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PEEL PUBLIC HEALTH
SECTION 2-3
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS
ADDITIONAL PRECAUTIONS
Additional Precautions refer to IPAC interventions (e.g. PPE, accommodation,
additional environmental cleaning) to be used in addition to Routine Practices to
protect staff and clients/patients/residents by interrupting transmission of
suspected or identified infectious agents.
1. Refer to Appendix N, Clinical Syndromes / Conditions with Required Level of
Precautions, for infectious diseases and agents that require Additional Precautions found
in Public Health Ontario. Provincial Infectious Disease Advisory Committee. Routine
Practices and Additional Precautions in All Health Care Settings (2012).
http://www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng20
12.pdf
Additional Precautions are based on the mode of transmission (e.g. direct or
indirect contact, airborne or droplet) 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.
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:
 Specialized accommodation and signage specifying the precautions
needed, but protecting resident confidentiality;
 PPE as appropriate;
 Dedicated equipment
 Additional cleaning measures
 Limited transport
 Effective communication and education to staff, visitors, volunteers and
residents.
Note: See 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.
Peel Public Health - Take Control Guide 2013
PEEL PUBLIC HEALTH
SECTION 2-3
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS
PPE consisting of gloves and gown are needed by staff when providing direct
resident care.
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
Peel Public Health - Take Control Guide 2013
PEEL PUBLIC HEALTH
SECTION 2-3
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS
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.
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.
Peel Public Health - Take Control Guide 2013
PEEL PUBLIC HEALTH
SECTION 2-3
INFECTION PREVENTION AND CONTROL RESOURCE GUIDE
ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS
 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
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/Health Canada. Canadian Tuberculosis
Standards 7th Edition 2013 http://www.respiratoryguidelines.ca/tb-standards2013
Ontario Lung Association. Tuberculosis Information for Health Care Providers.
4th edition 2009 http://www.on.lung.ca/Document.Doc?id=475
Public Health Ontario. Provincial Infectious Disease Advisory Committee.
Routine Practices and Additional Precautions in All Health Care Settings (2012).
http://www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Setting
s_Eng2012.pdf
Peel Public Health - Take Control Guide 2013