Transmission-based precautions
Universal precautions is the practice of treating all bodily fluids as if it is infected with HIV, HBV, or other blood borne pathogens.
[3] Transmission-based precautions build on the so-called "standard precautions" which institute common practices, such as hand hygiene, respiratory hygiene, personal protective equipment protocols, soiled equipment and injection handling, patient isolation controls and risk assessments to limit spread between patients.
[14] Contact precautions also apply where the presence of excessive wound drainage, fecal incontinence, or other discharges from the body suggest an increased potential for extensive environmental contamination and risk of transmission.
Donning PPE upon room entry and discarding before exiting the patient room is done to contain pathogens, especially those that have been implicated in transmission through environmental contamination (e.g., VRE, C. difficile, noroviruses and other intestinal tract pathogens; RSV)[15][16][17][18][19][20][21] As of 2020, the classification systems of routes of respiratory disease transmission are based on a conceptual division of large versus small droplets, as defined in the 1930s.
Because certain pathogens do not remain infectious over long distances in a healthcare facility, special air handling and ventilation are not required to prevent droplet transmission.
Infectious agents for which mere droplet precautions are indicated include B. pertussis, influenza virus, adenovirus, rhinovirus, N. meningitidis, and group A streptococcus (for the first 24 hours of antimicrobial therapy).
Healthcare personnel wear a simple mask (a respirator is not necessary) for close contact with an infectious patient, which is generally donned upon room entry.
For example, during the annual monsoon season in Arizona the cooling is going to be adversely affected due to high relative humidity.
A respiratory protection program that includes education about use of respirators, fit-testing, and user seal checks is required in any facility with AIIRs.
Healthcare personnel caring for patients on airborne precautions wear a mask or respirator, depending on the disease-specific recommendations (Appendix A),[1] that is donned prior to room entry.
While it is not possible to identify prospectively all patients needing transmission-based precautions, certain clinical syndromes and conditions carry a sufficiently high risk to warrant their use empirically while confirmatory tests are pending.
¹ Patients with the syndromes or conditions listed below may present with atypical signs or symptoms (e.g.neonates and adults with pertussis may not have paroxysmal or severe cough).
[1] Localized disease in immunocompromised patient until disseminated infection ruled out Note: (Recent assessment of outbreaks in healthy 18- to 24-year-olds has indicated that salivary viral shedding occurred early in the course of illness and that 5 days of isolation after onset of parotitis may be appropriate in community settings; however the implications for healthcare personnel and high-risk patient populations remain to be clarified.)
[55] 1 Type of precautions: A, airborne; C, contact; D, droplet; S, standard; when A, C, and D are specified, also use S. ² Duration of precautions: CN, until off antimicrobial treatment and culture-negative; DI, duration of illness (with wound lesions, DI means until wounds stop draining); DE, until environment completely decontaminated; U, until time specified in hours (hrs) after initiation of effective therapy; Unknown: criteria for establishing eradication of pathogen has not been determined Transmission-based precautions remain in effect for limited periods of time (i.e., while the risk for transmission of the infectious agent persists or for the duration of the illness (Appendix A).
[82][83] Although early guidelines for VRE suggested discontinuation of contact precautions after three stool cultures obtained at weekly intervals proved negative,[21] subsequent experiences have indicated that such screening may fail to detect colonization that can persist for >1 year.
[84][85][86][87] Likewise, available data indicate that colonization with VRE, MRSA,[88] and possibly MDR-GNB, can persist for many months, especially in the presence of severe underlying disease, invasive devices, and recurrent courses of antimicrobial agents.
Alternatively, an interval free of hospitalizations, antimicrobial therapy, and invasive devices (e.g., 6 or 12 months) before reculturing patients to document clearance of carriage may be used.
See the 2006 HICPAC/CDC MDRO guideline[14] for discussion of possible criteria to discontinue contact precautions for patients colonized or infected with MDROs.
[citation needed] Patients with known contact transmitted diseases coming into ambulatory clinics should be triaged quickly and placed in a private room.
[citation needed] When transmission-based precautions are indicated, efforts must be made to counteract possible adverse effects on patients (i.e., anxiety, depression and other mood disturbances,[89][90][91] perceptions of stigma,[92] reduced contact with clinical staff,[93][94][95] and increases in preventable adverse events[96] in order to improve acceptance by the patients and adherence by health care workers).
This article incorporates text from a scholarly publication published under a copyright license that allows anyone to reuse, revise, remix and redistribute the materials in any form for any purpose: Siegel, Jane D.; Rhinehart, Emily; Jackson, Marguerite; Chiarello, Linda (2007-12-07).
