Currently 6% of patients globally contract a healthcare associated infection as a result of receiving care.
Viruses, bacteria and fungi are always present in healthcare facilities. Without procedures in place to limit these germs multiplying and spreading, patients are at risk of acquiring dangerous infections. It is crucial that hospitals and aged care facilities follow basic infection control precautions when treating patients to limit the risk of cross-infection.
These precautions are separated into the following 2 stages:
Standard infection control precautions (SICPs)
Standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of the suspected or confirmed infection status of the patient.
Transmission-based precautions (TBPs)
Transmission-based precautions are additional precautions put in place to prevent cross transmission of specific infectious agents. Transmission based precautions should be applied when caring for:
- Patients with a known infection
- Patients who are colonised with an infectious organism
- Patients who are suspected of colonisation or infection with an infectious microorganism (even if they are asymptomatic).
It is important that these precautions are carefully followed to protect healthcare staff, visitors and other patients. In the rest of this article, we will further explore transmission-based precautions.
3 transmission-based precautions
There are 3 different transmission-based precautions that have been categorized based on how the infectious agent is transmitted:
1. Contact precautions
Contact precautions should be put in place as soon as a patient is known or suspected of having an infection, that represents an increased risk of contact transmission. This includes MRSE, VRE and C Difficile.
A study found that there are over 93 contact episodes per hour between patients, staff and visitors, demonstrating the potential for cross-infection. Contact precautions are important to help stop the infection spreading by either direct contact with an infected patient or indirect contact with contaminated items in the patient’s environment.
There are several precautions that healthcare facilities should put in place:
- Use the appropriate personal protective equipment (PPE), including disposable gloves and gowns. Ensure that all PPE is properly and safely discarded after being in contact with the infected patient, to limit the risk of cross-infection.
- Ensure that the patient is isolated from others in your facility, limiting their movements outside of their room as much as possible to reduce the risk of infection spreading.
- Use disposable patient care equipment wherever possible, to eliminate the risk of patient-to-patient contamination. One of the easiest switches you can make is using disposable, pulp containers such as bedpans, washbowls and urinals, instead of reusable plastic containers.
- In situations where it is necessary to reuse equipment for multiple patients (e.g. blood pressure cuffs, commodes etc.), carefully clean and disinfect all equipment between each use. This can be done by using 70% IPA Disinfectant wipes which eliminates 99.9999% of bacteria living on surfaces
- Prioritise environmental cleaning and disinfection to inhibit the build-up of infectious agents and reduce the risk of transmission. There should be a focus on frequently touched surfaces and equipment in the patient’s vicinity, although it is important that all surfaces are well disinfected.
- Upgrade to touchless technology wherever possible to minimise pathogens spreading from surface to surface. Hospital macerators are one example of an upgrade your facility can make to greatly reduce the risk of infection. There are several high-risk contact points when healthcare workers load dirty items into a bedpan washer. Contactless hospital macerators ensure that dirty bedpans and their contents are disposed of without having to touch any potentially contaminated surfaces.
2. Droplet precautions
Droplet precautions should be put in place as soon as a patient is known or suspected of being infected with a disease that is transmitted by respiratory droplets. Droplet precautions help to prevent transmission of pathogens when an infected person coughs, sneezes or talks. These infected droplets put others at risk from both direct inhalation and indirect contact, when they touch droplets that have landed on nearby surfaces.
Healthcare facilities can prevent transmission of these pathogens in a number of ways:
- Use the appropriate personal protective equipment (PPE) including a face mask, gloves and a gown as soon as you enter the patient’s room. If you are within 2 metres of the patient, eye protection is also necessary.
- Limit the patient’s movements around the facility as much as possible. When it is medically necessary to move a patient, ask them to wear a face mask and carefully follow respiratory hygiene. This includes asking the patient to cover their mouth when they cough or sneeze and ensure they use a tissue to reduce the risk of transmitting germs on their hands.
- Try to ensure that infected patients are isolated in their own room with a private toilet and sink. Where this is not possible and patients do have to share a room, they should be placed at least 2 metres from others. In these cases, privacy curtains are recommended to minimise the opportunity of droplets spreading. For cohabiting patients, it is important that you carefully consider the risk of infection to other uninfected patients sharing the room. Always determine the safest solution that does not place immunocompromised patients at risk.
3. Airborne precautions
Airborne precautions should be put in place when an individual is known or suspected of being infected with microbes that are spread through the air. Examples of airborne diseases include tuberculosis, measles and chickenpox.
Controlling airborne diseases is particularly difficult because the infection can be spread and caught simply by breathing. It is therefore very important that these precautions are quickly put into place:
- Ensure patients are placed in an airborne isolation room with a private toilet and sink for the patient to use and a separate, designated sink for healthcare professionals. In settings where Airborne Precautions cannot be implemented due to limited engineering resources, make sure the patient is masked and placed in a private room with the door closed, to reduce the risk of airborne transmission to other patients or staff.
- Wherever possible, restrict which healthcare professionals visit the patient’s room, to only those who have immunity to the disease. This immunity may be because they have been vaccinated, or because they have already been ill and recovered from the infection.
- Always use PPE appropriately, when dealing with airborne diseases, this includes using a N95 or higher-level respirator upon entering the patients’ room. These high efficacy masks work by filtering the very fine particles that might otherwise be transmitted, to provide extra protection for staff.
- During aerosol generating procedures, such as intubation and manual ventilation, ensure that healthcare professionals are equipped with full PPE, including high efficacy masks, to protect them from becoming infected.
- Limit the patient’s movement around the facility as much as possible. When it is medically necessary to move a patient, ask them to wear a face mask and carefully follow respiratory hygiene. This includes asking the patient to cover their mouth when they cough or sneeze and ensure they use a tissue to reduce the risk of the patient transmitting germs on their hands.
- Upon discharge or discontinuation of airborne precautions the door to the isolation room must remain closed and negative air flow maintained until all air in the room has been replaced.
For more information on both standard and transmission-based precautions the CDC website is a great resource.
If you are interested in reviewing and updating your infection prevention practices and procedures, in the field of human waste disposal and environmental cleaning, Vernacare are here to help. Find out more about our market-leading hygiene solutions that help healthcare facilities around the world prevent infection and create a safer future.