IC.04.04 DROPLET and DROPLET & CONTACT PRECAUTIONS REV. JULY 2017 Standard In addition to Routine Practices, Droplet Precautions will be used for patients known or suspected of having an infection with a microorganism that can be transmitted by large respiratory droplets. Some microorganisms may also be transmitted by the Contact Route so will require both Droplet & Contact Precautions. A physician's order is not required to initiate Droplet or Droplet & Contact Precautions. Droplet or Droplet & Contact Precautions will be discontinued only in consultation with the Infection Prevention & Control Service (IPACS). Examples of conditions and microorganisms requiring Droplet Precautions are: respiratory tract viruses or bacteria (e.g., rubella, mumps and pertussis.) Examples of conditions and microorganisms requiring Droplet & Contact Precautions are: respiratory tract viruses (e.g., norovirus, adenovirus, influenza, parainfluenza, rhinovirus, human metapneumovirus, respiratory syncytial virus (RSV)), and congenital rubella. Refer to the table in Section 5 for Infection Control Precautions on specific infectious diseases, conditions and/or microorganisms for children, adult and maternal-infant population. Description of Droplet Transmission Droplet transmission occurs when droplets carrying an infectious agent exit the respiratory tract of a person. These droplets may be produced during coughing, sneezing or certain procedures such as suctioning. These droplets are propelled a short distance and may enter the susceptible host s eyes, nose or mouth or fall onto surfaces. Studies suggest that droplets forcibly expelled by a cough or sneeze travel for up to two meters. Droplets do not remain suspended in the air. Microorganisms contained in these droplets are deposited on surfaces in the patient s immediate environment and some microorganisms remain viable for extended periods of time. Contact transmission can then occur by touching surfaces and objects contaminated with respiratory droplets. Description of Contact Transmission Contact transmission is the most common route of transmission of infectious agents. There are two types of contact transmission: Direct contact is the transfer of microorganisms via direct physical contact between an infected or colonized individual and a susceptible host (body surface to body surface). Transmission may result in infection. Indirect contact is a passive transfer of microorganisms to a susceptible host via an intermediate object, such as contaminated hands that are not cleaned between episodes of patient care, contaminated instruments that are not cleaned between patients/uses or other contaminated objects in the patient s immediate environment. INTERVENTIONS FOR DROPLET PRECAUTIONS Routine Practices are used by all Health care workers (HCW) for all patients. The following additional precautions will be used for all patients on Droplet Precautions. IC.04.04 Infection Prevention & Control Manual Page 1 of 5
Accommodation or Patient Placement Acute Care o Single room with patient sink and toilet, bathing facilities, and dedicated staff hand washing sink is preferred. o If a private bathroom is not available, then a commode must be dedicated to the patient during the entire stay. o Negative pressure is not required. o Door may remain open. o Pass-through cupboards will remain unlocked when Droplet or Droplet & Contact Precautions are put in place. o If a single room is not possible, consult IPACS. o Patients should not wait in a common area/waiting room. o Patients should be placed into an examining room as soon as possible, maintaining a 2 meter separation between patients. Signage A Droplet Precautions Sign must be placed at the entrance of the patient room that is visible to all those who enter the room. Personal Protective Equipment (Note: please refer to IC.03.05 Personal Protective Equipment for more information) Acute Care: Masks and Eye Protection or Face Shield A surgical or procedure mask and eye protection must be worn by any individual who is within two meters of the patient on Droplet Precautions. o Exception: For care of patients with rubella and mumps, a mask is not needed if the HCW is immune. If the HCW is not immune or is not aware of immune status, the HCW should not be assigned to care for that patient (nor enter the room) unless absolutely essential. Mask and eye protection must be worn within 2 meters of the patient. Other Personal Protective Equipment such as gloves and gown may be used based on the risk assessment (e.g., nature of interaction, status of patient). Please refer to IC.03.04 Routine Practices - Risk Assessment. Equipment Environmental Cleaning Dishes, Glasses, Cups and Eating Utensils IC.04.04 Infection Prevention & Control Manual Page 2 of 5
Patient Transport/Transfer/Discharge Avoid transfer within and between facilities if possible unless medically necessary. Receiving department must be notified of the precautions in place, prior to transport, and make a notation of precautions required when preparing requisition. The patient must wear a mask during transport if tolerated. If the patient cannot tolerate wearing a mask, the transport staff should wear a mask and eye protection. On discontinuation of Additional Precautions and discharge: o All disposable patient equipment and supplies must be disposed of and not returned to general stock. Supplies may be sent with patients who are transferred. o All reusable equipment must be cleaned and reprocessed as per established guidelines o Contact Environmental Services for room cleaning. Visitors Visitors of patients on Additional Precautions in health care facilities should be kept to a minimum. HCW must inform patients and visitors about the reason for implementing Droplet Precautions and should provide instruction on how to enter and leave the room safely, hand hygiene, respiratory etiquette, and a demonstration in putting on, taking off and disposing of PPE, if required. Household members may choose to wear PPE. Visitors, other than household members, should wear required PPE. For rubella, mumps or pertussis, visitors who are susceptible to the disease or unaware of their immune status should not visit unless absolutely necessary. Instruct visitors and family to visit patient only and not go to other shared patient care areas of the hospital (e.g., playroom, teen lounge, school room, patient kitchen). Documentation In progress notes, enter date and time that Droplet Precautions were started and discontinued. INTERVENTIONS FOR DROPLET & CONTACT PRECAUTIONS Routine Practices are used by all Health care workers (HCW) for all patients. The following additional precautions will be used for all patients on Droplet & Contact Precautions. Accommodation or Patient Placement Same as interventions for Droplet Precautions. Please see above. In addition: if a private bathroom is not available, then a commode must be dedicated to the patient during the entire stay. Signage A Droplet & Contact Precautions Sign must be placed at the entrance of the patient room that is visible to all those who enter the room. Personal Protective Equipment (Note: please refer to IC.03.05 Personal Protective Equipment for more information) Acute Care: IC.04.04 Infection Prevention & Control Manual Page 3 of 5
Masks and Eye Protection or Face Shield A surgical or procedure mask and eye protection must be worn by any individual who is within two meters of the patient on Droplet & Contact Precautions. Gloves Always perform hand hygiene before donning gloves and after removal. Gloves must be worn on entering the patient s room or bed space. Change gloves during care to prevent cross-contamination of sites. Gowns A gown must be worn when entering room. Remove gown before leaving the room and discard in the laundry hamper or garbage if disposable. Do not re-use gown. After gown removal, ensure clothes do not contact contaminated surfaces. A gown, gloves, mask and eye protection must be worn by any individual who is within two meters of the patient on Droplet & Contact Precautions. Equipment Environmental Cleaning Dishes, Glasses, Cups and Eating Utensils Patient Transport/Transfer/Discharge Avoid transfer within and between facilities if possible unless medically necessary. The patient must wear a mask during transport if tolerated. If the patient cannot tolerate a wearing a mask, the transport staff should wear a mask and eye protection. It is not appropriate for the patient to wear gloves or isolation gowns while outside their room. HCW should wear gloves and gowns for direct contact with patient during transport. On discontinuation of Additional Precautions and discharge: o All disposable patient equipment and supplies must be disposed of and not returned to general stock, Supplies may be sent with patients who are transferred. o All re-usable equipment must be cleaned and reprocessed as per established guidelines o Contact Environmental Services for room cleaning. Visitors Visitors of patients on Additional Precautions in health care facilities should be kept to a minimum. HCW must inform patients and visitors about the reason for implementing Droplet & Contact Precautions and should provide instruction on how to enter and leave the room safely, hand hygiene, respiratory etiquette, and a demonstration in putting on, taking off and disposing of PPE, if required. Household members may choose to wear PPE. Visitors, other than household members, should wear required PPE. For rubella, mumps or pertussis, visitors who are susceptible to the disease or unaware of their immune status should not visit unless absolutely necessary. IC.04.04 Infection Prevention & Control Manual Page 4 of 5
Instruct visitors and family to visit patient only and not go to other shared patient care areas of the hospital (e.g., playroom, teen lounge, school room, patient kitchen). Documentation In progress notes, enter date and time that Droplet & Contact Precautions were started and discontinued. Resources: Droplet Precaution Sign PHSA344 available through Print Shop. Droplet & Contact Precaution Sign PHSA343 available through Print Shop. REFERENCES Association for Professionals in Infection Control and Epidemiology (APIC). Chapter 29: Isolation Precautions. APIC Text of Infection Control and Epidemiology. October, 2014. Provincial Infectious Diseases Advisory Committee (PIDAC). Routine Practices and Additional Precautions in All HealthCare Settings. 3rd edition. Ontario Agency for Health Protection and Promotion. Toronto, ON, November 2012. http://www.publichealthontario.ca/en/erepository/rpap_all_healthcare_settings_eng2012.pdf. Public Health Agency of Canada (PHAC). Routine Practices and Additional Precautions for Preventing the Transmission of Infection in HealthCare Settings. Ontario, 2013. http://publications.gc.ca/collections//collection_2013/aspc-phac/hp40-83-2013-eng.pdf Reviewed July 2017. IC.04.04 Infection Prevention & Control Manual Page 5 of 5