Antibiotic Policy Full time Care givers

Policies and Procedures on Infection Control Ministry of Health Malaysia 130 5. Avoid fresh salads, fresh fruits, raw peanuts and seeds and raw or undercooked seafood. 6. Avoid naturopathic foods that may contain moulds. Pepper is to be avoided. 7. Sterile foods, on the other hand are expensive, tasteless and not proven in benefit 8. Low microbial diet should continue at least 3 months after chemotherapy or autologous stem cell transplant. In allogenic stem cell transplant, it should continue until all immune-suppressives are stopped.

6.9.5 Facilities

1. Isolation in single rooms is beneficial in the setting of aplastic anaemia, induction therapy of high risk AML patients especially elderly and in haemopoietic stem cell transplant setting. All haemato-oncology patients should be placed in single rooms where possible. Where not possible, they can be nursed in open cubicles with isolation facilities made available when necessary e.g. during MRSA or ESBL- infections. 2. For isolation rooms, HEPA filter with a capacity of maintaining 310,000 atmospheric particles of 0.3microns with 12 air exchanges per hour will remove bacteria and fungal spores. This is most effective to prevent hospital acquired aspergillus. The use of laminar air flow rooms is controversial. 3. Isolation rooms should have self-closing doors and well-sealed windows. Avoid false ceilings. Flooring and wall finishing can be scrub, non-porous and easily disinfected. A constant positive pressure of 2.5 Pa between the patient’s room and hall way should be maintained. Back-up emergency power should be available. 4. Wards and rooms should be regularly cleaned at least once a day. Avoid vacuuming. Any water leaks should be attended to within 72 hours. 5. Avoid construction or renovation areas during transportation of patients to other facilities e.g. X-ray. Patients should wear an N95 mask if this is unavoidable. 6. Any construction or renovation activities adjacent to the units should be discussed with the infection control unit before proceeding. Refer to section on construction and renovation 7. Patients with concomitant active infectious diseases e.g. tuberculosis or measles should be nursed in isolation room with negative pressure with an adjacent anteroom. 8. Equipment should be cleaned regularly and disinfected at least once a week. 9. Plants – fresh or dried and soft toys are prohibited. Only toys, games and videos that can be cleaned are allowed.

6.9.6 Personnel precautions

1. Health care workers should practice standard precautions. Personnel should wear surgical masks when entering rooms. They should practice hand hygiene with alcohol based hand rubs before entering and after leaving rooms. Gloves should be worn after entering room and washing hands and discarded before exiting. Policies and Procedures on Infection Control Ministry of Health Malaysia 131 2. Health-care workers should practise hand hygiene before and after any direct contact with patients. 3. Personnel should also comply to the immunization policy of the hospital. Generally health-care workers should be immune to measles, mumps, rubella, varicella and influenza. 4. Personnel with active upper respiratory infection should avoid attending to patients.

6.9.7 Visitors

1. Written policies for visitors should be documented and made available. 2. Restriction to visitor numbers to two per patient at any one time is recommended. Visitors are requested to practice hand hygiene before any contact with patient and should not sit on patient’s bed. 3. Children under 12 years are not allowed. 4. Visitors who have communicable infections e.g. upper respiratory tract infections, recent exposure to communicable infections, active shingles, recent vaccination within 6 weeks should not be permitted.

6.9.8 Surveillance cultures

1. Routine bacteria and fungal cultures of asymptomatic patients, environment, equipment and devices are not recommended. 2. Colonization with MRSA may be eradicated with 0.2 chlorhexidine or mupirocin. This may be indicated during outbreaks. 3. An outbreak e.g. twofold or greater increase in aspergillus infections during any 6 month period may suggest a lapse in infection control procedures and attention to environment or ventilation should be carefully evaluated.