Guidelines on Infection Prevention and Control for Cork Kerry Community Healthcare 06: Transmission Based Precautions

Transcription

1 Guidelines on Infection Prevention and Control for Cork Kerry Community Healthcare 06: Transmission Based Precautions This guidance document has been adopted as the policy document by: Organisation:... Signed:... Job Title:... Date adopted:... Review date:... While this document may be printed please note that the electronic version on the website is the only version that is maintained. Any printed copies should therefore be seen as uncontrolled and may not contain the latest updates. Document Source Infection Prevention and Control, Cork Kerry Community Healthcare, Cork Kerry Community Healthcare Page 1 of 21

2 SECTION 6 TRANSMISSION BASED PRECAUTIONS 1. Introduction 2. Contact Precautions 3. Droplet Precautions 4. Airborne Precautions Appendices Appendix 6.1 Transmission Based Precautions Signs Contact Precautions Droplet Precautions Airborne Precautions Appendix 6.2 Application of Standard and Transmission Based Precautions Appendix 6.3 Donning and Removal of Personal Protective Equipment Developed by Niamh Mc Donnell, Patricia Coughlan, Liz Forde, Helena Sheahan Infection Prevention & Control Nurses In conjunction with Date Approved September 2017 Approved by Cork Kerry Community Healthcare Healthcare Associated Infections (HCAI) / Antimicrobial Resistance (AMR) Committee Reference number IPCG 6.0/ 2017 Revision number 01 Revision cycle September 2020 or sooner if new evidence becomes available Responsibility for Infection Prevention and Control Nurses review Cork Kerry Community Healthcare Page 2 of 21

3 1. Introduction Transmission Based Precautions are additional precautions that are recommended when Standard Precautions alone may not be sufficient to prevent the transmission of certain infectious agents such as Clostridium difficile, influenza or tuberculosis etc. Transmission Based Precautions address the specific mode of transmission of the infecting micro-organism which can be by contact - direct or indirect, and/or droplet, and/or airborne. The key elements of Transmission Based Precautions are; Resident Placement Hand hygiene Personal protective equipment Transport Care equipment Environmental cleaning Management of laundry Occupational health and Duration of precautions. Before implementing Transmission Based Precautions, it is important to first consider; the individual resident the setting the infectious agent the presence of other vulnerable resident and the type of procedures/activities being undertaken. Please discuss individual cases with Infection Prevention and Control for further advice. Standard Precautions must always be used in addition to Transmission Based Precautions. Cork Kerry Community Healthcare Page 3 of 21

4 2. Contact Precautions Contact Precautions are recommended in addition to Standard Precautions when a resident is known or suspected to be infected or colonised with specific infectious agents that are spread by direct or indirect contact. Examples of infections spread by contact include, Clostridium difficile Infection (CDI), Norovirus or some multidrug resistant organisms (MDRO s). Standard Precautions must always be used in addition to Transmission Based Precautions. Please discuss individual cases with Infection Prevention and Control for further advice. Key Elements of Contact Precautions Resident Placement Appropriate resident placement is assessed in conjunction with infection prevention and control or, where relevant the Department of Public Health. A risk assessment will include the suspected/confirmed infection and the infection risk to other resident in the vicinity to determine resident placement. A single room with staff hand washing facilities and en-suite toilet facilities is the preferred option. However, if a single room is not available, the following options may be advised; 1. Single room with staff hand washing facilities but with no en-suite facilities. A dedicated commode must be used. 2. A single room without any hand washing or toilet facilities. A dedicated commode must be used. A notice should be placed on the room door/area advising visitors and other HCW s to report to staff-in-charge before entering. Signage indicating only the precautions that are required and not information regarding the residents condition to maintain their privacy. Refer to appendix 6.1 for Contact Precautions signs. Resident should be educated regarding the reason/indication for Contact Precautions, educated to wash their hands with soap and water after using the bathroom and before eating. Resident who are unable to perform hand hygiene should be given assistance and requested not to leave the room unless absolutely necessary. Hand Hygiene Hand hygiene is the single most important measure in preventing and reducing the spread of infection. In accordance with The WHO Moments for Hand Hygiene, clean hands 1. Before touching a resident. 2. Before aseptic or clean procedures. 3. After blood or body fluid exposure risk. 4. After touching a resident. 5. After touching resident surroundings/environment. Cork Kerry Community Healthcare Page 4 of 21

5 Hands should be decontaminated with an alcohol hand rub or an antimicrobial soap except in the following situations- C. difficile: Hands should be washed with soap (antimicrobial or nonantimicrobial) and water. Alcohol hand rubs are not effective against C. difficile spores. Research indicates that removal of C. difficile occurs as a result of the physical action of hand washing and rinsing (Dept of Health, 2014). Norovirus: There is conflicting evidence and guidance regarding the efficacy of hand hygiene products on Norovirus (WHO, 2009, Public Health England, 2012). Therefore from a practical application hand washing with soap and water is advised when caring for all patients with diarrhoea. Personal Protective Equipment (PPE) In addition to the PPE advised for Standard Precautions the following measures apply to resident being cared for using Contact Precautions: Disposable gloves and plastic aprons should be worn for all care activities that involve direct contact with the resident skin, equipment used for client care or surfaces in close proximity to the resident. Aprons and gloves should be put on before entering the resident room. PPE should be removed and hand hygiene performed before leaving the resident room. PPE should be disposed of in the resident room. During care gloves should be changed and hand hygiene carried out in line with the 5 moments for hand hygiene. Resident Transport The movement and transport of resident should be limited to essential purposes only. If movement or transport of a resident is required; Inform transport personnel and the receiving department/healthcare facility of the need for Contact Precautions. Remove and dispose of contaminated aprons and gloves and perform hand hygiene prior to transporting the resident being cared for using Contact Precautions. Don appropriate PPE (apron/gown and gloves) prior to touching the resident at the transport destination. Transport equipment (stretcher, bed, wheelchair) used for the transfer must be cleaned and decontaminated before use on another resident. Care Equipment In addition to Standard Precautions the following applies to resident being cared for using Contact Precautions. Only take essential equipment and supplies into the room. Do not overstock the room as unused stock will have to be discarded on cessation of Contact Precautions. Residents charts/records should not be taken into the room. Medical devices (e.g. thermometers, stethoscopes) and care equipment (e.g. commode) should be dedicated for individual resident use for the duration of Contact Precautions. Where possible use single use items. Cork Kerry Community Healthcare Page 5 of 21

6 If communal equipment is used, such equipment must be cleaned and disinfected in accordance with the manufacturers instructions, immediately after use. For majority of items use o a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. Environmental Cleaning In addition to Standard Precautions the following applies were a resident is being cared for using Contact Precautions. The residents environment should be thoroughly cleaned using a neutral detergent and water daily. Particular attention should be given to frequently touched surfaces (e.g. bed rails, over bed table, door handles) and equipment in the immediate vicinity of the resident. In addition to cleaning, the requirement for disinfection should be based on a risk assessment, considering the following: National guidance on specific infectious agents e.g Norovirus Resident ability to maintain their hygiene Degree of environmental contamination Local guidance from Infection Prevention and Control Nurse. Where required clean and disinfect the environment using either o a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. Disposable gloves should be worn for environmental cleaning/disinfection when implementing Contact Precautions. Deep cleaning of the environment following transfer/discharge/death of resident who was on Contact Precautions Prior to initiating environmental cleaning and disinfection: All privacy and window curtains must be removed and sent for laundering. All disposable items including paper towels and toilet paper must be discarded. All sterile and non-sterile supplies in the resident environment which cannot be reprocessed must be discarded. Clean and disinfect the environment and all resident care equipment using either o a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. Management of Laundry All linen from a resident being cared for using Contact Precautions should be placed in an alginate/water soluble bag for laundering and then placed in the appropriate laundry stream as per local laundry policy. Occupational Health Cork Kerry Community Healthcare Page 6 of 21

7 In addition to Standard Precautions, staff should be aware of their immune status for infectious pathogens (e.g. Varicella). Non- immune staff should avoid direct contact with infected resident. If a staff member is unsure of his/her immune status for a particular pathogen, it is advisable to clarify with the Occupational Health Department. Visitors Where visiting is essential advice visitors of the precautions needed before and after visiting including, not to visit other residents in the facility. Visitors should be encouraged to carry out hand hygiene before entering and on leaving the room, and before and after resident contact where they provide direct care. Visitors are not required to wear PPE unless they are carrying out direct care for a resident. Duration of Contact Precautions Infection Prevention and Control advice should be sought. Contact Precautions should be continued while the resident remains symptomatic and/or considered infectious or until the completion of effective treatment. Cork Kerry Community Healthcare Page 7 of 21

8 3. Droplet Precautions Droplet Precautions are recommended in addition to Standard Precautions for resident with infectious agents transmitted by large droplets. Droplet transmission occurs when large droplets from the respiratory tract of an infected individual are transferred directly on to a mucosal surface or conjunctivae (e.g. eyes, nose, mouth) of another individual. Respiratory droplets are expelled when a person is coughing, sneezing or talking, they may also be expelled during certain healthcare aerosol generating procedures such as intubation. Transmission from large particle droplets requires relatively close contact (approximately 3 feet) between the infected individual and another person. Examples of infections spread by droplets are influenza, meningococcal disease (for the first 24 hours of antimicrobial treatment), group A streptococcal (for the first 24 hours of antimicrobial treatment) and mumps. Standard Precautions must always be used in addition to Transmission Based Precautions. Please discuss individual cases with Infection Prevention and Control for further advice. Key Elements of Droplet Precautions Resident Placement Appropriate resident placement is assessed in conjunction with infection prevention and control or, where relevant the Department of Public Health. A risk assessment will include the suspected/confirmed infection and the infection risk to other resident in the vicinity to determine resident placement. A single room with staff hand hygiene and en-suite toilet facilities is the preferred option. The door of the room should remain closed. A notice should be placed on the room door/area advising visitors and other HCW s to report to staff-in-charge before entering. Signage indicating only the precautions that are required and not information regarding the residents condition to maintain their privacy. Refer to appendix 6.1 for Droplet Precautions signs. Resident should be educated regarding the reason/indication for Droplet Precautions, on respiratory hygiene and cough etiquette, on how and when to perform hand hygiene. Resident who are unable to perform hand hygiene should be given assistance and Residents should be requested not to leave the room unless absolutely necessary. Hand Hygiene Hand hygiene is the single most important measure in preventing and reducing the spread of infection. In accordance with The WHO Moments for Hand Hygiene, clean hands 1. Before touching a resident. 2. Before aseptic or clean procedures. 3. After blood or body fluid exposure risk. Cork Kerry Community Healthcare Page 8 of 21

9 4. After touching a resident. 5. After touching resident surroundings/environment. Personal Protective Equipment (PPE) In addition to the PPE advised for Standard Precautions the following measures apply to resident being cared for using Droplet Precautions: PPE is applied before entering the resident s room. put on and removed as outlined in Appendix 6.3 Donning and Removal of PPE Clean hands before leaving the resident room. Surgical face masks A fluid repellent surgical face mask should be worn by all HCW s when undertaking care activities and within 3 feet/1 metre of a resident. Masks should be changed when heavily contaminated e.g. wet with breath moisture or if torn or damaged. Masks are a single use items. Respirator mask (FFP2/3) mask may be required for specific suspected or confirmed infections during aerosol generating procedures such as intubation/manual ventilation of a resident with influenza. Gloves and Plastic Apron Gloves and a disposable plastic apron should be worn for all activities that involve direct contact with the residents skin or surfaces and equipment in close proximity to the client. During care gloves should be changed and hand hygiene carried out in accordance with the WHO 5 Moments for Hand Hygiene Resident Transport The movement and transport of resident should be limited to essential purposes only. If movement/transport of a resident is necessary Inform transport personnel and the receiving department/healthcare facility of the need for Droplet Precautions. If tolerated, the resident should be instructed to wear a surgical facemask, and instructed on respiratory hygiene and cough etiquette when moving outside their room. Healthcare workers should wear a surgical face mask where a resident is unwilling or unable to wear a surgical face mask. Remove and dispose of contaminated aprons and gloves and perform hand hygiene prior to transporting resident on Droplet Precautions. Don PPE prior to contact with the resident at the transport destination. Transport equipment (stretcher, bed, wheelchair) used for the transfer must be cleaned and disinfected after use. Care Equipment In addition to the Standard Precautions the following measures apply to resident on Droplet Precautions: Cork Kerry Community Healthcare Page 9 of 21

10 Only take essential equipment and supplies into the room. Do not overstock the room as unused stock will have to be discarded on cessation of Droplet Precautions. Resident charts/records should not be taken into the room. Medical devices (e.g. thermometers, stethoscopes) and resident care equipment (e.g. commode) should be dedicated for individual resident use for the duration of Droplet Precautions. Where possible use single use items. If communal equipment is used, such equipment must be cleaned and disinfected in accordance with the manufacturers instructions, immediately after use. For majority of items use o a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. Environmental Cleaning In addition to Standard Precautions the following applies to residents/client being cared for using Droplet Precautions. Clean and disinfect the environment using either o a neutral detergent and disinfect a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. The frequency of cleaning and disinfection may need to be increased if resident are producing copious amounts of respiratory secretions. Items or surfaces likely to be contaminated with blood or body fluids/excretions/secretions should be cleaned and disinfected immediately. Personal protective equipment as recommended above should be worn for environmental cleaning/disinfection due to Droplet Precautions. Deep cleaning of the environment following transfer/discharge/death of resident who was on Droplet Precautions Prior to initiating environmental cleaning and disinfection: o All privacy and window curtains must be removed and sent for laundering. o All disposable items including paper towels and toilet paper must be discarded. o All sterile and non-sterile supplies in the resident environment which cannot be reprocessed must be discarded on transfer/discharge. o Clean and disinfect the environment using either o a neutral detergent and disinfect a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. Cork Kerry Community Healthcare Page 10 of 21

11 Management of Laundry All linen from a resident being cared for with Droplet Precautions should be placed in an alginate/water soluble bag for laundering and then placed in the appropriate laundry stream as per local policy. Occupational Health In addition to Standard Precautions, staff should be aware of their immune status for infectious pathogens known to be transmissible via droplet route (e.g. mumps). Non-immune staff should avoid direct contact with infected resident. If a staff member is unsure of his/her immune status for a particular pathogen, it is advisable to clarify with Occupational Health Dept. Visitors Visitors should be limited and visitors who are non-immune to the infection should avoid contact until the resident is deemed to be no longer infectious to others. Where visiting is essential and visitors are non-immune, visitors should be educated on the precautions needed before and after visiting including 1. how to put on a surgical mask prior to entering the resident room 2. how to remove a surgical mask, dispose of it safely and clean their hands and 3. requested not to visit other resident in the facility. Duration of Droplet Precautions Infection Prevention and Control advice should be sought. Droplet Precautions should be continued while the resident remain symptomatic and/or considered infectious or until the completion of effective treatment. Cork Kerry Community Healthcare Page 11 of 21

12 4. Airborne Precautions Airborne Precautions are recommended in addition to Standard Precautions to prevent the transmission of infections spread by very small respiratory particles which are expelled from an infected individual during activities like coughing, sneezing or talking. They are also generated during particular healthcare aerosol generating procedures such as intubation. Examples of infection spread by airborne route are infectious pulmonary or laryngeal tuberculosis, rubella, measles and chicken pox. Standard Precautions must always be used in addition to Transmission Based Precautions. Please discuss individual cases with Infection Prevention and Control for further advice. Key Elements of Airborne Precautions Resident Placement Where applicable contact Infection Prevention and Control/the Department of Public Health to assess appropriate resident placement. A risk assessment will include the suspected/confirmed infection and the infection risk to other residents in the vicinity to determine resident placement. Depending on what infection is suspected, An airborne isolation room may be required. An airborne isolation room is a negative pressure isolation room with an anteroom or a room with neutral pressure design. The door must remain closed. However if an airborne isolation room is not available, the following may be advised; 1. transfer to another unit/hospital with suitable facilities, 2. a single room with staff hand washing and ensuite facilities and the door must remain closed. A notice should be placed on the room door/area advising visitors and other HCW s to report to staff-in-charge before entering. Signage indicating only the precautions that are required and not information regarding the residents condition to maintain their privacy. Refer to appendix 6.1 for Airborne Precautions signs. Resident should be educated regarding the reason/indication for Airborne Precautions on respiratory hygiene and cough etiquette on how and when to perform hand hygiene. Resident who are unable to perform hand hygiene should be given assistance Residents should be instructed not to leave the room unless absolutely necessary and to wear a surgical facemask if movement outside the room is required and is tolerated. Hand Hygiene Hand hygiene is the single most important measure in preventing and reducing the spread of infection. In accordance with The WHO Moments for Hand Hygiene, decontaminate hands Cork Kerry Community Healthcare Page 12 of 21

13 1. Before touching a resident. 2. Before aseptic or clean procedures. 3. After blood or body fluid exposure risk. 4. After touching a resident. 5. After touching resident surroundings/environment. Personal Protective Equipment (PPE) In addition to the PPE advised for Standard Precautions the following measures apply to residents being cared for using Airborne Precautions: PPE is applied before entering the resident s/client s room. put on and removed as outlined in Appendix 6.3 Donning and Removal of PPE Clean hands before leaving the resident room. Respiratory Masks and other face protection FFP3 masks are recommended for aerosol generating procedures (e.g. suctioning) for all residents and for routine care of residents with Multi Drug Resistant TB (MDR- TB) and Extensively Drug Resistant TB (XDR-TB). FFP2 masks are recommended for routine care of residents with known or suspected pulmonary or laryngeal TB where MDR-TB or XDR-TB is not suspected. HCWs visiting a resident in their own home should wear either an FFP2 or FFP3 mask in accordance with the above recommendations for FFP2 and FFP3 masks. Resident privacy must be maintained if mask is worn in the home. Apply the mask on entry in to the home and remove mask on leaving the home. The supervising clinician should be consulted before the use of masks is discontinued. The FFP 2 and FFP 3 masks must; Conform to EN Be fit tested. In order to be effective the mask must fit tightly to the wearers face, fit testing should be undertaken by a trained professional. Be fit checked (i.e. the wearer must check that the mask fits properly on their face every time they enter the resident area). Be put on before entering the isolation room. Be changed when torn or damaged. Be removed and disposed of as per local waste policy. Gloves and a disposable plastic apron Gloves and a disposable plastic apron should be worn for all activities that involve direct contact with the resident/residents skin or surfaces and equipment in close proximity to the resident/resident (e.g. medical equipment, beside locker, bed rails etc). PPE must be changed and hand hygiene performed in accordance with WHO 5 Moments for hand hygiene during care. Cork Kerry Community Healthcare Page 13 of 21

14 Care Equipment In addition to the Standard Precautions the following measures apply to resident on Airborne Precautions: Only take essential equipment and supplies into the room. Do not overstock the room as unused stock will have to be discarded on cessation of Airbourne Precautions. Resident charts/records should not be taken into the room. Medical devices (e.g. thermometers, stethoscopes) and resident care equipment (e.g. commode) should be dedicated for individual resident use for the duration of Airborne Precautions. Where possible use single use items. If communal equipment is used, such equipment must be cleaned and disinfected in accordance with the manufacturers instructions, immediately after use. For majority of items use o a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. Environmental Cleaning In addition to Standard Precautions the following applies to residents being cared for using Airborne Precautions. Clean and disinfect the environment using either o a neutral detergent and disinfect a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. The frequency of cleaning and disinfection may need to be increased if resident are producing copious amounts of respiratory secretions. Items or surfaces likely to be contaminated with blood or body fluids/excretions/secretions should be cleaned and disinfected immediately. Personal protective equipment as recommended above should be worn for environmental cleaning/disinfection due to Airborne Precautions. Deep cleaning of the environment following transfer/discharge/death of resident who was on Airborne Precautions Prior to initiating environmental cleaning and disinfection: All privacy and window curtains must be removed and sent for laundering. All disposable items including paper towels and toilet paper must be discarded. All sterile and non-sterile supplies in the resident environment which cannot be reprocessed must be discarded on transfer/discharge. Clean and disinfect the environment using either o a neutral detergent and disinfect a general purpose neutral detergent in a solution of warm water followed by a disinfection solution of 1,000 parts per million (ppm) available chlorine or o a combined detergent/disinfectant solution at a dilution of 1,000 ppm available chlorine. Cork Kerry Community Healthcare Page 14 of 21

15 Resident Movement/Transport Residents being cared for using Airborne Precautions should not be transferred unless their medical condition warrants it or for placement in an appropriate isolation room. If movement/transport of a resident is necessary; The resident should be encouraged to wear a surgical mask, and instructed on respiratory hygiene and cough etiquette. Surgical masks if worn should be changed when heavily contaminated, wet with breath moisture or damaged. It may be necessary for transport personnel to wear a surgical mask or respirator (depending on the individual disease suspected) if the resident cannot tolerate wearing a surgical mask. FFP2 or FFP3 masks are not recommended for use by resident on Airborne Precautions. Remove and dispose of contaminated aprons and gloves and perform hand hygiene prior to transporting residents on Airborne Precautions. Don appropriate PPE (apron/gown and gloves) prior to contact with the resident at the transport destination. Management of Laundry All linen from a resident being cared for using Airborne Precautions should be placed in an alginate/water soluble bag for laundering and then placed in the appropriate laundry stream as per local policy. Occupational Health In addition to Standard Precautions, staff should be aware of their immune status for infectious pathogens known to be transmitted via the airborne route (e.g., varicella zoster virus, measles virus). Non-immune staff should avoid direct contact with infected residents. Specific guidance should be sought from the occupational health department. Visitors Visitors should be limited and visitors who are non-immune to the infection should avoid contact until the resident is deemed to be no longer infectious to others. Where visiting is essential and visitors are non-immune, visitors should be educated on the precautions needed before and after visiting including 1. how to put on the appropriate mask prior to entering the resident room 2. how to remove the mask, dispose of it safely and clean their hands and 3. requested not to visit other residents in the facility. Duration of Airborne Precautions Airborne precautions should continue until signs and symptoms of infection have resolved, or upon completion of the infectious period, or until effective treatment has been completed. In the case of TB the duration of precautions will be on the advice of the supervising physician. Cork Kerry Community Healthcare Page 15 of 21

16 References and Bibliography Department of Health (2014) Surveillance, Diagnosis and Management of Clostridium difficile Infection in Ireland National Clinical Guideline No. 3 Available at Z/Gastroenteric/Clostridiumdifficile/Guidelines/File,13950,en.pdf Healthcare Infection Control Practices Advisory Committee (2007) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Health Protection Surveillance Centre (2010) Guidelines on the Prevention and Control of Tuberculosis in Ireland National TB Advisory Committee Dublin. Amended Public Health England (2012) Norovirus: managing outbreaks in acute and community health and social care settingshttps:// Royal College of Physicians of Ireland/HSE (2015) Guidelines for Hand Hygiene in Irish Healthcare Settings (2015) update of the 2005 Guidelines, Dublin. Z/Gastroenteric/Handwashing/Publications/File,15060,en.pdf World Health Organisation (2009) WHO Guidelines on Hand Hygiene in Healthcare. First Global Resident Safety Challenge. World Health Organisation (2012) Hand Hygiene in Out Patient and Home based care and Long-term care facilities. Geneva. Cork Kerry Community Healthcare Page 16 of 21

17 Appendix 6.1 Transmission Based Precaution Signs Contact Precautions Posters available on Cork Kerry Community Healthcare Page 17 of 21

18 Appendix 6.1 Transmission Based Precautions Signs Droplet Precautions Posters available on Cork Kerry Community Healthcare Page 18 of 21

19 Appendix 6.1 Transmission Based Precaution Signs Airborne Precautions Posters available on Cork Kerry Community Healthcare Page 19 of 21

20 Appendix 6.2 Application of Standard and Transmission Based Precautions Type of precautions Example of infectious agent Single room Gloves Apron/gown Mask Application and Removal of PPE Standard Standard precautions apply to the care of all residents regardless of their diagnosis or presumed infectious status Contact Droplet Airborne C. difficile, enteric infections, Norovirus, infectious skin conditions Influenza, meningococcal disease, mumps Open Pulmonary/Laryngeal TB, chicken pox, measles Apply PPE before entering single room Remove and dispose of PPE inside single room Apply PPE before entering single room Remove and dispose of PPE inside single room Apply PPE before entering single room Remove and dispose of PPE outside single room Cork Kerry Community Healthcare Page 20 of 21

21 Appendix 6.3 Donning and Removal of Personal Protective Equipment Cork Kerry Community Healthcare Page 21 of 21