HSE InfectionPreventionBody_36054 30/08/2012 13:19 Page 71
Airborne Precautions
Airborne Precautions are a set of infection control measures recommended in
addition to Standard Precautions to prevent the transmission of infections spread
by very small respiratory particles to residents/clients and healthcare workers.
Small respiratory particles are expelled from an infected individual during activities
like coughing, sneezing or talking. They are also generated during particular
healthcare aerosol generating procedures such as suctioning.
Examples of infection spread by airborne route are infectious pulmonary or
laryngeal tuberculosis, rubella, measles and chicken pox.
Key Elements of Airborne Precautions
Resident/Client Placement
Early assessment and resident/client placement is essential. Delays can lead to
unnecessary exposures of susceptible residents/client, visitors and HCW’s.
• When a resident/client is suspected to have an infection that is spread by the
airborne route, they should be placed in a single room with ensuite facilities.
• The room should be well ventilated and the door should be kept closed.
• The resident/client should be instructed on respiratory hygiene/cough
etiquette and may be asked to wear a surgical mask (depending on what
infection is suspected and a risk assessment).
If an isolation room is not available, transfer to another unit/hospital with suitable
facilities should be considered.
• If a resident/client is to be transferred, the patient /client should wear
a surgical mask during transfer and be instructed to follow respiratory
hygiene and cough etiquette.
• Surgical masks should be changed when wet with breath moisture,
heavily contaminated with respiratory secretions or if torn or
damaged.
In day care facilities place the client in a treatment room as soon as it is possible to
do so. If it is clinically indicated discharge the client home until signs & symptoms
of infection have resolved, or upon completion of effective treatment, or upon
completion of the infectious period.
A notice should be placed on the isolation room door/area advising visitors and
other HCW’s to report to staff-in-charge before entering.
Visitors should be limited. Visitors who are non-immune to the infection with which
the resident/client is in isolation for should avoid contact until the resident/client is
deemed to be no longer infectious to others. Where visiting is essential, the visitor
should be instructed how to put on a surgical mask prior to entering the
residents/clients room.
Residents/clients should be educated regarding the reason/indication for Airborne
Precautions and requested not to leave the room unless absolutely necessary.
Where movement outside the isolation room is required the resident/client should
be instructed to wear a surgical face mask, and instructed on respiratory hygiene
and cough etiquette when moving outside their room.
Further advice should be sought from local Infection Prevention and Control/Public
Health Teams.
Guidelines on Infection Prevention & Control 2012
HSE South (Cork &Kerry)
Community & Disability Services
Transmission Based Precautions
Page 11 of 20
HSE InfectionPreventionBody_36054 30/08/2012 13:19 Page 72
Hand Hygiene
Hand hygiene is the single most important measure in preventing and reducing the
spread of infection. In accordance with The WHO Moments for Hand Hygiene,
decontaminate hands
1. Before touching a resident/client.
2. Before aseptic or clean procedures.
3. After blood or body fluid exposure risk.
4. After touching a resident/client.
5. After touching resident/client surroundings/environment.
• Hands should be decontaminated with an antimicrobial soap or an alcohol
hand rub.
• Visitors should be encouraged to carry out hand hygiene before and after
visiting, and before and after resident/client contact where they provide
direct care.
• Residents/clients who are unable to perform hand hygiene should be given
assistance.
Personal Protective Equipment
In addition to the PPE advised for Standard Precautions the following measures
apply to residents/clients on Airborne Precautions:
Respiratory Masks and other face protection
• FFP3 masks are recommended for aerosol generating procedures (e.g.
suctioning) for all patients and for routine care of patients with Multi Drug
Resistant TB (MDR- TB) and Extensively Drug Resistant TB (XDR-TB).
• FFP2 masks are recommended for routine care of patients with known or
suspected pulmonary or laryngeal TB where MDR-TB or XDR-TB is not
suspected.
• HCWs visiting a patient in their own home should wear either an FFP2 or
FFP3 mask in accordance with the above recommendations for FFP2 and
FFP3 masks. Patient privacy must be maintained if mask is worn in the
home. Apply the mask on entry into the home and remove mask on leaving
the home.
The FFP 2 and 3 masks must;
• Conform to EN1492001
• Be fit tested. In order to be effective the mask must fit tightly to the wearers
face, fit testing should be undertaken by a trained professional.
• Be fit checked (i.e. the wearer must check that the mask fits properly on
their face every time they enter the patient/resident area).
• Be put on before entering the isolation room.
• Changed when torn or damaged.
• Removed outside the isolation room.
Gloves and a disposable plastic apron
• Gloves and a disposable plastic apron should be worn for all activities that
involve direct contact with the patient/residents skin or surfaces and
equipment in close proximity to the patient/resident (e.g. medical
equipment, beside locker, bed rails etc).
• PPE should be put on before entering the patient’s room.
Guidelines on Infection Prevention & Control 2012
HSE South (Cork &Kerry)
Community & Disability Services
Transmission Based Precautions
Page 12 of 20
HSE InfectionPreventionBody_36054 30/08/2012 13:19 Page 73
A fluid repellent gown should be worn when there is a risk of extensive
exposure of clothing or skin, to blood, body fluids, excretions or secretions.
• PPE must be changed and hand hygiene performed in between different care
activities on the same patient /client.
• PPE should be removed and hand hygiene performed before leaving the
patients /residents room.
• PPE should be put on and removed as outlined in Appendix 2
PPE should be discarded immediately after removal in a healthcare risk waste bag.
•
PPE and Visitors;
Where visiting is essential, the visitor should be instructed how to put on a FFP2
mask prior to entering the residents/clients room.
Resident/Client-Care Equipment
• In addition to the PPE advised for Standard Precautions the following
measures apply to residents/clients on Droplet Precautions:
• Only take essential equipment and supplies into the room. Do not overstock
an isolation room as unused stock will have to be discarded on cessation of
Droplet Precautions.
• Residents/clients charts/records should not be taken into the isolation room.
• Medical devices (e.g. thermometers, stethoscopes) and resident/client care
equipment
(e.g.
commode)
should
be
dedicated
for
individual
residents/clients use for the duration of Droplet Precautions. Where possible
use single use items.
• If communal equipment is used, such equipment must be cleaned and
decontaminated in accordance with the manufacturers instructions,
immediately after use and before use on another resident/client- For majority
of items clean using a neutral detergent and water and disinfect using a
hypochlorite 1,000 parts per million (ppm) e.g. Klorsept/Milton, alternatively
use a one step product -combined detergent and hypochlorite 1,000 ppm
e.g. Chlor clean.
Environmental Measures
• In addition to Standard Precautions the following applies to residents/client
being cared for using Airborne Precautions.
• Thoroughly clean the environment and all resident/client care equipment
daily with a neutral detergent and water and disinfect using a hypochlorite
1,000 parts per million (ppm) e.g. Klorsept/Milton, alternatively use a one
step product -combined detergent and hypochlorite 1,000 ppm e.g. Chlor
clean. Paying special attention to frequently touched sites and equipment
close to the patient.
• Disposable gloves should be worn for environmental cleaning/disinfection due
to airborne precautions .
• The frequency of cleaning and disinfection may need to be increased if
residents/clients are producing copious amounts of respiratory secretions.
• Items or surfaces likely to be contaminated with blood or body
fluids/excretions/secretions should be cleaned and disinfected immediately.
Guidelines on Infection Prevention & Control 2012
HSE South (Cork &Kerry)
Community & Disability Services
Transmission Based Precautions
Page 13 of 20
HSE InfectionPreventionBody_36054 30/08/2012 13:19 Page 74
Terminal
cleaning
of
the
environment
following
transfer/discharge/death of resident/client who was on Droplet
Precautions
o
o
o
o
o
Prior to initiating environmental cleaning and disinfection:
All privacy and window curtains must be removed and sent for laundering.
All disposable items including paper towels and toilet paper must be
discarded.
All sterile and non-sterile supplies in the residents/clients environment which
cannot be reprocessed must be discarded on transfer/discharge.
Clean the environment and all resident/client care equipment with a neutral
detergent and disinfect with a disinfectant (e.g., hypochlorite solution 1000
ppm Klorsept/Milton, alternatively use a one step product -combined
detergent and hypochlorite 1,000 ppm e.g. Chlor clean.
Resident/Client Movement/Transport
Residents/client on Airborne Precautions should not be transferred unless their
medical condition warrants it or for placement in an appropriate isolation room.
If movement/transport of a resident/client is necessary;
• The resident/client should be encouraged to wear a surgical mask, and instructed
on respiratory hygiene and cough etiquette.
• Surgical masks if worn should be changed when heavily contaminated, wet with
breath moisture or damaged.
• It may be necessary for transport personnel to wear a surgical mask or respirator
(depending on the individual disease suspected) if the resident/client is confused
or disturbed and cannot tolerate wearing a surgical mask.
• FFP2 or FFP3 masks are not recommended for use by residents/clients on
Airborne Precautions.
• Remove and dispose of contaminated aprons/gowns and gloves and perform
hand hygiene prior to transporting patients on Contact Precautions.
• Don appropriate PPE (apron/gown and gloves) prior to handling the patient at the
transport destination.
Management of Laundry
All linen from a resident/client in isolation with Airborne Precautions should be
placed in an alginate/water soluble bag for laundering and then placed in the
appropriate laundry stream as per local policy.
Occupational Health
In addition to Standard Precautions, staff should be aware of their immune status
for infectious pathogens known to be transmitted via the airborne route (e.g.,
varicella zoster virus, measles virus).Non-immune staff should avoid direct contact
with infected patients. Specific guidance should be sought from the occupational
health department.
Duration of Airborne Precautions
•
Airborne precautions should continue until signs and symptoms of infection
have resolved, or upon completion of the infectious period, or until effective
treatment has been completed e.g. 2 weeks worth of effective treatment for
pulmonary or laryngeal TB.
Guidelines on Infection Prevention & Control 2012
HSE South (Cork &Kerry)
Community & Disability Services
Transmission Based Precautions
Page 14 of 20