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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Don a gown that is impervious to moisture when there is a risk for excess soiling.undefined#ref3">3
Place patients who require airborne isolation in a negative-pressure airborne infection isolation room (AIIR).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 must evaluate the need for barrier precautions for each planned task and for each patient, regardless of the diagnoses. 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.
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 patients (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 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 (i.e., 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.
Second tier precautions include transmission-based precautions designed for the care of a patient who is known 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 contact, droplet, or airborne route or 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).3 Whether used singly or in combination, the precautions should be employed in conjunction with standard precautions.
Rationale: Using equipment that is dedicated for use only with the patient on isolation precautions further minimizes the risk of transmission of infection to other patients.
Rationale: Donning a gown properly prevents the transmission of infection and provides protection if the patient has excessive drainage or discharge.
Rationale: Donning the correct mask properly reduces the risk of exposure to airborne microorganisms or exposure to microorganisms from splashing fluids.
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 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 them with soap and water or use an ABHR.
Do not touch the outer surface of the mask.
Rationale: The outside of the eye protection is contaminated. Handling as described allows removal without contaminating hands.
Do not touch the outer surface of the N95 respirator.
Rationale: The front of the N95 respirator is contaminated. Touching only the elastic or N95 respirator strings protects ungloved hands from contamination. Untying the bottom mask string first prevents the top part of the N95 respirator from falling down over the health care team member’s uniform.
Rationale: Reusable storage bags keep equipment contaminant free and should be labeled to prevent more than one person from wearing the mask.
If storing the N95 respirator, use caution not to crush it. A damaged or crushed N95 respirator may not seal properly. Do not leave the N95 respirator hanging around the neck.
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