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Winnipeg Regional Health Authority
Personal Care Home/Long Term Care Facility
Infection Prevention & Control Manual
Additional Precautions
1. Introduction
Additional Precautions are infection prevention and control precautions and
practices required in addition to Routine Practices. They are based on the mode
(means) of transmission of the infectious agent: airborne, droplet, and contact.
Some microorganisms may be transmitted by more than one route which would
indicate more than one type of Additional Precautions are required (e.g.,
Airborne/Contact, Droplet/Contact).
Additional Precautions is the isolation system that will be used for residents with
specific infectious diseases in personal care homes within the Winnipeg Regional
Health Authority.
It is not necessary to wait for a specific diagnosis or microbiological confirmation
to implement additional precautions.
Additional Precautions include:
o Airborne
o Contact
o Airborne/Contact
o Droplet
o Droplet/Contact
Signs are available for specific Additional Precautions (Appendices 5A, 5B, 5C,
5D, 5E).
Refer to the Management of Communicable Diseases in Personal Care Homes
table (Section 8) for specific Additional Precautions required.
Refer to Disease Specific Protocols (Section 9) for additional information.
Section 5_ Additional Precautions_approved April 28, 2008
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2. Implementation of Additional Precautions
To implement Additional Precautions:
2.1 Post the appropriate Additional Precautions sign on the door if the
resident is in a private room.
•
If the resident is in a multi-bed room, post the sign on the door and in
an easily identified location in the room (e.g., on the privacy curtain).
2.2 Obtain isolation supplies according to facility procedure.
2.3 Do not overstock supplies in the resident room.
2.4 No special precautions are required for linen and dishes other than
Routine Practices.
2.5 Discuss the Additional Precautions with the resident. Refer to
Resident/Family/Visitor Information Sheets (Appendices 5F, 5G, 5H, 5I,
5J).
2.6 Notify:
2.6.1 The physician, if required
2.6.2 Infection Prevention and Control/designate
2.6.3 Housekeeping
2.6.4 Family, if required
2.7 Document on the resident’s health record the type of Additional
Precautions, and the date and time the Additional Precautions were
implemented.
Section 5_ Additional Precautions_approved April 28, 2008
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3. Discontinuation of Additional Precautions
Discontinue Additional Precautions in consultation with the Infection
Prevention & Control Practitioner/designate.
When Additional Precautions are discontinued:
3.1 Maintain the indicated Additional Precautions until the room has been
cleaned.
3.2 Clean and disinfect reusable non-critical equipment with a facilityapproved disinfectant.
3.3 Discard all disposable supplies/equipment if unable to appropriately clean
and disinfect.
3.4 If no sterile reprocessing department is available in your facility,
arrangements must be made to send semi critical devices to a facility
where sterile processing can occur.
3.5 If the resident was on Airborne Precautions, leave the Additional
Precautions sign on the door and keep the door closed for 1 hour before
cleaning.
3.6 Contact housekeeping to clean the room.
3.7 Document on the resident’s health record the date and time Additional
Precautions were discontinued.
Section 5_ Additional Precautions_approved April 28, 2008
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4. Airborne Precautions
4.1 Introduction
Airborne Precautions are required for residents diagnosed with, or suspected
of having an infectious microorganism transmitted by the airborne route. For
a description of airborne transmission refer to section 3 page 5.
Airborne Precautions are followed in addition to Routine Practices.
Routine Practices shall be adhered to at all times by all healthcare workers.
4.2 Indications for Airborne Precautions
Airborne Precautions are implemented according to the Management of
Communicable Diseases in Personal Care Homes table (Section 8). Refer to
this table for specific disease/microorganism information. To implement
Additional Precautions reference Implementation of Additional Precautions
(Section 5, page 2).
4.3 Accommodation
Ideally residents on Airborne Precautions are placed in a single room with
negative pressure ventilation.
When a negative pressure isolation room is not available consult Infection
Prevention and Control/designate before resident placement. All attempts
must be made to accommodate the resident in a single room.
NOTE: Facilities that cannot provide properly ventilated (e.g., negative
pressure) rooms should transfer a resident with infectious forms of
tuberculosis to a facility with such accommodation. Coordinate these
arrangements with the receiving facility. If transfer is delayed or not possible,
implement the following directives until transfer to a facility with adequately
ventilated negative pressure rooms can take place:
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•
•
•
•
•
•
•
•
Place the resident in a single room with the door and windows closed.
Room should have dedicated toilet, hand hygiene and bathing facilities
Instruct health care workers, residents, families and visitors about the
importance of following Airborne Precautions
When an N95 respirator is required the health care worker will be fit
tested with the appropriate N95 respirator. Family members/ visitors
will have the N95 respirator seal checked
Limit the number of people entering the room. Prohibit visits by
children under the age of 12
When there are exceptional circumstances, the resident may leave the
room in consultation with Infection Prevention and Control/designate
Keep the door and windows closed at all times regardless if the room
is occupied or not
Discontinue airborne precautions only after the resident is no longer
infectious and only in consultation with the Infection Control
Practitioner/designate
Keep the door and windows closed for one hour following the
discontinuation of precautions
Tuberculosis
• Residents with infectious forms of Tuberculosis, in addition to the
accommodation guidelines for Airborne Precautions, if it is necessary
for the resident to leave the room, the resident must wear a
surgical/procedure mask continuously while out of the room
• Have the resident perform hand hygiene after removal of the mask
Measles
•
•
•
•
•
•
•
Airborne Precautions are required unless all other residents and all
health care workers are immune to measles (Adults borne prior to
1970 can be assumed to have acquired natural immunity to measles)
Non-immune visitors and employees are restricted from entering the
area
Do not put infected resident on units where there are susceptible
immunocompromised residents
Keep resident in room until 4 days after the onset of rash
Susceptible health care workers and visitors are not to enter the room.
If exceptional circumstances make this necessary the health care
worker and/or visitor must wear an N95 respirator
The resident is to wear a surgical/procedure mask when out of the
room. The resident must perform hand hygiene after removal of mask
Determine the immune status of exposed room mates and other close
contacts and if they are susceptible consult the Infection Control
Practitioner/designate
Section 5_ Additional Precautions_approved April 28, 2008
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4.4 Healthcare Workers
Healthcare workers should be aware of their immunity status.
• Non-immune healthcare workers should not care for residents with
vaccine-preventable airborne diseases (e.g., measles, chickenpox)
unless absolutely necessary. If it is absolutely necessary to care for
one of these residents, the health care worker must wear a N95 fit
tested respirator to enter the isolation room.
4.5 Hand Hygiene
Perform hand hygiene before leaving the isolation room, and after removal of
N95 respirator.
4.6 Personal Protective Equipment (PPE)
Masks/Respirators
•
•
•
•
•
•
•
•
Special masks/ N95 respirators: N95 respirators* shall be available for
persons entering the isolation room.
Individuals who are immune to vaccine-preventable diseases (e.g.
measles, chickenpox) do not need to wear N95 respirators to go into
the isolation room.
Individuals who are not immune or are uncertain of their immunity shall
not enter the room unless absolutely necessary. If it is absolutely
necessary to enter the room an N95 respirator must be worn.
N95 respirators shall be fit tested for healthcare workers, as directed
by Occupational Health and seal checked by healthcare workers prior
to each use. Seal checking procedure is as follows:
• Cover respirator with both hands and perform one of the
following:
„
Inhalation Test: If respirator collapses slightly there is an
adequate seal
„
Exhalation Test: If no air escapes respirator, there is an
adequate seal
Wear the N95 respirator once.
Change the N95 respirator when wet, if the front of the N95
respirator was touched, and/or when contaminated with resident
secretions.
Remove the N95 respirator in a manner preventing contamination.
Remove the N95 respirator immediately after exiting the isolation
room. To remove the N95 respirator refer to Removal of Personal
Protective Equipment (Appendices 4E &4F).
Note: Never have the N95 respirator dangle around the neck.
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*N95 respirators shall be certified by the National Institute of Occupational
Safety and Health (NIOSH) with an N95 efficiency rating or better.
4.7 Resident Transport
If the resident is transported to another unit/facility, notify the receiving
unit/facility by telephone of the resident’s status and required infection
prevention & control precautions. Document on the Regional Health
Authorities of Manitoba Transfer Referral form.
Notify transport services of the necessary infection prevention & control
precautions.
Maintain Airborne Precautions while the resident is outside the isolation room.
Healthcare workers wear fit tested N95 respirators when transporting
residents requiring Airborne Precautions.
The resident wears a surgical/procedure mask and performs hand hygiene
prior to leaving the room.
The resident with skin lesions associated with Varicella, Smallpox, or draining
wounds caused by M. tuberculosis shall have them securely covered
• Consult Respiratory Therapy if the resident has an artificial airway
4.8 Resident/Family
Educate the resident, and/or family about:
• The nature of the resident’s infectious disease
• The precautions to adhere to, and
• The length of time the precautions will be in place. Refer to the
‘Resident /Family Information Sheet on Airborne Precautions’
(Appendix 5F)
Instruct the resident /family regarding Respiratory Hygiene/Cough Etiquette
as per Cover Your Cough pamphlet (Appendix 4G):
• When coughing or sneezing, cover nose and mouth with a tissue, or
cough into shoulder
• Immediately dispose of the tissue in the appropriate waste receptacle,
and,
• Perform hand hygiene
Instruct the resident about the appropriate use and management of PPE:
• How to correctly apply and wear a surgical/procedure mask
Section 5_ Additional Precautions_approved April 28, 2008
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Infection Prevention & Control Manual
•
•
How to remove the surgical/procedure mask without contaminating
oneself
Know the procedure and the importance of hand hygiene prior to
leaving the room and following removal of the surgical/procedure mask
Instruct the family about the appropriate use and management of PPE.
If required, instruct the family about assisting with application of the
surgical/procedure mask for the resident and how to correctly apply a N95
respirator, including seal check.
Instruct the resident and family about preventing transmission of the
infectious disease to his/her family, and friends.
Instruct the resident and family about the procedure, and importance of
performing hand hygiene
4.9 Visitors
Inform visitors of the necessary precautions.
Instruct visitors about the procedure, and importance of performing hand
hygiene.
If susceptible to the airborne microorganism requiring Airborne Precautions,
visitors should not visit unless there are exceptional circumstances. If this is
the case, consult Infection Prevention and Control/designate prior to the visit
• The nurse shall:
ƒ Talk with visitors before they enter the isolation room, and
assess risk to the health of the visitor and the risk of the visitor
transmitting infection
ƒ Instruct the visitor about the appropriate use of respirators and
other precautions
ƒ Keep the number of visitors to a minimum (at the discretion of
the unit staff)
Section 5_ Additional Precautions_approved April 28, 2008
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5. Contact Precautions
5.1 Introduction
Contact Precautions are required for residents diagnosed with, or
suspected of having infectious microorganisms transmitted by the contact
route. For a description of direct and indirect contact transmission
reference section 3 page 4.
Contact Precautions are followed in addition to Routine Practices.
Routine Practices shall be adhered to at all times by all healthcare
workers.
5.2 Indications for Contact Precautions
Contact Precautions are implemented according to the Management of
Communicable Diseases in Personal Care Homes table (Section 8). Refer
to this table for specific disease/microorganism information. To implement
Additional Precautions reference Implementation of Additional Precautions
(Section 5, page 2).
Contact Precautions may be indicated for certain organisms when Routine
Practices are not sufficient to control transmission.
Use contact precautions for:
• Acute diarrhea of likely infectious cause if uncontrolled (incontinent,
stool cannot be contained in incontinent products)
• Extensive desquamating skin disorder with known or suspected
infection or significant colonization
• Skin rash compatible with scabies
• Draining infected wound in which drainage cannot be contained by a
dressing.
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5.3 Accommodation
•
•
•
•
•
•
Maintain a one metre spatial separation between the infected resident
and other residents and visitors.
Restrict participation in group activities until the symptoms are
resolved/treated. Exceptions should be discussed with the Infection
Prevention & Control Practitioner/designate.
Roommates and visitors must be aware of precautions to follow.
A single room is preferable. No special air handling and ventilation are
necessary.
ƒ The door may remain open
ƒ Room should have dedicated toilet, hand hygiene, and bathing
facilities.
In instances where there are not a sufficient number of single rooms,
cohort residents with the same microorganism together. This shall be
done in consultation with the Infection Prevention & Control
Practitioner/designate.
If a single room is not available and cohorting is not possible, consult
the Infection Prevention & Control Practitioner/designate.
ƒ Maintain a separation of at least one metre between infected
resident and other residents and visitors
ƒ Inform roommates and all visitors of precautions to follow
ƒ Select roommates for their ability, and that of their visitors, to
comply with Contact Precautions.
ƒ Roommates should be at low risk for acquiring an infection:
- No open wounds
- No decubitus ulcers
- No urinary catheter, feeding tube or other invasive
devices
- No debilitated or bed bound residents requiring extensive
hands on care.
- Not receiving dialysis, chemotherapy, or radiation
treatments
5.4 Hand Hygiene
•
•
Remove gloves and gown. Perform hand hygiene before leaving the
room/designated bed space.
After hand hygiene, take care not to contaminate hands before leaving
the room.
Section 5_ Additional Precautions_approved April 28, 2008
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5.5 Personal Protective Equipment (PPE)
Gloves
• Wear gloves if direct contact with the resident is required or if direct
contact with frequently touched environmental surfaces is anticipated
and significant contamination of the environment is occurring
(uncontrolled diarrhea, uncontained wound drainage, excessive skin
desquamation).
• Remove gloves before leaving the room or the resident’s designated
bed space. Refer to Removal of Personal Protective Equipment
(Section 4, Appendix 4E).
• Perform hand hygiene after removing gloves.
Gowns
•
•
•
Wear gowns if direct contact with the resident is required or if direct
contact with frequently touched environmental surfaces is anticipated
and significant contamination of the environment is occurring
(uncontrolled diarrhea, uncontained wound drainage, excessive skin
desquamation).
Remove gowns before leaving the room or the resident’s designated
bed space. Refer to Removal of Personal Protective Equipment
(Section 4, Appendix 4E).
Perform hand hygiene after removing gown.
5.6 Resident Transport
•
•
If the resident is transported to another unit/facility, notify the receiving
unit/facility by telephone of the resident’s status and required Infection
control Precautions. Document on the Regional Health Authorities of
Manitoba Transfer/Referral form.
Notify transport services of the necessary infection prevention &
control precautions.
5.7 Equipment and Environment
•
•
•
•
Resident care equipment (e.g., thermometers, blood pressure cuffs,
lifts/slings) should be dedicated for the resident’s use, identified, and
stored in a manner that prevents use by another resident. Clean and
disinfect before reuse with another resident.
Discard disposable resident care equipment and supplies.
Do not share toys and personal effects with other residents.
Clean all horizontal and frequently touched surfaces daily and
immediately when visibly soiled.
Section 5_ Additional Precautions_approved April 28, 2008
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5.8 Resident/Family/visitors
•
•
•
•
Educate the resident and/or family/visitor about the nature of the
resident’s infectious disease, the precautions to adhere to, and the
length of time the precautions will be in place. Refer to the Resident/
Family/Visitors Information Sheet on Contact Precautions (Appendix 5
G).
Instruct the resident and family about preventing transmission of the
infectious disease to his/her family, and friends.
Instruct the resident and family/visitor how to perform hand hygiene
and the importance of performing hand hygiene.
If indicated, instruct the family/visitor about the appropriate use of
gowns, gloves, and other precautions.
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6. Airborne/Contact Precautions
6.1 Introduction
Airborne/Contact Precautions are required for residents diagnosed with, or
suspected of having an infectious microorganism transmitted by the
airborne and contact routes. For a description of airborne transmission
and direct and indirect contact transmission refer to section 3, page 4 & 5.
Airborne/Contact Precautions are followed in addition to Routine
Practices.
Routine Practices shall be adhered to at all times by all healthcare
workers.
6.2 Indications for Airborne/Contact Precautions
Airborne/Contact Precautions are implemented according to the
Management of Communicable Diseases in Personal Care Homes table
(Section 8). Refer to this table for specific disease/microorganism
information.
Ideally residents on Airborne/Contact Precautions should be placed in a
negative pressure room or transferred to an acute care facility as soon as
possible. Negative pressure rooms may be available in long term care
facilities, but are generally not available in personal care homes.
See Implementation of Additional Precautions (Section 5, page 2).
Varicella (Chickenpox) or Disseminated Herpes Zoster (Shingles)
• Airborne/Contact Precautions are required unless:
ƒ All other residents and all health care workers are immune to
varicella, and
Section 5_ Additional Precautions_approved April 28, 2008
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ƒ
•
•
•
•
•
•
non-immune visitors and employees are restricted from entering
the area.
Do not put infected resident on units where there are susceptible
immunocompromised residents.
Keep the resident in the room until all lesions have crusted.
Susceptible health care workers and visitors are not to enter the room.
If exceptional circumstances make this necessary the health care
worker must wear a fit tested N95 respirator. Susceptible visitors are
to wear a seal checked N95 respirator.
If the resident is on Airborne/Contact Precautions, the resident should
leave the room for essential purposes only.
If the resident must leave the room, the resident is to wear a
surgical/procedure mask and have skin lesions covered when out of
the room.
Determine the immune status of exposed roommates and other close
contacts and if they are susceptible consult the Infection Control
Practitioner/designate.
.
6.3 Healthcare Workers
•
•
Healthcare workers should be aware of their immunity status.
Non-immune healthcare workers should not care for residents with
vaccine-preventable airborne diseases (e.g. chickenpox, measles)
unless absolutely necessary. If it is absolutely necessary to care for
one of these residents, the health care worker must wear a N95 fit
tested respirator to enter the isolation room.
6.4 Hand Hygiene
•
•
•
Remove gloves and gown and perform hand hygiene before leaving
the isolation room. After hand hygiene, take care not to contaminate
hands before leaving the room.
Perform hand hygiene after removal of the fit tested N95 respirator.
To remove gown, gloves and respirator refer to Removing Personal
Protective Equipment (Section 4, Appendix 4E).
6.5 Personal Protective Equipment
Masks/Respirators
Special masks/ N95 respirators: N95 respirators* shall be available for
persons entering the isolation room.
• Individuals who are immune to vaccine-preventable diseases (e.g.
chickenpox, measles) do not need to wear N95 respirators to go into
the isolation room.
•
Section 5_ Additional Precautions_approved April 28, 2008
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•
•
•
•
•
•
•
•
Individuals who are not immune or are uncertain of their immunity shall
not enter the room unless absolutely necessary. If it is absolutely
necessary to enter the room an N95 respirator must be worn.
N95 respirators shall be fit tested for healthcare workers, as directed
by Occupational Health/designate and seal checked by healthcare
workers prior to each use.
N95 respirators worn by visitors will be seal checked only.
Seal checking procedure is as follows:
ƒ Cover respirator with both hands and perform one of the
following:
- Inhalation Test: If respirator collapses slightly there is an
adequate seal
- Exhalation Test: If no air escapes respirator, there is an
adequate seal.
Wear the N95 respirator once.
Change the N95 respirator when wet, if the front of the N95 respirator
was touched, and/or when contaminated with resident secretions.
Remove the N95 respirator in a manner preventing contamination. To
remove the N95 respirator refer to Removal of Personal Protective
Equipment (Section 4, Appendix 4F).
Remove the N95 respirator immediately after exiting the isolation room
Note: Never have the N95 respirator dangle around the neck.
*N95 respirators shall be certified by the National Institute of Occupational
Safety and Health (NIOSH) with an N95 efficiency rating or better.
Gloves
•
•
•
Wear gloves if direct contact with the resident is required or if direct
contact with frequently touched environmental surfaces is anticipated
and significant contamination of the environment is occurring
(uncontrolled diarrhea, uncontained wound drainage, excessive skin
desquamation).
Remove gloves before leaving the room or the resident’s designated
bed space. Refer to Removal of Personal Protective Equipment
(Section 4, Appendix 4E).
Perform hand hygiene after removal of gloves.
Gowns
•
Wear gowns if direct contact with the resident is required or if direct
contact with frequently touched environmental surfaces is anticipated
Section 5_ Additional Precautions_approved April 28, 2008
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•
•
and significant contamination of the environment is occurring
(uncontrolled diarrhea, uncontained wound drainage, excessive skin
desquamation).
Remove gowns before leaving the room or the resident’s designated
bed space. Refer to Removal of Personal Protective Equipment
(Section 4, Appendix 4E).
Perform Hand hygiene after removal of gown.
6.6 Resident Transport
•
•
•
•
•
•
•
If the resident is transported to another unit/facility, notify the receiving
unit/facility by telephone of the resident’s status and required Infection
control Precautions. Document on the Regional Health Authorities of
Manitoba Transfer/Referral form.
Notify transport services of the necessary infection prevention &
control precautions.
Maintain Airborne/Contact Precautions while the resident is outside the
isolation room.
Healthcare workers wear N95 respirators when transporting residents
requiring Airborne Precautions.
The resident wears a surgical/procedure mask and performs hand
hygiene prior to leaving the room.
The resident with skin lesions associated with varicella, disseminated
herpes zoster shall have them securely covered.
Consult Respiratory Therapy if the resident has an artificial airway.
6.7 Equipment and Environment
•
•
•
•
•
Resident -care equipment (e.g., thermometers, blood pressure cuffs,
lifts/slings) should be dedicated for the resident’s use, identified, and
stored in a manner that prevents use by another resident. Clean and
disinfect before reuse with another resident.
Discard disposable resident care equipment and supplies.
Do not share toys and personal effects with other residents.
Clean all horizontal and frequently touched surfaces daily and
immediately when visibly soiled.
6.8 Resident/Family/Visitor
•
Educate the resident, and/or family/visitor about the nature of the
resident’s infectious disease, the precautions to adhere to, and the
length of time the precautions will be in place. Refer to the Resident/
Family/Visitor Information Sheet on Airborne/Contact Precautions
(Appendix 5H).
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•
•
•
•
•
•
Instruct the resident /family/visitor regarding Respiratory
Hygiene/Cough Etiquette:
ƒ When coughing or sneezing, cover his/her nose and mouth
with a tissue, or cough into his/her shoulder
ƒ Immediately dispose of the tissue in the appropriate waste
receptacle, and,
ƒ Perform hand hygiene.
See Cover Your Cough pamphlet (Section 4, Appendix 4G).
Instruct the resident/family/visitor about the appropriate use and
management of PPE:
ƒ How to correctly apply and wear a surgical/procedure mask
ƒ How to remove the surgical/procedure mask without
contaminating oneself
ƒ How to perform hand hygiene and the importance of hand
hygiene prior to leaving the room and following removal of
the surgical/procedure mask.
If required, instruct the family about assisting with application of the
surgical/procedure mask for the resident and how to correctly apply a
N95 respirator, including seal check.
Instruct the resident and family/visitor about preventing transmission of
the infectious disease to his/her family, and friends.
If family/visitor is susceptible to the airborne microorganism requiring
Airborne /Contact Precautions, visitors/family should not visit unless
there are exceptional circumstances. If this is the case, consult the
Infection Control Practitioner/designate prior to the visit.
The nurse shall:
ƒ Talk with family/ visitors before they enter the isolation room,
and assess risk to the health of the visitor and the risk of the
visitor transmitting infection
ƒ Instruct the family/visitor about the appropriate use of
respirators and other precautions
ƒ Keep the number of visitors to a minimum (at the discretion of
the unit staff)
Section 5_ Additional Precautions_approved April 28, 2008
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7. Droplet Precautions
7.1 Introduction
Droplet Precautions are required for residents diagnosed with, or
suspected of having infectious microorganisms transmitted by the droplet
route. For a description of droplet transmission refer to section 3, page 5).
Droplet Precautions are followed in addition to Routine Practices.
Routine Practices shall be adhered to at all times by all healthcare
workers.
7.2 Indications for Droplet Precautions
Droplet Precautions are implemented according to the Management of
Communicable Diseases in Personal Care Homes table (Section 8).
Refer to this table for specific disease/microorganism information.
To implement Additional Precautions reference Implementation of
Additional Precautions (page 2).
7.3 Accommodation
•
•
•
•
A single room is preferable. No special air handling and ventilation
are necessary.
The door may remain open.
Room should have dedicated toilet, hand hygiene, and bathing
facilities.
In instances where there are not a sufficient number of single rooms,
cohort residents with the same microorganism together in consultation
with the Infection Control Practitioner/designate.
Section 5_ Additional Precautions_approved April 28, 2008
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•
•
•
•
If a single room is not available and cohorting is not possible consult
the Infection Prevention and Control Practitioner/designate.
Select roommates for their ability, and that of their visitors, to comply
with Droplet Precautions
ƒ Roommates should be at low risk for acquiring an infection:
(e.g., no chronic lung disease, severe congenital heart disease,
or immunodeficiency).
Maintain a separation of at least one metre between residents and
from visitors.
Inform roommates and all visitors of precautions to follow.
7.4 Hand Hygiene
•
Remove surgical/procedure mask. Perform hand hygiene before
leaving the resident’s room /designated bed space. After hand
hygiene, take care not to contaminate hands before leaving the room.
7.5 Personal Protective Equipment
Masks
•
•
•
•
•
•
All health care workers are to wear a surgical/procedure mask when
within one metre of resident, and for procedures that may result in
coughing, splashing, and aerosol production.
For care of residents with Rubella or Mumps, immune persons do not
need to mask. Non-immune persons shall enter the room only if
absolutely necessary and shall wear a surgical/procedure mask
Wear a mask once only.
Change mask when it is wet, if the front of the mask has been touched
and/or contaminated with residents secretions.
Remove mask and discard it in a manner to prevent contamination
after leaving the room/designated bed space of resident on isolation.
See Removal of Personal Protective Equipment (Section 4, Appendix
4F).
Never have the mask dangling around the neck.
Eye Protection
•
•
Goggles, glasses, or face shields are worn when within one metre of a
coughing resident with symptoms of respiratory infection, and for
procedures that may result in coughing, splatter, and/or aerosols
Remove goggles, glasses or face shields in a manner preventing
contamination. Refer to Removal of Personal Protective Equipment
(Section 4, Appendix 4F).
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•
If reusable, send the eye protection for cleaning and disinfection
according to facility policy
7.6 Resident Transport
•
•
If the resident is transported to another unit/facility, notify the receiving
unit/facility by telephone of the resident’s status and required infection
prevention & control precautions. Document on the Regional Health
Authorities of Manitoba Transfer/Referral form.
Notify transport services of the necessary infection control precautions.
7.7 Resident/Family/Visitor
•
•
•
•
•
Educate the resident and/or family/visitor about the nature of the
resident’s infectious disease, the precautions to adhere to, and the
length of time the precautions will be in place. Refer to the Resident
/Family/visitor Information Sheet on Droplet Precautions (Appendix 5I).
Instruct the resident /family regarding Respiratory Hygiene/Cough
Etiquette:
ƒ When coughing or sneezing, cover the nose and mouth with a
tissue, or cough into his/her upper sleeve
ƒ Immediately dispose of the tissue in the appropriate waste
receptacle, and
ƒ Perform hand hygiene. Refer to the Cover Your Cough
Pamphlet (Section 4, Appendix 4G).
Instruct the family/visitor about the appropriate use and management
of PPE.
ƒ How to correctly apply and wear a surgical/procedure mask
ƒ How to remove the surgical/procedure mask without
contaminating oneself
ƒ How to perform hand hygiene and the importance of hand
hygiene prior to leaving the room and following removal of the
surgical/procedure mask
Instruct the resident and family/visitor about preventing transmission of
the infectious disease to his/her family, and friends.
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8. Droplet/Contact Precautions
8.1 Introduction
Droplet/Contact Precautions are required for residents diagnosed with, or
suspected of having infectious microorganisms transmitted by the droplet
route and contact routes. For a description of droplet transmission and
direct and indirect contact transmissions refer to section 3, pages 4 & 5.
Droplet/Contact Precautions are followed in addition to Routine Practices.
Routine Practices shall be adhered to at all times by all healthcare
workers.
8.2 Indications for Droplet/Contact Precautions
Droplet/Contact Precautions are implemented according to the
Management of Communicable Diseases in Personal Care Homes table
(Section 8). Refer to this table for specific disease/microorganism
information.
See implementation of Additional Precautions page 2.
8.3 Accommodation
•
•
•
A single room is preferable. No special air handling and ventilation
are necessary.
The door may remain open.
Room should have dedicated toilet, hand hygiene, and bathing
facilities.
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•
•
•
•
In instances where there are not a sufficient number of single rooms,
cohort residents with the same microorganism together in consultation
with the Infection Control Practitioner/designate.
If a single room is not available and cohorting is not possible consult
the Infection Prevention and Control Practitioner/designate.
Select roommates for their ability, and that of their visitors, to comply
with Droplet Precautions
ƒ Roommates should be at low risk for acquiring an infection:
(e.g., no chronic lung disease, severe congenital heart disease,
or immunodeficiency).
Maintain a separation of at least one metre between residents and
from visitors.
Inform roommates and all visitors of precautions to follow.
8.4 Hand Hygiene
•
•
•
Remove gloves and gown and perform hand hygiene before leaving
the room/designated bed space. After hand hygiene take care not to
contaminate hands before leaving the room.
Perform hand hygiene after removal of the surgical/procedure mask.
Refer to Removing Personal Protective Equipment (Section 4,
Appendices 4E & 4F).
8.5 Personal Protective Equipment
Masks
•
•
•
•
•
•
All health care workers are to wear a surgical/procedure mask when
within one metre of resident, and for procedures that may result in
coughing, splashing, and aerosol production.
For care of residents with Rubella or Mumps, immune persons do not
need to mask. Non-immune persons shall enter the room only if
absolutely necessary and shall wear a surgical/procedure mask.
Wear a mask once only.
Change mask when it is wet, if the front of the mask has been touched
and/or contaminated with residents secretions.
Remove mask and discard it in a manner to prevent contamination
after leaving the room/designated bed space of resident on isolation.
See Removal of Personal Protective Equipment (Section 4, Appendix
4F).
Never have the mask dangling around the neck.
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Eye Protection
•
•
•
Goggles, glasses, or face shields are worn when within one metre of a
coughing resident with symptoms of respiratory infection, and for
procedures that may result in coughing, splatter, and/or aerosols.
Remove goggles, glasses or face shields in a manner preventing
contamination. Refer to Removal of Personal Protective Equipment
(Section 4, Appendix 4F).
If reusable, send the eye protection for cleaning and disinfection
according to facility policy.
Gloves
•
•
•
Wear gloves if direct contact with the resident is required or if direct
contact with frequently touched environmental surfaces is anticipated
and significant contamination of the environment is occurring
(uncontrolled diarrhea, uncontained wound drainage, excessive skin
desquamation).
Remove gloves before leaving the room or the resident’s designated
bed space. Refer to Removal of Personal Protective Equipment
(Section 4, Appendix 4E).
Perform hand hygiene after removing gloves.
Gowns
•
•
•
Wear gowns if direct contact with the resident is required or if direct
contact with frequently touched environmental surfaces is anticipated
and significant contamination of the environment is occurring
(uncontrolled diarrhea, uncontained wound drainage, excessive skin
desquamation).
Remove gowns before leaving the room or the resident’s designated
bed space. Refer to Removal of Personal Protective Equipment
(Section 4, Appendix 4E).
Perform hand hygiene after removing gown.
8.6 Patient Transport
•
•
If the resident is transported to another unit/facility, notify the receiving
unit/facility by telephone of the resident’s status and required infection
control precautions. Document on the Regional Health Authorities of
Manitoba Transfer/Referral form.
Notify transport services of the necessary infection control precautions.
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8.7 Equipment and Environment
•
•
•
•
Resident care equipment (e.g., thermometers, blood pressure cuffs,
lifts/slings) should be dedicated for the resident’s use, identified, and
stored in a manner that prevents use by another resident. Clean and
disinfect before reuse with another resident.
Discard disposable resident care equipment and supplies.
Do not share toys and personal effects with other residents.
Clean all horizontal and frequently touched surfaces daily and
immediately when visibly soiled.
8.8 Resident/Family/Visitor
•
The resident and/or family/visitor should be educated about the nature
of the resident’s infectious disease, the precautions to adhere to, and
the length of time the precautions will be in place. Refer to the
Resident/Family/Visitor Information Sheet on Droplet/Contact
Precautions (Appendix 5J).
• Instruct the resident /family/visitor regarding Respiratory
Hygiene/Cough
Etiquette:
ƒ When coughing or sneezing, cover the nose and mouth with a
tissue, or cough into his/her upper sleeve.
ƒ Immediately dispose of the tissue in the appropriate waste
receptacle, and
ƒ Perform hand hygiene
Refer to the Cover Your Cough Pamphlet (Section 4, Appendix 4G).
• Instruct the family/visitor about the appropriate use and management
of PPE.
• Instruct the resident and family/visitor about preventing transmission of
the infectious disease to his/her family, and friends.
• Instruct the resident and family/visitor about the procedure, and
importance of hand hygiene.
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