Healthcare associated infections
February 2006
Strategies for improvement: role of the healthcare professional
Screening and isolation
In reducing the risk and spread of HCAIs, screening and isolation of patients provides a preventive and proactive method of infection control practice. Patients are not currently routinely screened for any HCAI when they enter healthcare environments, although some may be screened preoperatively where there is considered to be a high risk of infection. When an HCAI is suspected, swabs are taken and sent for diagnosis. If positive, isolation measures to limit the spread of an HCAI include:
- putting patients into isolation wards
- ‘nurse cohorting’: physically segregating infected patients in one part of a ward, with nursing by designated staff
- putting cohorts of patients on general wards (without designated nursing staff);
- use of single-bedded rooms
- healthcare workers using barrier precautions (gowns, gloves, masks) as physical barriers to transmission. [Go to note 46]
A study of MRSA bacteraemia in patients on arrival in a hospital between 1997 and 2003 found that a quarter of hospital cases occur in patients who have previously been in hospital and subsequently readmitted. [Go to note 47] In its proposed code of practice for reducing HCAIs, the DH has indicated that there should be written protocols for the screening and isolation of potentially colonised or infected patients in specified risk categories. [Go to note 16] The proposals outline a system of evidence-based clinical care protocols that encompass infection control of patients in isolation, and incorporate preadmission screening for MRSA and screening of high risks groups for GRE. Screening of healthcare professionals is usually only done in the context of an outbreak because of the practical difficulties and limited usefulness of continuous or regular screening.
Further information
- The DH draft code of practice for the prevention and control of HCAIs, including isolation and screening criteria can be accessed on its website here at www.dh.gov.uk
- The HAI Task Force working group of the SEHD is currently developing a draft document on the management of incidents and outbreaks of HAI, including guidance on staff screening. Further information can be found on the SEHD website here at www.show.scot.nhs.uk/sehd