Precautions
Preventing the spread of infection
Preventing the spread of infection
The Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) has developed guidelines for isolation precautions in hospitals. These guidelines have two levels of precautions:
♦ Standard precautions
♦ Transmission-based precautions, which are further divided into airborne precautions, droplet precautions, and contact precautions.
Standard precautions
Standard precautions are designed to decrease the risk of transmission of microorganisms from recognized and unrecognized sources of infection. They should be followed at all times and with every patient.
HICPAC and the CDC define these materials as infectious, and standard precautions must be observed:
♦ blood
♦ body fluids, secretions, and excretions (except sweat)
♦ nonintact skin
♦ mucous membranes.
Standard precautions combine the major features of universal precautions, which were developed specifically to reduce the transmission of blood-borne pathogens, such as human immunodeficiency virus and hepatitis B virus (HBV), and body substance isolation, which was developed to decrease the risk of transmission of pathogens from moist body surfaces. Because standard precautions reduce the risk of transmission of blood-borne and other pathogens, many patients with diseases or conditions that previously required category- or diseasespecific isolation precautions now require only standard precautions.
Implementation
♦ Wash your hands immediately if they become contaminated with blood or body fluids, secretions, or excretions; also wash your hands before and after providing patient care and after removing gloves.
♦ Use nonantimicrobial soap for routine hand washing.
♦ Wear gloves if you will or could come in contact with blood, specimens, tissue, body fluids, secretions, excretions, or contaminated surfaces or objects.
♦ Change your gloves between tasks and procedures performed on the same patient if you touch anything that might have a high concentration of microorganisms. Also change gloves between patient contacts to avoid crosscontamination. Remove your gloves immediately after use and before touching noncontaminated areas, and wash your hands. Vinyl and nitrile gloves are available for anyone who’s allergic to latex.
♦ Wear a gown, eye protection (goggles or glasses), and a mask during procedures (such as extubation, surgery, endoscopic procedures, and dialysis) that are likely to generate droplets of blood or body fluids, secretions, or excretions.
♦ Carefully handle used patient care equipment that’s soiled with blood, body fluids, secretions, or excretions to prevent exposure to skin and mucous membranes, contamination of clothing, and transfer of microorganisms to other patients and environments. Patient care equipment must be cleaned with a facility-approved disinfectant between patients. Discard disposable equipment appropriately.
♦ Make sure that procedures for routine care, cleaning, and disinfection of environmental surfaces and equipment are followed.
♦ Keep contaminated linens away from your body to prevent contamination and transfer of microorganisms. Place linens in properly labeled containers and make sure that the linens
are transported and processed according to facility policy.
are transported and processed according to facility policy.
♦ Handle used needles and other sharps carefully. Don’t bend them, break them, reinsert them into their original sheaths, or handle them unnecessarily. Immediately after use, discard them intact in an impervious disposal box. These measures reduce the risk of accidental injury and infection.
♦ Use sharps with safety features whenever available.
♦ Use mouthpieces, resuscitation bags, or other ventilation devices in place of mouth-to-mouth resuscitation whenever possible.
♦ Place the patient who can’t maintain appropriate hygiene or who contaminates the environment in a private room. Notify infection control personnel.
♦ If you have an exudative lesion, avoid direct patient contact until the condition has resolved and the employee health provider clears you.
♦ Because precautions can’t be specified for every clinical situation, use your judgment in individual cases. Refer to your facility’s infection control manual or check with infection control personnel when you need more information.
♦ If occupational exposure to blood is likely, get vaccinated with the HBV vaccine series.
Transmission-based precautions
Whenever a patient is known or suspected to be infected with highly contagious or epidemiologically important pathogens that are transmitted by air, droplet, or contact with dry skin or other contaminated surfaces, follow transmission-based precautions along with standard precautions. Examples of such pathogens include those that cause measles (air); influenza (droplet); and GI tract, respiratory tract, skin, and wound infections (contact). In fact, transmission-based precautions replace all older categories of isolation. One or more types of transmission-based precautions may be combined and followed when a patient has a disease with multiple routes of transmission.
Airborne precautions
Along with standard precautions, follow these precautions:
♦ Place the patient in a private room that has monitored negative air pressure in relation to surrounding areas, 6 to 12 air exchanges per hour, and appropriate outdoor air discharge or highefficiency filtration of room air. The room door should remain closed. If a private room isn’t available, consult with infection control personnel. As an alternative, he may be placed in a room with a patient who has an active infection with the same microorganism.
♦ Wear respiratory protection, such as a surgical mask or N-95 respirator (for tuberculosis [TB]), when entering the room of a patient with a known or suspected respiratory tract infection. Persons immune to measles and varicella don’t need to wear respiratory protection when entering the room of a patient with these illnesses.
♦ Limit patient transport and movement out of the room. If the patient must leave the room, have him wear a surgical mask.
Droplet precautions
In addition to standard precautions, follow these precautions:
♦ Place the patient in a private room. If a private room isn’t available, consult with infection control personnel. As an alternative, he may be placed in a room with a patient who has an active infection with the same
microorganism. Special ventilation isn’t necessary.
microorganism. Special ventilation isn’t necessary.
♦ Wear a mask when working within 3′ (0.9 m) of the infected patient. For a patient with known TB, it’s necessary to wear an N-95 respirator.
♦ Instruct visitors to stay at least 3′ away from the infected patient.
♦ Limit movement of the patient from the room. If the patient must leave the room, have him wear a surgical mask.
N-95 respirator
You’re required to wear a mask, called a respirator, when caring for a patient with known or suspected infectious pulmonary TB. The specific type that the National Institute for Occupational Safety and Health and the Occupational Safety and Health Administration has approved for this purpose is the N-95 respirator. This type of respirator effectively protects and screens the wearer from at least 95% of particles the size of the TB droplet nuclei, if the respirator fits correctly and there’s minimal face-seal leakage. Fit testing, which detects such leakage, is mandatory when a respirator is first given to an employee. Make sure you wash your hands before and after handling the mask.
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