The potential for transmission of infection must be assessed on the patients arrival to the care area, before transferring a patient to another care area and should be continuously reviewed throughout their stay. The assessment should influence placement decisions in accordance with clinical/care need(s).

Patients who may present a  transmission risk in any setting include, but is not limited to those:

• with symptoms such as loose stools or diarrhoea, vomiting, fever or respiratory symptoms. 
• with a known (laboratory confirmed) or suspected infectious pathogen for which appropriate duration of precautions as outlined in A-Z of pathogens are not yet complete
• known or suspected to have been previously positive with a Multi-drug Resistant Organism (MDRO), for example MRSA, CPE
• who have been hospitalised (inpatient) outside Scotland in the last 12 months (including those who received dialysis)

Further information regarding general respiratory screening questions can be found within the resources section of the NIPCM.

Within healthcare settings, different types of specialised ventilation isolation facilities are used to prevent transmission of infection.  Those most commonly found in NHS Scotland are;

• Negative pressure isolation room (NPIR)
• Positive pressure isolation room (PPIR)
• Positive Pressure Ventilated Lobby (PPVL) room

A description of these rooms and their intended use can be found in the glossary.

Isolation facilities should be prioritised depending on the known/suspected infectious agent (refer to Aide Memoire - Appendix 11).  All patient placement decisions and assessment of infection risk (including isolation requirements) must be clearly documented in the patient notes.

• Patient placement should be reviewed daily, taking account of the clinical judgement and expertise of the staff involved in a patient's management. Where required, the advice of the Infection Prevention and Control Team (IPCT) or Health Protection Team (HPT) should be sought, for example, for isolation prioritisation when single rooms are in short supply.
• When specialised ventilated isolation facilities are indicated but unavailable, the next best option should be considered with an appropriate risk assessment. Options are provided in Appendix 11.
• Those who are at increased risk of acquisition and adverse outcomes resulting from HAI should also be prioritised for placement in a single room.

Hospital settings

Patients who present transmission risk should be risk assessed and placed in appropriate isolation as follows:

• Patients with a known or suspected pathogen spread by the airborne route, should be placed in a specialised negative pressure isolation facility where available.

• • If this is not available, such a patient can be placed in a single room when it is appropriate and following risk assessment.

• Patients with a known or suspected infection spread by the contact route, should be placed in a single room.
• Signage should be used on doors/areas to communicate isolation and TBP requirements.
• Doors to isolation rooms should be kept closed, where it is safe to do so.
• Infectious patients should only be transferred to other departments if medically 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 transfer.
• Receiving department/hospital and transporting staff must be aware of the necessary precautions.

 

Cohorting in hospital settings

Cohorting of patients 

Cohorting of patients should only be considered when single rooms are in short supply and should be undertaken in conjunction with the local IPCT.

Patients who should not be placed in multi bed cohorts:

• patients with different infectious pathogens/strains and patients with unknown infectious pathogens (laboratory confirmation still awaited)
• patients considered more vulnerable to infection
• patients with a known or suspected infectious pathogen spread by the droplet/airborne route who will undergo an AGP

Patients with suspected infection should not be cohorted alongside  those with confirmed infection even if the same infectious agent is suspected.

• In such circumstances, suspected patients should be prioritised for single-room isolation.

Staff cohorting

Where possible, consider assigning a dedicated team of care staff to patients in isolation or cohort rooms as an additional infection control measure during outbreaks/incidents.

Before discontinuing isolation in hospital settings

Individual patient risk factors should be considered, for example there may be prolonged shedding of certain microorganisms in immunocompromised patients). Clinical and molecular tests to show the absence of microorganisms may be considered in the decision to discontinue isolation and can reduce isolation times. The clinical judgement and expertise of the staff involved in a patient’s management and the Infection Prevention and Control Team (IPCT) or Health Protection Team (HPT) should be sought on decisions regarding isolation discontinuation.

Primary care/out-patient settings

• Where possible, virtual assessments (by telephone, email or other appropriate media) of infection risk should be conducted for patients who are due to attend these settings.
• Patients attending these settings with suspected/known infection/colonisation should be prioritised for assessment/treatment, for example scheduled appointments at the start or end of the clinic session. Infectious patients should be separated from other patients whilst awaiting assessment and during care management wherever possible.
• If transfer from a primary care facility to hospital is required, the ambulance service should be informed of the infectious status of the patient.

Resources

Further information can be found in the patient placement literature review.