The standard infection and transmission based precautions patient placement, isolation and cohorting literature review has been updated and the following changes made to the NIPCM.

Chapter 1

Inclusion of new paragraph:

'Patients who may present a particular cross-infection risk should be isolated on arrival and appropriate clinical samples and screening undertaken as per national protocols to establish the causative pathogen. This includes but is not limited to patients:'

Inclusion of new bullet points:

• Who have been a close contact of a person who has been colonised or infected with CPE in the last 12 months.
• Who have been in contact with a confirmed COVID-19 individual and are still within the 14-day self-isolation period.

Updated bullet points:

• With symptoms such as loose stools or diarrhoea, vomiting, fever or respiratory symptoms.
• Who have been hospitalised outside Scotland in the last 12 months (including those who received dialysis).

Chapter 2

New and updated bullets as per Chapter 1.

New paragraph

'When single-bed rooms are limited, patients who have conditions that facilitate the transmission of infection to other patients (e.g., draining wounds, stool incontinence, uncontained secretions) and those who are at increased risk of acquisition and adverse
outcomes resulting from HAI (e.g., immunosuppression, open wounds, invasive
devices, anticipated prolonged length of stay, total dependence on HCWs for
activities of daily living) should be prioritised for placement in a single-bed
room. Single-bed room prioritisation should be reviewed daily and...'

Hospital settings:

Updated bullet point

• Isolation of infectious patients can be in specialised isolation facilities, single room isolation, cohorting of infectious patients where appropriate, ensuring that they are separated by at least 2 metres with the door closed.

Cohorting in hospital

New paragraph in discontinuing isolation.

'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/outpatient settings

Updated bullet point

• Patients attending these settings with suspected/known infection/colonisation should be prioritised for assessment/treatment e.g. 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 by at least 2 metres.