Isolation - yes/no

This probably isn't the answer you were hoping for, but do you have a supervisor you can ask? That sounds like the kind of situation where if coded and billed incorrectly, it could be an insurance fraud issue.

Unfortunately, my supervisor is the one who asked me to look into this. We are both concerned about miscoding and hoping to find more info. This is our first opportunity to code "isolation" since our facility moved to a new private-room only building. Thank you for responding though!

This is what the RAI says...

Code for single room isolation” only when all of the following conditions are met:

1. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.

2. Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.

3. The resident is in a room alone because of active infection and cannot have a roommate. This means that the resident must be in the room alone and not cohorted with a roommate regardless of whether the roommate has a similar active infection that requires isolation.

4. The resident must remain in his/her room. This requires that all services be brought to the resident (e.g. rehabilitation, activities, dining, etc.).

C. Diff does not satisfy #2 since stool can be contained with standard precautions.

This is what the RAI says...

Code for single room isolation” only when all of the following conditions are met:

2. Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.

C. Diff does not satisfy #2 since stool can be contained with standard precautions.

The CDC recommends contact precautions (gown and gloves) for any patient with a C. Diff infection in any healthcare setting. Standard precautions alone are not effective enough to prevent transmission. So C. Diff would satisfy requirement #2.

I don't think that it would satisfy requirement #3 based on the RAI wording because patients with a C. Diff infection can be cohorted with another patient with the same infection.

I believe your patient satisfies all the criteria outlined in the RAI. Code for isolation. I have done this and never had a problem. Any place I have ever worked required more than just gloves for someone with C-diff. That is a totally contact isolation situation. And two people with C-diff in one room can continue to reinfect each other. It is a very poor idea and should not be done. The fact that all your rooms are single rooms doesn't matter. The patient is in a single room with a highly contagious infection and all isolation precautions necessary should be utilized. Who knows what that person has touched in that room? Visitors should gown and glove as well. How do you think it spreads so rapidly throughout a unit in nursing homes that allow cohabiting or just standard precautions? Just asking for trouble. The latest from the CDC is that staff carries infection on their uniforms, especially the abdominal area of their tops and the pockets from room to room. MRSA and VRE would never have become the problem they are, imo, if we had maintained isolation that we had in the 1980's. Don't believe it would be a community issue either. But it was all about money and getting people out of hospitals and into nursing homes that started that mess. Now look where we are?!

Make sure the charting supports the need for isolation. At least one nurse every day should chart that the resident is under contact isolation precautions r/t C-diff. and the need to contain the infection complicated by frequent loose stools.

When I was working in SNF we only kept residents in isolation (and billed for it) as long as the stools could not be contained. Once the resident reached the stage of being continent with formed stools, isolation was discontinued.