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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.4
Avoid physical contact with the patient before donning appropriate PPE.1
Transmission of pathogens via the contact route can be divided into subgroups: direct contact and indirect contact. Direct contact is when direct transmission occurs because microorganisms are transferred from one infected person to another (e.g., cuts or abrasions in skin where blood or bodily fluids come into contact with mucous membranes).3 Indirect contact transmission involves the transfer of an infectious agent through a contaminated intermediate object or person (e.g., contact with contaminated equipment, surfaces, or supplies).3
Contact isolation is used for 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 presenting with fecal incontinence (e.g., norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure injuries, or a generalized rash.
Standard precautions, or tier one precautions, are used based on the assumption that every patient is potentially infected or colonized with a transmissible organism. Standard precautions are primary 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.
Respiratory hygiene and cough etiquette should be used by any person entering a health care facility with signs of respiratory infection (e.g., cough, congestion, rhinorrhea, increased production of respiratory secretions). Key elements of respiratory hygiene include proper hand hygiene, covering the mouth and nose with a tissue when coughing or sneezing, coughing or sneezing into the elbow, wearing a mask, and properly discarding used tissues.
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 isolation room, PPE must remain in place and worn correctly. A breach may include skin exposure, a needlestick, or a tear in the PPE. Removing or adjusting PPE while in the procedure room increases the risk of contamination. The doffing process is a time of high risk, and a systematic procedure must be followed.1
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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: 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 the hands become contaminated with 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.
Rationale: The outside of the eye protection is contaminated. Handling as described allows removal without contaminating hands.
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.
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, or any other step in the PPE doffing procedure, immediately perform hand hygiene.
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