Isolation Precautions: Airborne (Pediatrics)
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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Perform hand hygiene with soap and water or use an alcohol-based hand sanitizer immediately after removing all PPE.undefined#ref6">6
Avoid physical contact with the patient with suspected or confirmed airborne pathogen before donning appropriate PPE.
Ensure that patients who require airborne isolation are placed in a negative-pressure airborne infection isolation room (AIIR). If an AIIR is not available, place a surgical mask on the patient.6
Airborne precautions are the highest level of isolation. Until an airborne-transmitted illness is diagnosed, airborne precautions represent the safest precautions.
Infection prevention and control measures help to ensure the protection of patients in a range of settings who may be vulnerable to acquiring an infection both in the general community and when receiving care because of health problems.
Infection-control practices that reduce and eliminate sources of infection transmission help to protect patients and health care team members from disease. The health care team member is responsible for educating a patient about infection control. Knowledge of the infectious process, disease transmission, and critical-thinking skills associated with use of aseptic techniques and barrier protection is essential for both health care team members and patients.
For pediatric patients, airborne isolation precautions are used for rubeola (measles), chickenpox, tuberculosis (TB), and some coronaviruses.
Rubeola is a childhood illness that with vaccination was declared eliminated in the United States (US) in 2000.1 This means that there were no endemic outbreaks. All cases could be traced to travel outside the US. With a growing fear of vaccination and an increasing number of unvaccinated pediatric patients, the cases of rubeola have risen in recent years.1
Rubeola is a highly contagious illness with respiratory and dermatologic components. Prodromal signs and symptoms include high fever (as high as 40.5°C [105.0°F]),1 malaise, cough, coryza, conjunctivitis, and Koplik spots. About 14 days1 after exposure, a maculopapular rash develops, with a head-to-toe spread. Patients are considered contagious 4 days before the rash appears until 4 days1 after the rash appears. The rubeola virus can live in the air for up to 2 hours.1 Rubeola must be reported to the health department within 24 hours1 of diagnosis. All health care team members and visitors must follow airborne isolation precautions regardless of immunity status.1
Chicken pox is a highly contagious childhood illness with respiratory and dermatologic components. The incubation period is 14 to 16 days.3 Prodromal signs and symptoms include mild fever and malaise. The rash develops 1 to 2 days after the prodromal manifestations.3 The rash is highly pruritic and begins on the chest, back, and face, then spreading to the rest of the body. The rash starts as macular, becomes papular, and then vesicular. The vesicles are fluid filled and are contagious via the contact route. Symptoms generally last 4 to 7 days.3 The patient is contagious from onset of the prodrome (i.e., 1 to 2 days before the onset of the rash) until 4 days after all vesicular lesions have crusted over.3 Patients with chicken pox should be cared for in airborne isolation precautions by health care team members with documented immunity. Shingles, also a varicella infection, requires airborne isolation precautions if it is disseminated, the patient is immunosuppressed, or disseminated infection has not yet been ruled out.6
TB should be suspected in any patient who has a persistent cough lasting longer than 3 weeks accompanied by chest pain, bloody sputum, unexplained weight loss or loss of appetite, fever, chills, night sweats, malaise, or fatigue.4
Airborne isolation precautions include an AIIR with special air-handling and ventilation capacity.6 Health care team members who care for patients on airborne isolation precautions should wear nonpowered air-purifying respirators (i.e., N95 [Figure 1]).6 These respirators are high-efficiency particulate masks that have the ability to filter 95% of very small (0.3 micron) airborne particles.2
N95 respirators must be fit-tested to determine which size mask is appropriate and to ensure that the wearer knows when a good seal is achieved. Fit-testing must be performed before use and repeated at least annually. Fit-testing must also be conducted whenever respirator design or facial changes that may affect a proper fit take place. A respirator that has not been fitted properly may leave unprotected gaps between it and the face, impairing its effectiveness.
If facial hair or unusual facial features make fitting a mask-type respirator properly difficult, a powered air-purifying respirator (PAPR) may be used. A PAPR has the same filtering properties as the mask-type respirator and is approved by national organization guidelines.4 This type of respirator covers the head and uses a blower to move air through the filter and into the face piece, helmet, or hood. A PAPR does not require fit-testing before use.
Using a respirator does not, on its own, fully protect a health care team member from acquiring an infection. Other infection-control practices, such as performing hand hygiene, isolating an infected patient, and using appropriate coughing etiquette are also important to minimize the risk of infection.
All organizations should have a procedure for removing their particular N95 or PAPR and preparing equipment for reprocessing (e.g., bagging for temporary storage before reprocessing, immediate reprocessing in the doffing area).
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Rationale: This prevents contamination of the outside of the biohazard bag.
At the completion of the procedure, ensure that all choking hazards (e.g., syringe caps, port caps, adhesive bandages, bits of tape, twist-off caps from saline bullets) are removed from the patient’s linens and placed in the appropriate receptacle.
If hands become contaminated during glove removal, or any other step in the PPE doffing procedure, immediately perform hand hygiene.
Rationale: Properly removing gloves prevents contact with the contaminated gloves’ outer surface.
If a PAPR with a self-contained filter and blower unit inside the helmet is used, remove the hood and wait until later in the procedure to remove the integrated components.
Rationale: The front of the gown and sleeves are contaminated. Removing the gown as described prevents contact with the contaminated front of the gown.
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 eye protection properly reduces the risk of exposure to microorganisms that may occur from splashing fluids.
Rationale: The outside of the eye protection is contaminated. Handling as described allows removal without contaminating hands.
Rationale: Tilting the head forward aids the doffing process and minimizes the risk of contamination.
Rationale: Avoiding touching the front of the N95 respirator aids the doffing process and minimizes the risk of contamination.
Centers for Disease Control and Prevention (CDC). (n.d.). Sequence for putting on personal protective equipment (PPE). Retrieved September 11, 2023, from https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
Clinical Review: Marlene L. Bokholdt, MS, RN, CPEN, TCRN, CEN
Published: October 2023
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