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SESLHD PROCEDURE COVER SHEET NAME OF DOCUMENT Standard and Transmission Based (Additional) Precautions with Infectious Diseases TYPE OF DOCUMENT Procedure DOCUMENT NUMBER SESLHDPR/357 DATE OF PUBLICATION July 2014 RISK RATING Medium LEVEL OF EVIDENCE NSW Ministry of Health Policy Directives, Health Practitioner National Law – Sect 247A NSW Regulations (NSW) and National Safety and Quality Health Service Standard No. 3 ‘Preventing and Controlling Healthcare Associated Infections’(Criteria 3.1, 3.2, 3.3.2, 3.5, 3.7, 3.10, 3.11 and 3.19) REVIEW DATE July 2017 FORMER REFERENCE(S) Standard Precautions SESLHNPD/112 Transmission Based (Additional) Precautions SESLHNPD/123 Personal Protective Equipment SESLHNPD/118 Infectious Diseases/Conditions – Summary Table of Precautions for Preventing Transmission SESLHNPD/105 EXECUTIVE CLINICAL SPONSOR Prof George Rubin AUTHOR SESLHD Infection Prevention and Control Policy Working Party Director Clinical Governance POSITION RESPONSIBLE FOR THE SESLHD Infection Prevention and Control Policy Working DOCUMENT Party [email protected] KEY TERMS Standard Precautions, Transmission Based Precautions, Contact Precautions, Droplet Precautions, Airborne Precautions, Personal Protective Equipment, PPE SUMMARY This procedure outlines SESLHD’s consistent infection prevention and control practices to effectively prevent transmission of infections, infectious diseases and multiresistant organisms by implementing: Standard precautions Transmission Based precautions effectively practiced to ensure the management of infectious agents where standard precautions may not be sufficient on their own. COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. Feedback about this document can be sent to seslhde√[email protected] SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions 1. PR 357 PROCEDURE STATEMENT Standard precautions are to be used by healthcare workers to prevent or reduce the likelihood of transmission of infectious agents from one person or place to another; and to render and maintain objects and areas as free as possible from infectious agents. Transmission Based (previously known as Additional) precautions are used in addition to standard precautions, where the suspected or confirmed presence of infectious agents represents an increased risk of transmission. 2. BACKGROUND Successful infection prevention and control involves implementing work practices that prevent the transmission of infections and multi-resistant organisms through a two-tiered approach including: Standard precautions Transmission Based precautions effectively practiced to where standard precautions may not be sufficient on their own. Standard and Transmission Based Precautions are underpinned by the use of Personal Protective Equipment (PPE), hand hygiene, patient flow/bed management and compliance with healthcare worker (HCW) vaccination to reduce the risk of acquisition of infectious agents in the health setting. 3. RESPONSIBILITIES 3.1 Directors of Operations are to: Provide resources to enable compliance with this Procedure; and Ensure compliance with this Procedure is monitored and evaluated. 3.2 Directors of Clinical Operations and Directors of Nursing and Midwifery are to: Delegate the day-to-day responsibility of establishing and monitoring the implementation of this Procedure to the relevant clinical teams Make appropriate education and training available to all clinical staff Review education and occupational exposure outcomes on an annual basis 3.3 Line Managers will: Ensure there are adequate resources for infection prevention precautions including adequate supplies of PPE and hand hygiene material Ensure all staff have appropriate education Ensure staff comply with Occupational Screening and Vaccination policy requirements Ensure that PPE is available for HCW to readily access and that HCW are trained in its use and are aware of how to report exposures through the occupational exposure management program 3.4 Employees will: Risk assess procedures to determine correct personal protective equipment (PPE) required to prevent occupational exposures Revision 1 Trim No. T14/20775 Date: July 2014 Page 1 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 Ensure they follow this Procedure at all times 4. DEFINITIONS Airborne Precautions: precautions applied to patients known or suspected to be infected with pathogens that can be transmitted by the airborne route to reduce the risk of transmission of infectious agents Airborne transmission: occurs by dissemination of either airborne droplet nuclei (smallparticle residue 5µm or smaller in size of evaporated droplets that may remain suspended in the air for long periods of time) or dust particles containing the infectious agent Aseptic technique: Is a set of specific practices and procedures performed under carefully controlled conditions. Its primary aim is to prevent pathogenic organisms, in sufficient quantity to cause infection and/or contamination, from being introduced to susceptible sites by hands, surfaces and equipment. It protects patients during clinical procedures by utilising infection prevention measures that minimise the presence of micro-organisms. While the principles of aseptic technique remain constant for all procedures, the level of practice will change depending upon a standard risk assessment Body substance: includes any human bodily secretions or substances other than sweat Chemoprophylaxis: drug treatment designed to prevent future occurrence of disease Clinical waste: waste that has the potential to cause injury, infection or offence. This includes: Sharps: any object capable of inflicting a penetrating injury, which may or may not be contaminated with blood and/or body substances Bulk body fluids and blood Visibly blood stained body fluids, visibly blood stained disposable material and equipment Laboratory specimens and cultures Human tissue, excluding hair, nails and teeth Animal tissue or carcasses and waste arising from laboratory investigation or for medical or veterinary research This does not include drained dialysis waste and disposable nappies which are defined as general waste Cohort: A group of individuals kept together to minimise contact with other patients or staff to decrease opportunities for transmission of infectious agents Combination of Precautions: may be required for diseases that have multiple routes of transmission or those diseases whose mode of transmission changes throughout its course, e.g. Chicken Pox required both Standard and Airborne Precautions Revision 1 Trim No. T14/20775 Date: July 2014 Page 2 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 Contact Precautions: precautions designed to reduce the risk of transmission of microorganisms by direct or indirect contact Direct contact transmission: involves skin-to-skin contact and physical transfer of microorganisms directly from one person to another person such as when health care workers perform patient care activities that require physical contact; or contact between two patients with one serving as the source of infectious microorganisms and the other as a susceptible host Droplet Precautions: precautions applied to patients known or suspected to be infected with pathogens that can be transmitted by droplets to reduce the risk of transmission Droplet transmission: involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large particle droplets (larger than 5 µm in size) containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets do not remain suspended in the air Health care settings: any place where health care is provided to patients on a commercial or public health basis Health care workers (HCWs): persons, including students and trainees, whose activities involve contact with patients or with blood or body substances from patients Immunoglobulin: a specific protein substance produced by plasma cells to aid in fighting infection Immunosuppressed: an abnormal condition of the immune system characterised by markedly inhibited ability to respond to antigenic stimuli Indirect contact transmission: involves transfer of an infectious agent through a contaminated intermediate object or person. Hands of health care workers and patient care devices, instruments and equipment that are inadequately cleaned / processed between patients are examples Infectious diseases: any communicable disease, or one that can be transmitted from one human being to another or from animal to human by direct or indirect contact Multiresistant organism (MRO): A MRO can be defined as any organism that is resistant to a number of antimicrobial drug families. Organisms may develop resistance in a variety of ways. Notifiable disease: diseases listed under the Public Health Act 2010 and the Public Health Regulation 2012 that are required to be reported by doctors, hospital chief executive officers, pathology laboratories, directors of child care centres and school principals. By convention, hospital chief executive officers devolve notification responsibility to the medical officer caring for the patient at the time the diagnosis of a Notifiable disease is made. Revision 1 Trim No. T14/20775 Date: July 2014 Page 3 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 Occupational exposure: an incident which occurs during the course of a person’s employment and involves contact with blood or other body substances which may put the person at risk of acquiring a blood borne infection Particulate mask (P2, N95 or PFR95): a mask which provides a tight facial seal with a face-seal leakage of < 10 % and ability to filter particles 1 micron in size in the unloaded state with a filter efficiency of greater than/equal to 95% given flow rates of up to 50 litres per minute Personal protective equipment (PPE): equipment designed to prevent contamination of the health care worker and/or their clothing, for example gloves, goggles, face shields, gowns Post exposure prophylaxis (PEP): administration of anti HIV drugs for 28 days following an exposure to prevent the exposure becoming an infection or administration of Hepatitis immunoglobulin following exposure to Hepatitis B. Prodrome: period of non-specific generalised symptoms that occur prior to the development of specific localised features of an illness Respiratory hygiene/cough etiquette: comprises of: a. covering the nose/mouth with a tissue when coughing or sneezing b. using tissues to contain respiratory secretions c. spitting into a tissue if spitting is necessary d. disposing of tissues into the nearest rubbish bin after use e. performing hand hygiene after contact with respiratory secretions and contaminated objects/materials e.g. tissue Standard Precautions: the minimum level of work practices required to achieve a standardised basic level of infection control by reducing the risk of transmission of microorganisms from both recognised and unrecognised sources of infection in the health care setting Transmission Based Precautions: infection control measures designed for patients known or suspected to be infected with pathogens for which Transmission Based precautions beyond Standard Precautions are needed to interrupt transmission in health care settings. There are three types of Transmission Based Precautions: a. Airborne Precautions b. Droplet Precautions c. Contact Precautions Vertical transmission: transmission of bacteria or virus from mother to foetus 5. PROCEDURE 5.1 Standard Precautions Standard Precautions require HCWs to assume that all blood and body substances and the patient environment be considered potential sources of infection, regardless of the source’s diagnosis or presumed infection status Revision 1 Trim No. T14/20775 Date: July 2014 Page 4 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 Standard Precautions must be used for the care and treatment of all patients and in the handling of: blood (including dried blood) all body substances, secretions and excretions, (excluding sweat), regardless of whether or not they contain visible blood non intact skin mucous membranes including eyes patient environment and equipment The application of Standard Precautions involves the use of safe work practices and protective barriers including: good hand hygiene and hand care practices use of PPE including gloves, facial protection and apron/gowns adoption of sharps safety principles including minimisation of sharps and maximising the use of safety devices wherever possible appropriate use of single use medical devices appropriate reprocessing of reusable equipment and instruments, including appropriate use of disinfectants identification of potential infection control risks and adoption of infection transmission minimisation practices such as isolation and respiratory hygiene/cough etiquette aseptic technique, including appropriate use of approved skin antiseptics appropriate provision of support services, such as laundry and food services environmental controls, including design and maintenance of premises, cleaning and spills management correct segregation of waste reporting of all occupational exposures appropriate HCW vaccination, assessment and screening 5.2 Transmission Based precautions The use of Transmission Based Precautions must always be in conjunction with Standard Precautions Transmission Based Precautions are to be applied in accordance with Tables 2-4: Guidelines for Contact, Droplet and Airborne Precautions Patient Flow/bed management decisions about patient placement must take into account the existing isolation burden in the unit, staff availability and skill, facilities for isolation and the patient mix and susceptibility. Some patient populations are at risk of serious sequelae from transmissible diseases if cross infection occurs, so the decision to locate patients requiring Transmission Based Precautions in high risk units must be discussed with infection prevention and control and/or infectious diseases/microbiology staff When a patient requires Airborne Precautions and there are competing patient priorities for a negative pressure room, infection control and infectious diseases/microbiology staff must be consulted Revision 1 Trim No. T14/20775 Date: July 2014 Page 5 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 When a single room is not available, the patient may be placed with patient(s) colonised/infected with the same microorganism in consultation with infection prevention and control and infectious disease/microbiology staff Transmission Based Precautions are not to be ceased without approval from infection prevention and control or infectious diseases/microbiology staff See Table of Infectious Diseases, Modes of Transmission and Recommended Precautions for Staff and Patients to Prevent Transmission for a quick reference for common infectious diseases and multi-resistant organism’s mode of transmission and recommended precautions for staff and patients to prevent transmission 5.3 Personal Protective Equipment (PPE) PPE refers to a variety of barriers, used alone or in combination, to protect mucous membranes, airways, skin and clothing from contact with infectious agents. In determining the type of PPE to be used, the following must be taken into consideration: risk of exposure to blood and/or body substance the amount of the substance to be encountered probable route of transmission type of substance 5.3.1 Clothing/uniforms Clothing contaminated with blood or body substances should be removed as soon as possible and before HCWs attend to other patients If skin is contaminated with blood or body substances, shower or wash the affected area 5.3.2 Aprons/Gowns A fluid-resistant gown or apron made of impervious material must be worn during any procedure where there is a likelihood of splashes or contamination with blood or other body substance Cloth (cotton/polyester-cotton) gowns do not provide protection to the HCW or their clothing and should not be used 5.3.3 Gloves Gloves are worn as a barrier to protect the wearer’s hands from contamination or to prevent the transfer of organisms already on the hands The use of gloves does not eliminate the need for hand hygiene Hand hygiene must be performed before and after glove use. Gloves must be used in situations where the HCW is potentially exposed to blood and/or body substances, for example: during any procedure where direct contact is anticipated with a patient’s blood or body substance, mucous membranes or non-intact skin while suctioning a patient while handling items or surfaces that have come into contact with blood or body substances Revision 1 Trim No. T14/20775 Date: July 2014 Page 6 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 while performing an invasive procedure, venepuncture or a finger or heel stick Disposable gloves must never be re-used Gloves must be changed and discarded: as soon as they are torn or punctured, hand hygiene performed as soon as practicable, and new gloves. The sharp or instrument involved in the incident must also be removed from the sterile field when performing separate procedures on the same patient and there is a risk of transferring infection from one part of the body to another after procedure is complete 5.3.4 Glove selection Patient care: nitrile/latex non-sterile - contact with contaminated items, blood/body substances and mucous membranes and non-intact skin of all patients sterile gloves - contact with tissue that would be sterile under normal circumstances. Sterile gloves are not required for most dental procedures except where invasive procedures are anticipated high risk latex gloves (4 times thicker than standard exam gloves) – may be used in high risk areas such as psychiatric services, Emergency Department and security to provide a higher level protection latex free (nitrile, sterile or unsterile) - latex allergy of staff or patient Other: blue or opaque vinyl - catering services heavy duty such as leather – collection of clinical or general waste, soiled linen general purpose utility/rubber household – housekeeping tasks including: instrument cleaning general cleaning tasks decontamination procedures potential for gross contamination or blood contact exists general purpose utility/rubber household gloves should be labelled and allocated to individuals where possible; washed in detergent after use and hung to dry. They are to be discarded if peeled, cracked, discoloured, torn, punctured or deteriorated 5.3.5 Face shields/protective eye wear Protective eye wear/facial protection must be worn while performing any procedure where there is a likelihood of splashing or splattering of blood and/or other body substances Must be worn and fitted in compliance with the manufacturer’s instructions Goggles/face shields must be discarded once worn if single use Reusable goggles/face shields must be cleaned in accordance with the manufacturer’s instructions 5.3.6 Masks Use of masks is intended to prevent transmission of infectious agents through the air and: must be worn and fitted following the manufacturer’s instructions should not be touched by hand while being worn Revision 1 Trim No. T14/20775 Date: July 2014 Page 7 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 should be removed as soon as practicable after becoming moist must be removed by touching the strings/loops only must be discarded once it has been worn and it must not be worn again hand hygiene should be performed after donning and doffing the mask are required when attending patients with droplet or airborne precautions in place Particulate masks should be worn by: HCWs attending a smear positive pulmonary TB patient all visitors in direct contact with a smear positive pulmonary TB patient refer to SESLHN Tuberculosis: Patient Management TB policy HCW attending suspect/probable/confirmed emerging infectious respiratory disease patients Surgical masks should be worn by: HCWs performing aseptic/invasive procedures HCWs attending to patients nursed in droplet precautions patients leaving their room who may be suspect/probable/confirmed respiratory disease spread by droplet or airborne all visitors to suspect/probable/confirmed respiratory disease spread by droplet patients who are susceptible to infection who leave their protective isolation room temporarily 6. DOCUMENTATION Patient Healthcare Record PowerChart and iPM (Infection Control Alerts) Doctor / hospital notification form (Notifiable Diseases) Confidential Staff Health Records Occupational exposure management records Occupational Screening, Assessment and Vaccination records 7. AUDIT Compliance with standard and transmission based precautions Required in outbreaks or when there is an increase above the normal numbers 8. REFERENCES American Academy of Paediatrics, Red Book Online Australian Guidelines for the Prevention and control in health care (2010) Heymann, D.L MD, Editor. Control of Communicable Diseases Manual. 18th Edition. American Public Health Association 2004 Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e, Geo F. Brooks, Karen C. Carroll, Janet S. Butel, Stephen A. Morse, Timothy A. Mietzner National Health and Medical Research Council. Staying Healthy in Childcare – Preventing infectious diseases in child care - Fourth edition. Commonwealth of Australia. 2006 National Health and Medical Research Council. The Australian Immunisation Handbook. 10th Edition. Commonwealth of Australia. 2013 Revision 1 Trim No. T14/20775 Date: July 2014 Page 8 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 NHMRC (2010) Australian Guidelines for the Prevention and Control of Infections in Healthcare. Commonwealth of Australia. NSW Health Disease Notifications NSW Health Policy Directive PD2007_036 Infection Control Policy South Australia Health; Infection Control Management for Infectious Diseases. June 2013 9. REVISION AND APPROVAL HISTORY Date Revision No. Author and Approval Jul 2014 7 Combines Standard and Transmission based precautions, included summary tables. Attached an Infectious disease table summary. Updated references and included Nation Standards Jul 2014 7 Re-formatted by District Policy Officer. Approved by Executive Clinical Sponsor, Prof George Rubin. Revision 1 Trim No. T14/20775 Date: July 2014 Page 9 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 Appendix 1 Table 1: Summary of recommended Standard Precautions Requirements Standard Precautions Single room All persons blood (including dried blood); all body substances, secretions and excretions (excluding sweat); non-intact skin; and mucous membranes including eyes No Negative pressure No Hand hygiene Yes Gloves Hand Hygiene with alcohol based hand rub or liquid soap and water 5 Moments of hand hygiene for patient care (Clean In – Clean Out) Protect for anticipated contact with blood or body substances Apron/Gown Protect where soiling or splashing are likely on uniforms and clothing Mask Protect face if splash or aerosol likely Protective eyewear Protect eyes if splash likely or where aerosol may be generated Aseptic technique Prevents microorganisms on hands from being introduced into a susceptible site Yes Avoid contaminating environmental surfaces and equipment with used gloves Clean shared patient care equipment after use Cover all patient’s open wounds Respiratory hygiene for coughing and sneezing patients suspected of having an infectious respiratory illness Patients to be provided an opportunity to perform hand hygiene prior to transport Exposure to blood/body substances – immediately wash site, promptly notify supervisor and seek management of occupational exposure Handle sharps with care. Use approved rigid sharps containers for disposal. DO NOT recap, break or bend needles Ensure compliance with occupational screening and vaccination policy requirements Refer to local facility environmental cleaning procedures Handle used linen with care and do not contaminate clean linen Special handling of Equipment Transport of Patients Workplace Health & Safety Cleaning Linen Revision 1 Trim No. T14/20775 Date: July 2014 Page 10 of 10 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 Table 2: Summary of recommended Contact Precautions Requirements Contact Precautions Single room Yes, with ensuite facilities or dedicated bathroom and toilet or cohort with patient(s) with same microorganism ( risk stratify e.g. immunocompromised, pregnant patients have a high priority for a single room) Clear visible signage of room precautions required Negative pressure Hand hygiene No Yes Hand Hygiene with alcohol based hand rub or liquid soap and water 5 Moments of hand hygiene for patient care (Clean In – Clean Out) Gloves Yes for contact with patient, patient’s environment or contaminated items/equipment or cleaning remove first prior to leaving patient room, perform hand hygiene and avoid touching contaminated surfaces/equipment avoid contaminating environmental surfaces and equipment with used gloves Apron/Gown Protective eyewear Mask Patient care equipment Transport of patients Room cleaning NOTES Revision 1 Yes for contact with patient, patient’s environment or contaminated items/equipment. After gown/apron removal, ensure that clothing does not contact potentially contaminated environmental surfaces If splash or aerosol likely. Remove after leaving patient’s room If splash or aerosol likely. Remove last after leaving patient’s room. Perform hand hygiene Single use or dedicate. Clean and process before next patient Respiratory hygiene for coughing and sneezing patients suspected or confirmed of having an infectious respiratory illness Patients to be provided an opportunity to perform hand hygiene prior to transport Limit transfer to other wards/facilities. Notify area receiving patient and transport staff of precautions to be maintained Clean patient care items, bedside equipment and frequently touched surfaces at least daily. On discharge terminal clean. Remove personal protective equipment and perform hand hygiene on leaving the room Respiratory hygiene for coughing and sneezing patients suspected of having an infectious respiratory disease Patient medical records must not be taken into the room Trim No. T14/20775 Date: July 2014 Page 1 of 3 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 Table 3: Summary of recommended Droplet Precautions NB. Staff who care for patients with droplet transmissible diseases must have demonstrated immunity by vaccine, serology or history as indicated within the Occupational Screening and Vaccination Policy Directive PD2011_005 Requirements Single room Negative pressure Hand hygiene Gloves Apron/Gown Protective eyewear Mask Patient care equipment Transport of patients Room cleaning NOTES Revision 1 Droplet Precautions Yes with ensuite facilities or dedicated bathroom or cohort with patient(s) with same microorganism and maintain at least one metre of separation (risk stratify e.g. immunocompromised, pregnant patients have a high priority for a single room) Clear visible signage of precautions required No Yes Hand Hygiene with alcohol based hand rub or liquid soap and water 5 Moments of hand hygiene for patient care (Clean In – Clean Out) Yes for anticipated contact with blood and body substances. Remove first before leaving patient’s room. Perform hand hygiene and avoid touching contaminated surfaces/equipment Avoid contaminating environmental surfaces and equipment with used gloves Yes if soiling or splashing are likely. Remove before leaving patient’s room Yes. Remove after leaving patient’s room Yes, Surgical mask, remove last after leaving patient’s room. Perform hand hygiene Clean / process before next patient Surgical mask for patient when they leave the room. Patients on oxygen therapy must be changed to nasal prongs and have a surgical mask over the top of the nasal prongs if condition allows. Respiratory hygiene for coughing and sneezing patients suspected or confirmed of having an infectious respiratory illness Patients to be provided an opportunity to perform hand hygiene prior to transport Limit transfer to other wards/facilities. Notify area receiving patient and transport staff of precautions to be maintained Clean patient care items, bedside equipment and frequently touched surfaces at least daily Remove mask after leaving the room Respiratory hygiene for coughing and sneezing patients suspected of having an infectious respiratory illness Visitors to patient room must wear a surgical mask and protective eyewear Patient medical records must not be taken into the room Trim No. T14/20775 Date: July 2014 Page 2 of 3 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Standard and Transmission Based (Previously known as Additional) Precautions PR 357 Table 4: Summary of recommended Airborne Precautions NB. Staff who care for patients with airborne transmissible diseases must have demonstrated immunity by vaccine, serology or history as indicated within the Occupational Screening and Vaccination Policy Directive PD2011_005 Requirements Single room Negative pressure Hand hygiene Gloves Apron/Gown Protective eyewear Mask Patient care equipment Transport of patients Room cleaning NOTES Revision 1 Airborne Precautions Yes, with ensuite facilities or dedicated bathroom or cohort with patient(s) with same microorganism Keep door closed Clear visible signage of precautions required Yes if available or keep door closed and, only if there is no possibility of air currents resulting in transmission the window may be opened Yes Hand Hygiene with alcohol based hand rub or liquid soap and water 5 Moments of hand hygiene for patient care (Clean In – Clean Out) Yes for anticipated contact with blood and body substances avoid contaminating environmental surfaces and equipment with used gloves. Remove before leaving patient’s room. Perform hand hygiene and avoid touching contaminated surfaces/equipment Yes if soiling or splashing are likely. Remove before leaving patient’s room If splash or aerosol likely. Remove after leaving patient’s room Yes, P2 (N95) mask. Remove last after leaving patient room. Perform hand hygiene Clean / process before next patient Surgical mask for patient when they leave the room. Patients on oxygen therapy must be changed to nasal prongs and have a surgical mask over the top of the nasal prongs if condition allows. Respiratory hygiene for coughing and sneezing patients suspected or confirmed of having an infectious respiratory illness Patients to be provided an opportunity to perform hand hygiene prior to transport Limit transfer to other wards/facilities. Notify area receiving patient and transport staff of precautions to be maintained Clean patient care items, bedside equipment and frequently touched surfaces at least daily Visitors to patient room must wear P2 (N95) mask Patient medical records must not be taken into the room Trim No. T14/20775 Date: July 2014 Page 3 of 3 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated.