Word: Airborne Precautions



IC.04.03 StandardIn addition to Routine Practices, Airborne Precautions will be used for patients known or suspected of having an infection with a microorganism that is transmitted by the airborne route. A prescriber’s order is not required to initiate Airborne Precautions.Nursing staff will notify Infection Prevention and Control (IPAC) that Airborne Precautions have been initiated. Airborne Precautions will be discontinued only in consultation with IPAC. All health care workers (HCW) are to wear a fit-tested N95 respirator when entering the room of a patient on airborne precautions. .Note: If the number of negative pressure rooms is limited, priority for use will be decided by IPAC according to the impact of potential airborne transmission.Examples of microorganisms that are spread by the airborne route include: Mycobacterium tuberculosis, measles virus (rubeola). Refer to the table in Section 5 for Infection Control Precautions for specific infectious diseases, conditions and/or microorganisms for children, adult and maternal-infant population.Refer to “IC.06.10 Management of Emerging Respiratory Illnesses for more information”.Description of Airborne TransmissionAirborne transmission may occur when viable microorganisms contained in aerosolized secretions from an infected source are propelled a short (i.e., within two meters) or long (i.e., greater than two meters) distance through the air are inhaled, come into contact with receptors in a susceptible host’s airway, overcome host defenses and cause disease. For transmission of infection to occur, the microorganisms contained in the particles must be capable of remaining viable in the air for a prolonged period of time, and the susceptible host must be exposed to a sufficient concentration (infectious dose) of these viable microorganisms.Control of airborne transmission requires control of air flow through special ventilation systems and the use of respirators.Effective control of airborne microorganisms hinges on maintaining a high degree of suspicion for those who present with compatible symptoms of an airborne infection, early isolation in an appropriate environment and rapid diagnosis. Immunization plays a key role in preventing the transmission of measles and varicella (two vaccine-preventable airborne diseases). Interventions for Airborne PrecautionsRoutine Practices are used by all HCW for all patients. Patient Placement Single room accommodation in an airborne isolation room with an anteroom is preferred.If an airborne isolation room is not available, a negative pressure room is preferred. If either of the above rooms is not available, a single room may be used and the patient examined and discharged or transferred as quickly as possible. For admitted patients on inpatient units, the room must have a patient sink and toilet, bathing facilities, and dedicated staff hand washing sink.The doors and windows must remain closed and pass-through cupboards will be locked and not used.Patient must not visit shared patient care areas (playroom, school room or family kitchens)Patients shall not wait in a common area/waiting room. In outpatient settings patients shall be placed into an examining room immediately, with the door closed. ***If a room other than an airborne isolation room is used the room needs to remain closed to other patients until sufficient air exchanges have occurred. Contact IPAC to determine the appropriate amount of time that the room should remain closed. If staff needs to enter the room prior to this time period, they must wear an N95 Respirator. Please contact IPAC for any questions on patient placement.SignageAn “Airborne 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 Refer to IC.03.05 Personal Protective Equipment for more information)Acute Care and Ambulatory Care/Emergency:RespiratorsSelect an N95 Respirator for which the HCW has been fit-tested.Perform a seal-check each time a respirator is applied.Apply an N95 Respiratory prior to entering the patient’s room*Remove the respirator correctly by the strings outside the patient room after the door is closed. Other Personal Protective equipment such as gloves, gowns, and face protection may be used based on the risk assessment (e.g., nature of interaction, status of patient) as outlined in Routine Practices.EquipmentPlease refer to IC.04.01 Principles of Additional Precautions. Environmental CleaningPlease refer to IC.04.01 Principles of Additional Precautions. Dishes, Glasses, Cups and Eating UtensilsPlease refer to IC.04.01 Principles of Additional Precautions. Patient Transport/Transfer/DischargeAvoid transfer within and between facilities if possible unless medically necessary.IPAC must be consulted prior to transport of patients on Airborne Precautions. Receiving department must be notified of the precautions in place, prior to transport. Notation of precautions is required when preparing the requisition.If it is not possible to do procedures in the patient’s room, special arrangements must be made with the specific department (e.g. Radiology, OR, PACU). The department will consider the following; arranging the test at the end of the day when no other patients are in the department, arranging an appropriate room, organizing the appropriate staff, supplies, and equipment. Consult with IPAC. The patient must wear a procedure/surgical mask during transport, if tolerated. It is not appropriate for the patient to wear gloves or isolation gowns while being transported outside their room. HCW must wear an N95 Respirator during transport.On discontinuation of Additional Precautions and discharge: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.All reusable equipment/items must be cleaned and reprocessed as per established guidelines.Contact Environmental Services for room cleaning.The door to the patient’s room must be kept closed until sufficient air exchanges have occurred. Contact IPAC to determine. If staff needs to enter the room prior to this time period, they must wear an N95 Respirator. This room must not be used by another patient until sufficient air exchanges have occurred. VisitorsVisitors of patients on Airborne Precautions in health care facilities should be kept to a minimum.HCW must inform patients and visitors about the reason for implementing Airborne Precautions and should provide instruction on how to enter and leave the room safely, hand hygiene, respiratory etiquette, and demonstrate putting on, taking off and disposing of PPE, if required.Household members may choose to wear PPE.Visitors, other than household members, must wear required PPE.For patients who are suspected or confirmed to have Tuberculosis (TB), household contacts must be assessed for active TB. Household contacts are not required to wear an N95 Respirator when visiting the patient in the room, as they will already have been exposed in the household. Household contacts of patients suspected or known to have TB must wear a surgical mask when moving through the hospital until their TB status has been determined. Instruct visitors and family to visit patient only and not go to other shared patient care areas (e.g., playroom, teen lounge, school room, patient kitchen).DocumentationIn progress notes, enter date and time that Airborne Precautions were started and discontinued. Related DocumentsAirborne Precaution Sign – PHSA341 – available through Print Shop.ReferencesAssociation for Professionals in Infection Control and Epidemiology (APIC). Chapter 29: Isolation Precautions. APIC Text of Infection Control and Epidemiology. October, 2014.Canadian Standards Association. Special Requirements for Heating, Ventilation, and Air Conditioning (HVAC) Systems In Health Care Facilities (Z7317.2-15 Or Newest Version).Canadian Standards Association. Selection, use, and care of respirators. (Z94.4-11.Or Newest Version).Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, MMWR, December 30, 2005/54(RR17):1. Infectious Diseases Advisory Committee (PIDAC), Ministry of Health and Long Term Care, Routine Practices and Additional Precautions In All Health Care settings November, 2012, Ontario. Health Agency of Canada (PHAC). Canadian Tuberculosis Standards, 7th edition, 2014. Health Agency of Canada (PHAC). Routine Practices and Additional Precautions for Preventing the Transmission of Infection in HealthCare Settings. Ontario, 2013. group of Occupational Health & Safety Professionals from each of the Health Authorities in the Province of British Columbia. Respiratory Protection Program for Air-Purifying Respirators. September, 2013. ByInfection Prevention & Control – Infection Control PractitionerVersion HistoryDATEDOCUMENT NUMBER and TITLEACTION TAKEN26-Sept-2019C-0506-15-60380 Airborne PrecautionsApproved at: Infection Control CommitteeDisclaimerThis document is intended for use?within?BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document.?This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.? ................
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