The Revised CDC Guidelines for Isolation Precautions in Hospitals: Implications for Pediatrics

The Hospital Infection Control Practices Advisory Committee of the US Centers for Disease Control and Prevention and the National Center for Infectious Diseases have issued new isolation guidelines that replace earlier recommendations. Modifications of these guidelines for the care of hospitalized infants and children should be considered specifically as they relate to glove use for routine diaper changing, private room isolation, and common use areas such as playrooms and schoolrooms. These new guidelines replace those provided in the 1994 Red Book and have been incorporated into the 1997 Red Book. ABBREVIATION. CDC, Centers for Disease Control and Prevention. These new isolation guidelines developed by the Hospital Infection Control Practices Advisory Committee of the US Centers for Disease Control and Prevention (CDC) and the National Center for Infectious Diseases are specifically recommended for use in the care of hospitalized adults and children.1 Settings such as schools and child care centers are similar to hospital environments in which children share common space but differ in that the involved children are, for the most part, healthy. These recommendations, therefore, should not be applied to those settings. These new guidelines are simpler and rely on very consistent strategies to prevent the spread of infection to uninfected hospitalized patients. These new recommendations specifically state that “No guideline can address all of the needs of the more than 6000 US hospitals, which range in size from five beds to more than 1500 beds and serve very different patient populations. Hospitals are encouraged to review the recommendations and to modify them according to what is possible, practical, and prudent . . . ”1 Therefore, with these new recommendations as a guide, each institution must create its own specific isolation policies. These isolation policies, supplemented by hospital policies and procedures for other aspects of infection and environmental control and occupational health, coupled with common sense, will serve to create reasonable policies for each unique medical center. These new guidelines rely on the routine and optimal performance of an expanded set of universal precautions, now called standard precautions, for the care of all patients regardless of their diagnosis or presumed infection status, and pathogen and syndrome-based precautions, termed transmissionbased precautions, for the care of patients who are infected or colonized with pathogens spread through airborne, droplet, or contact routes. STANDARD PRECAUTIONS Standard precautions now apply to nonintact skin, mucous membranes, blood, all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood. These general methods of infection prevention are indicated for all patients and are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals. TRANSMISSION-BASED PRECAUTIONS Transmission-based precautions are designed for patients documented or suspected to be infected or colonized with pathogens that require additional precautions beyond the standard precautions necessary to interrupt transmission. These precautions apply to airborne, droplet, and contact transmissions. The precautions may be combined for diseases that have multiple routes of transmission. Whether singly or in combination, they are always to be used in addition to standard precautions. Contact Transmission Contact transmission, the most important and frequent mode of transmission of nosocomial infections, is divided into two subgroups: direct-contact transmission and indirect-contact transmission. Direct-contact transmission involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host. Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, dressings, or contaminated The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. PEDIATRICS (ISSN 0031 4005). Copyright © 1998 by the American Acad-