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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 rub (ABHR) immediately after removing all PPE.
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.
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 the 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.undefined#ref1">1
Droplet transmission is a form of contact transmission when some form of infectious agent is transmitted by droplet route (direct or indirect contact). However, in contrast to contact transmission, respiratory droplets carrying infectious pathogens transmit infection when they travel directly from the infectious person’s respiratory tract (e.g., coughing, sneezing, talking) to the recipient’s susceptible mucosal surfaces, generally over short distances.4
Health care team members working with patients who have an illness that can be transmitted via droplet route (e.g., influenza) should don a mask when within 91.4 cm (3 ft) of the patient or upon entry into the patient’s room.4 The difference between droplet precautions and airborne precautions is related to the size of the particle. With droplet-transmitted pathogens, the particle is greater than 5 micrometers4 and does not hang suspended in air. Airborne-transmitted pathogens are less than 5 micrometers4 and are able to hang suspended in the air for long periods of time. Airborne precautions require special air handling and ventilation.4
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).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 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.
Tier two precautions include measures designed for the care of a patient who is known to be or suspected of being infected or is 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 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).4 Whether used alone or in combination, these isolation precautions should be employed in conjunction with standard precautions.
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.4
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.
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.4
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.
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.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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