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 Cork Kerry Community Healthcare Page 1 of 5
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 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 EN1492001 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). Cork Kerry Community Healthcare Page 2 of 5
PPE must be changed and hand hygiene performed in accordance with WHO 5 Moments for hand hygiene during care. 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 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 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 Cork Kerry Community Healthcare Page 3 of 5
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 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 Cork Kerry Community Healthcare Page 4 of 5
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 5 of 5