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Transmission based precautions infection control

WHAT ARE THE TRANSMISSION-BASED PRECAUTIONS

Transmission-based precautions are additional infection control precautions in health care, and the latest routine infection prevention and control practices applied for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens. The latter require additional control measures to effectively prevent transmission.

There are three types of transmission-based precautions:

  • Contact precautions (for diseases spread by direct or indirect contact),
  • Droplet precautions (for diseases spread by large particles in the air), and
  • Airborne precautions (for diseases spread by small particles in the air).

Each type of precautions has some unique prevention steps that should be taken, but all have standard precautions as their foundation.

Contact isolation precautions

The term “contact precautions” means that everyone coming into a patient’s room is asked to wear a gown and gloves. Contact precautions are used when a person has a type of bacteria or virus on the skin or in a sore, or elsewhere in the body, such as the intestine, that can be transmitted to someone else if that person touches the infected individual or contaminated surfaces or equipment near the infected individual.

  • Contact transmission can occur in two ways:
    • Direct Contact Transmission
    • Indirect Contact Transmission

Contact precautions are required to protect against either direct or indirect transmission.

Direct Contact Transmission

  • Involves body-surface to body-surface contact and physical transfer of microorganisms between a susceptible person (host) and an infected or colonized person.
  • More often occurs between a healthcare worker and a patient than between patients.

Indirect Contact Transmission

  • Involves contact of susceptible person (host) with a contaminated intermediate object such as needles, dressings, gloves or contaminated (unwashed) hands.
  • Disease is more likely to develop following direct or indirect contact transmission when the pathogen is highly virulent or has a low infectious dose or the patient or healthcare worker is immunocompromised.
  • Poor hand hygiene is most often cited as a cause of contact transmission.
  • Used for infections, diseases, or germs that are spread by touching the patient or items in the room (examples: MRSA, VRE, diarrheal illnesses, open wounds, RSV).
    Healthcare workers should Instruct patients with known or suspected infectious diarrhoea to use a separate bathroom, if available; clean/disinfect the bathroom before it can be used again
  • Wear gloves when touching the patient and the patient’s immediate environment or belongings
  • Wear a gown if substantial contact with the patient or their environment is anticipated
  • Prioritize placement of patients in an exam room if they have stool incontinence, draining wounds and/or skin lesions that cannot be covered, or uncontrolled secretions
  • Perform hand hygiene before touching patient and prior to wearing gloves
  • Wear a gown and gloves while in the patient’s room.
  • Remove the gown and gloves before leaving the room.
  • Clean hands (hand washing or use hand sanitizer) when entering and leaving the room.
  • Visitors must educate with the doctor/ nurse before taking anything into or out of the room

Droplet isolation precautions

Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets (larger than 5 µm in size) containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets are generated from the source person primarily during coughing, sneezing, or talking and during the performance of certain procedures such as suctioning and bronchoscopy.

Transmission via large-particle droplets requires close contact between source and recipient persons, because droplets do not remain suspended in the air and generally travel only short distances, usually 3 ft or less, through the air. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission.

Used for diseases or germs that are spread in tiny droplets caused by coughing and sneezing (examples: pneumonia, influenza, whooping cough, bacterial meningitis).

  • Place the patient in an exam room with a closed door as soon as possible (prioritize patients who have excessive cough and sputum production); if an exam room is not available, the patient is provided a facemask and placed in a separate area as far from other patients as possible while awaiting care.
  • Wear a facemask, such as a procedure or surgical mask, for close contact with the patient; the facemask should be donned upon entering the exam room
  • If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles (or face shield in place of goggles) should be worn
  • Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
  • Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients, and practice respiratory hygiene and cough etiquette
  • Clean and disinfect the exam room accordingly

Healthcare workers should…

  • Wear a surgical mask while in the room. Mask must be discarded in trash after leaving the room.
  • Clean hands (hand washing or use hand sanitizer) when they enter the room and when they leave the room.

Airborne isolation precautions

Airborne transmission occurs by dissemination of either airborne droplet nuclei (small-particle residue [5 µm or smaller in size] of evaporated droplets that may remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by or deposited on a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air handling and ventilation are required to prevent airborne transmission.

Used for diseases or very small germs that are spread through the air from one person to another (examples: Tuberculosis, measles, chickenpox).

  • Have patient enter through a separate entrance to the facility (e.g., dedicated isolation entrance), if available, to avoid the reception and registration area
  • Place the patient immediately in an airborne infection isolation room (AIIR)
  • If an AIIR is not available:
  • Provide a facemask (e.g., procedure or surgical mask) to the patient and place the patient immediately in an exam room with a closed door
  • Instruct the patient to keep the facemask on while in the exam room, if possible, and to change the mask if it becomes wet
  • Initiate protocol to transfer patient to a healthcare facility that has the recommended infection-control capacity to properly manage the patient
  • hand hygiene before and after touching the patient and after contact with respiratory secretions and/or body fluids and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
  • instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients , and practice respiratory hygiene and cough etiquette
  • Once the patient leaves, the exam room should remain vacant for generally one hour before anyone enters; however, adequate wait time may vary depending on the ventilation rate of the room and should be determined accordingly
  • If staff must enter the room during the wait time, they are required to use respiratory protection

Healthcare workers should…

  • Ensure patient is placed in an appropriate negative air pressure room (a room where the air is gently sucked outside the building) with the door shut.
  • Wear a fit-tested NIOSH-approved N-95 or higher level respirator while in the room. Mask must be discarded in trash after leaving the room.
  • Clean hands (hand washing or use hand sanitizer) when they enter the room and when they leave the room.
  • Ensure the patient wears a surgical mask when leaving the room.
  • Instruct visitors to wear a  mask while in the room.


Isolation precautions

Isolation precautions are used to help stop the spread of germs from one person to another. These precautions protect patients, families, visitors, and healthcare workers from the spread of germs.

Generally, when patients are placed on isolation precautions, there will be a sign at the door of their hospital rooms to remind visitors and healthcare workers which isolation precautions are needed. All healthcare workers and visitors need to follow these guidelines. Healthcare workers should not eat or drink in isolation rooms and should always clean their hands before entering the room and upon exiting the room.