Infection Control: Standard and Transmission-Based Precautions

Standard Precautions

Standard precautions are essential practices used to prevent the spread of infection for all clients receiving care, regardless of their presumed infection status. The single most effective method for infection control is hand hygiene, which includes thorough handwashing. In situations where there is a potential for contact with blood, vomit, urine, or any bodily secretions, gloves must be worn. These precautions emphasize treating every client as if they might be carrying a disease, especially in acute care settings or hospitals where a patient's medical history or infectious status may be unknown or awaiting confirmation. Therefore, handwashing and donning gloves are routine actions to mitigate potential risks.

Transmission-Based Precautions

Transmission-based precautions are implemented for patients with known or suspected infections that can be transmitted through specific routes (air, droplet, or contact). These precautions are selected based on the proven microorganisms in a patient's body, often confirmed through blood tests or other diagnostics. An example provided is a patient with tuberculosis (TB).

Airborne Precautions

For diseases spread through airborne particles (e.g., tuberculosis), specific measures are required:

Isolation: The patient must be separated from other patients and placed in a negative pressure room. A negative pressure room is designed to prevent contaminated air from escaping into other areas by maintaining a lower pressure inside the room, allowing only filtered air to exit.
Respiratory Protection: Healthcare workers must wear an N95 respirator mask, not a regular surgical mask, when providing care to these patients. The N95 mask is designed to filter out at least 95\% of airborne particles, including microorganisms.
N95 Fit Testing: Proper fit of the N95 mask is crucial. A fit test is conducted to ensure an adequate seal between the face and the mask. This involves spraying a substance with an unpleasant taste while the individual wears different mask sizes. If the wearer tastes the substance, the mask is not properly fitted and needs to be replaced with a different size until a secure seal is achieved. This ensures maximum protection against airborne microorganisms or germs.

Modes of Transmission and Prevention

Infections can travel through three primary modes:

Airborne Transmission: As explained above, requires N95 masks and negative pressure rooms.
Droplet Transmission: Occurs when droplets containing microorganisms generated during coughing, sneezing, or talking travel short distances through the air. Requires surgical masks and often eye protection.
Direct Contact Transmission: Occurs through direct physical contact with an infected person or indirect contact with a contaminated object (fomite).

Preventing Contact Transmission

Direct contact transmission can be effectively avoided through:

Handwashing: Frequent and thorough hand hygiene.
Gloves: Wearing gloves when there is a potential for contact with infectious material.
Gowns: Wearing gowns if there is a risk of clothing contamination.

Following Personal Protective Equipment (PPE) Instructions

Healthcare facilities post clear instructions regarding the appropriate PPE required for entering a patient's room who is on precautions. These displays detail the specific PPE needed and the correct order for donning (putting on) and doffing (taking off) the PPE. It is imperative for all healthcare workers to strictly follow these instructions.

Ignoring PPE protocols, even for a quick task like grabbing something from a patient's room, can have serious consequences. For instance, touching contaminated surfaces like doorknobs without proper PPE can lead to pathogen transmission to oneself. Air-traveling pathogens can also be ingested. Adhering to these practices is crucial for healthcare workers to:

Prevent Self-Contamination: Protect themselves from acquiring microorganisms or pathogens.
Prevent Being a Carrier: Avoid becoming a carrier, a person who may not show symptoms but carries and can spread the germ to others. Carriers pose a significant risk as they can unknowingly transmit infections.

These practices are foundational to preventing the spread of microorganisms and ensuring the safety of both healthcare providers and patients.