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Department of Infection Prevention

Discontinuation of Isolation

 
Q:       How do I remove a patient with MRSA from Contact Precautions?
A:       Patients 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.  
 
Q:       How do I remove a patient with VRE from Contact Precautions?
A:       Patients 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.  
 
Q:       How do I remove a patient with C. difficile infection from Contact Precautions? (UPDATED NOV 2011)
A:       1)      Patients for whom a C. difficile test is ordered are placed on empiric Contact Precautions. If the test is negative and an alternative diagnosis for the diarrheal symptoms is documented by the patient’s provider, Contact Precautionscan be discontinued. 
2)      A negative test is NOT required for removal from isolation. 
3)   Patients placed on Contact Precautions for confirmed C. difficile infection stay on isolation until the following has occurred:
A.      Resolution of symptoms for 48 hours AND
B.      Discharge or transfer from room so that all surfaces in room may be cleaned thoroughly (NOTE: patient must be bathed, placed in a clean gown, and placed in a clean bed if transferred to new room) AND
C.      Approval by the Department of Infection Prevention
Q:       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?
A:       Patients with these multidrug-resistant Gram-negative organisms must stay on Contact Precautions until discharge from VUMC due to the high concern for nosocomial transmission of these agents and the limited number of antibiotics available to treat such pathogens.  
 
Q:       How do I remove a patient from Airborne Precautions/TB isolation?
A:       Removal from Airborne Precautions must be made in consultation with the Department of Infection Control & 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.

 

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