General Information
Infections Disease and Barrier Precautions
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Introduction
Based on the latest information on the transmission of infections in hospitals, The Centers
for Disease Control/Hospital Infection Control Practices Advisory Committee (HICPAC) has
revised the The Guideline for Isolation Precautions in Hospitals with the
recommendation that hospitals and patient care institutions implement Standard
Precautions in the place of Universal Precautions. Standard Precautions correlates with
Universal Precautions with minor revisions in nomenclature only. Additional categories of
Airborne, Droplet, and Contact Precautions have been developed to manage specific
diseases transmitted via such routes.
The concept of isolating patients with transmissible diseases is the cornerstone of a
hospital's program of infection prevention and control. This concept is an outgrowth of
earlier practices where persons diagnosed with a transmissible infectious disease were
"quarantined." Traditional systems of isolation precautions have relied on an
understanding of the mechanisms by which disease can be spread and have focused the
use of protective barrier equipment, such as gloves, gowns, masks, and protective
eyewear in order to interrupt transmission and to break the chain of infection.
Universal precautions:
approaches to infection control designed to prevent transmission of
bloodborne diseases, such as AIDS and hepatitis B in health care settings. Universal precautions were
initially developed in 1987 by the Centers for Disease Control and Prevention (CDC) and in 1989 by the
Bureau of Communicable Disease Epidemiology in Canada. The guidelines include specific
recommendations for use of gloves and masks and protective eyewear when contact with blood or body
secretions containing blood or blood elements is anticipated. In 1996 the CDC expanded the concept and
changed the term to standard precautions
Standard precautions:
guidelines recommended by the Centers for Disease Control and
Prevention for reducing the risk of transmission of blood-borne and other pathogens in
hospitals. The standard precautions synthesize the major features of universal precautions
(designed to reduce the risk of transmission of bloodborne pathogens) and body substance
isolation (designed to reduce the risk of pathogens from moist body substances) and apply
them to all patients receiving care in hospitals regardless of their diagnosis or presumed
infection status.
Standard precautions apply to (1) blood; (2) all body fluids, secretions, and excretions
except sweat, regardless of whether or not they contain blood; (3) nonintact skin; and (4)
mucous membranes. The precautions are designed to reduce the risk of transmission of
microorganisms from both recognized and unrecognized sources of infection in hospitals.
Depending on the anticipated potential exposure, it may include only gloves, for example if
you are doing a simple venapuncure or may include mask and gloves for intubation.
Standard Precautions combine the major features of Universal Precautions and Body
Substance Isolation (BSI) and are based on the principle that all blood, body fluids,
secretions, excretions except sweat, nonintact skin, and mucous membranes may contain
transmissible infectious agents. Standard Precautions include a group of infection prevention
practices that apply to all patients, regardless of suspected or confirmed infection status, in
any setting in which healthcare is delivered These include: hand hygiene; use of gloves,
gown, mask, eye protection, or face shield, depending on the anticipated exposure; and
safe injection practices. Also, equipment or items in the patient environment likely to have
been contaminated with infectious body fluids must be handled in a manner to prevent
transmission of infectious agents (e.g. wear gloves for direct contact, contain heavily soiled
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equipment, properly clean and disinfect or sterilize reusable equipment before use on
another patient). The application of Standard Precautions during patient care is determined
by the nature of the HCW-patient interaction and the extent of anticipated blood, body fluid,
or pathogen exposure. For some interactions (e.g., performing venipuncture), only gloves
may be needed; during other interactions (e.g., intubation), use of gloves, gown, and face
shield or mask and goggles is necessary. Education and training on the principles and
rationale for recommended practices are critical elements of Standard Precautions because
they facilitate appropriate decision-making and promote adherence when HCWs are faced
with new circumstances. An example of the importance of the use of Standard Precautions
is intubation, especially under emergency circumstances when infectious agents may not be
suspected, but later are identified (e.g., SARS-CoV, N. meningitides). The application of
Standard Precautions is described below and summarized in in my attached word document
which summarized most of the general information about barrier precautions and the
methods to implement to implement to protect the Health Care Worker. (HCW).
Barrier Protection
The type of protective apparel chosen depends on the clinical situation and the type of
patient care interaction that is anticipated. The selection of barrier protection, equipment, or
work practice should include consideration of the following issues:
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Probability of exposure to blood and body
Amount of blood or body substances likely to be encountered
Probable route of transmission
Gloves
Gloves are worn to prevent the health care worker's hands from becoming contaminated
with blood or body substances. Gloves should be worn for:





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Procedures involving direct contact with the blood and body substances of any
patient
Procedures where contact with blood and body substances might be expected to
occur
Procedures involving direct or potential contact with the mucous membranes of
any patient.
Procedures involving direct or potential contact with the non-intact skin of any
patient. Non-intact skin is skin that is cut, chapped, abraded, cracked, afflicted
with weeping or exudative lesions, or is otherwise broken
Touching or handling any instruments, equipment, or surfaces that have been, or
may have been, in contact with blood or body substances.
In addition, gloves should be worn in providing care to a patient or in managing
equipment when the health care worker has cuts, scratches, or other breaks in
the skin on his/her hands.
Sterile gloves should be used for all sterile procedures and for activities that involve
contact with areas of the body that are normally sterile.
There should be an adequate supply of clean disposable gloves on the standard
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precautions stations or in other locations that are convenient to each patient's room.
Gloves used in patient's care should be worn only for contact with the patient. Once
used, gloves must be discarded before leaving the patient's room.
Masks
Standard surgical masks are to be used:
When splashing, splattering, or spraying of blood or
body fluids is likely in order to prevent exposure to
the mucous membranes of the nose/mouth.
Additionally, eye protection is warranted in such
situations as well.
When within 3 feet of a patient on Droplet
Precautions.
When working in a sterile field to prevent droplets
from contaminating the field.
Surgical masks do NOT provide adequate protection for
those diseases spread by the airborne route (i.e.,
Mycobacterium tuberculosis). For suspected or confirmed
patients with pulmonary TB, a N-95/HEPA respirator must be
worn.
Gowns
Gowns, aprons, and other protective apparel are worn to
prevent clothing from becoming soiled with blood and
body substances. Selection of the appropriate type of
protective apparel is based on the amount of blood and
body substances likely to be encountered and the
probability that clothing may by soiled. Gowns should be
worn:
During activities that involve the management of
large amounts of blood or body substances that
may be difficult to contain properly.
During procedures that may result in the splashing
or splattering of blood or body substances.
Gowns should be:
Large enough to cover the clothing which is likely to
be contaminated.
Made of a moisture-resistant material that provides
an effective barrier to body substances.
Sterile gowns should be worn for procedures that
require a sterile field.
Gowns should be changed:
After giving care to an individual patient.
After performing any procedure involving
instruments, equipment, or surfaces contaminated
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by blood or body substances.
Whenever gross soiling occurs.
Discard used gowns in the patient care area or in the
other areas in which they were used.
Protective Eyewear
Protective eyewear is worn to prevent blood and body substances from
contaminating the mucous membranes of the eyes. Protective eyewear
is available by request for employee use and will be replaced if lost or
damaged. In hospital areas where non-hospital employees routinely
work, such as in the Labor and Delivery Unit, protective eyewear, as
well as other barrier protection equipment, will be available in a central
location for use by these persons.
Protective eyewear should be worn during procedures where blood and
body substances may be expected to splash or splatter.
Face Shields
Face shields are worn to prevent blood and body substances from contaminating the
mucous membranes of the eyes, nose, and mouth during procedures which may
cause splashing or splattering. If blood and body substances are expected to become
aerosolized during a procedure, a mask should also be worn. Non-disposable face
shields should be removed and cleaned after each use with soap and water and dried
with a paper towel. If visibly soiled, wipe the face shield with a 70% alcohol solution.
Respirators
Respirators are masks specifically designed to filter small particles
spread by the airborne route. Current OSHA standards as developed by
NIOSH (National Institute for Occupational Safety & Health) require that
respirators used for Airborne Precautions for supected/confirmed
pulmonary tuberculosis minimally filter 95% of 0.3µm sized particles.
The two respirators which meet these requirements are: the N-95
respirator and HEPA respirator. All personnel who care for a patient with
suspected/confirmed pulmonary TB must wear an N-95/HEPA respirator
upon entering the room of such a patient.
Personnel using a N-95/HEPA respirator must be fit-tested before using either
respirator. If one has been previously fit-tested for a HEPA respirator, one must be fittested again before using a N-95 respirator. Fit-testing can be arranged through YNHH
Occupational Health Services (8-2462).
Transmission-Based Precautions
Transmission-Based Precautions are designed for patients documented or suspected to
be infected/colonized with highly transmissible or epidemiologically important pathogens
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for which additional precautions beyond Standard Precautions are needed to interrupt
transmission. The three categories of Transmission-Based Precautions include:
Airborne Precautions
Droplet Precautions
Contact Precautions
These categories may be combined for diseases that have multiple routes of
transmission. When used either singularly or in combination, they are to be used in
addition to Standard Precautions.
Airborne Precautions
Airborne Precautions are designed to reduce the risk or eliminate the airborne transmission
of infectious agents. Airborne transmission occurs by dissemination of either airborne
droplet nuclei (small-particle residue-5 um or smaller sized evaporated droplets which
remain suspended in the air for long periods of time) or dust particles containing the
infectious agent. Microorganisms carried in this manner can be dispersed widely by air
currents and may become inhaled by or deposited on a susceptible host within the same
room or over a longer distance from the source patient, depending on environmental
factors; therefore, special air handling and ventilation (i.e. negative pressure isolation) are
required to prevent airborne transmission. Airborne Precautions apply to patients known or
suspected to be infected with epidemiologically important pathogens that can be
transmitted by the airborne route, (e.g. Mycobacterium tuberculosis).
Droplet Precautions
Droplet Precautions are designed to reduce the risk of droplet transmission of infectious
agents. Droplet transmission involves contact of the conjunctivae or the mucous
membrances of the nose or mouth of a susceptible person with large-particle droplets
(larger than 5 um in size) containing microorganisms generated from a person who has a
clinical disease or who is a carrier of the microorganism. Droplets are generated by the
source person during coughing, sneezing, or talking and/or during the performance of
certain procedures such as suctioning and bronchoscopy. Transmission via large-particle
droplets requires close contact between source and recipient persons, because droplets do
not remain suspended in the air and generally travel only short distances, usually 3 ft or
less. Since droplets do not remain suspended in the air, special air handling and
ventilation are not required to prevent droplet transmission. Droplet Precautions apply to
any patient known or suspected to be infected with epidemiologically important pathogens
that can be transmitted by infectious droplets.
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Contact Precautions
Contact Precautions are designed to reduce the risk of transmission of epidemiologically
important microorganisms by direct or indirect contact. Direct contact transmission
involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host
from an infected or colonized person, such as occurs when personnel turn patients, bathe
patients, or perform other patient-care activities that require physical contact. Direct
contact transmission also can occur between two patients (e.g., by hand contact), with one
serving as the source of infectious microorganisms and the other as a susceptible host.
Indirect contact transmission involves contact of a susceptible host with a contaminated
intermediate object, usually inanimate, in the patient's environment. Contact Precautions
apply to patients known or suspected to be infected or colonized (presence of
microorganism in or on patient but without clinical signs and symptoms of infection) with
epidemiologically important microorganisms that can be transmitted by direct or indirect
contact.
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RECOMMENDATIONS FOR APPLICATION OF STANDARD PRECAUTIONS FOR THE CARE OF ALL PATIENTS IN ALL
HEALTHCARE SETTINGS
(See Sections II.D.-II.J. and
RECOMMENDATIONS
III.A.1) COMPONENT
Hand hygiene
After touching blood, body fluids, secretions, excretions, contaminated items; immediately after
removing gloves; between patient contacts.
Personal protective equipment (PPE)
Gloves
For touching blood, body fluids, secretions, excretions, contaminated items; for touching
mucous membranes and nonintact skin
Gown
During procedures and patient-care activities when contact of clothing/exposed skin with
blood/body fluids, secretions, and excretions is anticipated..
Mask, eye protection
During procedures and patient-care activities likely to generate splashes or sprays of blood,
(goggles),
body fluids, secretions, especially suctioning, endotracheal intubation
face shield*
Soiled patient-care equipment Handle in a manner that prevents transfer of microorganisms to others and to the environment;
wear gloves if visibly contaminated; perform hand hygiene.
Environmental control
Develop procedures for routine care, cleaning, and disinfection of environmental surfaces,
especially frequently touched surfaces in patient-care areas.
Textiles and laundry
Handle in a manner that prevents transfer of microorganisms to others and to the environment
Do not recap, bend, break, or hand-manipulate used needles; if recapping is required, use a
Needles and other sharps
one-handed scoop technique only; use safety features when available; place used sharps in
puncture-resistant container
Patient resuscitation
Use mouthpiece, resuscitation bag, other ventilation devices to prevent contact with mouth and
oral secretions
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