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Contact – which is divided into: • Direct Contact – occurs through touch • Indirect Contact – occurs when micro-organisms are transferred by contaminated object coming into contact with anothersurface the procedure(s)to be performed (e.g., hand hygiene & PPE required) and whether Additional Precautions are required • whether there will be contact with non-intact skin or mucous membranes • the potential for handling sharp or contaminated Droplet Transmission – occurs instruments or equipment when large droplets exit the respiratory tract of a person when he/she coughs orsneezes. Can also be generated by some procedures (e.g.,suctioning). These droplets are projected a short distance of usually < 2m and enter the hosts eyes, nose, mouth or fall onto surfaces. Airborne Transmission – occurs when airborne particlesremain suspended in the air, travel on air currents and are then inhaled by others who are nearby or who may be some distance away from the source patient, in a different room or ward (depending on air currents) or in the same room that a patient hasleft, if there have been insufficient air exchanges. (PIDAC, 2012b, p. 38). Page 11 www.crto.on.ca Infection Prevention and Control CBPG Links in the Chain of Transmission are: Breaking the Chain of Transmission by Assessing: MODES OF TRANSMISSION (continued) Parenteral Transmission – the spread of an agent through intact skin by a sharp (e.g., needle stick injury). Common Vehicle Transmission – the spread of an agent through a common contaminated source (e.g., multi-dose vials) Vector Transmission – occurs when a host is bitten by an animal or insect carrying the infectious agent (e.g., mosquito transmitting West Nile virus) PORTAL OF ENTRY the point at which the agent enters the host (e.g., non-intactskin, respiratory or GI tract, mucous membranes) the need for aseptic technique the appropriate catheter and wound care SUSCEPTIBLE HOST any person at risk of infection (e.g., immunosuppressed patients, burn victims) the need for appropriate immunization Page 12 Routine Practices Routine practices must be applied to all patients at all times, in all settings, regardless of diagnosis or infectious status. The basics of Routine Practices include: • Hand Hygiene • Personal Protective Equipment (PPE) • Needlesticks and Sharps Injuries Prevention & Safe Injection Practices • Cleaning, Disinfection & Sterilization of Medical Devices • Waste Disposal • Performing a Risk Assessment • Additional Precautions For any procedure with the potential to generate respiratory droplets or aerosolization (including but not limited to the procedures listed on the next page), Routine Practices require the addition of Droplet Precautions. Proper PPE must be used by staff when within two metres of procedures generating droplets/aerosols on any client/patient/resident, with or without symptoms of an acute respiratory infection, to prevent deposition of droplets/aerosols on staff mucous membranes. Infection Prevention and Control CBPG www.crto.on.ca Droplet Precautions are not required when performing aerosol-generating on stable, afebrile patients/clients without new or worsening cough or shortness of breath [such as those who require routine tracheostomy care at home, or chronic or home use of non-invasive positive pressure ventilators (NIPPV)]. Professional Accountabilities: These precautions may be a departure for many CRTO Members, however, lessons learned during the SARS crisis remind us that strict vigilance to appropriate infection control prevention activities are vital to ensuring a safe environment for both our patients and ourselves. With the emerging threat of an influenza pandemic and other emerging pathogens, it is crucial that RRTs follow the MOHLTC’s recommended infection control guidelines. Aerosol-Generating Respiratory Procedures There are certain procedures where there has been confirmed transmission of infectious agents via droplets or aerosols. In other cases, transmission may be possible but not yet proved. The table below illustrates which category many Aerosol-Generating Respiratory Procedures fit into. Page 13 www.crto.on.ca