Download (Additional) Precautions with Infectious Diseases

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
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Date: July 2014
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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
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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.
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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