DROPLET + CONTACT PRECAUTIONS – Acute Care Facilities
Hand Hygiene as per Routine Practices Hand hygiene is performed:
Before and after each patient contact Before performing invasive procedures
Before preparing, handling, serving or eating food
After care involving body fluids and before moving to another activity Before putting on and after taking off gloves and other PPE
After personal body functions (e.g., blowing one’s nose)
Whenever hands come into contact with secretions, excretions, blood and body fluids After contact with items in the patient’s environment
Whenever there is doubt about the necessity for doing so Patient Placement
Single room with own toileting facilities if available, or maintain a spatial separation of at least 2 metres between the patient and others in the room, with privacy curtain drawn Door may remain open
Perform hand hygiene on leaving the room Mask and Eye Protection or Face Shield Wear within 2 metres of the patient
Remove and perform hand hygiene on leaving the room Gown [based on risk assessment] and Gloves
Wear gloves when entering the patient’s room or bed space Wearing gloves is NOT a substitute for hand hygiene.
Remove gloves on leaving the room or bed space and perform hand hygiene Wear a long-sleeved gown when entering the patient’s room or bed space if skin or
clothing will come into direct contact with the patient or the patient’s environment Environment and Equipment
Dedicate routine equipment to the patient (e.g., stethoscope, thermometer) Disinfect all equipment that comes out of the room
All high-touch surfaces in the patient’s room must be cleaned at least daily Patient Transport
Patient to wear a mask during transport
Visitors
Non-household visitors wear a mask and eye protection within 2 metres of the patient Visitors must wear gloves and a long-sleeved
gown if they will be in contact with other patients or will be providing direct care* Visitors must perform hand hygiene before
entry and on leaving the room
* Direct Care: Providing hands-on care, such as bathing, washing, turning the patient, changing clothing,
continence care, dressing changes, care of open wounds/lesions or toileting. Feeding and pushing a wheelchair are not classified as direct care.
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 68
APPENDIX J: SAMPLE SIGNAGE FOR ENTRANCE TO ROOM OF A RESIDENT REQUIRING DROPLET
AND CONTACT PRECAUTIONS IN NON-ACUTE CARE FACILITIES
DROPLET + CONTACT PRECAUTIONS – Non-acute Care Facilities
Hand Hygiene as per Routine Practices Hand hygiene is performed:
Before and after each resident contact Before performing invasive procedures
Before preparing, handling, serving or eating food
After care involving body fluids and before moving to another activity Before putting on and after taking off gloves and other PPE
After personal body functions (e.g., blowing one’s nose)
Whenever hands come into contact with secretions, excretions, blood and body fluids After contact with items in the resident’s environment
Whenever there is doubt about the necessity for doing so Resident Placement
Single room with own toileting facilities if resident hygiene is poor and if available, or maintain a spatial separation of at least 2 metres between the resident and others in the room, with privacy curtain drawn
Door may remain open
Perform hand hygiene on leaving the room Mask and Eye Protection or Face Shield Wear within 2 metres of the resident
Remove and perform hand hygiene on leaving the room Gown and Gloves [based on risk assessment]
Wear a long-sleeved gown for direct care* when skin or clothing may become contaminated
Wear gloves for direct care*
Wearing gloves is NOT a substitute for hand hygiene.
Remove gloves on leaving the room or bed space and perform hand hygiene Environment and Equipment
Dedicate routine equipment to the resident if possible (e.g., stethoscope, thermometer) Disinfect all equipment before it is used for another resident
All high-touch surfaces in the patient’s room must be cleaned at least daily Resident Transport
Resident to wear a mask during transport
Visitors
Non-household visitors wear a mask and eye protection within 2 metres of the resident Visitors must wear gloves and a long-sleeved
gown if they will be in contact with other residents or will be providing direct care*
Visitors must perform hand hygiene before entry and on leaving the room
* Direct Care: Providing hands-on care, such as bathing, washing, turning the patient, changing clothing,
continence care, dressing changes, care of open wounds/lesions or toileting. Feeding and pushing a wheelchair are not classified as direct care.
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 69
APPENDIX K: SAMPLE SIGNAGE FOR ENTRANCE TO ROOM OF A PATIENT REQUIRING AIRBORNE
PRECAUTIONS IN ALL HEALTH CARE FACILITIES
AIRBORNE PRECAUTIONS – All Facilities
Hand Hygiene as per Routine Practices Hand hygiene is performed:
Before and after each client/patient/resident contact Before performing invasive procedures
Before preparing, handling, serving or eating food
After care involving body fluids and before moving to another activity Before putting on and after taking off gloves and other PPE
After personal body functions (e.g., blowing one’s nose)
Whenever hands come into contact with secretions, excretions, blood and body fluids After contact with items in the client/patient/resident’s environment
Whenever there is doubt about the necessity for doing so Client/Patient/Resident Placement
Single room with own toileting facilities
Room must have negative pressure ventilation with room air exhausted outside or through a HEPA filter
Monitor negative pressure daily while in use Door must remain closed
N95 Respirator
Wear a fit-tested, seal-checked N95 respirator for entry to the room for TB patients For measles, varicella or disseminated zoster, only immune staff are to enter the room
and an N95 respirator is not required Environment and Equipment
Equipment that is being used by more than one client/patient/resident must be cleaned between patients/residents
All high-touch surfaces in the patient’s room must be cleaned at least daily Transport of the Client/Patient/Resident
Client/patient/resident to wear a mask during transport Transport staff to wear an N95 respirator during transport
Visitors
Visitors must be kept to a minimum
Visitors must perform hand hygiene before entry and on leaving the room For TB, household members do not require an N95 respirator
For TB, non-household visitors require an N95 respirator
For measles/varicella, visitors should be counselled before entering the room
* Direct Care: Providing hands-on care, such as bathing, washing, turning the resident, changing clothing,
continence care, dressing changes, care of open wounds/lesions or toileting. Feeding and pushing a wheelchair are not classified as direct care.
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 70
APPENDIX L: RECOMMENDED STEPS FOR PUTTING ON AND TAKING OFF PERSONAL
PROTECTIVE EQUIPMENT (PPE)
[Images developed by Kevin Rostant.
Some images adapted from Northwestern Ontario Infection Control Network – NWOICN]
4. Put on Protective Eyewear
Put on eye protection and adjust to fit
Face shield should fit over brow
3. Put on Mask/N95 Respirator
Place mask over nose and under chin Secure ties, loops or straps
Mould metal piece to your nose bridge For respirators, perform a seal-check 5. Put on Gloves
Put on gloves, taking care not to tear or puncture glove
If a gown is worn, the glove fits over the gown’s cuff
2. Put on Gown
Tie neck and waist ties securely 1. Perform
Hand Hygiene PUTTING ON PPE
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 71 1. Remove Gloves
Remove gloves using a glove-to- glove/skin-to-skin technique Grasp outside edge near the wrist and
peel away, rolling the glove inside-out Reach under the second glove and
peel away
Discard immediately into waste receptacle
4. Remove Eye Protection
Arms of goggles and headband of face shields are considered to be ‘clean’ and may be touched with the hands The front of goggles/face shield is
considered to be contaminated Remove eye protection by handling ear
loops, sides or back only
Discard into waste receptacle or into appropriate container to be sent for reprocessing
Personally-owned eyewear may be cleaned by the individual after each use
5. Remove Mask/N95 Respirator
Ties/ear loops/straps are considered ‘clean’ and may be touched with hands
The front of the mask/respirator is considered to be contaminated Untie bottom tie then top tie, or grasp
straps or ear loops
Pull forward off the head, bending forward to allow mask/respirator to fall away from the face
Discard immediately into waste receptacle
6. Perform Hand Hygiene 3. Perform Hand Hygiene
2. Remove Gown
Remove gown in a manner that prevents contamination of clothing or skin
Starting at the neck ties, the outer, ‘contaminated’, side of the gown is pulled forward and turned inward, rolled off the arms into a bundle, then discarded immediately in a manner that minimizes air disturbance TAKING OFF PPE
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 72
APPENDIX M: ADVANTAGES AND DISADVANTAGES OF PPE
MEDICAL GLOVES
Type Use Advantages Disadvantages
Vinyl Protection for:
o Minimal exposure to blood/body fluids/infectious agents
o Contact with strong acids and bases, salts, alcohols
o Short duration tasks
Protection for staff with documented skin breakdown
Good level of protection but based on the quality of manufacturer Medium chemical
resistance
Not recommended for contact with solvents, aldehydes, ketones Quality varies with
manufacturers Punctures easily when
stressed
Rigid – non elastic Latex Activities that require sterility
Protection for:
o Heavy exposure to blood/body fluids/infectious agents
o Contact with weak acids and bases, alcohols
Good barrier qualities Strong and durable Has re-seal qualities Good comfort and fit Good protection from
most caustics and detergents
Not recommended for contact with oils, greases and organics
Not recommended for individuals in the vicinity of those who have allergic reactions or sensitivity to latex
Nitrile Protection for:
o Heavy exposure to blood/body fluids/infectious agents o Tasks of longer duration o Tasks with high stress on glove o Tasks requiring additional dexterity o Chemicals and chemotherapeutic agents o Recommended for contact with oils,
greases, acids, bases o Sensitivity to vinyl
Preferred replacement for vinyl gloves when a documented allergy or sensitivity occurs
Offers good dexterity Strong and durable Puncture-resistant Good comfort and fit Excellent resistance
to chemicals
Not recommended for contact with solvents, ketones, esters
Neopre ne
Replacement sterile glove for latex when a documented allergy or sensitivity occurs Recommended for contact with acids, bases,
alcohols, fats, oils, phenol, glycol ethers
Good barrier qualities Strong and durable Good comfort and fit Good protection from
caustics
Not recommended for contact with solvents
[Adapted from Sunnybrook Health Sciences Centre, Patient Care Policy Manual Section II: Infection Prevention and Control [Policy No: II-D-1200, ‘Gloves’. Revised July, 2007 and London Health Sciences Centre, Occupational Health and Safety Services, ‘Glove Selection and Use’. Revised April 26, 2005.]
START START
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 73
MASKS AND N95 RESPIRATORS
Type of Mask Use Advantages Disadvantages
Standard Face Mask (‘procedure’ mask or ‘isolation’ mask)
Protection for:
o Minimal exposure to infectious droplets
o Short duration tasks
o Tasks that do not involve exposure to blood/body fluids
Protection from client/patient/resident during transportation outside of room
Inexpensive Not fluid or water resistant
Fluid Resistant Mask Protection for:
o Heavy exposure to infectious droplets or blood/body fluids
Good comfort and fit Fluid resistant
Expensive
Surgical Mask Protection for:
o Exposure to infectious droplets or blood/body fluids
o Long duration tasks
Good comfort and fit Fluid resistant Inexpensive NIOSH- certified N95 respirator
Protection for airborne pathogens Provides protection from small particle aerosols Better face seal
prevents leakage around mask
Requires fit-testing, training and seal- checking Expensive
Uncomfortable for long periods of use
EYE PROTECTION
Type ofEyewear
Use Advantages Disadvantages
Safety Glasses
Protection for:
o Exposure to infectious droplets or blood/body fluids
may be cleaned and re-used until visibility is compromised may be worn over
prescription eyeglasses good visibility
with continued use, visibility may be compromised
Goggles Protection for:
o Exposure to infectious droplets or blood/body fluids
may be cleaned and re-used until visibility is compromised may be worn over
prescription eyeglasses poor visibility Face Shield Protection for:
o Exposure to infectious droplets or blood/body fluids
may be worn over prescription eyeglasses good visibility Visor attached to Mask Protection for:
o Minimal exposure to infectious droplets or blood/body fluids
May be worn with prescription eyeglasses Quick to put on
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 74
APPENDIX N: CLINICAL SYNDROMES/CONDITIONS WITH REQUIRED LEVEL OF PRECAUTIONS
ORGANISM/ DISEASE CATEGORY * TYPE OF PRECAUTION SINGLE ROOM? DURATION OF PRECAUTIONS COMMENTS
* = Paediatric precautions apply to children who are incontinent or too immature to comply with hygiene RP = Routine Practices
ABSCESS Minor RP No If community-associated
MRSA is suspected, use Contact Precautions until ruled out.
Major (drainage not contained by dressing)
Contact Yes Continue precautions
for duration of uncontained drainage.
ADENOVIRUS INFECTION
Conjunctivitis Contact Yes Continue precautions for duration of symptoms.
May cohort patients in outbreaks.
Pneumonia Droplet + Contact§
Yes
AIDS See HIV
AMOEBIASIS
(Dysentery)
Entamoeba histolytica
Adult RP No Reportable Disease
Paediatric* and incontinent or non- compliant adult Contact Yes ANTHRAX Bacillus anthracis
Cutaneous or pulmonary RP No Reportable Disease Notify Infection Control
ANTIBIOTIC-RESISTANT ORGANISMS (AROs)
- not listed elsewhere
Contact may be indicated
May be indicated
Precautions, if required, are initiated and discontinued by Infection Control.
See also listings under MRSA, VRE, ESBL and CPE.
ARTHROPOD-BORNE VIRAL INFECTIONS
Eastern, Western, & Venezuelan equine
encephalomyelitis; St. Louis & California encephalitis; West Nile virus RP No Reportable Disease No person-to-person transmission. ASCARIASIS (Roundworm) Ascaris lumbricoides RP No No person-to-person transmission. ASPERGILLOSIS Aspergillus species
RP No If several cases occur in close proximity, look for environmental source.
BABESIOSIS RP No Tick-borne. Not
transmitted from person- to-person except by transfusion.
BLASTOMYCOSIS
Blastomyces dermatitidis
Cutaneous or pulmonary RP No No person-to-person transmission.
BOTULISM See Food Poisoning/Food-borne Illness
BRONCHITIS/ BRONCHIOLITIS
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 75 ORGANISM/ DISEASE CATEGORY * TYPE OF PRECAUTION SINGLE ROOM? DURATION OF PRECAUTIONS COMMENTS
* = Paediatric precautions apply to children who are incontinent or too immature to comply with hygiene RP = Routine Practices BRUCELLOSIS (Undulant fever) RP No Reportable Disease No person-to-person transmission If lesions present, see
Abscess
CAMPYLOBACTER Adult RP No Reportable Disease
Notify Infection Control
Paediatric* and incontinent or non- compliant adult
Contact Yes Continue precautions
until stools are formed.
CARBAPENEMASE- PRODUCING
ENTEROBACTERIACEAE (CPE)
See Enterobacteriaceae, Resistant
CAT-SCRATCH FEVER Bartonella henselae RP No No person-to-person transmission. CELLULITIS , with drainage See Abscess
CELLULITIS Child < 5 years of age if
Haemophilus influenzae
type B is present or suspected
Droplet Yes Continue precautions
until 24 hours of appropriate
antimicrobial therapy or until H. influenzae type B is ruled out.
CHANCROID
Haemophilus ducreyi
RP No Reportable Disease
CHICKENPOX See Varicella
CHLAMYDIA Chlamydia trachomatis
genital infection or lymphogranuloma venereum RP No Reportable Disease Chlamydia pneumonia, psittaci RP No CHOLERA Vibrio cholera
Adult RP No Reportable Disease Notify Infection Control
Paediatric* and incontinent or non- compliant adult Contact Yes CLOSTRIDIUM DIFFICILE
Contact Yes Continue precautions
until formed stool for at least two consecutive days.
Outbreaks Reportable Notify Infection Control.
Laboratory-confirmed cases may be cohorted.
COCCIDIOIDOMYCOSIS (Valley Fever) Draining lesions or pneumonia RP No No person-to-person transmission. COMMON COLD Rhinovirus Droplet + Contact
Yes Continue precautions for duration of symptoms.
CONGENITAL RUBELLA See Rubella
CONJUNCTIVITIS Contact Yes Continue precautions
until viral aetiology ruled out or for
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 76 ORGANISM/ DISEASE CATEGORY * TYPE OF PRECAUTION SINGLE ROOM? DURATION OF PRECAUTIONS COMMENTS
* = Paediatric precautions apply to children who are incontinent or too immature to comply with hygiene RP = Routine Practices
duration of symptoms.
COXSACKIEVIRUS See Enteroviral Infections CREUTZFELDT-JAKOB
DISEASE (CJD)
RP No Reportable Disease.
Notify Infection Control.
Equipment in contact with infectious material requires special handling & disinfection practices.
CROUP Droplet +
Contact
Yes Continue precautions for duration of illness or until infectious cause ruled out.
CRYPTOCOCCOSIS
Cryptococcus neoformans
RP No No person-to-person transmission.
CRYPTOSPORIDIOSIS Adult RP No Reportable Disease
Notify Infection Control
Paediatric* and incontinent or non- compliant adult Contact Yes CYSTICERCOSIS RP No No person-to-person transmission. CYTOMEGALOVIRUS (CMV) RP No Reportable Disease if congenital Transmitted by close, direct personal contact, blood transfusions or transplants.
DECUBITUS ULCER, infected See Abscess
DENGUE See Arthropod-borne viral infections
DERMATITIS RP Yes, if
extensive
If compatible with scabies, see Scabies
DIARRHEA Acute infectious See Gastroenteritis
Suspected C. difficile diarrhea
See Clostridium difficile
DIPHTHERIA
Corynebacterium diphtheriae
Pharyngeal Droplet Yes Continue precautions until two appropriate cultures taken at least 24 hours apart after cessation of antibiotics are negative for C.
diphtheriae.
Reportable Disease Notify Infection Control
Cutaneous Contact Yes
EBOLA VIRUS See Haemorrhagic Fevers
ECHINOCOCCOSIS RP No No person-to-person
transmission.
ECHOVIRUS DISEASE See Enteroviral Infections EHRLICHIOSIS
Ehrlichia chaffeensis
PIDAC: Routine Practices and Additional Precautions in All Health Care Settings | November, 2012 77 ORGANISM/ DISEASE CATEGORY * TYPE OF PRECAUTION SINGLE ROOM? DURATION OF PRECAUTIONS COMMENTS
* = Paediatric precautions apply to children who are incontinent or too immature to comply with hygiene RP = Routine Practices
ENCEPHALITIS Adult RP No Reportable Disease
Paediatric* Contact Yes Continue precautions until Enterovirus is ruled out. ENTEROBACTERIACEAE- RESISTANT Carbapenemase-producing Enterobacteriaceae (CPE)
Contact Yes Continue precautions
for duration of hospitalization
Notify Infection Control
If readmitted, use Contact precautions Extended-spectrum Beta- lactamase producing Enterobacteriaceae (ESBL) Contact may be indicated May be indicated Precautions, if indicated, are initiated and discontinued by Infection Control
Notify Infection Control
ENTEROBIASIS (Pinworm disease) Enterobius vermicularis RP No Transmission is faecal-oral directly or indirectly through contaminated articles e.g., bedding.
ENTEROCOLITIS See Gastroenteritis - Necrotizing Enterocolitis ENTEROVIRAL
INFECTIONS
(Coxsackie viruses, Echo viruses)
Adult RP No
Paediatric* Contact Yes Continue precautions for duration of illness.
EPIGLOTTITIS, due to Haemophilus
influenzae Type B
Adult RP No Type B is Reportable Disease.
Notify Infection Control
Paediatric* Droplet Yes Continue precautions for 24 hours after start of effective therapy.
EPSTEIN-BARR VIRUS
(Infectious Mononucleosis)
RP No Transmitted via intimate contact with oral secretions or articles contaminated by them.
ERYSIPELAS See Streptococcal Disease
ERYTHEMA INFECTIOSUM
(Parvovirus B19)
Aplastic crisis Droplet Yes Continue precautions