Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Place patients who require airborne isolation in a negative-pressure airborne infection isolation room (AIIR).undefined#ref3">3
Perform hand hygiene with soap and water or use an alcohol-based hand rub (ABHR) immediately after removing all PPE.3
When a patient has a known or suspected source of colonization or infection, health care team members must follow specific infection prevention and control practices to reduce the risk of cross-contamination to other patients and health care team members. Body substances (e.g., feces, urine, mucus, wound drainage) contain potentially infectious organisms. Isolation or barrier precautions include the appropriate use of PPE, such as a gown, mask, eye protection, and gloves. Health care team members should evaluate the need for barrier precautions for each planned task and for each patient, regardless of the patient’s diagnosis. Increased attention to the prevention of blood-borne pathogens and airborne pathogens, such as tuberculosis (TB), has led to the stressed importance of barrier protection by the Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA).3
Published guidelines for isolation precautions contain recommendations based on current epidemiologic information regarding disease transmission in health care settings. Organizations should modify the recommendations based on their specific needs and as dictated by federal, state, or local regulations.3
Standard precautions, or tier one precautions, assume that every patient is potentially infected or colonized with an organism that could be transmitted in the health care setting. The health care team member should apply standard precautions when caring for all patients regardless of risk or presumed infection status (Box 1).3 Standard precautions are the primary strategies for preventing infection transmission and apply to contact with blood, bodily fluids, nonintact skin, and mucous membranes, as well as contact with equipment or surfaces contaminated with potentially infectious materials. The strategy for respiratory hygiene and cough etiquette applies to any person with signs of respiratory infection (e.g., cough, congestion, rhinorrhea, increased production of respiratory secretions) when entering a health care facility. Key elements of respiratory hygiene education for health care team members, patients, and visitors include covering the mouth and nose with a tissue when coughing and properly discarding used tissues.
Tier two precautions include transmission-based measures designed for the care of a patient who is known to be or suspected to be infected, or is colonized with highly transmissible or epidemiologically important pathogens for which additional precautions are needed to prevent transmission (Table 1).3 Organisms may be transmitted by one of three routes: contact (including contact with contaminated surfaces), droplet, or airborne. The transmission-based precautions—airborne, droplet, and contact—may be used alone or in combination for diseases that have multiple routes of transmission (e.g., chickenpox) (Table 1).3 Whether used alone or in combination, these isolation precautions should be employed in conjunction with standard precautions.
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Rationale: The mode of transmission for an infectious microorganism determines the type and degree of precautions used.
Rationale: Using equipment that is dedicated for use only with the patient on isolation precautions minimizes the risk of infection transmission to other patients.3
Rationale: Donning a gown properly prevents the transmission of infection and provides protection if the patient has excessive drainage or discharge.
Avoid pinching the nosepiece, which may result in an improper fit.
Rationale: Donning the correct mask properly reduces the risk of exposure to airborne microorganisms.
Rationale: Donning eye protection properly reduces the risk of exposure to microorganisms that may occur from splashing fluids.
Rationale: Single-use medication containers minimize the transfer of microorganisms.
Rationale: Gloves act as a barrier to reduce the risk of exposure to blood.
Ensure that linens or waste are totally contained to protect health care team members from exposure to infectious organisms.
Rationale: Disinfecting equipment after use decreases the risk of infection transmission.3
If hands become contaminated at any time during PPE removal, immediately perform hand hygiene with soap and water or use an ABHR.
Do not touch the outer surface of the gloves; it is considered contaminated.
Do not touch the outer surface of the eye protection or face shield; it is considered contaminated.
Do not touch the front surface or sleeves of the gown; it is considered contaminated.
Do not touch the front of the mask or mask with face shield; it is considered contaminated.
Do not touch the outer surface of the N95 respirator mask.
Rationale: The front of the N95 respirator is contaminated. Touching only the elastic or N95 respirator strings protects ungloved hands from contamination.
If hands become contaminated during any part of the PPE removal, immediately perform hand hygiene with soap and water or use an ABHR.
Do not touch the front surface or sleeves of the gown or outside of the gloves; it is considered contaminated.
Centers for Disease Control and Prevention (CDC). (2021). Implementing filtering facepiece respirator (FFR) reuse, including reuse after decontamination, when there are known shortages of N95 respirators. Retrieved October 13, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
Centers for Disease Control and Prevention (CDC). (2021). Strategies for optimizing the supply of N95 respirators. Retrieved October 13, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html#convcapstrategies
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