04 Nov How Do Facilities Determine the Type and Duration of Transmission-Based Precautions?
Infection control is a critical aspect of healthcare facilities’ operations, ensuring the safety of patients, healthcare workers, and visitors. One key component of infection control is the implementation of transmission-based precautions. These precautions are additional measures taken when patients are suspected or confirmed to be infected or colonized with certain infectious agents. Determining the appropriate type and duration of transmission-based precautions is crucial to prevent the spread of infections within healthcare settings.
Understanding Transmission-Based Precautions
Transmission-based precautions are the second tier of basic infection control measures, implemented in addition to standard precautions. While standard precautions are applied to all patients, transmission-based precautions are specifically tailored to individuals who may pose a higher risk of transmitting infectious agents. These precautions are categorized into three types: contact precautions, droplet precautions, and airborne precautions.
Contact Precautions
Contact precautions are used for patients with known or suspected infections that have an increased risk of contact transmission. This means that the infectious agent can be transmitted by direct or indirect contact with the patient or their immediate environment. Examples of infections requiring contact precautions include:
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Vancomycin-resistant Enterococcus (VRE)
- Carbapenamase-producing Enterobacterales (CRE)
- Candida auris
To implement contact precautions effectively, healthcare facilities should adhere to specific guidelines like what is outlined below.
Patient Placement
Patients on contact precautions should ideally be placed in single-patient rooms. However, in settings where single rooms are not available, efforts should be made to balance the risks to other patients and prevent the spread of infection. In ambulatory settings, the patient should be placed in an exam room as soon as possible.
Personal Protective Equipment (PPE)
Healthcare workers should wear gloves and gowns when entering the patient’s room or coming into contact with the patient or their immediate environment. Proper donning and doffing of PPE is crucial to prevent contamination.
Limiting Patient Movement
To minimize the risk of transmission, unnecessary transport or movement of patients should be limited. When transport is necessary, infected or colonized areas should be covered or contained, and contaminated PPE should be discarded before leaving the patient’s room.
Equipment and Environmental Cleaning
Patient-care equipment should be dedicated to each patient or properly cleaned and disinfected between uses. Regular cleaning and disinfection of patient rooms, focusing on frequently-touched surfaces and equipment, are essential to prevent the spread of infection.
Droplet Precautions
Droplet precautions are necessary when patients are known or suspected to be infected with pathogens transmitted by respiratory droplets. These droplets are generated when a person coughs, sneezes, or talks. Examples of infections requiring droplet precautions include influenza, pertussis, and Meningitis caused by Neisseria meningitidis. Below, we will explore the key considerations for implementing droplet precautions.
Patient Placement
Ideally, patients requiring droplet precautions should be placed in single-patient rooms. If single rooms are not available, healthcare facilities should follow alternative patient placement recommendations based on the specific infection risks and available alternatives.
Personal Protective Equipment
Healthcare workers should wear a mask upon entering the patient’s room or patient space. Proper hand hygiene should be practiced after leaving the patient’s environment.
Limiting Patient Movement
Non-essential transport or movement of patients on droplet precautions should be minimized. Patients should wear a surgical mask if transport or movement is necessary, and respiratory hygiene/cough etiquette should be followed.
Airborne Precautions
Airborne precautions are necessary when patients are known or suspected to be infected with pathogens that can be transmitted through the airborne route. These pathogens remain infectious over long distances when suspended in the air. Examples of infections requiring airborne precautions include tuberculosis, measles, and chickenpox. Note that patients with chickenpox should be placed in contact and airborne precautions.
To implement airborne precautions effectively, healthcare facilities should consider the following.
Patient Placement
Patients requiring airborne precautions should ideally be placed in airborne infection isolation rooms (AIIRs) constructed according to specific guidelines. In cases where AIIRs are not available, patients should be placed in private rooms with closed doors, healthcare personnel should wear an N95 or higher level respirator when entering the room to minimize airborne transmission, and the patient or resident should be transferred to a facility with an AIIR.
Personal Protective Equipment (PPE)
Healthcare workers should use appropriate PPE, including a fit-tested NIOSH-approved N95 respirator or higher level respirator. PPE should be worn upon entry into the patient’s room or patient space.
Limiting Patient Movement
Non-essential transport or movement of patients on airborne precautions should be limited. Patients should wear a surgical mask if movement outside an AIIR is necessary, and respiratory hygiene/cough etiquette should be followed.
Steps to Take to Limit Transmission to A Roommate
When a single or private room is not available for patients or residents on Contact or Droplet Precautions, consider enacting the following:
- Maintaining spatial separation of at least three feet
- Using privacy curtains to limit direct contact
- Educating healthcare personnel to remove PPE and perform hand hygiene when moving between roommates and to apply new PPE if required for care rendered to the roommate.
- Cleaning and disinfecting shared reusable equipment
- Cleaning and disinfecting environmental surfaces more frequently
Factors Influencing Determination of Type and Duration of Precautions
The determination of the type and duration of transmission-based precautions depends on several factors. Healthcare facilities consider the following elements when making decisions:
Clinical Presentation
The clinical presentation of the patient’s infection plays a significant role in determining the type of precautions required. The symptoms, mode of transmission, and potential for spreading the infection are carefully assessed.
Laboratory Confirmation
Laboratory tests are essential to confirm the presence of specific infectious agents. The results of these tests help healthcare facilities categorize the type of precautions necessary for patient care.
Epidemiological Factors
Healthcare facilities take into account the epidemiological factors, including the prevalence of the infection within the facility or community. This information helps determine the level of precautions required to prevent transmission.
Risk Assessment
Performing a risk assessment allows healthcare facilities to evaluate the potential risks associated with specific infections and tailor the precautions accordingly. Factors such as the vulnerability of the patient population and the likelihood of transmission are considered.
Guidelines and Recommendations
Healthcare facilities follow established guidelines and recommendations provided by reputable organizations, such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). These guidelines provide evidence-based protocols for determining the type and duration of transmission-based precautions.
Infection Control Expertise
Infection control professionals, including infection preventionists and healthcare epidemiologists, play a critical role in determining the appropriate precautions. Their expertise and knowledge guide the decision-making process and ensure the effective implementation of infection control measures.
Ongoing Assessment and Review
The type and duration of transmission-based precautions are not set in stone. Healthcare facilities continuously assess and review the precautions based on the patient’s condition, the effectiveness of the implemented measures, and new information or research findings.
Assess and Implement Transmission-Based Precautions
Determining the type and duration of transmission-based precautions is a complex process that requires careful consideration of various factors. By implementing the appropriate precautions, healthcare facilities can effectively prevent the transmission of infectious agents and ensure the safety of patients, healthcare workers, and visitors. To determine the proper precautions, contact Infection Control Results today for an on-site infection assessment.