutropenia lasting for 1 to 2 days. By contrast, intensive chemotherapy for AML may cause neutropenia lasting for 2 to 3 weeks or longer. ALL and allograft SCT combine neutropenia and immunosuppression.

Hand Hygiene

On entering the B6, all people must perform hand hygiene (either hand washing or alcohol hand rub). All people entering side rooms must perform hand hygiene in the airlock.

Medical and nursing staff should perform hand hygiene according to the 5 Moments for Hand Hygiene.

Warning: Alcohol-based hand wash is not effective against C. difficile. It is important that patients understand this.

Single Rooms

Ensure strict hand hygiene policies are adhered to.

• Intensively treated patients are isolated when the neutrophil count is <0.5 x ¹09/L. They remain in isolation until neutrophils rise above this threshold. This may vary depending on availability of facilities. Decisions on isolating patients in single rooms should be made in consultation with the haematology team. If a decision is made to keep a patient with a neutrophil count of <0.5x¹09/L out of hospital, they need to be seen at least every second day for full review including a CRP. A rising CRP may be the first indication of a significant infection. Shivers or rigors, abdominal tenderness, or other signs of inflammation, are an indication to undertake cultures and commence antibiotics – we have had many examples of patients with septicaemia who are not actually febrile.

  Note: People with respiratory viral symptoms, including health care workers, should not have any patient contact.

Clothing

Make sure you have clean clothes and clean shoes when working on the Unit. The introduction of fungi into the Unit must be kept to a minimum. This can be achieved by avoiding dirt, farmyard material, compost, etc, on clothes or shoes.

Visitors

• Visitors should be encouraged to leave their coats in the ante room.
• The number of visitors should be no more than four at any one time (however, this should be at the staff’s discretion).
• Exclude visits from any person with signs or symptoms of a cold, respiratory infection, flu, gastroenteritis, or other infectious disease.
• Exclude fresh flowers/plants from anywhere within the unit.

Aprons and gowns

All clinical staff performing procedures where it is anticipated that they may have contact with body fluids, will wear gloves and aprons as part of standard precautions. Long-sleeved disposable gowns are also available if there is risk of significant contamination to arms or clothing.

Disposable plastic aprons may also be worn for examination of patients by clinical staff who do not wear a uniform and have concerns regarding cross infection via their clothing.

Masks

Masks are not required to be worn by staff as part of precautions for protective isolation. If a staff member has signs or symptoms of a cold or other respiratory infection, they must not enter the patient’s room.

Patients are encouraged to wear an earloop surgical/droplet mask when transiting around the hospital for appointments and when they are coming and going from the ward. They can remove their mask once they have exited the hospital grounds and when they enter the ward. Patients should discard their mask after use.

Topic Code: 4969