Download Transmission-based precautions in healthcare facilities Outline

Transmission-based precautions
in healthcare facilities
Outline
 Chain of infection
 Routes of transmission
 Precautions levels
– Standard precautions
– Transmission-based precautions
• Contact
• Droplet
• Air-borne
Chain of Infection
+
Quantity of
pathogen
Virulence
Route of
transmission
Port
Sensitive
host
Routes of Transmission
• Respiratory
– Cough
– Sneeze
• Fecal-oral
– Feces contaminate food, environment, or
hands
• Vector-borne
– Transmitted by insects
Routes of Transmission
Contact
Direct Contact
Indirect Contact
• Host comes into
contact with reservoir
• Disease is carried from
reservoir to host
• Kissing, skin-to-skin
contact, sexual
intercourse
• Contaminated surfaces
(fomites)
• Contact with soil or
vegetation
Routes of Transmission
Droplet
Large droplets within 1 meter transmit
infection via:
– Coughing, sneezing, talking
– Medical procedures
Examples:
• Diphtheria
• Severe Acute Respiratory Syndrome
• Avian influenza in humans
Routes of Transmission
Airborne (droplet nuclei)
Very small particles of evaporated
droplets or dust with infectious agent
may..
– Remain in air for a long time
– Travel farther than droplets
– Become aerosolized during procedures
Examples:
• Tuberculosis
• Measles (Rubeola)
Precaution Levels
All levels require hand hygiene
•
Standard Precautions
Transmission based precautions:
• Contact Precautions
• Droplet Precautions
• Airborne Precautions
Standard Precautions
• Essential to prevent transmission of
infectious agents.
• Applied to all patients regardless of
diagnosis and modes of transmission
Transmission-based
Precautions
• Higher level of precautions
• Applied in addition to standard precautions
• Different types of transmission-based
precautions:
–
–
–
–
Contact precautions
Droplet precautions
Airborne precautions
Airborne and contact precautions
Contact Precautions
• Prevent infection through
direct or indirect contact with
patients or patient care
environment
• Examples
–
–
–
–
–
Avian influenza
Ebola hemorrhagic fever
Methicillin Resistant S. Aureus
Shigellosis
C. difficile associated diarhea
Contact Precautions
Taken in addition to Standard Precautions
• Isolate or cohort patients
• Limit patient movement
• Gown + gloves for patient / room contact
– Remove immediately after contact
• Do not touch eyes, nose, mouth with hands
• Avoid contaminating environmental surfaces
Contact Precautions
• Wash hands immediately after patient
contact
• Use dedicated equipment if possible
– If not, clean and disinfect between uses
• Clean, then disinfect patient room daily
– Bed rails
– Bedside tables
– Lavatory surfaces
– Blood pressure cuff, equipment surfaces
Droplet Precautions
• Prevent infection by large
droplets from
– Sneezing
– Coughing
– Talking
• Examples
–
–
–
–
–
Neisseria meningitidis
Pertussis
Influenza
Avian influenza (probable)
Rubella
Droplet Precautions
Taken in addition to Standard Precautions
• Wear surgical mask within 1 meter of patient
• Wear face shield or goggles within 1 meter of patient
• Place patients in single rooms or cohort 1 meter apart
• Limit patient movement within facility
– Patient wears mask when outside of room
Airborne Precautions
Taken in addition to Standard Precautions
• Prevent spread of infection through very
small (< 5 microns) airborne particles
• Examples
–
–
–
–
Tuberculosis
Measles
Varicella
Variola
Airborne Precautions
• N95 mask (or equivalent) for personnel
– Check seal with each use
• Negative pressure isolation room
– Air exhaust to outside versus re-circulated
• Patient to wear a surgical mask if
outside of the isolation room
Negative Pressure Isolation Room
Natural Ventilation
Cohorting Room
1 meter