Download Transmission Based Precautions Policies

Transmission Based Precautions Policies (TBP) – Information on
Droplet/Contact/Airborne Precautions
Date of issue: April 2009
Date of re-issue: April 2010
1) Who should use Transmission Based Precautions policies?
The policies can be used by for example, infection control teams, health and social care
managers, nurses, doctors, or other health and social care providers. They should be read in
conjunction with the associated literature reviews. The policies can be used as a ‘check’ to
ensure relevant policies are in place, to ensure content in local policies is current and
comprehensive, to inform the basis of local policy development or used in their entirety.
2) What are the objectives of these policies?
It is intended that these policies will provide a common, consistent approach to infection
prevention and control, prevent duplication of effort and therefore reduce time spent on policy
development. They intend to provide evidence based guidance where possible (a standardised
scientific methodology has been applied to literature reviewing and critiquing of the evidence
base to inform the policies).
3) What are Transmission Based Precautions?
Transmission Based Precautions, in addition to Standard Infection Control Precautions (SICPs),
are a set of measures that should be implemented when patients/clients are either suspected or
known to be infected with a specific infectious agent, when aiming to prevent and control
spread, particularly in relation to Healthcare Associated Infections (HAI). Transmission Based
Precautions are categorised according to the route of transmission of the infectious agent such
as droplet, contact and/or airborne.
4) Why are Transmission Based Precautions necessary?
They are necessary because transmission of specific infectious agents will not be prevented by
SICPs alone e.g. Mycobacterium tuberculosis. SICPs are the minimum set of measures to be
applied at all times within a health and social care setting or where health and social care is
being provided. SICPs should be applied for both recognised and unrecognised sources of
infection and are intended to protect the patient/client, health and social care worker and any
visitors/carers.
SICPs must underpin all health and social care activities and should be applied at all times,
when exposure to blood, other body fluids secretions or excretions (except sweat) non intact
skin or mucous membranes may occur. SICPs also apply to equipment or items in the
patient/client environment that may have become contaminated.
Transmission Based Precautions (TBP) – Information on Droplet/Contact/Airborne Precautions
HPS ICT 2009
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5) When should Transmission Based Precautions be applied?
Transmission Based Precautions are required in all health and social care settings when a
patient/client is known or suspected to be infected/colonised with an infectious agent or an
epidemiologically important organism that can be spread by the droplet, contact and/or airborne
route.
This includes precautions to be taken with those; with active infections, who are incubating
infectious disease, who are asymptomatic but suspected to be infectious and those who are
colonised with pathogenic microorganisms.
Examples of these infectious agents include those of HAI concern such as MRSA and
Clostridium difficile that may spread and cause harm to others while care is being delivered.
6) How do the elements of Transmission Based Precautions relate to Standard
Infection Control Precautions?
The nine elements of SICPs must underpin all health and social care activities. It is therefore
assumed, for the purpose of the Transmission Based Precautions policies, that all SICPs are
being adhered to and they are therefore not specifically addressed within the documents. More
information on SICPs is available from:
http//www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx
7) Is there specific concern around multi-drug resistant organisms (MDROs)
The need for droplet, contact and/or airborne precautions will vary depending on the
patient/client, the setting, and the organism (Refer to Appendix 1). For example highly
dependant in-patient areas such as intensive care require different considerations than areas
such as mental health settings, however further advice may be required from local Infection
Control/Health Protection Teams.
Within non acute settings such as care homes, community clinics, during home care, individual
risk assessments are required to determine for example, the use of shared facilities such as
toilets, based on the patient/clients symptoms, other individuals in the same setting and the
availability of hand hygiene facilities, etc.
Advice from local Infection Control/Health Protection Teams may be required in the case of
MDROs to facilitate risk assessments and provide appropriate individual guidance based on the
principles described in the policies.
The information within the policies applies to all organisms transmitted via all routes whether
MDRO or not. Specific points of note related to MDROs include:
Droplet
Additional face protection including masks may be required when caring for patients/clients with
MDROs when performing certain healthcare activities, even if not routinely advocated for
droplet precautions, e.g. during aerosol-generating procedures.
Contact
Surgical masks are not recommended for the routine care of patients/clients with MDROs cared
for under contact precautions such as MRSA. Face protection including surgical masks
however are recommended for use with patient/clients with MDROs when performing certain
healthcare activities which for example may result in splashing to the face e.g. wound irrigation
and intubation, in conjunction with recommendations for eye/face protection as per SICPs.
Transmission Based Precautions (TBP) – Information on Droplet/Contact/Airborne Precautions,
HPS ICT 2009
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Airborne
The importance of respiratory masks (FFP3) when caring for patients/clients with MDRO.
7) How long should Transmission Based Precautions remain in place?
The duration of Transmission Based Precautions for specific infectious agents spread by
droplet, contact and airborne is listed within Appendix 1. However, this list is not exhaustive
and is for guidance only. Transmission Based Precautions may require to be lengthened, for
example for immunocompromised patients due to the risk of prolonged shedding of organisms.
This decision should be based on the individual’s situation, symptoms and treatment and be
guided by the physician/clinician in conjunction with the local Infection Control/Health Protection
Team.
8) What terms were previously used to describe aspects of Transmission Based
Precautions in practice?
The terms that were previously used include; barrier nursing, enteric precautions, isolation
nursing and source isolation.
Transmission Based Precautions incorporate all the measures that have previously been
recommended under these terms.
Some infectious agents are spread by more than one route, such as both droplet and
contact in the case of influenza, therefore these policies should not be considered in
isolation.
Policies and literature reviews for Transmission Based Precautions can be found at
http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx.
Transmission Based Precautions (TBP) – Information on Droplet/Contact/Airborne Precautions,
HPS ICT 2009
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Droplet Precautions Policy and Procedure
(an element of Transmission Based Precautions)
Date of issue: April 2009
Date of re-issue: April 2012
Introduction
What are droplet precautions?
Droplet* precautions are a set of infection control measures (to be used in addition to Standard
Infection Control Precautions* (SICPs)), which are designed specifically to prevent and control
the transmission of infectious agents* spread by droplets to patients/clients and health and
social care workers during provision of care.
These precautions include: isolation, use of personal protective equipment (PPE), hand
hygiene, care of equipment and environment including decontamination, safe handling of linen
and waste.
Why are droplet precautions important within health and social care settings?
It is important to prevent infectious agents that could be present in, for example, the respiratory
tract of individuals being transmitted via droplets to others and resulting in healthcare
associated infection*.
When are droplet precautions required?
The need for droplet precautions will vary depending on the patient/client, the setting, the
infectious agent (Refer to Appendix 1) and the procedures/activities being undertaken. For
example highly dependent in-patient areas such as intensive care require different
considerations than areas such as mental health settings. Further advice may be required from
local Infection Control/Health Protection Teams.
Within non acute settings, such as care homes, community clinics or during home care,
individual risk assessments are required.
Droplet precautions are required in all health and social care settings when a patient/client is
known or suspected to be infected*/colonised* with an infectious agent or an epidemiological
important organism* that can be spread by droplets.
They include precautions to be taken with those; with active infections, who are incubating
infectious disease, who are asymptomatic but suspected to be infectious and those whose
respiratory tract is colonised with pathogenic microorganisms*.
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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How do you decide which precautions are required?
Not all elements may be required for every patient/client or situation. The use of risk
assessment should be applied when assessing the requirement for precautions and further
specialist advice should be sought from local Infection Control/Health Protection Teams as
required.
This policy describes the key precautions to be considered when delivering care to those with
infections spread by droplets.
Examples of infections spread by droplets and of Healthcare Associated Infection (HAI)
concern
• Group A streptococcal disease
• Meningococcal disease (meningitis/septicaemia)
• Influenza
• Others causing concern identified locally including those resistant to antibiotics
Remember other infections are spread via droplet, airborne and contact (see full list in
Appendix 1, this list is not exhaustive and some infectious agents are spread by more than
one route)
This policy does not give specific guidance for outbreak situations or extremely rare infectious
conditions which will require additional critical infection control measures
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Contents
This policy contains information on:
Page
Underpinning responsibilities for droplet precautions............................................................... 7
Rationale for droplet precautions .............................................................................................10
Patient/client placement (e.g. use of single rooms/isolation)....................................................11
Duration of droplet precautions ................................................................................................13
Patient/client transfers..............................................................................................................13
Respiratory hygiene/cough etiquette........................................................................................13
Personal Protective Equipment (PPE) .....................................................................................14
Masks and other face protection.........................................................................................14
Gloves and aprons..............................................................................................................14
General good practice points..............................................................................................14
Hand hygiene...........................................................................................................................15
Management of care equipment and control of the environment .............................................15
Safe management of linen .......................................................................................................16
Safe disposal of waste .............................................................................................................16
Occupational exposure management ......................................................................................17
Glossary...................................................................................................................................18
Appendix 1 – Infectious agents – Clinical infections or diseases warranting Transmission
Based Precautions in addition to Standard Infection Control Precautions ...............................21
Appendix 2 – Hierarchy of placement for those known or suspected to have an infection
spread by infectious droplets ...................................................................................................34
Appendix 3 – Putting on and removing PPE ............................................................................35
Appendix 4 – Summary of precautions to minimise the spread of diseased caused by
infectious droplets ....................................................................................................................36
For further background information, see associated literature review
on the elements of droplet precautions
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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What are the underpinning responsibilities for droplet precautions?
NHS Boards must:
• Ensure systems and resources are in place to facilitate implementation of the policy
Managers must:
• Ensure that all staff have had instruction/education on the principles of droplet
precautions, Standard Infection Control Precautions and risk assessment
• Ensure that adequate resources are in place to allow for the recommended infection
control measures to be implemented
• Ensure areas participate in surveillance and audit programmes at a national and/or local
level where required. This will help support the implementation of precautions at the most
appropriate times
• Undertake a risk assessment to optimise patient/client and staff safety, consulting expert
infection control guidance as required
• Support staff in any corrective action or interventions if an incident occurs that may have
resulted in cross transmission*
• Ensure any staff with health concerns or who may have become ill due to occupational
exposure are referred to the relevant agency e.g., General Practitioner or Occupational
Health
• Ensure that estates/facilities management provide a safe environment to allow infection*
prevention and control precautions to be applied.
All staff – (providing direct care in a health or social care setting including patient’s/clients’ own
homes) must:
• Apply Standard Infection Control Precautions and the measures described in this policy
• Ensure all other staff/agencies apply the principles of Standard Infection Control
Precautions and the measures described in this policy
• Undertake risk assessments when assessing the requirement for droplet precautions
• Document when droplet precautions according to the policy cannot be implemented for
clinical or other relevant reasons
• Provide information on the precautions being taken. This should be communicated to all
staff, the patients/clients, and visitors without breaching confidentiality
• Offer reassurance to patients/clients and visitors/carers regarding the need for droplet
precautions
• Advise the patient/client, carers or visitors of any infection prevention and control
requirements such as hand hygiene and respiratory hygiene/cough etiquette
• Ensure occupational immunisations are up to date (if applicable)
• Report to line managers any deficits in; knowledge in relation to droplet
precautions/Standard Infection Control Precautions, facilities/equipment or incidents that
may have resulted in cross transmission
• Attend any mandatory or update infection control education sessions
• Report any illness that may be as a result of occupational exposure to their line manager
and Occupational Health Department (if applicable)
* denotes glossary
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• Not provide direct patient/client care while infectious e.g. suffering diarrhoea and
vomiting, as this could cause harm to the patient/client/others. If in any doubt consult
with your manager, General Practitioner, Occupational Health Department or the local
Infection Control/Health Protection Team
• Support other staff in any corrective action or interventions if an incident occurs that may
have resulted in cross transmission
• Ensure staff with health concerns or who have become ill due to occupational exposure
are referred to the relevant agency e.g., General Practitioner or Occupational Health
• Ensure that estates/facilities management provide a safe environment to allow infection*
prevention and control precautions to be applied.
Staff with infection control/health protection responsibilities must:
• Provide education for staff and management on this policy
• Act as a resource for guidance and support when droplet precautions are required
• Provide expert advice on the points below and/or seek additional expert advice from
infection control specialists on these matters where required;
o Provide expert advice for incidents involving epidemiologically important organisms
(and outbreaks/incidents)
o Provide advice on individual risk assessments, for example a placement* decision
Visitors should be advised:
• To contact the person in charge before visiting if they are unsure of the infectious status
of the person they are visiting
• Of appropriate hand hygiene to be carried out before and after visiting as well as other
relevant infection prevention and control measures
• Of appropriate respiratory hygiene/cough etiquette which should be adhered to
• Of the Chief Medical Officer 5 top tips for all patients, staff and visitors. See
http://www.scotland.gov.uk/Publications/2004/08/hai
Incident reporting:
• Any incidents where failures in adopting droplet precautions have occurred and/or
incidents which have resulted in cross transmission should be documented and reported
as per local incident reporting procedures.
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Communication and general good practice:
• Effective communication between all members of the health and social care team is
imperative for the management of infectious agents
• Those who are unwell with respiratory symptoms should be advised not to attend non-
urgent appointments or visit other settings where infections might spread to those who
are vulnerable
• Means of communication to alert staff that droplet precautions need to be in place, for
example signage that does not breach confidentiality
Everyone has an important part to play in improving patient/client safety. Undertaking
Transmission Based Precautions is an essential element to ensure everyone’s safety.
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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What is the rationale for droplet precautions?
• Droplet precautions are required to prevent the transmission of infectious agents via droplets
and to minimise healthcare associated infection (HAI). It is essential to apply the relevant
infection control precautions during any health and social activity. Due to the distance that
droplets can travel from infected respiratory tracts, which depends on a number of factors
including their speed, size, density and a number of additional environmental factors such as
temperature, humidity etc., the precautions described are pivotal. Droplet transmission is
defined as the transfer of large droplets (>5µm) from the respiratory tract of an infected
individual directly onto a mucosal surface or conjunctivae of another individual. Due to the
comparative large size of the particles it is accepted that droplets when dispelled only travel
relatively short distances through the air, e.g. less than 3 feet (1 metre). The activity, which
resulted in the droplet expulsion from the respiratory tract, affects this distance of spread
and therefore has to be considered when precautions are being taken
• Infected individuals can cause respiratory droplets to be expelled as a result of a number
of human activities such as coughing, sneezing and even talking. They can also be a risk
during certain healthcare procedures such as endotracheal intubation and suctioning
• Droplets are transmitted over short distances and this has been historically defined as
less than 3 feet (1 metre) from the patient. This distance has been used as a measure
and prevention measures based on this have been shown to be effective
NB. Certain respiratory infections spread by droplets, such as SARS, require additional infection
control measures. Refer to the literature reviews for additional information sources, seek advice
from local Infection Control/Health Protection Teams and in addition, for guidance on Pandemic
Influenza see http://www.hps.scot.nhs.uk/resp/guidelines.aspx
Remember Transmission Based/additional precautions are always applied in addition
to Standard Infection Control Precautions
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Where should those requiring droplet precautions be cared for?
• This requires risk assessment in order to determine the most appropriate placement for
patients/clients. This will depend on:
• The infectious agent (refer to Appendix 1)
• The patient/client and their overall condition e.g. a productive cough
• The area where the patient/client is being cared for. This includes the potential for
adverse outcomes in others (e.g. consider risks to immunocompromised* patients, those
with invasive devices) and the availability of single rooms
• The procedure/activities being undertaken
• Timeliness of assessment and placement is essential. Additional support may be required if
this is problematic and, for example, greater than one hour has elapsed
Acute settings
• Patients with known/suspected infections requiring droplet precautions should be placed in
single rooms with en suite facilities as soon as possible. The door should be kept closed
• Certain conditions require the patient to be placed in monitored specialised isolation
rooms* as soon as is practical, e.g. SARS. Seek advice from local Infection
Control/Health Protection Teams
• If rooms are unavailable then transfer to another unit/hospital with suitable facilities should
be considered (providing the patient/client is medically stable). A risk assessment by
clinicians and managers supported by local Infection Control/Health Protection Teams will
help determine when an alternative setting or a transfer is possible
• During transfer the patient should wear a surgical mask* and be instructed on the
principles of respiratory hygiene/cough etiquette if their condition allows and is practical
• If there are no en suite single rooms available then placement decisions should be subject to
local risk assessment supported by a member of the local Infection Control/Health Protection
Team and might include:
• Placement in a single room with no en suite but hand washing facilities with the door
being kept closed. The patient should be instructed on the principles of respiratory
hygiene/cough etiquette. The room should be suitably ventilated (via an open window if
possible) to allow the change of air. The patient should wear a surgical mask where
possible when having close contact* with others
• Cohorting - where cohorting is the only option this should be considered based on
placing those with the same known/suspected infection in the same designated area.
This approach is particularly relevant when there are increased numbers of cases e.g.
influenza
• If cohorting those with the same infection is not possible avoid placing the infected
patient with those who are immunocompromised or within long stay facilities such as
care homes. Local Infection Control/Health Protection Teams should be consulted for
advice on individual risk assessments
* denotes glossary
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• Cohorted patients should be at least 3 feet (1 metre) from each other (this should also be
considered for patients within for example out-patient/other departments if these visits
are essential)
• Separation by using a single room without any facilities or in a cubicle* can be used if
other options are unavailable. Doors should be kept closed
• The use of closed bed screens/curtains should be considered as a final option only and
separation of at least 3 feet (1 metre) should be maintained. Particular attention must be
given to decontamination of curtains during these times to prevent further spread of
infectious agents via this route
• The decision to cohort or use rooms/cubicles without facilities will depend on a number of
factors. Advice should be sought from local Infection Control/Health Protection Teams
Non acute settings (such as care home facilities/community settings)
• Where optimum facilities as described are not available and transfer to an acute setting is
awaited or not an option:
• Separation of patients/clients should still be attempted, as has been described
• All other precaution measures as described in this policy should be adhered to,
whatever facilities are available, wherever care is being provided
• In GP surgeries, for example, where infectious droplets are known/suspected, the person
may be requested to wear a surgical mask (dependent on risk assessment/infection
suspected) and placed in a single/private consulting room (if practical). The door should
be kept closed. The patient/client should be instructed on the principles of respiratory
hygiene/cough etiquette. The room should be suitably ventilated (via an open window if
possible) to allow the change of air. Surgical masks being worn should be changed when
heavily contaminated and/or wet with breath moisture or if damaged/torn
• Individual risk assessments based on potential infection risks to other patients/clients as well
as individual care needs should take place with additional expert input where required
Additional points
• During placement or transfers, contact with any immunocompromised patients/clients should
be avoided
• Patient/clients requiring droplet precautions within acute and/or non acute long
stay/community settings should not be transferred unnecessarily to other areas unless
essential due to medical reasons
•
Information on the precautions being applied should be communicated to all staff providing
care and the patient/client and visitors without breaching confidentiality
• All of the other precaution measures described in this policy should be adhered to as well as
ensuring appropriate placement of patients/clients and ensuring all elements of Standard
Infection Control Precautions are applied
Also see Appendix 2 ‘A Hierarchy for placement of those known or suspected to have an
infection spread by infectious droplets’
NB. This policy does not give specific guidance for outbreak situations. Local policies should be
referred to or advice sought from local Infection Control/Health Protection Teams
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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How long should droplet precautions remain in place?
• Droplet precautions/placement should remain until the cessation of symptoms, clearance of
specimens and/or completion of effective treatment or according to the specific advice
relevant to the infectious agent (Refer to Appendix 1 for infectious agents). Contact local
Infection Control/Health Protection Teams for further advice
What if a patient/client has to be transferred within acute or non acute
settings?
• It is recommended that patients/clients requiring droplet precautions within acute or non
acute settings are not transferred unless there is a necessary requirement (e.g. medical
reasons or for placement in an appropriate single room)
• The transferring area should give guidance to transport staff and to the receiving area on the
droplet precautions required for the individual patient/client
• The patient/client should be instructed on respiratory hygiene/cough etiquette and requested
to wear a surgical mask if possible. Surgical masks should be changed when heavily
contaminated and when wet with breath moisture or if damaged and torn.
• PPE may be required for transfers depending on the contact that will be made with the
patient/client during that time. Hand hygiene following contact and/or transfer is also
important. (See What Personal Protective Equipment (PPE) should be considered for
droplet precautions and when should it be worn?). Additionally consider:
• An individual risk assessment if the patient/client cannot wear a mask e.g. confused,
disturbed or with respiratory distress and unable to tolerate a mask. This should include
the known or suspected infectious agent, the contact that will be made, and the need for
transfer staff to wear masks. Local Infection Control/Health Protection Teams should be
consulted for advice. Routine wearing of masks by transport staff is not normally required
• Equipment/linen used for the transfer must be subject to decontamination
(See Why are management of care equipment and control of the environment
additional considerations for droplet precautions and Why is safe management of
linen an additional consideration for droplet precautions?)
What are respiratory hygiene/cough etiquette precautions?
• Cover nose and mouth with disposable single-use tissues when sneezing, coughing, wiping
and blowing nose
• Dispose of used tissues into the nearest waste bin
• Wash hands after coughing, sneezing, using tissues, or after any contact with respiratory
secretions and contaminated objects
• Keep hands away from the mucous membranes of the eyes and nose. Certain
patients/clients (e.g. the elderly, children) may need assistance with containment of
respiratory secretions; those who are immobile will need a receptacle (e.g. a plastic bag)
readily at hand for the immediate disposal of used tissues and offered hand hygiene facilities
• Instruct all affected patients/clients and any visitors or carers on the steps described
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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What Personal Protective Equipment (PPE) should be considered for droplet
precautions and when should it be worn?
Masks and other face protection:
• A surgical mask is one of the key precautions to be considered when providing care in close
contact. It should be put on before care is provided, i.e. on entry into a room or cohort area
• The use of these masks can apply to the infectious agents featured in Appendix 1 that are
spread via infectious droplets
• Masks are not expected to be routinely worn, for example when the health/social care
worker has known or proven immunity or close contact care is not being provided. In other
seasonal situations, for example, when there are increased numbers of influenza or RSV
cases, routine wearing of masks may not be realistic. Seek advice from local Infection
Control/Health Protection Teams
• Respiratory masks (FFP3)* are not generally expected to be worn for droplet precautions.
These masks would only be required when delivering care to those with infections of
additional epidemiological significance and/or transmissible by the airborne route (more
information can be found in the HPS Airborne Precautions Policy and Procedure
http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx) and depending
on the activity being undertaken. Advice should be sought from local Infection Control/Health
Protection Teams
•
Face/eye protection is required if there is a risk of mucosal splashing to the eyes as a result
of coughing/sneezing
•
Where masks are not worn all other precautions as described should still be adhered to
Gloves and aprons:
• Disposable gloves and plastic aprons should be put on before and worn during care
activities and where there will be contact with the patient/client or their immediate
environment
• The use of a disposable fluid repellent gown may be more appropriate in order to gain fuller
body protection from specific infectious agents. Advice should be sought from local Infection
Control/Health Protection Teams
General good practice points:
• Supplies of PPE should be available at the single room/cohort area
• Aprons (or disposable fluid repellent gowns), masks and gloves should be put on before
undertaking care activities
• Those entering rooms/areas should not be wearing any outer coats
• Keep hands away from face and PPE being worn
• PPE should be removed immediately upon leaving the room/area and hand hygiene
performed
• PPE must be changed and hand hygiene performed between different procedures/care
activities on the same patient/client. This is particularly important for gloves as they will
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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become contaminated following one procedure and could lead to cross transmission of
infectious agents even in the same patient
• PPE must be changed and hand hygiene performed between every patient/client, including
others being cared for under droplet precautions within the same area
• Surgical masks being worn should be changed when heavily contaminated or wet with
breath moisture or if damaged/torn
• Gloves should be changed if torn or heavily contaminated
• Putting on and removal of PPE should be performed as in Appendix 3
• Safe disposal of PPE is essential immediately following removal
Hand Hygiene
• Hand hygiene is essential (refer to the HPS Model Infection Control Policy on Hand
Hygiene http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx which
includes the ‘Your 5 moments for hand hygiene’ and other times when hand hygiene must
be performed)
Why are management of care equipment and control of the environment
additional considerations for droplet precautions?
• Care equipment and the environment must be given additional consideration in order to
prevent the spread of infectious droplets/respiratory secretions that may be contaminating
items:
• The patient’s/client’s environment should be cleaned at least daily or when visibly
contaminated. Particular attention should be paid to frequently touched and horizontal
surfaces surrounding the patient/client (e.g. bed tables, door handles, etc)
• Refer to http://www.scotland.gov.uk/Publications/2004/05/19319/36643 for more
information on cleaning specifications and HPS Model Infection Control Policy on
Management of Care Equipment
http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx
• An increase in cleaning frequency should be considered particularly if patients/clients are
producing copious amounts of respiratory secretions
• Equipment should be allocated to individuals being cared for under droplet precautions,
e.g. thermometers
• Equipment should not be shared with others, where this is unavoidable equipment must
be decontaminated following manufacturer’s guidance/local instruction prior to use on
others (also refer to HPS Model Infection Control Policy on Management of Care
Equipment
http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx)
• Items of equipment and the environment should be intact. Items that are not intact
should be reported and replaced to prevent unnecessary harbouring of infectious agents
• The environment should be clutter free to allow for ease of cleaning
• Where possible use single use/single patient use equipment and dispose of it after use
* denotes glossary
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• Equipment such as mops/buckets used for cleaning in-patient areas (hospital) should be
colour coded as stated in the NHSScotland Colour Coding for Hospital Cleaning
Materials and Equipment (HFS, 2008). In isolation or dedicated single rooms/areas
these should be yellow in colour and should not be used in other rooms/areas. These
items should also be clean, fit for purpose and decontaminated or disposed of as
appropriate following use. Cleaning equipment should not be left in a patient’s/client’s
room between use, unless there is a dedicated storage area
• Within NHSScotland premises, the NHSScotland Cleaning Specifications should be
complied with.
• The NHSScotland Cleaning Specification and Colour Coding of Hospital Cleaning
Materials is not applicable in care homes and other community settings however the
principles of this policy should be applied.
• Terminal cleaning* of equipment and the environment is essential before others are
cared for in that area (refer to HPS Model Infection Control Policies on Control of the
Environment Policy and Management of Care Equipment
http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx It is
important that all items are decontaminated (e.g. curtains, bed frames, etc))
•
PPE should be worn while undertaking decontamination of equipment/the environment, i.e.
gloves and plastic apron
•
Hand hygiene should always be performed after undertaking decontamination of
equipment/the environment
Why is safe management of linen an additional consideration for droplet
precautions?
NHSScotland settings
• Linen that could be contaminated with infectious droplets must be managed safely in order
to avoid cross transmission of infectious agents. This should be bagged as infected linen
within the Healthcare Setting.
•
•
•
•
Ensure safe handling of linen, i.e. wear PPE and wash hands on removal
Place contaminated linen into an alginate bag at the point of removal. Do not carry linen
Place alginate bags into appropriately colour coded linen bag
Communicate with others who may handle the infected linen to ensure they take
precautions
Care Home settings
• In care home settings the principles of this policy should be applied when dealing with linen
that could be contaminated with infectious droplets. This would include bagging infected
linen directly into water soluble/alginate bags providing that industrial washing machines are
in use. If domestic washing machines are in use or if home laundering is undertaken refer
to HPS Washing Clothes at Home leaflet
http://www.documents.hps.scot.nhs.uk/hai/infection-control/publications/washingclothes-home.pdf
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
Page 16 of 36
• See HPS Model Infection Control Policy on Safe Management of Linen
http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx) for more
information on care of other linen such as people’s own clothing and seek further advice on
this from local Infection Control/Health Protection Teams
Why is safe disposal of waste an additional consideration for droplet
precautions?
• Waste that could be contaminated with infectious droplets must be managed safely in order
to avoid cross transmission of infectious agents via this route:
• Ensure safe handling of waste, i.e. wear PPE and wash hands on removal
• Bag waste generated as a result of care activities as per national/local policy for
healthcare waste (See HPS Model Infection Control Policy, Safe Disposal of Waste
http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx for more
information on healthcare waste)
Why is occupational exposure management an additional consideration for
droplet precautions?
• Occupational exposure management is essential for the protection of all health and social
care workers and relevant immunisation is an essential consideration when caring for those
with diseases spread by infectious droplets:
• Ensure occupational immunisations (if required) are up to date, e.g. influenza
• Report and manage occupational exposure incidents immediately, including any mucosal
splashes.
Also refer to Appendix 4 for summary of precautions to minimise the spread of infections
transmitted by infectious droplets
* denotes glossary
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
Page 17 of 36
Glossary
Aerosol-generating procedures associated with pathogen transmission - Procedures that
have been reported to be aerosol-generating and associated with a documented increased risk
of pathogen transmission. These include intubation and related procedures, cardiopulmonary
resuscitation, bronchoscopy, autopsy and surgery where high-speed devices (e.g. saw) are
used
Close Contact - Within 3 feet (1 metre) of the patient/client and/or while performing care
activities
Colonised - This is when a microorganism establishes itself in a particular body site or the
environment without producing disease or causing harm
Cubicle - A room/space which is not fully enclosed but is cordoned off by partitions, e.g. the
'walls' of the enclosed space provide a degree privacy for the patient/client but do not
completely shut the area off from the outside as they are not continuous from floor to ceiling
Cross Transmission – The transmission of an infectious agent from one individual to another
via a direct or indirect exposure
Droplet - Droplets are particles propelled by coughing and sneezing and during the
performance of some procedures. They are generally regarded to be larger than 5 μm in
diameter although there is no consensus on size. Droplets can be deposited on the conjunctiva
or mucous membranes of the nose, mouth or respiratory tract and the environment. However
because of their relatively large size, generally droplets travel only short distances (typically less
than 3 feet (1 metre)) before falling
Epidemiologically important organism – This encompasses a growing list of pathogenic
organisms, which have been identified based on published reports of clusters (>2 patients)
within healthcare settings where additional monitoring/precautions are required to control them.
Another feature of epidemiologically important organisms is that a number are resistant to
antibiotics e.g. MRSA, VRE etc
FFP3 respirator mask – FFP stands for ‘filter face piece’. The 3 means high protection that
provides protection against small particles in the respirable size range (≤5 µm in size). FFP3
facemasks if worn correctly protect the wearer from inhalation of infectious respiratory droplet
nuclei through and around the facemask. FFP3 facemasks conform to the European Standard
EN149 2001 (Box CE marked). Fit testing must be carried out prior to providing any care where
this type of masks may require to be worn. Fit checking must be carried out each time before
entering the isolation room. Further information can be found at:
Fit testing - http://www.hse.gov.uk/pubns/fittesting.pdf
Fit checking - http://www.documents.hps.scot.nhs.uk/respiratory/general/fitcheckmasks.pdf
Both these links are contained within HPS FFP3 frequently asked questions:
http://www.documents.hps.scot.nhs.uk/hai/infection-control/faqs/ffp3-faqs.pdf
Healthcare Associated Infection (HAI) – Infections that are not present at the time the
individual’s care commences, but which arise afterward
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
Page 18 of 36
Immunocompromised patient/individual - Patients who have congenital primary immune
deficiencies or acquired disease (e.g. treatment-induced immune deficiencies) are at increased
risk for numerous types of infections while receiving healthcare and may be located throughout
the healthcare facility. The specific defects of the immune system determine the types of
infections that are most likely to be acquired (e.g., viral infections are associated with T-cell
defects and fungal and bacterial infections occur in patients who are neutropenic). As a general
group, immunocompromised patients can be cared for in the same environment as other
patients; however, it is always advisable to minimise exposure to other patients with
transmissible infections such as influenza and other respiratory viruses. The use of more
intense chemotherapy regimens for treatment of childhood leukaemia may be associated with
prolonged periods of neutropenia and suppression of other components of the immune system,
extending the period of infection risk and raising the concern that additional precautions may be
indicated for select groups. With the application of newer and more intense
immunosuppressive therapies for a variety of medical conditions (e.g., rheumatologic disease,
inflammatory bowel disease), immunosuppressed patients are likely to be more widely
distributed throughout a healthcare facility rather than localised to single patient units (e.g.
haematology-oncology)
Immunodeficient - Lacking immunity and so susceptible to infection.
Infection - Is the deposition and multiplication of bacteria and other microorganisms in tissues
or on surfaces of the body with an associated host reaction, causing harm or clinical disease
Infectious agent - Any organism, such as a pathogenic virus, parasite, or bacterium, that is
capable of invading body tissues, multiplying, and causing disease
Multidrug-Resistant Organisms (MDROs) – Microorganisms – predominantly bacteria – that
are resistant to more than one class of microbial agents
Negative pressure isolation room (with anteroom) – These rooms maintain a negative
pressure, i.e. the airflow is from the outside adjacent space (e.g. corridors) into the room and
then is exhausted to the outside (the anteroom, which is the area with a door to/from the outside
corridor and another door giving access to the patient area, must never have both these doors
open at the same time). These rooms require strict airflow monitoring
Non-enveloped virus - a virus lacking an outer lipoprotein bilayer
Pathogenic microorganisms - This is the ability of the species or strain of the microorganism
to cause disease. This depends on a number of factors including the number of microorganism,
the host defence, treatment etc
Placement - This refers to the need for a single room or isolation room, as well as the
application of other infection control measures that will minimise the spread of infection by
contact, droplet or airborne routes. This provides a physical separation between patients/clients.
Refer to Appendix 2
Prolonged shedding – An increased duration of the dissemination of pathogenic
microorganisms, commonly associated with immunocompromised individuals, leading to
prolonged infectivity
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Small particles in the respirable size range (≤5 µm) - These aerosolised small particles can
retain their infectivity and remain suspended in air over a long period of time, after expulsion
through coughing, talking, etc., allowing them to enter the respiratory tract of others including
those not within close contact or even the same area as the infected individual. This includes
what are sometimes referred to as respiratory droplet nuclei, which are particles that slightly
different as they can arise from desiccation of suspended droplets associated with airborne
transmission
Specialised Isolation Room - This is an enhanced single room with en suite facilities and
ventilated lobby (isolation suite). An enhanced single room with a positive pressure ventilated
entry lobby and en suite facilities with extract ventilation provides both source and protective
isolation. The positive pressure lobby ensures that air from the corridor does not enter the
isolation room, and that air from the room does not escape into the corridor. This simple design
enables the suite to be used for either source or protective isolation without the need for
switchable ventilation or special training for staff. It also provides safe isolation/segregation for
patients whose condition is unknown. These rooms require strict airflow monitoring
Standard Infection Control Precautions (SICPs) - These are the minimum precautions
necessary to reduce the risk of transmission of microorganisms from both recognised and
unrecognised sources of infectious agents that may be present in blood, other body fluids,
secretions, excretions, non intact skin and mucous membranes. These must be used by ALL
health and social care workers in ALL situations involving the care of patients/clients in order to
prevent spread of infectious agents to other non intact skin and/or mucous membranes (this
includes sharp injuries). They should also be applied when dealing with the immediate
patient/client environment which might be contaminated with blood, other body fluids, etc.
There are nine elements to SICPs and they are essential in preventing and controlling HAI.
These are available on
http://www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrolpolicies.aspx
Surgical mask - This is a disposable fluid repellent mask that offers protection from splashes to
mucous membranes of the mouth and from infectious droplets
Terminal cleaning - This is environmental cleaning after discharge or transfer of an
infected/colonised patient/client. The timing of the terminal clean should be discussed with
Infection Control/Health Protection Staff as this can vary according to the organism. Follow the
procedures recommended in http://www.scotland.gov.uk/Publications/2004/05/19319/36643
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Appendix 1 - Infectious agents – Clinical Infections or diseases warranting Transmission Based Precautions in
addition to Standard Infection Control Precautions
Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected
to have an infection)
This document does not include exclusion criteria, give full public health guidance, occupational health or disease management.
Refer to local NHS Boards for additional information
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Abscess Draining, major
Contact
48 hours following antibiotics (depending on the
organism) or until drainage stops or can be
contained within a dressing
Nil
Adenovirus (Respiratory
infection in paediatrics)
Contact/Droplet
Requirements of precautions may be extended
due to prolonged shedding* of virus, generally until
48 hours following cessation of symptoms
Nil
Bronchiolitis
Contact/Droplet
Infectious agents causing this condition will vary
Includes Adenovirus, Parainfluenza and Influenza
Precautions usually 5-8 days
Nil
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
Page 21 of 36
Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Clostridium difficile or
Clostridium difficile associated
disease (CDAD)
Contact
Precautions remain until patient is 48 hours
symptom free
Mandatory Surveillance Programme
exists for this organism in Scotland
http://www.hps.scot.nhs.uk/surveillance/
SystemsDetail.aspx?id=277
Infection can incubate for up to 12 weeks following
antibiotic therapy
If possible discontinue the offending
antibiotic therapy
Specimens are not required for
clearance however 25% of cases suffer
recurrence of symptoms
Conjunctivitis (acute
viral/haemorrhagic)
Contact
Adenovirus – most common lasts 7-15 days.
Enterovirus lasts up to 12 days
Highly contagious outbreaks in eye clinics,
paediatrics, neonatal and long term care
Nil
Diarrhoea with a suspected
infectious cause
Contact
Varies depending on the organism seek local
guidance from local Infection Control/Health
Protection team
Many enteric pathogens are notfiable
diseases consult local Health Protection
Team
Diphtheria – Cutaneous
Contact
Until 2 negative cultures taken 24 hours apart
Notifiable Disease
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Diphtheria – Pharyngeal
toxigenic strains
(Cornynebacterium
diphtheriae)
Droplet/Contact
Until negative
Notifiable Disease
Epiglottitis due to
(Haemophilus influenzae type
b)
Droplet/Contact
Patient considered negative when two cultures
(Nasal Pharyngeal Aspirate) are taken 24 hours
apart
Until 24 hours into the course of corrective
antibiotic therapy
Most common in children 2 months – 5
years
Hepatitis, viral Type A&E
Contact
Herpes simplex (Herpesvirus
hominis)
• Anogenital Herpesviral
Infection
• Neonatal
Contact
For duration of hospital stay – Hep A
For duration of hospital illness – Hep E
Specifically for nappy wearing infants/incontinent
adults
Can infect oral mucosa (HSV1) or genital tract
(HSV 2). Primary and recurrent infections can
occur and duration of precautions will vary but
usually until lesions or cold sores disappear
Local Health Protection Teams should be
informed of cases
Notifiable disease
Risk to exposed infants delivered vaginally
or by C- section and if mother has active
infection and membranes have been
ruptured for more than 4-6 hours
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
Page 23 of 36
Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Herpes zoster
(varicella-zoster)
(Shingles)
Contact/Airborne –
disseminated
disease
Infectious until vesicles are dry usually 5-7 days
this may be extended for immunocompromised
individuals
Susceptible health/social care workers
should not give direct care if immune
caregivers are available
Disseminated disease may require an increase in
the duration of the precautions
Immune caregivers no additional
precautions, non immune may require
surgical mask in disseminated disease
Human metapneumovirus
Contact
See section on RSV
Virus closely related to RSV
Impetigo
Contact
Nil
Influenza (seasonal)
Droplet/Contact
Until 48 hours following corrective antibiotic
therapy
5 days except in immunocompromised persons
Influenza (pandemic)
Droplet/Contact
5 days from onset of symptoms
Use of vaccine or antiviral drugs may be
considered
Avoid placing infected individuals with
immunocompromised patients
See link to HPS respiratory web pages
http://www.hps.scot.nhs.uk/resp/guideli
nes.aspx
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
Page 24 of 36
Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Lice
1. Head
2. Body
3. Pubic
Contact
Investigation of close contacts is
required
Measles (rubeola)
Airborne
1. Infectious until completion of treatment and/or
removal of live lice/eggs
2. Infectious until 24 hours following treatment
with an effective insecticide
3. Infectious until completion of treatment and/or
removal of live lice/eggs
Precautions remain until 4 days after onset of rash.
For immunocompromised individuals this is
increased for the duration of illness
Notifiable disease
Susceptible health/social care workers
should not enter the room if immune
care givers are available.
Exposed susceptible care givers may
require post exposure vaccine
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
Page 25 of 36
Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Meningitis – meningococcal
Neisseria meningitidis
Droplet/Contact
Until 24 hours into the course of corrective
antibiotic therapy
Notifiable disease
Post exposure chemoprophylaxis based
on local risk assessments for exposed
HCW as per Infection Control Team /
Health Protection Team advice
Meningitis (other causes)
Contact
Precaution duration depends on the causative
organism
Household contacts are given
prophylactic antibiotics to eliminate
carriage and prevent clinical illness,
based on local Health Protection Teams
advice
Enterovirus most common cause and
symptoms generally do not exceed 10
days. However aetiology can be due to
a variety of viruses and bacteria
Airborne precautions may be required in
cases of suspected/known
Mycobacterium tuberculosis presenting
with Meningitis
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Monkeypox
Contact/Airborne
Duration of precautions can vary always seek
advice from local Infection Control/Health
Protection Teams
Inform local Health Protection Teams
Transmission in hospital unlikely.
Mumps (infectious parotitis)
Droplet/Contact
Until approximately 9 days following appearance of Notifiable Disease
symptoms in hospital. Some evidence that this can
be reduced to 5 days in community settings for
Non immune HCW should not provide
previously healthy individuals
direct care
Multidrug-resistant organisms
(MDROs) infection or
colonisation (e.g. MRSA, VRE,
VISA/VRSA, ESBLs, resistant
Streptococcus pneumoniae,
Multi drug resistant
Mycobacterium tuberculosis
Contact/Airborne/
Droplet depending
on the infectious
agent
MDROs will be judged by local or national
recommendations depending on the clinical and
epidemiological significance.
Nil
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration of
requirements of precautions
Additional remarks
Mycobacterium tuberculosis –
Extrapulmonary
Contact
Risk assessment required
Precautions to remain until drainage stops or
patient has three negative cultures from exudate
Notifiable disease
Mycobacterium tuberculosis
Pulmonary or laryngeal
disease – confirmed
Mycobacterium tuberculosis
Pulmonary or laryngeal
disease – suspected
Airborne
Airborne
Airborne precautions are only required if any
aerosol-generating procedures* are being
undertaken e.g. suctioning risk assessment in
conjunction with the local Infection Control Team
Discontinue precautions only when patient is on
effective therapy, condition is improving and has 3
negative sputum smears for acid fast bacilli (AFB)
collected on 3 consecutive days
Discontinue precautions only when the likelihood of
infectious TB is deemed negligible and either there
is an alternative diagnosis or the 3 sputum smears
are negative for AFB. Specimen should be
collected 8-24 hours apart at one should be early
morning
Notifiable disease
MDR TB cases always seek guidance
when suspected/confirmed cases
further information
http://www.hps.scot.nhs.uk/resp/guideli
nes.aspx
There are some exceptions to
precaution requirements and local
Infection Control/Health Protection/ TB
teams must be consulted
Notifiable disease
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration of
requirements of precautions
Additional remarks
Mycoplasma – atypical
pneumonia
Droplet/Contact
Nil
Norovirus
Contact/Airborne
Precautions remain for duration of hospital stay or
when symptoms resolve. Patients can be
infectious for up to 13 weeks
Patients/clients are infectious until 48 hours
following last episode of diarrhoea and/or vomiting
Parainfluenza virus infection
Contact
Precautions remain for duration of active disease
usually 5 days following onset of symptoms,
however this can vary depending on the organism
Nil
Parvovirus B19 – slapped
cheek syndrome (Erythema
infectiosum – Erythrovirus
B19)
Droplet
Non-infectious when the rash appears. If the
patient has a chronic disease or is
immunocompromised maintain precautions for the
duration of illness or whilst patient is hospitalised
A common childhood infection lasting 23 days followed by the rash on the
cheeks. In adults can be associated
with athralgia
PlagueYersinia pestis-
Droplet/Contact
Until 48 hours of the course of antibiotic therapy
have been completed
Common cause of hospital and long
term care setting outbreaks
Advice should be sought from an
Infection Control/Disease/ Public Health
Physician or Consultant Microbiologist
when this disease is identified or
suspected in pregnancy
Notifiable disease
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration of
requirements of precautions
Additional remarks
Pneumonia Adenovirus
Droplet/Contact
Ensure applied for duration of illness
Outbreaks reported in paediatric settings
Pressure sores (Infected –
Major)
Contact
Precautions should remain unless infectious wound
can be occluded or contained within a drainage
system
Consider precautions for other conditions
e.g. leg ulcers
Rubella (German Measles)
Droplet/Contact
Until 7 days after onset of rash
Notifiable disease
Susceptible HCW should not provide
direct clinical care
Particularly affects young children, infants
and immunosuppressed patients. Highly
transmissible in paediatrics
Respiratory syncytial virus
(RSV)
Droplet/ Contact
Duration of symptoms (whilst in acute care setting
specifically)
Rotavirus
Contact/Droplet
Until 48 hours symptom free. A negative sample is
not usually required. Precautions may increase
depending on individual situations
Prolonged shedding may occur in
immunodeficient* or
immunocompromised children
Scabies
Contact
Patient/Client infectious until completion of the first
insecticide application
Consider close/household contacts
Severe acute respiratory
syndrome (SARSCoV)
Droplet/Airborne/
Contact
Duration of illness and 10 days following resolution
of pyrexia providing no respiratory symptoms
Not currently notifiable but ALWAYS
notify specialist Infection Control/Health
Protection Team
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Smallpox
Contact/Airborne
Continue precautions until all scabs have crusted
and separated (3-4 weeks)
Notifiable disease
Currently eradicated
Non immune healthcare workers should
not provide care
Staphylococcal disease (skin,
wound, burn – major)
Contact
Infectious unless wound can be occluded or
contained within a drainage system or until 48 hours
of corrective antibiotic therapy
Nil
Streptococcus disease Group
A (Streptococcus pyogenes)
• Erysipelas – contact
• Tonsillitis – droplet
• Scarlet fever – droplet
• Necrotising fasciitis –
contact
• Puerperal fever – contact
Droplet/Contact
Until 24 hours of the course of corrective antibiotic
therapy or if present in a wound if this is occluded/
contained
Erysipelas, Scarlet fever & Puerperal
fever are notifiable diseases
Contact precautions particularly important if lesions
present
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or Causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Varicella
(Chickenpox)
Airborne/Contact
Until all lesions are dry and crusted
Susceptible health/social care workers
(e.g. those who are pregnant or
immunocompromised) should not enter
the room if immune care givers are
available
In immunocompromised individuals with varicella
pneumonia prolonged precautions may be required
Pre + post exposure prophylaxis guidance
is available
http://www.dh.gov.uk/en/Publichealth/Hea
lthprotection/Immunisation/Greenbook/DH
_4097254
Whooping cough –
Bordetella pertussis
Droplet/Contact
Until 5 days of the commencement of antibiotic
therapy
If untreated patient infectious for up to 3 weeks
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Notifiable disease
Post exposure prophylaxis for household
contacts and in rare circumstances may
be indicated for HCWs following
prolonged exposure to respiratory
secretions
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Refer to the full Transmission Based Precautions Policies and also Appendix 2 (A hierarchy for placement of those known or suspected to
have an infection)
Disease/condition/syndrome
or causative organism
Type of
precautions
Additional information on duration and
requirements of precautions
Additional remarks
Vaccination site infection
Contact
Until drainage stops from site or if area can be
occluded/contained
Nil
Viral Haemorrhagic Fevers e.g.
• Lassa
• Ebola
• Marburg
• Crimean-Congo fever
virus
Droplet/Contact
Duration of illness. Patient highly infectious in the
final stages of illness
Notifiable Disease
ALWAYS seek specialist infection control
advice if suspected
(Precautions should remain until the cessation of symptoms, clearance of specimens and/or completion of effective treatment or according to
the specific advice relevant to the infectious agent. Contact local Infection Control/Health Protection Teams for further advice.)
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Appendix 2
A hierarchy for placement of those known or suspected to
have an infection spread by infectious droplets
Refer to the full droplet precautions policy for further details1
A risk assessment process should be applied2
Be alert to potential cases/symptoms Early recognition is important
Diagnosis/suspicion of need for droplet precautions
Examples of infections
spread by
droplets and of HAI concern
•Group A streptococcal
disease
•Meningococcal disease
(meningitis/septicaemia)
•Influenza
•Other infections causing
concern – identified locally
Isolate all cases as follows in descending
order, depending on available facilities:
Timeliness of placement is
essential – additional support
may be required if >1 hr has
elapsed.
Single room with hand washing facilities and
en suite toilet
Single room with hand washing facilities only
Cohorting: Sharing a room with 1 or more of those
with known/suspected same infection
(each placed > 3 feet (1 metre) apart)
Don’t delay action but seek
expert infection control advice
to inform risk assessments and
subsequent actions.
Cohorts
Avoid cohorting in long term
care facilities and do not
include
immunocompromised
individuals in cohort areas
If not available:
Separation of at least 3 feet (1 metre) from any
adjacent persons by use of; single room with no
facilities, cubicle, use of closed bed curtains
Infection Control Droplet
Precautions
Precautions are essential in
order to limit the possibility of
infection spreading
Key Practice Points
• Ensure all isolation/cohort areas are supplied with surgical masks, gloves/gowns, aprons and hand hygiene
supplies
• Teach and reinforce respiratory hygiene/cough etiquette with all individuals
• Ensure ongoing and terminal cleaning of isolation areas
• Avoid transfer of isolated/cohorted individuals unless clinically essential
• Keep in mind that infectious droplets can also be spread via contact
• Only discontinue placement/precautions on cessation of symptoms/clearance of specimens/completion of
treatment and/or on the advice of specialists in infection control
Note
1. Consult the full policy for more detail and for a full list of organisms/diseases requiring precautions. Some infectious agents may
require care in specialist isolation rooms
2. Decisions made regarding placement will depend on the many factors including the infectious agent and number of cases. Refer to
full policy and local Infection Control/Health Protection Team
NB. This hierarchy may not apply to those being cared for in their own homes
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Appendix 3 – Putting on and removing PPE
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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Appendix 4
Model Infection Control Policies (Droplet Precautions), HPS ICT 2009
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