Infection Control for New York Health Care Professional ‒ 2024 Update ________________________________
Prevention Strategies: Standard, Transmission, and Isolation Precautions HICPAC is a federal advisory committee appointed to provide advice and guidance to Department of Health and Human Services (DHHS) and CDC regarding the practice of infection control and strategies for surveillance, prevention, control of HAI, antimicrobial resistance, and related events in U.S. healthcare settings [11]. There are two tiers of Healthcare Infection Control Practices Advisory Committee precautions to prevent transmission of infectious agents: Standard Precautions and Transmission- Based Precautions. Standard Precautions are intended to be applied to the care of all patients in all healthcare settings, regardless of the suspected or confirmed presence of an infec- tious agent. Transmission-Based Precautions are for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically impor- tant pathogens, which require additional control measures to effectively prevent transmission. Standard Precautions Standard Precautions combine the major features of Universal Precautions (UP) and Body Substance Isolation (BSI) and are based on the principle that all blood, body fluids, secre- tions, excretions, except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents [5]. These include hand hygiene; use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated expo- sure; and safe injection practices. Equipment or items in the patient environment that are likely to have been contaminated with infectious body fluids must be handled in a manner to prevent transmission of infectious agents (e.g., wear gloves for direct contact, contain heavily soiled equipment, properly clean, and disinfect or sterilize reusable equipment before use on another patient). The application of Standard Precautions during patient care is determined by the nature of the healthcare worker (HCW) and patient interaction, and the extent of anticipated blood, body fluid, or pathogen exposure. For some interactions (e.g., performing venipuncture), only gloves may be needed; during other interactions (e.g., intubation), use of gloves, gown, and face shield or mask and goggles is necessary. An example of the importance of the use of Standard Precautions is intubation, especially under emergency circumstances when infectious agents may not be suspected but that are later identified (e.g., SARS-CoV, N. meningitides ). Respiratory Hygiene/Cough. Respiratory hygiene/cough etiquette is to be incorporated into infection control practices as a new component of Standard Precautions. The strategy is targeted at patients and accompanying family members and friends with undiagnosed transmissible respiratory infections and applies to any person with signs of illness, including cough, congestion, rhinorrhea, or increased production of respiratory secretions when entering a healthcare facility.
The elements of respiratory hygiene/cough etiquette include the following. 1. Education of healthcare facility staff, patients, and visitors 2. Posted signs, in language(s) appropriate to the population served, with instructions to patients and accompanying family members or friends 3. Source control measures (e.g., covering the mouth/ nose with a tissue when coughing and prompt disposal of used tissues, using surgical masks on the coughing person when tolerated and appropriate) 4. Hand hygiene after contact with respiratory secretions 5. Spatial separation, ideally more than three feet, of persons with respiratory infections in common waiting areas when possible Transmission-Based Precautions There are three categories of transmission-based precautions: Contact Precautions, Droplet Precautions, and Airborne Precautions. Transmission-Based Precautions are used when the route(s) of transmission is/are not completely interrupted using Standard Precautions alone [11]. Contact Precautions. Contact Precautions, which are always preceded by Standard Precautions, prevent transmission of infectious agents, including epidemiologically important microorganisms, that are spread by direct or indirect contact with the patient or the patient’s environment. They apply where the presence of excessive wound drainage, fecal incon- tinence, or other discharge from the body suggest an increased potential for extensive environmental contamination and risk of transmission. A single-patient room is preferred for patients who require contact precautions. Droplet Precautions. Droplet Precautions prevent transmis- sion of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions. Because these pathogens do not remain infectious over long distances in a healthcare facility, special air handling and ventilation are not required to prevent droplet transmission. A single-patient room is preferred for patients who require droplet precautions. Spatial separation of more than three feet and drawing the curtain between patient beds is especially important for patients in multiperson bedrooms with infec- tions transmitted by the droplet route. Healthcare personnel wear a mask for close contact with an infectious patient, and the mask is generally donned upon entry into the room. Patients on Droplet Precautions who must be transported outside of the room should wear a mask if tolerated and follow respiratory hygiene/cough etiquette. Airborne Precautions. Airborne precautions prevent trans- mission of infectious agents that remain infectious over long distances when suspended in the air. The preferred placement for patients who require airborne precautions is in an airborne
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