Download ADDITIONAL PRECAUTIONS

PEEL PUBLIC HEALTH
SECTION 2-3
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS
ADDITIONAL PRECAUTIONS
Certain pathogens and clinical presentations require the use of additional
precautions (AP) in addition to Routine Practices. AP are based on the mode of
transmission of the suspected/known organism or disease and must be instituted
as soon as symptoms suggestive of an infection are noted, not only when
diagnosis is confirmed.
Education of staff, volunteers, residents, families and visitors is an important
aspect of initiating Additional Precautions. Educational information (both written
and verbal) regarding the reason for the precautions and the specific procedures
to be followed should be provided.
There are three categories of Additional Precautions: Contact Precautions,
Droplet Precautions and Airborne Precautions. Some microorganisms may be
transmitted by more than one route, e.g., respiratory viruses may remain viable
for some time in the resident environment and may be picked up on the hands of
staff, volunteers and visitors. Therefore a combination of Droplet and Contact
Precautions would be utilized.
Additional Precautions includes:
 signage specifying the precautions needed, but protecting resident
confidentiality;
 PPE as appropriate;
 equipment dedicated to the resident;
 additional cleaning measures;
 effective communication and education to staff, visitors, volunteers and
residents.
Note: See Appendix A for Peel Health link to Airborne, Droplet and Contact
signage
Contact Precautions
Contact transmission is the most frequent mode of transmission of health care
associated infections. Transmission occurs from direct physical contact between
an infected or colonized individual and a susceptible host. Indirect contact
involves transfer of microorganisms to a susceptible host via an intermediate
object, such as contaminated hands that are not washed between residents, or
contaminated equipment or other inanimate objects in the resident environment.
PPE consisting of gloves and gown are needed by staff when providing direct
resident care.
Peel Public Health - Take Control Guide 2011
PEEL PUBLIC HEALTH
SECTION 2-3
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS
Contact precautions may be indicated for certain organisms.
 If the organism has a low infective dose. (For example: It takes only a very
small amount of the Norovirus organism present in the environment to be
transmitted to hands and then to mouth to cause a gastrointestinal infection
and subsequent outbreak).
 If the organism may be transmitted from the source resident’s intact skin (such
as MRSA)
 If there is potential for widespread environmental contamination.
Contact precautions should be used for:
 Acute diarrhea if uncontrolled (incontinent, stool cannot be contained within
incontinence wear and resident not confined to bed) and/or vomiting
 Residents with suspected or confirmed Norovirus, Clostridium difficile
 Extensive desquamating skin disorder with known or suspected infection or
significant colonization
 Skin rash compatible with scabies or other undiagnosed, new onset skin rash
 Draining, infected wound in which drainage cannot be contained by dressing
 Varicella or disseminated herpes zoster (with airborne precautions)
 During outbreaks of influenza in the facility (with droplet precautions).
In addition to Routine Practices, contact precautions include the following:
 Gloves and gowns should be used for direct contact with the resident or
environmental surfaces that are frequently touched by the resident.
 Equipment/supplies should be dedicated to the resident and identified and
stored in a way that prevents use for or by other residents. If this is not
possible it must be cleaned and disinfected prior to being used for another
resident.
 Roommates and visitors should be educated and aware of the precautions to
follow.
 Residents with the same organism or symptoms should be grouped together
(cohorted) to reduce the risk of transmission to other residents.
Masks and eye protection are not required for clients on Contact Precautions.
However it is reasonable to consider wearing a surgical mask in addition to
gloves and gowns:
 If there is risk of splashing one’s face with blood or body fluids
 To mask unpleasant odours
 If the health care worker habitually touches his/her face.
Some illnesses/microorganisms can be spread through more than one route.
Influenza, like many respiratory viruses, may be transmitted through both droplet
and indirect contact. In this instance clients may be placed on both Droplet and
Contact Precautions. The PPE in this instance would include gown, gloves,
surgical mask and eye protection.
Peel Public Health - Take Control Guide 2011
PEEL PUBLIC HEALTH
SECTION 2-3
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS
Droplet Precautions
These precautions are based on the droplet route of transmission. The barriers
are designed to protect the healthcare provider and other individuals from
droplets which are aerosolized when the ill client coughs, talks, sneezes or
laughs.
Droplet precautions should be implemented for residents with infections such as
viral respiratory infections, influenza, and Group A streptococcus (see Appendix
E - Transmission Summary Table for complete list).
In addition to Routine Practices, droplet precautions include the following:
 If a resident is symptomatic of an acute viral infection (new onset cough, nasal
congestion/runny nose, fever, etc) a one to two metre/three to six feet spatial
separation should be provided between the other residents and visitors.
Residents will remain in their room until they are no longer symptomatic.
 Staff must wear a surgical mask and protective eyewear/goggles to provide
direct care (within 2 metres/6 feet) to the resident on droplet precautions.
 Hand hygiene must be performed before contact with the resident and after
personal protective equipment is removed.
 Participation in group activities should be restricted while the resident is
symptomatic.
 Roommates, visitors and staff should be aware of and educated in the
precautions to be followed.
 Residents with the same symptoms or infection should be grouped together
(cohorted) wherever possible to reduce the risk of transmission to other
residents. This can be done by either physically grouping the residents
together or assigning staff members to care only for the affected residents
(cohort nursing).
Airborne Precautions
These precautions are based on the airborne route of transmission and are
designed to prevent the transmission of droplet nuclei through air currents.
Airborne precautions should be implemented for residents with suspected
pulmonary or laryngeal tuberculosis, varicella (chickenpox) or disseminated
herpes zoster, and measles.
 Resident should be placed in a single room with special air handling and
ventilation (negative pressure) if possible.
 PPE consisting of fit tested high-efficiency (N95) masks should be used by all
staff to enter the room of a resident with pulmonary/laryngeal tuberculosis.
Staff who are confirmed to be immune to chickenpox and measles do not need
Peel Public Health - Take Control Guide 2011
PEEL PUBLIC HEALTH
SECTION 2-3
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS
to wear a mask to enter the room of a resident with either of those illnesses.
Non-immune staff should not enter these rooms.
 Residents with infectious diseases that are spread by airborne transmission
should be placed on Airborne Precautions and be transferred to a facility
where they can be managed safely and appropriately.
Additional Resources
Public Health Agency of Canada. Canadian Tuberculosis Standards 6th edition
2007 found at:
http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tbstand07-eng.php
Ontario Lung Association. Tuberculosis Information for Health Care
Providers. 4thedition. 2009 found at:
http://www.on.lung.ca/Page.aspx?pid=439
Ontario Agency for Health Protection and Promotion. Provincial Infectious
Disease Advisory Committee. Routine Practices and Additional Precautions in
All Health Care Settings (2009). Retrieved from website:
http://www.oahpp.ca/resources/pidac-knowledge/best-practice-manuals/routinepractices-and-additional-precautions.html
Peel Public Health - Take Control Guide 2011