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## Complete Summary

#### GUIDELINE TITLE

Guideline for isolation precautions: preventing transmission of
infectious agents in healthcare settings 2007. Administrative
responsibilities.

#### BIBLIOGRAPHIC SOURCE(S)

Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection
Control Practices Advisory Committee. 2007 guideline for isolation
precautions: preventing transmission of infectious agents in healthcare
settings. Administrative responsibilities. Atlanta (GA): Centers for
Disease Control and Prevention (CDC); 2007 Jun. 3 p.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control
and Prevention (CDC), Hospital Infection Control Practices Advisory
Committee. Guidelines for isolation precautions in hospital infection
control advisory committee. Atlanta (GA): Centers for Disease Control
and Prevention (CDC); 1996 Jan 1. 38 p. (CDC prevention guidelines; no.
1/96). \[97 references\]

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Healthcare-associated infections

#### GUIDELINE CATEGORY

Prevention

#### CLINICAL SPECIALTY

Infectious Diseases\
Nursing\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Health Care Providers\
Hospitals\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

-   To provide infection control recommendations for all components of
    the healthcare delivery system, including hospitals, long-term care
    facilities, ambulatory care, home care and hospice

-   To reaffirm Standard Precautions as the foundation for preventing
    transmission during patient care in all healthcare settings

-   To reaffirm the importance of implementing Transmission-Based
    Precautions based on the clinical presentation or syndrome and
    likely pathogens until the infectious etiology has been determined

-   To provide epidemiologically sound and, whenever possible,
    evidence-based recommendations

#### TARGET POPULATION

Patients, administrators, and healthcare personnel in all settings where
healthcare is delivered

#### INTERVENTIONS AND PRACTICES CONSIDERED

Planning and management of facilities, equipment, and personnel to
facilitate infection control measures

#### MAJOR OUTCOMES CONSIDERED

-   Adherence to infection control procedures by healthcare personnel

-   Rates of transmissions and acquisition of healthcare-associated
    infections

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Med-line and Pub Med were used to search for relevant studies published
in English, focusing on those published since 1996.

The quality of studies, consistency of results and correlation with
results from randomized, controlled trials when available were
considered during the literature review and assignment of evidence-based
categories to the recommendations in this guideline.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

The recommendations are categorized on the basis of existing scientific
data, theoretical rational, applicability, and when possible, economic
impact, as follows:

**Category IA**. Strongly recommended for implementation and strongly
supported by well-designed experimental, clinical, or epidemiologic
studies.

**Category IB**. Strongly recommended for implementation and supported
by some experimental, clinical, or epidemiologic studies and a strong
theoretical rationale.

**Category IC**. Required for implementation, as mandated by federal
and/or state regulation or standard.

**Category II**. Suggested for implementation and supported by
suggestive clinical or epidemiologic studies or a theoretical rationale.

**No recommendation**; unresolved issue. Practices for which
insufficient evidence or consensus regarding efficacy exists.

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Definitions for the strength of recommendation grading (IA-IC, II, and
no recommendation) are provided at the end of the \"Major
Recommendations\" field.

**Administrative Responsibilities**

Healthcare organization administrators should ensure the implementation
of recommendations in this section.

I.A. Incorporate preventing transmission of infectious agents into the
objectives of the organization\'s patient and occupational safety
programs (Institute of Medicine \[IOM\], 1999; Gerberding, 2002; Leape,
Berwick, & Bates, 2002; Burke, 2003; Larson et al., 2000; Lundstrom et
al., 2002; Clarke et al., 2002). (See also
[www.cms.hhs.gov/CLIA](http://www.cms.hhs.gov/CLIA).) **Category IB/IC**

I.B. Make preventing transmission of infectious agents a priority for
the healthcare organization. Provide administrative support, including
fiscal and human resources for maintaining infection control programs
(Friedman et al., 1999; Goldmann et al., 1996; Scheckler et al., 1998;
Boyce & Pittet, 2002; Larson et al., 2000; Haley et al., 1985; Kretzer &
Larson, 1998; O\'Boyle, Jackson, & Henly, 2002; Pittet et al., 2000;
Murthy, 2001; Rondeau & Wagar, 2002). (See also
[www.cms.hhs.gov/CLIA](http://www.cms.hhs.gov/CLIA).) **Category IB/IC**

I.B.1. Assure that individuals with training in infection control are
employed by or are available by contract to all healthcare facilities so
that the infection control program is managed by one or more qualified
individuals (O\'Boyle, Jackson, & Henly, 2002; Haley et al., 1985;
Richards et al., 2001; Stevenson et al., 2004; Emori, Haley, & Stanley,
1980; Morrison & Health Canada, 2004; Simonds et al., 1997). (See also
[www.cms.hhs.gov/CLIA](http://www.cms.hhs.gov/CLIA).) **Category IB/IC**

I.B.1.a. Determine the specific infection control full-time equivalents
(FTEs) according to the scope of the infection control program, the
complexity of the healthcare facility or system, the characteristics of
the patient population, the unique or urgent needs of the facility and
community, and proposed staffing levels based on survey results and
recommendations from professional organizations (Friedman et al., 1999;
Scheckler et al., 1998; O\'Boyle, Jackson, & Henly, 2002; Haley et al.,
1985; Richards et al., 2001; Pugliese et al., 1984; Morrison & Health
Canada, 2004; Stevenson et al., 2004; Richet et al., 2003; Anderson et
al., 2006). **Category IB**

I.B.2. Include prevention of healthcare-associated infections (HAI) as
one determinant of bedside nurse staffing levels and composition,
especially in high-risk units (Mayhall et al., 1979; Goldmann, Durbin, &
Freeman, 1981; Arnow et al., 1982; Haley & Bregman, 1982; Fridkin et
al., 1996; Robert et al., 2000; Archibald et al., 1997; Harbarth et al.,
1999; Jackson et al., 2002; Vicca, 1999; Stegenga, Bell, & Matlow, 2002;
Loeb, 2003; Alonso-Echanove et al., 2003; Petrosillo et al., 2001;
Needleman et al., 2002). **Category IB**

I.B.3. Delegate authority to infection control personnel or their
designees (e.g., patient care unit charge nurses) for making infection
control decisions concerning patient placement and assignment of
Transmission-Based Precautions (Scheckler et al., 1998; Friedman et al.,
1999). (See also <http://www.cms.hhs.gov/CLIA/>.) **Category IC**

I.B.4. Involve infection control personnel in decisions on facility
construction and design, determination of airborne infection isolation
room (AIIR) and Protective Environment capacity needs and environmental
assessments (Sehulster & Chinn, 2003; American Institute of Architects
\[AIA\], 2006; Harvey, 1998; Srinivasan et al., 2002; Jensen et al.,
2005). **Category IB/IC**

I.B.4.a. Provide ventilation systems required for a sufficient number of
AIIRs (as determined by a risk assessment) and Protective Environments
in healthcare facilities that provide care to patients for whom such
rooms are indicated, according to published recommendations (Sehulster &
Chinn, 2003; Jensen et al., 2005; AIA, 2006; \"Guidelines for
preventing,\" 2000). **Category IB/IC**

I.B.5.   Involve infection control personnel in the selection and
postimplementation evaluation of medical equipment and supplies and
changes in practice that could affect the risk of HAI (Maragakis et al.,
2006; Organizations JCAHO, 2007). **Category IC**

I.B.6 Ensure availability of human and fiscal resources to provide
clinical microbiology laboratory support, including a sufficient number
of medical technologists trained in microbiology, appropriate to the
healthcare setting, for monitoring transmission of microorganisms,
planning and conducting epidemiologic investigations, and detecting
emerging pathogens. Identify resources for performing surveillance
cultures, rapid diagnostic testing for viral and other selected
pathogens, preparation of antimicrobial susceptibility summary reports,
trend analysis, and molecular typing of clustered isolates (performed
either on-site or in a reference laboratory) and use these resources
according to facility-specific epidemiologic needs, in consultation with
clinical microbiologists (Peterson et al., 2001; Hacek et al., 1999;
Rodriguez, Schwartz, & Thorne, 2002; Uyeki, 2003; Mackie, Joannidis, &
Beattie, 2001; Peterson & Noskin, 2001; Barenfanger, Drake, & Kacich,
1999; Ginocchio, 2002; Barenfanger et al., 2000; Ramers et al., 2000;
National Committee on Clinical Laboratory Standards \[NCCLS\], 2002;
Simor, 2001; McGowan & Tenover, 2004; Pfaller & Herwaldt, 1997;
Halstead, Gomez, & McCarter, 2004; Ernst et al., 2004). **Category IB**

I.B.7. Provide human and fiscal resources to meet occupational health
needs related to infection control (e.g., healthcare personnel
immunization, post-exposure evaluation and care, evaluation and
management of healthcare personnel with communicable infections
(\"Occupational exposure,\" 2001; Jensen et al., 2005; Bolyard et al.,
1998; Pearson, Bridges, & Harper, 2006; Wright, Decker, & Edwards, 1999;
Calugar et al., 2006; Diekema & Doebbeling, 1995; Talbot et al., 2005).
(See also [www.cdc.gov/ncidod/sars](http://www.cdc.gov/ncidod/sars).)
**Category IB/IC**

I.B.8. In all areas where healthcare is delivered, provide supplies and
equipment necessary for the consistent observance of Standard
Precautions, including hand hygiene products and personal protective
equipment (e.g., gloves, gowns, face and eye protection) (\"Occupational
exposure,\" 2001; Boyce & Pittet, 2002). (See also
<http://www.cms.hhs.gov/CLIA/>.) **Category IB/IC**

I.B.9. Develop and implement policies and procedures to ensure that
reusable patient care equipment is cleaned and reprocessed appropriately
before use on another patient (Sehulster & Chinn, 2003; Rutala & Weber,
In preparation; Weems, 1993; Berthelot et al., 1993; CDC, 1999; Rutala &
Weber, 2004; Srinivasan et al., 2003; Heeg et al., 2001). (See also
[www.fda.gov/cdrh/reprocessing/](http://www.fda.gov/cdrh/reprocessing/).)
**Category IA/IC**

I.C. Develop and implement processes to ensure oversight of infection
control activities appropriate to the healthcare setting and assign
responsibility for oversight of infection control activities to an
individual or group within the healthcare organization that is
knowledgeable about infection control (Friedman et al., 1999; Scheckler
et al., 1998; Haley et al., 1985). **Category II**

I.D. Develop and implement systems for early detection and management
(e.g., use of appropriate infection control measures, including
isolation precautions, personal protective equipment \[PPE\]) of
potentially infectious persons at initial points of patient encounter in
outpatient settings (e.g., triage areas, emergency departments,
outpatient clinics, physician offices) and at the time of admission to
hospitals and long-term care facilities (LTCF) (Srinivasan et al., 2004;
Bloch et al., 1985; Shen et al., 2004; Gehanno et al., 1999). (See also
[www.cdc.gov/ncidod/sars](http://www.cdc.gov/ncidod/sars).) **Category
IB**

I.E. Develop and implement policies and procedures to limit patient
visitation by persons with signs or symptoms of a communicable
infection. Screen visitors to high-risk patient care areas (e.g.,
oncology units, hematopoietic stem cell transplant \[HSCT\] units,
intensive care units, other severely immunocompromised patients) for
possible infection (Garcia et al., 1997; Hall, 2000; Christie et al.,
1995; Bridges et al., 2003; Weinstock et al., 2000). **Category IB**

I.F. Identify performance indicators of the effectiveness of
organization-specific measures to prevent transmission of infectious
agents (Standard and Transmission-Based Precautions), establish
processes to monitor adherence to those performance measures, and
provide feedback to staff members (Dubbert et al., 1990; \"Occupational
exposure,\" 2001; Avila-Aguero et al., 1998; Babcock et al., 2004; Bloom
et al., 2003; Cromer et al., 2004; Braun et al., 2003; Baker, 1997).
**Category IB**

**Definitions**:

**Strength of the Recommendations**

The recommendations are categorized on the basis of existing scientific
data, theoretical rational, applicability, and when possible, economic
impact, as follows:

**Category IA**. Strongly recommended for implementation and strongly
supported by well-designed experimental, clinical, or epidemiologic
studies.

**Category IB**. Strongly recommended for implementation and supported
by some experimental, clinical, or epidemiologic studies and a strong
theoretical rationale.

**Category IC**. Required for implementation, as mandated by federal
and/or state regulation or standard.

**Category II**. Suggested for implementation and supported by
suggestive clinical or epidemiologic studies or a theoretical rationale.

**No recommendation**; unresolved issue. Practices for which
insufficient evidence or consensus regarding efficacy exists.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=10983)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is identified and graded for each recommendation
(see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate planning and management to prevent the transmission of
infectious agents in healthcare settings

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

Much of the evidence cited for preventing transmission of infectious
agents in healthcare settings is derived from studies that used
\"quasi-experimental designs\", also referred to as nonrandomized, pre-
post-intervention study designs. Although these types of studies can
provide valuable information regarding the effectiveness of various
interventions, several factors decrease the certainty of attributing
improved outcome to a specific intervention. These include difficulties
in controlling for important confounding variables; the use of multiple
interventions during an outbreak; and results that are explained by the
statistical principle of regression to the mean, (e.g., improvement over
time without any intervention). Observational studies remain relevant
and have been used to evaluate infection control interventions.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Safety

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection
Control Practices Advisory Committee. 2007 guideline for isolation
precautions: preventing transmission of infectious agents in healthcare
settings. Administrative responsibilities. Atlanta (GA): Centers for
Disease Control and Prevention (CDC); 2007 Jun. 3 p.

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1996 Jan (revised 2007 Jun)

#### GUIDELINE DEVELOPER(S)

Centers for Disease Control and Prevention - Federal Government Agency
\[U.S.\]

#### SOURCE(S) OF FUNDING

United States Government

#### GUIDELINE COMMITTEE

Healthcare Infection Control Practices Advisory Committee (HICPAC)

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Patrick J. Brennan, MD (*Chair*), Professor of Medicine, Division of
Infectious Diseases, University of Pennsylvania Medical School; Michael
Bell, MD (*Executive Secretary*), Division of Healthcare Quality
Promotion, National Center for Infectious Diseases, Centers for Disease
Control and Prevention; Vicki L. Brinsko, RN, BA, Infection Control
Coordinator, Vanderbilt University Medical Center; E. Patchen Dellinger,
MD, Professor of Surgery, University of Washington School of Medicine;
Jeffrey Engel, MD, Head General Communicable Disease Control Branch,
North Carolina State Epidemiologist; Steven M. Gordon, MD, Chairman,
Department of Infectious Diseases, Hospital Epidemiologist, Cleveland
Clinic Foundation, Department of Infectious Disease; Lizzie J. Harrell,
PhD, D(ABMM), Research Professor of Molecular Genetics, Microbiology and
Pathology, Associate Director, Clinical Microbiology, Duke University
Medical Center; Carol O\'Boyle, PhD, RN, Assistant Professor, School of
Nursing, University of Minnesota; David Alexander Pegues, MD, Division
of Infectious Diseases, David Geffen School of Medicine at UCLA; Dennis
M. Perrotta, PhD., CIC, Adjunct Associate Professor of Epidemiology,
University of Texas School of Public Health, Texas A&M University School
of Rural Public Health; Harriett M. Pitt, MS, CIC, RN, Director,
Epidemiology, Long Beach Memorial Medical Center; Keith M. Ramsey, MD,
Professor of Medicine Medical Director of Infection Control, The Brody
School of Medicine at East Carolina University; Nalini Singh, MD, MPH,
Professor of Pediatrics, Epidemiology and International Health, The
George Washington University Children\'s National Medical Center; Kurt
Brown Stevenson, MD, MPH, Division of Infectious Diseases, Department of
Internal Medicine, The Ohio State University Medical Center; Philip W.
Smith, MD, Chief, Section of Infectious Diseases, Department of Internal
Medicine, University of Nebraska Medical Center

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control
and Prevention (CDC), Hospital Infection Control Practices Advisory
Committee. Guidelines for isolation precautions in hospital infection
control advisory committee. Atlanta (GA): Centers for Disease Control
and Prevention (CDC); 1996 Jan 1. 38 p. (CDC prevention guidelines; no.
1/96). \[97 references\]

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from
[Centers for Disease Control and Prevention (CDC) Web
site](http://www.cdc.gov/ncidod/dhqp/gl_isolation.html).

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on April 25, 1999. The information
was verified by the guideline developer on November 15, 1999. This NGC
summary was updated by ECRI Institute on September 5, 2007.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### DISCLAIMER

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Date Modified: 11/3/2008