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GUIDING PRINCIPLES Maintain a high degree of suspicion for those patients who present with compatible symptoms of an airborne infection, prompt implementation of airborne precautions and rapid diagnosis. 3.2. For the purpose of this guideline, the term Airborne Isolation Room will be used to refer to a “negative pressure room”. An Airborne Isolation Room must have: · Ventilation creating inward directional airflow from adjacent spaces to the room (‘negative pressure’) that is regularly monitored. · Direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter before returning to circulation. · Twelve (12) air changes per hour. · The door into the room kept closed to maintain negative pressure, even if the patient is not in the room. · Windows closed at all times; opening the window may cause reversal of air flow, an effect that can vary according to wind direction and indoor/outdoor temperature differentials. All healthcare providers in high risk areas must be fit tested for an N95 respirator. REFER TO AV 1900 RESPIRATORY PROTECTION PROGRAM POLICY (NOT AVAILABLE TO NON IH FACILITIES. Only immune healthcare providers should enter a room where airborne precautions are in place for measles or varicella; an N95 respirator is not required. An N95 respirator must be worn if non-immune health care providers are required to enter the room of a patient with measles or varicella when there are no qualified immune health care providers available and patient safety would be compromised if they did not provide care. A point of care risk assessment for every patient interaction needs to be done to determine additional precautions, room placement and PPE: DEFINITIONS Airborne Precautions – measures used for diseases that are spread by airborne transmission. This primarily occurs through dissemination of microorganisms by aerosolization. Organisms are contained in droplet nuclei which are small airborne particles, less than 5 microns in size that result from evaporation of large droplets. Organisms can also be contained in debris in dust particles that remain suspended in the air for long periods of time. These microorganisms are then widely dispersed by air currents and can be inhaled by susceptible hosts who may be some distance away from the source patient. Control of airborne transmission is the most difficult, as it requires control of air flow through special ventilation systems and use of respirators. Conditions/clinical presentations and specific etiologies requiring airborne precautions: Conditions/clinical presentation Specific etiologies * Cough, fever, pulmonary infiltrate in person at risk for TB (pleuropulmonary or laryngeal TB) Rash, maculopapular with fever and one of coryza, conjunctivitis or cough Rash, vesicular with fever * * * * * Measles (rubeola) Monkeypox Tuberculosis (pleuropulmonary or laryngeal) ■ nonpulmonary lesions, during procedures that may aerosolize tuberculi bacilli Smallpox Varicella zoster virus ■ varicella (chicken pox) ■ zoster, disseminated ■ zoster in immunocompromised patient Aerosol-generating medical procedures (AGMPs) - are medical procedures that can generate aerosols as a result of artificial manipulation of a patient’s airway. Examples include intubation, manual ventilation, open endotracheal suctioning, CPR, bronchoscopy, sputum induction, nebulized therapy, surgery, autopsy, and non-invasive positive pressure ventilation (CPAP, BiPAP) Airborne Isolation Room – a single patient room that is equipped with special air handling (negative pressure) and ventilation capacity. Anteroom – is considered a clean area and is used to transition people in and out of the airborne isolation room when it is under negative pressure. An anteroom is used as a transitional space between the hallway and the airborne isolation room. This transition area is where the Healthcare Worker puts on their PPE when entering the Airborne isolation room. The HCW also will store all clean PPE in this area. See Anteroom Protocol Negative Pressure Room – also known as an Airborne Isolation Room; a negative pressure room that is a single-occupancy patient-care room used to isolate persons with a suspected or confirmed airborne infectious disease. N95 Respirators – specific masks that filter particles one micron in size, have a 95% filter efficiency and provide a tight facial seal with less than a 10% leak. Clinical Syndromes Requiring the Use of Controls (Including PPE) Pending Diagnosis · Acute diarrhea and / or vomiting of suspected infectious etiology: o GLOVES, SINGLE ROOM o GOWN if skin or clothing will come into direct contact with the patient or the patient’s environment and for paediatrics and incontinent/non-compliant adults · Acute respiratory infection, undiagnosed: o SINGLE ROOM/SPATIAL SEPARATION preferred, FACIAL PROTECTION, GLOVES o GOWN if skin or clothing will come into direct contact with the patient or the patient’s environment · Respiratory infection with risk factors and symptoms suggestive of Tuberculosis: o FIT-TESTED N95 RESPIRATOR, NEGATIVE PRESSURE ROOM · Suspected meningitis and/or sepsis with petechial rash: o SINGLE ROOM, FACIAL PROTECTION · Undiagnosed rash without fever: o GLOVES · Rash suggestive of varicella or measles: o NEGATIVE PRESSURE ROOM -= only immune staff to enter · Abscess or draining wound that cannot be contained: o GLOVES o GOWN if skin or clothing will come into direct contact with the patient PROCEDURE As well as Routine Practice, Airborne Precautions includes the following: Source Control a) A point of care risk assessment (PCRA) as per routine practices should be done to determine if airborne precautions are required. · Note that some diseases/conditions require two precaution categories; airborne and contact – see table above · Patients should be directed to put on a surgical/procedure mask, if tolerated when not in an airborne isolation room. · Place patients directly into an airborne isolation room with door closed. · If a facility does not have an airborne isolation room, patient to be placed into a single room; the patient should be instructed to keep the mask on and the door should remain closed. Transfer as soon as possible to a facility with an airborne isolation room. · Signage placed at the entrance to patient room. b) The following strategies should be applied to reduce the level of aerosol generation when performing aerosol-generating medical procedures (AGMPs) for patients with suspected airborne disease. · AGMPs should be limited to those that are medically necessary. · The number of personnel in the room should be limited to those required. · Consider appropriate patient sedation. · AGMPs should be performed in an airborne isolation room. · Single rooms (with the door closed and away from high-risk patients), should be used in settings where airborne isolation rooms are unavailable. · N 95 respirators should be worn by all personnel in the room during the procedure. ·