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Don appropriate PPE based on the patient’s signs and symptoms and indications for isolation precautions.
Avoid physical contact with the patient before donning appropriate PPE.undefined#ref1">1
Wash hands with soap and water or use an alcohol-based hand rub (ABHR) immediately after removing all personal protective equipment (PPE).4
Infection prevention and control measures help ensure the protection of individuals, in a range of settings who may be vulnerable to acquiring an infection.
Infection-control practices that reduce and eliminate sources of infection transmission help 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 the use of aseptic techniques and barrier protection is essential for both health care team members and patients.
Contact isolation can be divided into two subgroups: direct contact and indirect contact. Direct contact is when direct transmission occurs because microorganisms are transferred from one infected person to another without a contaminated intermediate object or person (e.g., cuts or abrasions in skin where blood or bodily fluids come in contact with mucous membranes, scabies-infested patient transfer to a health care team member with ungloved hands).3 Indirect contact transmission involves the transfer of an infectious agent through a contaminated intermediate object or person (e.g., patient care devices may transmit pathogens if devices contaminated with blood or bodily fluids are shared between patients; inadequately cleaned instruments used between patients before disinfection, such as endoscopes).3
Contact isolation applies to any person with signs of an illness easily transmitted by direct patient contact or by indirect contact with items in the patient’s environment. Illnesses requiring contact precautions may include those present with stool incontinence (e.g., norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure injuries, or a generalized rash.
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 patients (Box 1).4 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 equipment or surfaces contaminated with potentially infectious materials.
Tier two precautions include measures designed for the care of a patient who is known to be or suspected of being infected or colonized with highly transmissible or epidemiologically important pathogens for which additional precautions are needed to prevent transmission (Table 1).4 Organisms may be transmitted by contact, droplet, or air, as well as by contact with contaminated surfaces. The three types of transmission-based precautions—airborne, droplet, and contact—may be combined for diseases that have multiple routes of transmission (e.g., chickenpox) (Table 1).4 Tier two precautions should be used with standard precautions. Additionally, more stringent precautions may be applied to specific outbreaks of a virus or bacteria.
Health care team members must participate in and practice rigorous training of current PPE recommendations, which include the systematic donning and doffing of PPE. Once in the procedure room, health care team members must keep PPE in place and continue to wear it correctly. Removing or adjusting PPE while in the procedure room puts health care team members at risk of contamination. Repeated training and practice are required.
Rationale: Donning a gown properly prevents the transmission of infection and provides protection if the patient has excessive drainage or discharge.
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.
Rationale: Properly disposing of sharps reduces the risk of a needlestick injury.
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.
If hands become contaminated during glove removal, immediately wash them with soap and water or use an ABHR.
Rationale: Properly removing gloves prevents contact with the contaminated gloves’ outer surface.
Rationale: The front of the gown and sleeves are contaminated. Removing the gown as described prevents contact with the contaminated front of the gown.
Do not touch the outer surface of the mask or face shield.
Rationale: The front of the mask is contaminated. Touching only the elastic or mask strings protects ungloved hands from contamination. Untying the bottom mask string first prevents the top part of the mask from falling down over the health care team member’s uniform.
If hands become contaminated during glove removal, immediately wash hands with soap and water or use an ABHR.
Rationale: The outside of the eye protection is contaminated. Handling as described allows removal without contaminating hands.
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