Infection Precautions and Protocols

Precautions Based on Medical Diagnosis

  • A patient may be on specific precautions due to a confirmed or pending medical diagnosis.

  • Purpose of precautions:

    • Break the chain of infection.

    • Protect other users and health care providers.

Types of Precautions

Overview of Precautions

  • Types covered in this video:

    • Contact precautions

    • Droplet precautions

    • Airborne precautions

  • Always practice hand hygiene:

    • Required before entering the room.

    • Required upon exiting the room.

Contact Precautions

  • Indications:

    • Used for patients infected or colonized by multidrug-resistant organisms (MDROs).

  • Examples of MDROs:

    • Methicillin-resistant Staphylococcus aureus (MRSA)

    • Vancomycin-resistant Enterococci (VRE)

    • Extended-spectrum beta-lactamase (ESBL)

  • Requirements for contact precautions:

    • Use of gloves and gowns for providing care.

    • Avoid sharing patient equipment.

    • Limit patient movement outside of the room.

Droplet Precautions

  • Indications:

    • Used for patients with infections spread through large particle droplets.

  • Examples of infections:

    • COVID-19

    • Influenza

    • Rubella

    • Mumps

    • Diphtheria

    • Adenovirus

  • Requirements for droplet precautions:

    • Wear a surgical mask when entering the room.

    • Limit transport of patients outside of the room.

    • Place the patient in a surgical mask when leaving the room.

Airborne Precautions

  • Indications:

    • Used for infections transmitted in the air.

  • Examples of infections:

    • Tuberculosis

    • Measles

    • Chickenpox

    • Disseminated herpes zoster

  • Requirements for airborne precautions:

    • Private negative pressure room required with the door closed.

    • Personal protective equipment (PPE) includes:

    • Fit tested N95 respirator or higher-level respiratory protection.

    • Limit visitors for these patients.

    • Place the patient in a surgical mask if they need to leave the room.

Other Types of Precautions

  • Enteric precautions: Necessary for infections spread via the gastrointestinal tract.

  • Neutropenic precautions: Required for protecting immunocompromised patients from infections.

  • Example of an infectious agent requiring specific precautions:

    • Clostridium difficile (C. Diff): Highly infectious, common healthcare-associated infection.

    • Protocol:

    • Wash hands with soap and water (not alcohol-based hand gel).

    • Disinfect surfaces with bleach.

Private Room Requirements

  • Patients on contact, droplet, or airborne precautions should be placed in private rooms when available.

  • Avoid sharing equipment (e.g., blood pressure cuffs) between patients.

Multiple Precautions

  • It's possible for patients to be on more than one type of precaution at a time.

  • Use of eye protection is advisable:

    • Especially important if the patient is coughing or if there is a risk of splash exposure.

Proper Use of PPE

  • Proper sequence for putting on PPE:

    • Gown.

    • Mask.

    • Goggles.

    • Gloves last (think of going up the body).

  • Proper sequence for removing PPE:

    • Remove gloves and gown first.

    • Goggles next.

    • Mask last (to avoid contaminating the face).

  • All PPE should be removed before leaving the room.

Additional Guidelines

  • Post signs on the doorway of each patient’s room to indicate precautions.

  • Ensure PPE is readily available in appropriate areas.

  • Inform patients and their caregivers about precautions to prevent unintentional pathogen spread.

  • Adherence to all precautions is crucial for:

    • Preventing hospital-acquired infections.

    • Improving patient outcomes and safety.