An Effective Protocol is Critical
A diagnosis of bacterial meningitis invokes fear, but the key to dealing with it is preparation. In addition to proper training and equipment, an effective bacterial meningitis isolation protocol is critical for those dealing with patients and anything potentially carrying the pathogens. This dangerous disease is a compelling reason to ensure compliance with effective isolation protocols to avoid exposure of staff or others.
If approved protocols for dealing with patients, tissues and wastes that may carry the pathogen are not in place, they should be written and reviewed. The best time to develop these protocols is before they are actually needed.
Meningitis patients must be isolated while they are infectious, generally for the first 24 hours after antibiotic treatment. As the pathogens are generally passed to others by sputum or other bodily fluid contact, the highest level of isolation is not required. Normally, placing the patient in a private room and requiring staff and visitors to use surgical masks, gloves and gowns should be sufficient, while pathogenic microbes are still viable. If the patient is aspirating sputum or other activity is creating patient fluid aerosols, greater precautions may be required.
Infected tissues, fluids and instruments
Treatment produces laboratory specimens, soiled linens, red-bag wastes and instruments to be handled with appropriate isolation precautions. When these materials must be physically handled directly by staff, Personal Protective Equipment (PPE) such as gowns, face masks, respirators and gloves should be used to avoid skin and respiratory exposure.
Common conservative infection control protocols will be adequate, if they are carefully and fully implemented. Full, consistent protocol observation is critical in patient rooms, treatment areas, hazard disposal rooms and transport.
In the laboratory the use of PPE and conservative handling continues to be critical until the material is isolated in a barrier isolation enclosure, biological safety cabinet or fume hood, or is sealed in a closed vessel. If the laboratory bacterial meningitis isolation protocol to be applied for a given test is a general laboratory standard for tests on all pathogens, it should be reviewed for safety with these pathogen types. If there is no protocol in place we recommend working with your infection control department to develop and refine effective protocols. You may consider including the following elements in a draft protocol for lab work:
- A conservative transport protocol with materials in sealed containers and staff in appropriate pathogen safe PPE must be applied until materials are inside isolation enclosures.
- If possible, barrier isolation glove box cabinets should be used for processing.
- If a fume hood is used, the user must wear PPE during use, similar to PPE required for transport.
- While processing tissues, fluids or cultures, care must be exercised to minimize exposure to instruments, vessels, materials and enclosure interiors, and all exposed elements must be kept together and apart from those not exposed.
- After processing is completed, all exposed items must be sealed in containers, or thoroughly cleaned and disinfected with a broad spectrum antimicrobial.
- The enclosure interior and sealed containers must be cleaned and disinfected with a broad spectrum antimicrobial, with particular attention to areas known to be directly exposed.
- Only after antimicrobial agents are applied and allowed recommended times to act should enclosures be opened so tools, specimens and other materials removed
Developing the Site Protocols
It is critical to have final reviewed and approved bacterial meningitis isolation protocols in place for each facility, organization and process. While these protocols can be adopted from national or international organizations or developed locally, it is critical that they be reviewed and approved for and by those that will use them.
Not all facilities or teams have the same equipment, training, personnel or priorities, so protocols often must be adapted to the site and team. Whether they are adopted, adapted or written from scratch they must be reviewed, approved and tested by your infection control officer prior to approval for standard use. Once approved, the bacterial meningitis isolation protocol will only be effective if staff are trained and routinely audited to ensure consistent compiant application.
Image by Marvin 101 – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=12352584
Photo by Jensflorian (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons