Page 11
in a negative pressure room. 4.11 Airborne precautions for Residential Care In addition to routine practices: • Resident to be placed into a single room; the resident should be instructed to keep a mask on and the door should remain closed. Transfer as soon as possible to a facility with an airborne isolation room. 4.12 Airborne precautions for Clients in a Home Environment In addition to routine practices: • The healthcare worker should wear a fit-tested N95 respirator. 5.0 REFERENCES 1) Routine Practices and Additional Precautions In all Healthcare Settings. Provincial Infectious Diseases Advisory Committee (PIDAC), Ontario; November 2012. , http://www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng2012.pdf 2) Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care Settings; Public Health Agency of Canada; 2013. 3) Routine Practices and Additional Precautions Assessment and Educational Tools. Public Health Agency of Canada; 2013. 4) BCCDC Communicable Disease Control –Management of Measles September2014.http://www.bccdc.ca/resourcegallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Ma nual/Chapter%201%20-%20CDC/MeaslesSeptember2014.pdf Note: in this document the term “patient” is inclusive of patient, resident or client. Infection Prevention and Control Transmission-Based Precautions are the second tier of basic infection control and are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection transmission.Ensure appropriate patient placement in a single patient space or room if available in acute care hospitals. In long-term and other residential settings, make room placement decisions balancing risks to other patients. In ambulatory settings, place patients requiring contact precautions in an exam room or cubicle as soon as possible.Use personal protective equipment (PPE) appropriately, including gloves and gown. Wear a gown and gloves for all interactions that may involve contact with the patient or the patient’s environment. Donning PPE upon room entry and properly discarding before exiting the patient room is done to contain pathogens.Limit transport and movement of patients outside of the room to medically-necessary purposes. When transport or movement is necessary, cover or contain the infected or colonized areas of the patient’s body. Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. Don clean PPE to handle the patient at the transport location.Use disposable or dedicated patient-care equipment (e.g., blood pressure cuffs). If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient.Prioritize cleaning and disinfection of the rooms of patients on contact precautions ensuring rooms are frequently cleaned and disinfected (e.g., at least daily or prior to use by another patient if outpatient setting) focusing on frequently-touched surfaces and equipment in the immediate vicinity of the patient.Use Droplet Precautions for patients known or suspected to be infected with pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking.Ensure appropriate patient placement in a single room if possible. In acute care hospitals, if single rooms are not available, utilize the recommendations for alternative patient placement considerations in the Guideline for Isolation Precautions. In long-term care and other residential settings, make decisions regarding patient placement on a case-by-case basis considering infection risks to other patients in the room and available alternatives. In ambulatory settings, place patients who require Droplet Precautions in an exam room or cubicle as soon as possible and instruct patients to follow Respiratory Hygiene/Cough Etiquette recommendations.Use Airborne Precautions for patients known or suspected to be infected with pathogens transmitted by the airborne route (e.g., tuberculosis, measles, chickenpox, disseminated herpes zoster).Ensure appropriate patient placement in an airborne infection isolation room (AIIR) constructed according to the Guideline for Isolation Precautions. In settings where Airborne Precautions cannot be implemented due to limited engineering resources, masking the patient and placing the patient in a private room with the door closed will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned home.Restrict susceptible healthcare personnel from entering the room of patients known or suspected to have measles, chickenpox, disseminated zoster, or smallpox if other immune healthcare personnel are available.Use personal protective equipment (PPE) appropriately, including a fit-tested NIOSH-approved N95 or higher level respirator for healthcare personnel.Limit transport and movement of patients outside of the room to medically-necessary purposes. If transport or movement outside an AIIR is necessary, instruct patients to wear a surgical mask, if possible, and observe Respiratory Hygiene/Cough Etiquette. Healthcare personnel transporting patients who are on Airborne Precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and infectious skin lesions are covered.Immunize susceptible persons as soon as possible following unprotected contact with vaccine-preventable infections (e.g., measles, varicella or smallpox). Isolation Precautions Take proper precautions to prevent the spread of infection in the health care setting. Standard Precautions Standard precautions are based on the principle that all blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes may contain transmissible infectious agents. Standard precautions are the minimal protection that should be used to care for all patients at all times to protect health care workers and to prevent spread from health care worker to patient. They apply to all patients, regardless of suspected or confirmed infection status in all health care settings. Hand Hygiene • After touching blood, body fluids, secretions, excretions, and contaminated items • Immediately after removing gloves and before and after patient contact Personal Protective Equipment (PPE) • Gloves: for touching blood, body fluids, secretions, excretions, contaminated items, mucous membranes, and non-