Transmissionbased precautions in healthcare facilities Outline Chain of

Transmission-based precautions in healthcare facilities

Outline § Chain of infection § Routes of transmission § Precautions levels – Standard precautions – Transmission-based precautions • Contact • Droplet • Air-borne

Chain of Infection + Quantity of pathogen Virulence Route of transmission Port Sensitive host

Routes of Transmission • Respiratory – Cough – Sneeze • Fecal-oral – Feces contaminate food, environment, or hands • Vector-borne – Transmitted by insects

Routes of Transmission Contact Direct Contact Indirect Contact • Host comes into contact with reservoir • Disease is carried from reservoir to host • Kissing, skin-to-skin contact, sexual intercourse • Contaminated surfaces (fomites) • Contact with soil or vegetation

Routes of Transmission Droplet Large droplets within 1 meter transmit infection via: – Coughing, sneezing, talking – Medical procedures Examples: • Diphtheria • Severe Acute Respiratory Syndrome • Avian influenza in humans

Routes of Transmission Airborne (droplet nuclei) Very small particles of evaporated droplets or dust with infectious agent may. . – Remain in air for a long time – Travel farther than droplets – Become aerosolized during procedures Examples: • Tuberculosis • Measles (Rubeola)

Precaution Levels All levels require hand hygiene • Standard Precautions Transmission based precautions: • Contact Precautions • Droplet Precautions • Airborne Precautions

Standard Precautions • Essential to prevent transmission of infectious agents. • Applied to all patients regardless of diagnosis and modes of transmission

Transmission-based Precautions • Higher level of precautions • Applied in addition to standard precautions • Different types of transmission-based precautions: – – Contact precautions Droplet precautions Airborne and contact precautions

Contact Precautions • Prevent infection through direct or indirect contact with patients or patient care environment • Examples – – – Avian influenza Ebola hemorrhagic fever Methicillin Resistant S. Aureus Shigellosis C. difficile associated diarhea

Contact Precautions Taken in addition to Standard Precautions • Isolate or cohort patients • Limit patient movement • Gown + gloves for patient / room contact – Remove immediately after contact • Do not touch eyes, nose, mouth with hands • Avoid contaminating environmental surfaces

Contact Precautions • Wash hands immediately after patient contact • Use dedicated equipment if possible – If not, clean and disinfect between uses • Clean, then disinfect patient room daily – Bed rails – Bedside tables – Lavatory surfaces – Blood pressure cuff, equipment surfaces

Droplet Precautions • Prevent infection by large droplets from – Sneezing – Coughing – Talking • Examples – – – Neisseria meningitidis Pertussis Influenza Avian influenza (probable) Rubella

Droplet Precautions Taken in addition to Standard Precautions • Wear surgical mask within 1 meter of patient • Wear face shield or goggles within 1 meter of patient • Place patients in single rooms or cohort 1 meter apart • Limit patient movement within facility – Patient wears mask when outside of room

Airborne Precautions Taken in addition to Standard Precautions • Prevent spread of infection through very small (< 5 microns) airborne particles • Examples – – Tuberculosis Measles Varicella Variola

Airborne Precautions • N 95 mask (or equivalent) for personnel – Check seal with each use • Negative pressure isolation room – Air exhaust to outside versus re-circulated • Patient to wear a surgical mask if outside of the isolation room

Negative Pressure Isolation Room

Natural Ventilation Cohorting Room 1 meter
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