The Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA) are the regulating bodies of infection control, prevention, and awareness.
Precautions are preventative steps needed to be taken by healthcare team members and staff at healthcare facilities to prevent the spread of infections. There are universal standard precautions are the minimum infection prevention steps defined by the CDC as:
Hand hygiene, proper washing of hands before and after patient contact
Use of appropriate protective equipment (i.e., gloves) before patient contact
Respiratory hygiene (i.e., covering your cough and sneeze)
Injection and sharp object safety and proper disposal
Cleaning of supplies and disposal of waste
In addition to universal standard precautions, the Center for Disease Control (CDC) defines additional types of proper personal protective equipment (PPE)required for each kind of precaution. Signs defining the precaution category should be easily visible and placed on each patient's roomexplaining the PPE needed and the type of isolation in effect.
The maintypes of transmission-based precautions defined by the CDC result from direct or indirect patient contact, bloodborne products, droplet, and airborne.Each kind of transmission-based precaution is dependent on the type of infection or pathogen the patient or source has, as outlined as follows:
1. Contact precautions:
Defined as direct or indirect contact with a patient and/or his or her environment including person's room or objects in contact with the person, that has an infection with an organism transmitted fecal-orally, such as Clostridium difficile, orwound and skin infections, or multi-drug resistant bacteria such asmethicillin-resistantStaphylococcus aureus(MRSA).
PPE defined by the CDC required before entering a contact precaution designated room is always gloves and a gown.
Mask and eye protection are additionally required if contact with bodily secretions is possible.
2. Bloodborne precautions:
Blood-borne transmission of pathogens is largely due to percutaneous injuries, which can be prevented using changes in technique, experience, and safety devices.
According to the OSHA database, HIV, hepatitis B and C, malaria, measles, herpes, chickenpox, and various other bacterial infections are known for being transmitted through blood-containing fluids and products.
Blood-borne precautions include wearing gloves, a face mask, protective eyewear or goggles, and proper handling of sharp objects with appropriate disposal.
Sharps disposal should be in an approved puncture-proof "sharp-only" locked and secured bin.
All sharps should not be re-capped.
All sharps should not be bent or broken.
Safety devices should be implemented to prevent contact with needles and other sharps.
These precautions apply to any blood-containing fluids, including cerebrospinal fluid, pericardial fluid, pleural fluid, and peritoneal fluid.
Sputum, vomit, sweat, feces, and nasal secretions do not require blood-borne precautions unless there is visible blood noted.
If contact with blood-containing fluids or products occurs, it is important to immediately wash the affected area with soap and water and obtain bloodborne infection status and immunization history from the patient.
3. Droplet precautions:
Droplet precautions are necessary when a patient infected with a pathogen, such as influenza, iswithin three to six feet of the patient.
Infections are transmittable through air droplets by coughing, sneezing, talking, and close contact with an infected patient's breathing. Droplets areabout30 to 50 micrometers in size.
Patients should be placed in individualized rooms, if possible.
In addition to standard precautions, personnel should wear protective surgical masks should always before interacting between an infected patient or his/her environment.
4. Airborne precautions:
Airborne precautions are required whenever entering a patient's room or environment who has been diagnosed with or is being tested for with high suspicion of anthrax,tuberculosis, measles, chickenpox, or disseminated herpes zoster or other pathogens that can be transmitted through airflow that are5 micrometers or smaller in size and remains in the environment for long periods of time.
In addition to standard precautions of wearing gloves and a gown, the CDC requires additional PPE of an approved N95 respirator mask properly fitted for each person working in the healthcare environment.
The CDC also strongly recommends placing patients diagnosed with or receiving testing for, with high suspicion of an infectious airborne organismin a single room known as an airborne infection isolation room (AIIR). These are negative pressure rooms that provide air filtration and 6 to 12 air exchanges per hour to reduce the risk of transmission.
Whenever interacting with any patient in a healthcare facility, healthcare team members and visitors need to adhere to and comply with PPE andinfection control signs. It is also essential to wash hands thoroughly with soap and water before and when leaving a patient's room to ensure the safety of the patient and oneself.
Issues of Concern
Despite efforts made by the CDC, OSHA, and internal policies by healthcare organizations, infection control, and safety rules frequently get broken. Anobservational study analyzing adherence to contact precautions showed 27.9% of nurses and nursing assistants adheredtoproper personal protective equipment (PPE) in comparison to 100% of infectious disease physicians and 85.7% of housekeeping staff.Being on the front lines of patient interactions, physicians, nurses, and nursing assistants are the foundation of infection control, and should be aware of PPE and utilize them as expected. Prevention of infections in healthcare systems is critical in overall disease control and morbidity and mortality.
Health-care workers should be aware of bloodborne pathogens and consider safer practices and procedures when handling objects potentially contaminated with blood or bodily fluids to prevent injuries and the possible spread of infections. Studies have shown that awareness of technique and safety precautions can lead to decreased bloodborne infection transmission.
A retrospective cohort study also found that patients in isolation rooms requiring PPE received less attention and care from health care staff. The study determined that isolation precautionslead to poorer outcomes, more extended hospitalizations, and increased readmissions to healthcare facilities.These factors together also contribute to increased healthcare costs and time and increased morbidity and mortality of treatable infectious organisms.
Infection control through the use ofpersonal protective equipment (PPE) and alert signs designed by the CDC, OSHA, and individual internal policies in healthcare facilities is critical for proper patient care and prevention of prolonged hospitalizations and decreasing healthcare costs. While awareness of precautions is appreciated, adherence to following the precautions appears to be lacking.All healthcare team members and visitors to healthcare facilities must abide by those policies to encourage safe practices and reduce the spread of infections.
Nursing, Allied Health, and Interprofessional Team Interventions
Health-care team members, including physicians, nurses, and nursing assistants, should pay close attention to proper PPE use and isolation precautions for the personal safety and safety of the patients. It is also crucial for team members to enforce isolation precautions on visitors and other members not complying with standard protocols to reduce infection transmission within the workplace.
In the retrospective cohort study by Tran K. and Bell C. et al., patients on isolation precautions on average had a 17% increase in hospital stays and a 23% increase in healthcare cost due to lack of attention by healthcare staff.Health-care members must provide consistently high-quality care and attention to any patient, regardless of social or health status. [Level 3] Team members in any healthcare organization should be aware of the length of stay increase as well as the lack of quality care in isolation precaution patient populations.
Nursing, Allied Health, and Interprofessional Team Monitoring
Nursing and other healthcare team members should make every effort to consistently provide high-quality care and help enforce CDC, OSHA, and internal organization infection control rules and guidelines. When care is compromised, or there is a risk of infection transmission, it should bebrought to the attention of supervisors and managed, so that patient care takes precedence.
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Hand hygiene, proper washing of hands before and after patient contact. Use of appropriate protective equipment (i.e., gloves) before patient contact. Respiratory hygiene (i.e., covering your cough and sneeze) Injection and sharp object safety and proper disposal.What is contact and droplet precautions? ›
There are three types of transmission-based precautions: contact precautions (for diseases spread by direct or indirect contact), droplet precautions (for diseases spread by large particles in the air), and airborne precautions (for diseases spread by small particles in the air).What precautions are used in droplet precautions? ›
Health care personnel caring for patients on Droplet Precautions must wear a face mask for close patient contact, considered to be within six feet or less or in the room of the patient. Taking a blood pressure, listening to lung sounds and administering medication would all require staff to wear a face mask.What are the contact precautions for bloodborne pathogens? ›
Wear disposable gloves whenever providing care, particularly if you may come into contact ■ with blood or body fluids. Also wear protective coverings, such as a mask, eyewear and a gown, if blood or other body fluids can splash.What are 5 standard precautions used to prevent bloodborne pathogens? ›
The Bloodborne Pathogens standard (29 CFR 1910.1030) and CDC's recommended standard precautions both include personal protective equipment, such as gloves, gowns, masks, eye protection (e.g., goggles), and face shields, to protect workers from exposure to infectious diseases.What are 2 examples of contact precautions? ›
Wear gloves and gown when in contact with the individual, surfaces, or objects within his/her environment. All re-usable items taken into an exam room or home should be cleaned and disinfected before removed. Disposable items should be discarded at point of use.
Hand hygiene. Use of personal protective equipment (e.g., gloves, masks, eyewear). Respiratory hygiene / cough etiquette. Sharps safety (engineering and work practice controls).What is airborne and droplet precaution? ›
Airborne and contact precautions are steps that healthcare facility visitors and staff need to follow when going into or leaving a patient's room. They help stop germs from spreading so other people don't get sick. Airborne and contact precautions are for patients who have germs that can spread: through the air.Which of the following is part of contact precautions? ›
The term “contact precautions” means that everyone coming into a patient's room is asked to wear a gown and gloves.What is an example of a droplet infection? ›
Respiratory tract viruses (respiratory syncytial virus (RSV), metapneumovirus, bocavirus, parainfluenza viruses, coronavirus, influenza virus, etc.)
Contact Precautions are required when interacting with people known or suspected to have infections or diseases that can be transmitted through either direct or indirect contact with people, objects or environmental surfaces that have infectious matter on them.What is the OSHA standard for bloodborne pathogens? ›
What is the Bloodborne Pathogens Standard? OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) as amended pursuant to the 2000 Needlestick Safety and Prevention Act, is a regulation that prescribes safeguards to protect workers against health hazards related to bloodborne pathogens.What are three general prevention methods for exposure to bloodborne pathogens? ›
Dispose of used sharps promptly into an appropriate sharps disposal container. Use sharps devices with safety features whenever possible. Use personal protective equipment (PPE), such as gloves and face shields, every time there is a potential for exposure to blood or body fluids.What are 4 methods of compliance to bloodborne pathogens standards? ›
These include the use of Universal Precautions, Engineering Controls, Work Practice Controls, PPE, and Housekeeping Procedures.What are universal precautions vs standard precautions? ›
Universal precautions are applicable to all patients, while standard precautions provide an additional layer of protection for those at higher risk of transmitting certain infections. Together, they create a comprehensive and effective strategy for reducing the risk of healthcare-associated diseases.What are the droplet diseases? ›
- Pertussis (whooping cough)
- Respiratory Syncytial Virus (RSV)
Δ RSV may be transmitted by the droplet route but is primarily spread by direct contact with infectious respiratory secretions.What are 3 examples of standard precautions? ›
- hand hygiene before and after all patient contact.
- the use of personal protective equipment, which may include gloves, impermeable gowns, plastic aprons, masks, face shields and eye protection.
- the safe use and disposal of sharps.
- Use barrier protection at all times.
- Use gloves for protection when working with or around blood and body fluids.
- Change glove between patients.
- Use glasses, goggles, masks, shields, and waterproof gowns/aprons to protect face from splashes.
- Wash hands if contaminated and after removing gloves.
- Masks and Respirators.
- Other Face and Eye Protection.
- Hand Hygiene - always - following any patient contact.
- Provide negative pressure room with a minimum of 6 air exchanges per hour.
- Exhaust directly to the outside or through HEPA (High Efficiency Particulate Air) filtration.
Additional Personal Protective Equipment (PPE) for Contact with Droplet Precautions. Wear a fluid resistant, non-sterile gown if substantial contact with the patient or their environment is anticipated.Is RSV a droplet or airborne virus? ›
RSV is spread through contact with droplets from the nose and throat of infected people when they cough and sneeze. RSV can also spread through dried respiratory secretions on bedclothes and similar items.What 4 items of PPE should you have when dealing with contact or droplet? ›
Droplet precautions means wearing a face mask (also called a surgical mask) when in a room with a person with a respiratory infection. These precautions are used in addition to standard precautions, which includes use of a face shield or goggles as well as gown and gloves if contact with blood/body fluids is possible.What is an example of a droplet isolation? ›
Droplet Precautions—used for diseases or germs that are spread in tiny droplets caused by coughing and sneezing (examples: pneumonia, influenza, whooping cough, bacterial meningitis).What are examples of droplet transmission? ›
Droplet transmission occurs when a droplet from coughing, sneezing or talking carry the pathogen to the hosts body. The transmission is completed by: Inhaling droplets. Droplets entering the mucous membranes of the face.What is an example of disease transmitted by contact and droplet? ›
- common cold.
- meningococcal disease.