Chapter 22 Infectious Diseases
Isolation Precautions
The Centers for Disease Control and Prevention (CDC) has established isolation precautions to prevent the spread of infection in health care institutions. Isolation precautions are divided into two general categories: standard precautions and transmission-based precautions. The three primary routes of disease transmission are contact, droplet, and airborne.1 Table 22-1 lists examples of common conditions that require isolation.
TABLE 22-1 EXAMPLES OF COMMON CONDITIONS REQUIRING ISOLATION
| CONTACT | AIRBORNE | DROPLET |
|---|---|---|
Contact Precautions
There are two types of contact precautions:
• Direct—the infectious pathogen is transferred from an infected person directly to another without an intermediate object or person. An example is blood from an infected person that comes in contact with an open wound on the skin.
• Indirect—the infectious pathogen is transferred through an intermediate object or person. An example is the hands of a health care worker transmitting a pathogen to another person.
Blood-Borne Infections2
Human Immunodeficiency Virus
Transmission
• Unprotected sexual contact of any kind
• Vertical or perinatal transmission—occurs in utero or during birth process from mother to child
• Breastfeeding—an HIV-positive mother can transmit HIV when breastfeeding.
Therapeutic Interventions
Primary Therapeutic Interventions
Discharge Instructions
For those who present to the ED and are discharged with an HIV diagnosis:
• HIV follow-up care: If possible, schedule an appointment with an HIV care provider prior to discharge from the ED or hospital.
• Provide information on HIV and schedule an appointment for counseling services.
• Provide information regarding HIV transmission prevention.
For those who present to the ED and are discharged without an HIV diagnosis:
Hepatitis B
Signs and Symptoms3
• General gastrointestinal symptoms: nausea, vomiting, loss of appetite (31% to 69%)
• Viral symptoms or fever (70% to 94%)
• Pruritus from skin irritation by bile salts
• Dark urine (from bile); clay-colored stool (from lack of bile)
• Jaundice, if bilirubin two to three times the normal value (31% to 69%)
Diagnostic Procedures
• Liver enzymes ALT and AST (also known as SGOT and SGPT) must be at least two times the normal value.
• Hepatitis panel to determine whether patient has HBV, had HBV, or is resistant to the virus.
• If diagnosed with HBV, regular liver function testing will be conducted to measure progression and control side effects (cirrhosis and liver cancer).
Therapeutic Intervention
Acute HBV infection requires support and monitoring. Chronic HBV infection requires the following:
• Medication—currently, there is no cure available for HBV despite the approval of these seven drugs for treatment:
• Medical monitoring—blood work should be drawn on a regular basis.
Prevention
• Vaccination—HBV vaccination can start at the time of birth. It consists of a series of three injections over the course of 6 months.
• Engage in safe-sex practices.
• Use clean needles or needle exchange programs if an IV drug user.
• Practice universal safety precautions when providing health care.
• Avoid sharing personal items such as razors, toothbrushes, etc.
Discharge Instructions
Regardless of HBV type, all patients discharged from the hospital with HBV should be:
• Cautioned against sharing personal items that could spread HBV.
• Made aware of the importance of engaging in safe-sex practices.
• Advised to abstain from illicit drug use, hepatotoxic drug use such as acetaminophen (Tylenol), and alcohol use.
• Given instructions to follow up with their health care providers.
• Educated as to the importance of rest and good nutrition to help the liver regenerate.
