Kombinierte Kontakt- & Luftisolation stationär

• Mpox virus (monkeypox)
• Presence and confirmation of MERS infection(see case definition)
• Previous and confirmed avian influenza (see diagnostic criteria)

• Negative pressure room:
  • Intensive care unit and Building C (Clinic 2)
  • Activation by nursing staff
  • Keep windows and doors closed (avoid draughts)

• If no negative pressure room available or care in Building B (Clinic 1):
  • Single room with own wet room and HEPA filter
  • Window opening for room ventilation permitted
  • Keep doors closed (avoid draughts)

• In general:
  • Remove curtains and unnecessary material
  • Set up the room see work instructions for isolation
  • Attach "Insulation" sign and "Insulation room door sign" to the room door

• In consultation with infection prevention and control

• Mpox virus (monkeypox) and bird flu: standard
• MERS: Skinman™ Soft Protect

• Inside the room: MNS type II/IIR for contact with staff
• Outside the room: FFP2 without valve, gloves, apron (for MERS/bird flu: fully coated/liquid-proof apron)
• Hand disinfection when leaving the room (instructed by trained staff)
• Mpox virus (monkeypox): Cover skin lesions (if possible) (e.g. with plaster, clothing)

• FFP2 without valve (MERS/bird flu: FFP3)
• Protective goggles
• Apron (MERS/bird flu: fully coated/liquid-tight apron)
• Gloves
• No care by pregnant women or immunocompromised employees
• MERS/bird flu: remove protective equipment outside the room

• Diagnostics in the patient's room if possible
• Urgent diagnostic measures possible outside the room after prior information about isolation (coordination by department), if possible plan at the end of the program
• Avoid waiting times in front of treatment rooms/in the corridor
• Especially MERS and avian influenza: inform the laboratory via 54220, bring sample to the laboratory in person

• Therapies in the patient's room if possible
• Plan therapies outside the patient's room at the end of the program if possible
• Avoid waiting times in front of treatment rooms/in the corridor
• Use patient-related materials

• Plan at the end of the program if possible
• Advance information about reason for isolation when registering for surgery
• Surgical procedures in room with negative pressure
• Repositioning in the designated isolation operating room
• Staff in the operating theater wear FFP3 respirator mask with special valve
• Patients without intubation wear FFP2 without valve
• For intubation, use two hydrophobic ventilation filters on the ventilator (first filter close to the patient, second filter on the device side in the expiratory limb)
• Final cleaning/disinfection at the end of surgery

• Department informs transport service about isolation upon registration (MERS/bird flu: additional accompaniment by nursing staff)
• Preparation by responsible nurse, patient documents in plastic bag
• Patients only to be accompanied by instructed staff
• Clean pad for wheelchair
• Clean sheet for the bed
• Disinfection of bed frame (foot and head section) with ethanol 70% denat.

• Protective equipment for transporter: see above
• Protective equipment for walking/sitting patient: see above
• Lying patient: FFP2 mask without valve
  • O2 nasal cannula: FFP2 mask
  • O2 mask with reservoir: MNS type II/IIR over O2 mask

• Building B (K1): Single use patient lift
• Building C (K2): Emergency lift

• Generally valid:
  • Dispose of protective clothing on site (double bag system)
  • Disinfection of used items
  • Hand disinfection
• Additionally in the operating theater:
  • Removal and disposal of bed linen (double bag system)
  • Bed with "Disinfection" sticker in bed center

• Only red serving tray for isolations
• Clear trays of isolated patients last
• Responsibility generally for hotels, outside operating hours (7.00-20.00) for nursing care

• Wash dishes of isolated patients last
• Outside of hotel operating hours, dishes of isolated patients are not handled, but red trays are collected in the tray trolley

• Dishwasher with adequate program (A0 value 600 or equivalent process)
• Disinfect contaminated surfaces (in particular the shelf and tray trolley) with Relaclean 350
• Dispose of waste in a double bag
• Procedure in the IQSoft hotel industry

• Incidin™ Pro 0.5%
• Dismozon® plus 2.4% for MERS

• Meliseptol® Wipes sensitive 100
• Ethanol 70% denat. (only for alcohol-resistant surfaces)

• Daily disinfection of the room

• Leave negative pressure or HEPA filter for 1 h after discharge
• One-offFinal cleaning/disinfection (Exception: Mpox virus (monkeypox): perform twice here)
• Dispose of non-disinfectable items (incl. opened or unsealed packs)
• Dispose of curtains (if not already removed before isolation) before final disinfection in the double bag system (pink bag (Bardusch AG, no. 7119), then yellow-striped bag)

• Waste disposal in a double bag system
• Disposal of laundry in a double bag system (red laundry bag no. 20, then yellow-striped bag)
• Disposal of potentially infectious waste in accordance with the disposal guidelines
• Dispose of sharp, pointed objects in puncture-proof containers in the room

• Use disposable material if possible
• Use medical devices with direct physical contact (e.g. ECG electrodes, stethoscopes, blood pressure cuffs) for specific patients
• Disinfection/reprocessing of all reusable materials in accordance with the disinfection plan
• Handling paper documents: The person concerned only touches paper documents after observed hand disinfection. Documents must then be placed in a sealed plastic bag and disinfected when leaving the room.

• Disposal of bed linen and bed contents (comforter, pillow, sheet) in a double bag system (red laundry bag no. 20, then yellow striped bag) in the ward
• Mark bed with orange "Disinfection" sticker, disinfect bed frame (footboard and headboard) (ethanol 70% denat.) and take to the bed center
• Disinfection of mattress, protective cover and bed frame in the bed center
• CAVE: Mpox virus (monkeypox): Do not shake textiles
• CAVE: MERS/bird flu: daily change of bed linen, towelling and nightgowns

• Mpox virus (monkeypox): Visits permitted, protective equipment as for staff (see above under "Protective equipment for staff/visitors")
• MERS/bird flu: generally no visits allowed, exceptions must be discussed with Infection Prevention and Control or DA Infectiology
• Instruction on hand disinfection by trained staff
• Persons colonized with pathogens requiring isolation should generally not visit patients (exceptions possible through infection prevention and control)

• In consultation with infection prevention and control
• Specific criteria for de-isolation see respective pathogens

• Before leaving the room: hand disinfection
• Leaving the hospital directly
• Mpox virus (monkeypox): Patient is wearing MNS type II/IIR, wounds are covered
• MERS/bird flu: patient wears FFP2 without valve
• Important for transfers:
  Passing on information regarding isolation to the facility providing further treatment by the department

• Final cleaning/disinfection using the scrub-wipe method (see above)
• Transfer to another room and new bed OR final cleaning/disinfection of the same room and new bed

When initiating and lifting isolation and when transferring or discharging isolated patients

• Automatic notification to the IPC when isolation is entered in Meona
• Otherwise active notification via the "Isolation notification" form

• In principle no special regulations

• All isolation measures continue to apply unchanged
• Final cleaning/disinfection as usual

Department:

• Final cleaning/disinfection after transfer
• Disinfect valuables and personal belongings (see above), hand over in plastic bag to admissions office
• Clothes: hand over to relatives in plastic bag (note: wash at at least 60°C or dispose of; not in clothing collection)
• On the body note: note the isolation indication (e.g. "Isolation for MERS") with a permanent red colored pen

Transportation:

• See above

Mortuary:

• Disinfection of contact surfaces and mattress cover (see above under "Cleaning/disinfection/disposal")
• Deposit linen in double bag on bed
• Before leaving: remove and dispose of protective equipment, disinfect hands
• Mark the bed with an orange "Disinfection" sticker and take it to the bed center

Pathology:

• Protective equipment: apron (liquid-tight), gloves, FFP2 (Mpox virus), FFP3 (MERS, bird flu), protective goggles
• Disposal of protective equipment in the autopsy room, followed by hand disinfection
• One-off scrubbing and wiping disinfection of the autopsy room