The potential for transmission of infection must be assessed when a patient enters a care area. If hospitalised/in a care home setting, this should be continuously reviewed throughout the stay/period of care. The assessment should influence patient placement decisions in line with clinical/care need(s).
Patients who may present a cross-infection risk in any setting includes those:
- with diarrhoea, vomiting, an unexplained rash, fever or respiratory symptoms
- known to have been previously positive with multidrug-resistant organisms (MDRO) eg MRSA, CPE
- who have been an inpatient in any hospital in the UK or abroad or are a known epidemiological link to a carrier of
Isolation facilities should be prioritised depending on the known/suspected infectious agent (refer to the aides memoire in this document – appendices 11a and 11b).
All patient placement decisions and assessment of infection risk (including isolation requirements) must be clearly documented in the patient notes and provided in patient handovers with other healthcare/ care providers.
The clinical judgement and expertise of the staff involved in a patient’s management and the Infection Prevention and Control Team (IPCT) should be sought, particularly for the application of TBPs, eg isolation prioritization, when single rooms are in short supply.
Single room isolation in hospital settings:
- Isolation of infectious patients can be in specialised isolation facilities, single room isolation, cohorting of infectious patients where appropriate, ensuring that they are separated by at least 3 feet (1 metre) with the door closed.
- Signage should be used on doors/areas to communicate isolation requirements and prevent entry of unnecessary visitors, non-essential staff. Patient confidentiality must be
- Infectious patients should only be transferred to other departments if clinically necessary. If the patient has an infectious agent transmitted by the airborne/droplet route, then if possible/tolerated the patient should wear a surgical face mask during
- Receiving department/hospital and transporting staff must be aware of the necessary
- Isolation room doors should remain closed, if this is not possible, eg paediatrics, there should be a documented risk
Single room isolation in care settings with or without nursing care:
- Residents should remain in their bedroom while considered infectious and the door should remain closed (if unable to isolate this should be documented).
- If transfer to hospital is required, ambulance services and the hospital admission area should be informed of the infectious status of the
Advice on resident’s clinical management should be sought from the GP and the local health protection unit infection prevention team.
- Avoid unnecessary transfer of residents within/between care
Primary care/outpatient settings:
Patients attending with suspected/known infection/colonisation should be prioritised for assessment/treatment, eg scheduled appointments at the start or end of the clinic session.
Infectious patients should be separated from other patients while awaiting assessment and during care management by at least 3 feet (1m).
If transfer from a primary care facility to hospital is required, ambulance services should be informed of the infectious status of the patient.
Staff cohorting: consider assigning a dedicated team of care staff to care for patients in isolation/cohort rooms/areas as an additional infection control measure during outbreaks/incidents. This can only be implemented if there are sufficient levels of staff available (so as not to have a negative impact on non-affected patients’ care).
Before discontinuing isolation:
Individual patient risk factors should be considered (eg there may be prolonged shedding of certain microorganisms in immunocompromised patients).
- Patient placement
- Hand hygiene
- Respiratory and cough hygiene
- Personal protective equipment (PPE)
- Safe management of care equipment
- Safe management of the care environment
- Safe management of linen
- Safe management of blood and body fluid spillages
- Safe disposal of waste (including sharps)
- Occupational safety: prevention of exposure (including sharps injuries)
- Patient placement/assessment of infection risk
- Safe management of patient care equipment in an isolation room/cohort area
- Safe management of the care environment
- Personal protective equipment (PPE): respiratory protective equipment (RPE)
- Aerosol generating procedures
- Infection prevention and control when caring for the deceased