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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.4
Perform hand hygiene with soap and water or use an alcohol-based hand sanitizer immediately after removing all PPE.4
Place patients who require airborne isolation in a negative-pressure airborne infection isolation room (AIIR).4
Ensure that the door to the isolation room and the anteroom is never open at the same time.
When a patient has a known or suspected source of colonization or infection, specific infection prevention and control practices can reduce the risk of cross-contamination to other patients, family, visitors, and health care team members. Bodily fluids (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. Patients should be placed in isolation based on signs and symptoms until a diagnosis is confirmed.
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, mucous membranes, and 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.
Second tier precautions include protocols based on the route of transmission (Table 1).4 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, coronavirus) (Table 1).4 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 isolation room, PPE must remain in place and worn correctly. Removing or adjusting PPE while in the procedure room increases the risk of contamination. A breach may include skin exposure, a needlestick, or a tear in the PPE. The doffing process is a time of high risk, and a systematic procedure must be followed.4
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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 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: 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.
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. Using equipment that is dedicated for use only with the patient on isolation precautions further minimizes this risk.
If the 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.
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 face 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 the hands become contaminated during glove removal, or any other step during the PPE doffing procedure, immediately perform hand hygiene.
Do not touch the outer surface of the mask.
Rationale: Humidity, dirt, and crushing reduce the efficiency of the mask.
Rationale: Reusable storage bags keep equipment contaminant-free and should be labeled to prevent more than one person from wearing the mask. A damaged or crushed mask may not seal properly.
Use caution not to crush the mask. Do not leave the mask hanging around the neck.
Centers for Disease Control and Prevention (CDC). (n.d.). Sequence for putting on personal protective equipment (PPE). Retrieved April 1, 2020, from https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
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