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Patient Safety Tools: SARS, Smallpox, Monkeypox, and Avian Flu

  • Marlene Fishman
    Correspondence
    For correspondence, write: Marlene Fishman, Department of Nosocomial Infection, Our Lady of Fatima Hospital, 200 High Service Ave, North Providence, RI 02904
    Affiliations
    Marlene Fishman is Infection Control Director, Our Lady of Fatima Hospital, Department of Nosocomial Infection, North Providence, Rhode Island. Glenn G. Fort, MD, MPH, is Chairman, Infection Control Committee at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Gail Jackson, RN, BSN, CIC, is Infection Control Coordinator, Newport Hospital, Newport, RI. Dennis J. Mikolich, MD, is Infectious Disease Physician at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Nancy Vallande, MSM, MT(ASCP), CIC, is Director Epidemiology and Infection Control, Miriam Hospital, Providence, RI
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  • Glenn G. Fort
    Affiliations
    Marlene Fishman is Infection Control Director, Our Lady of Fatima Hospital, Department of Nosocomial Infection, North Providence, Rhode Island. Glenn G. Fort, MD, MPH, is Chairman, Infection Control Committee at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Gail Jackson, RN, BSN, CIC, is Infection Control Coordinator, Newport Hospital, Newport, RI. Dennis J. Mikolich, MD, is Infectious Disease Physician at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Nancy Vallande, MSM, MT(ASCP), CIC, is Director Epidemiology and Infection Control, Miriam Hospital, Providence, RI
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  • Gail Jackson
    Affiliations
    Marlene Fishman is Infection Control Director, Our Lady of Fatima Hospital, Department of Nosocomial Infection, North Providence, Rhode Island. Glenn G. Fort, MD, MPH, is Chairman, Infection Control Committee at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Gail Jackson, RN, BSN, CIC, is Infection Control Coordinator, Newport Hospital, Newport, RI. Dennis J. Mikolich, MD, is Infectious Disease Physician at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Nancy Vallande, MSM, MT(ASCP), CIC, is Director Epidemiology and Infection Control, Miriam Hospital, Providence, RI
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  • Dennis J. Mikolich
    Affiliations
    Marlene Fishman is Infection Control Director, Our Lady of Fatima Hospital, Department of Nosocomial Infection, North Providence, Rhode Island. Glenn G. Fort, MD, MPH, is Chairman, Infection Control Committee at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Gail Jackson, RN, BSN, CIC, is Infection Control Coordinator, Newport Hospital, Newport, RI. Dennis J. Mikolich, MD, is Infectious Disease Physician at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Nancy Vallande, MSM, MT(ASCP), CIC, is Director Epidemiology and Infection Control, Miriam Hospital, Providence, RI
    Search for articles by this author
  • Nancy Vallande
    Affiliations
    Marlene Fishman is Infection Control Director, Our Lady of Fatima Hospital, Department of Nosocomial Infection, North Providence, Rhode Island. Glenn G. Fort, MD, MPH, is Chairman, Infection Control Committee at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Gail Jackson, RN, BSN, CIC, is Infection Control Coordinator, Newport Hospital, Newport, RI. Dennis J. Mikolich, MD, is Infectious Disease Physician at Our Lady of Fatima Hospital, North Providence, RI, and Clinical Associate Professor at Brown Medical School, Providence, RI. Nancy Vallande, MSM, MT(ASCP), CIC, is Director Epidemiology and Infection Control, Miriam Hospital, Providence, RI
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      Emergency departments and clinics must be prepared not only to recognize individual patients who might have highly infectious diseases but to manage an influx of such cases. Previously we described case presentations and forms.
      • Fishman M.
      • Fort G.G.
      • Jackson G.
      • Mikolich D.J.
      • Vallande N.
      Patient safety tools to avoid disaster: healthcare facility management of biologic agents, SARS, and uncommon contagion.
      We now publish these forms to assist others in contagion containment (see Figure 1, Figure 2, Figure 3, Figure 4, Figure 5), exposure investigation (see Figure 6, Figure 7), and triage risk assessment (see Figure 8). Each of these documents can assist busy emergency staff in managing time efficiently while preventing the transmission of infection.
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      Figure 1This Restricted Room Entry Card (8½ × 11 inches, bordered) uses the internationally recognized “do not enter” symbol to prevent traffic into the patient's room.
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      Figure 2This Attire Card (8½ × 11 inches, bordered) lists all personal protective equipment that is required before entering the patient's area. HEPA, High-efficiency particulate air.
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      Figure 3This Strict Isolation Card (front and back) (8½ × 11 inches, bordered) uses the traditional style of combining all instructions onto one single bright yellow card.
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      Figure 4This Special Cleaning Card (5½ × 8½ inches) consolidates disinfection instructions using simple terms that enable everyone to fulfill the requirements.
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      Figure 5This Strict Airborne/Contact Isolation (5½ × 8½ inches) alternative purple card combines the traditional “strict isolation” approach with newer details of contact isolation and the respirator requirements for airborne infection isolation.
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      Figure 6This Employee/Staff Log tracks all health care workers who enter the patient's isolation area. This Log enables efficient collaboration with the Health Department to provide follow-up monitoring for control of potential secondary cases.
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      Figure 7This Visitor Log tracks all persons other than employees and staff who enter the patient's isolation area.
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      Figure 8This Triage Form documents and serves to inform the next health care provider whether CDC criteria have been met to suspect Severe Acute Respiratory Syndrome (SARS). It clearly lists instructions for personal protective equipment use, notifications, and infection control practices. HCWs, Health care workers.
      The isolation cards represent a means to implement Centers for Disease Control and Prevention (CDC) isolation guidelines. We have found that many health care workers prefer the old-fashioned Strict Isolation style card that combines all the requirements in one set of instructions. Others wish to retain the wording found for expanded precautions—the airborne infection isolation precautions and contact categories.

      Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention draft guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2004 [online] [accessed 2004 June]. Formerly available from: URL: http://www.cdc.gov/ncidod/hip/ISOLAT/2004DraftIsoGuideline.pdf.

      As we await final CDC guidelines, we recognize that there may be a need to revise again, but in the meantime, these tools are tried and proven.

      References

        • Fishman M.
        • Fort G.G.
        • Jackson G.
        • Mikolich D.J.
        • Vallande N.
        Patient safety tools to avoid disaster: healthcare facility management of biologic agents, SARS, and uncommon contagion.
        Am J Infect Control. 2004; 32: 421-423
      1. Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention draft guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2004 [online] [accessed 2004 June]. Formerly available from: URL: http://www.cdc.gov/ncidod/hip/ISOLAT/2004DraftIsoGuideline.pdf.