Additional Precautions - WRHA Professionals

[Pages:34]Winnipeg Regional Health Authority Personal Care Home/Long Term Care Facility Infection Prevention & Control Manual

Additional Precautions 1. Introduction Additional Precautions are infection prevention and control precautions and practices required in addition to Routine Practices. They are based on the mode (means) of transmission of the infectious agent: airborne, droplet, and contact. Some microorganisms may be transmitted by more than one route which would indicate more than one type of Additional Precautions are required (e.g., Airborne/Contact, Droplet/Contact). Additional Precautions is the isolation system that will be used for residents with specific infectious diseases in personal care homes within the Winnipeg Regional Health Authority. It is not necessary to wait for a specific diagnosis or microbiological confirmation to implement additional precautions. Additional Precautions include:

o Airborne o Contact o Airborne/Contact o Droplet o Droplet/Contact Signs are available for specific Additional Precautions (Appendices 5A, 5B, 5C, 5D, 5E). Refer to the Management of Communicable Diseases in Personal Care Homes table (Section 8) for specific Additional Precautions required. Refer to Disease Specific Protocols (Section 9) for additional information.

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Winnipeg Regional Health Authority Personal Care Home/Long Term Care Facility Infection Prevention & Control Manual

2. Implementation of Additional Precautions To implement Additional Precautions:

2.1 Post the appropriate Additional Precautions sign on the door if the resident is in a private room. ? If the resident is in a multi-bed room, post the sign on the door and in an easily identified location in the room (e.g., on the privacy curtain).

2.2 Obtain isolation supplies according to facility procedure. 2.3 Do not overstock supplies in the resident room. 2.4 No special precautions are required for linen and dishes other than

Routine Practices. 2.5 Discuss the Additional Precautions with the resident. Refer to

Resident/Family/Visitor Information Sheets (Appendices 5F, 5G, 5H, 5I, 5J). 2.6 Notify: 2.6.1 The physician, if required 2.6.2 Infection Prevention and Control/designate 2.6.3 Housekeeping 2.6.4 Family, if required 2.7 Document on the resident's health record the type of Additional Precautions, and the date and time the Additional Precautions were implemented.

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Winnipeg Regional Health Authority Personal Care Home/Long Term Care Facility Infection Prevention & Control Manual

3. Discontinuation of Additional Precautions Discontinue Additional Precautions in consultation with the Infection Prevention & Control Practitioner/designate. When Additional Precautions are discontinued: 3.1 Maintain the indicated Additional Precautions until the room has been cleaned. 3.2 Clean and disinfect reusable non-critical equipment with a facilityapproved disinfectant. 3.3 Discard all disposable supplies/equipment if unable to appropriately clean and disinfect. 3.4 If no sterile reprocessing department is available in your facility, arrangements must be made to send semi critical devices to a facility where sterile processing can occur. 3.5 If the resident was on Airborne Precautions, leave the Additional Precautions sign on the door and keep the door closed for 1 hour before cleaning. 3.6 Contact housekeeping to clean the room. 3.7 Document on the resident's health record the date and time Additional Precautions were discontinued.

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Winnipeg Regional Health Authority Personal Care Home/Long Term Care Facility Infection Prevention & Control Manual

4. Airborne Precautions 4.1 Introduction

Airborne Precautions are required for residents diagnosed with, or suspected of having an infectious microorganism transmitted by the airborne route. For a description of airborne transmission refer to section 3 page 5. Airborne Precautions are followed in addition to Routine Practices. Routine Practices shall be adhered to at all times by all healthcare workers.

4.2 Indications for Airborne Precautions Airborne Precautions are implemented according to the Management of Communicable Diseases in Personal Care Homes table (Section 8). Refer to this table for specific disease/microorganism information. To implement Additional Precautions reference Implementation of Additional Precautions (Section 5, page 2).

4.3 Accommodation Ideally residents on Airborne Precautions are placed in a single room with negative pressure ventilation. When a negative pressure isolation room is not available consult Infection Prevention and Control/designate before resident placement. All attempts must be made to accommodate the resident in a single room. NOTE: Facilities that cannot provide properly ventilated (e.g., negative pressure) rooms should transfer a resident with infectious forms of tuberculosis to a facility with such accommodation. Coordinate these arrangements with the receiving facility. If transfer is delayed or not possible, implement the following directives until transfer to a facility with adequately ventilated negative pressure rooms can take place:

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Winnipeg Regional Health Authority Personal Care Home/Long Term Care Facility Infection Prevention & Control Manual

? Place the resident in a single room with the door and windows closed. Room should have dedicated toilet, hand hygiene and bathing facilities

? Instruct health care workers, residents, families and visitors about the importance of following Airborne Precautions

? When an N95 respirator is required the health care worker will be fit tested with the appropriate N95 respirator. Family members/ visitors will have the N95 respirator seal checked

? Limit the number of people entering the room. Prohibit visits by children under the age of 12

? When there are exceptional circumstances, the resident may leave the room in consultation with Infection Prevention and Control/designate

? Keep the door and windows closed at all times regardless if the room is occupied or not

? Discontinue airborne precautions only after the resident is no longer infectious and only in consultation with the Infection Control Practitioner/designate

? Keep the door and windows closed for one hour following the discontinuation of precautions

Tuberculosis ? Residents with infectious forms of Tuberculosis, in addition to the accommodation guidelines for Airborne Precautions, if it is necessary for the resident to leave the room, the resident must wear a surgical/procedure mask continuously while out of the room ? Have the resident perform hand hygiene after removal of the mask

Measles ? Airborne Precautions are required unless all other residents and all health care workers are immune to measles (Adults borne prior to 1970 can be assumed to have acquired natural immunity to measles) ? Non-immune visitors and employees are restricted from entering the area ? Do not put infected resident on units where there are susceptible immunocompromised residents ? Keep resident in room until 4 days after the onset of rash ? Susceptible health care workers and visitors are not to enter the room. If exceptional circumstances make this necessary the health care worker and/or visitor must wear an N95 respirator ? The resident is to wear a surgical/procedure mask when out of the room. The resident must perform hand hygiene after removal of mask ? Determine the immune status of exposed room mates and other close contacts and if they are susceptible consult the Infection Control Practitioner/designate

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Winnipeg Regional Health Authority Personal Care Home/Long Term Care Facility Infection Prevention & Control Manual

4.4 Healthcare Workers

Healthcare workers should be aware of their immunity status. ? Non-immune healthcare workers should not care for residents with vaccine-preventable airborne diseases (e.g., measles, chickenpox) unless absolutely necessary. If it is absolutely necessary to care for one of these residents, the health care worker must wear a N95 fit tested respirator to enter the isolation room.

4.5 Hand Hygiene

Perform hand hygiene before leaving the isolation room, and after removal of N95 respirator.

4.6 Personal Protective Equipment (PPE)

Masks/Respirators

? Special masks/ N95 respirators: N95 respirators* shall be available for persons entering the isolation room.

? Individuals who are immune to vaccine-preventable diseases (e.g. measles, chickenpox) do not need to wear N95 respirators to go into the isolation room.

? Individuals who are not immune or are uncertain of their immunity shall not enter the room unless absolutely necessary. If it is absolutely necessary to enter the room an N95 respirator must be worn.

? N95 respirators shall be fit tested for healthcare workers, as directed by Occupational Health and seal checked by healthcare workers prior to each use. Seal checking procedure is as follows: ? Cover respirator with both hands and perform one of the following: Inhalation Test: If respirator collapses slightly there is an adequate seal Exhalation Test: If no air escapes respirator, there is an adequate seal

? Wear the N95 respirator once. ? Change the N95 respirator when wet, if the front of the N95

respirator was touched, and/or when contaminated with resident secretions. ? Remove the N95 respirator in a manner preventing contamination. ? Remove the N95 respirator immediately after exiting the isolation room. To remove the N95 respirator refer to Removal of Personal Protective Equipment (Appendices 4E &4F).

Note: Never have the N95 respirator dangle around the neck.

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Winnipeg Regional Health Authority Personal Care Home/Long Term Care Facility Infection Prevention & Control Manual

*N95 respirators shall be certified by the National Institute of Occupational Safety and Health (NIOSH) with an N95 efficiency rating or better.

4.7 Resident Transport

If the resident is transported to another unit/facility, notify the receiving unit/facility by telephone of the resident's status and required infection prevention & control precautions. Document on the Regional Health Authorities of Manitoba Transfer Referral form.

Notify transport services of the necessary infection prevention & control precautions.

Maintain Airborne Precautions while the resident is outside the isolation room.

Healthcare workers wear fit tested N95 respirators when transporting residents requiring Airborne Precautions.

The resident wears a surgical/procedure mask and performs hand hygiene prior to leaving the room.

The resident with skin lesions associated with Varicella, Smallpox, or draining wounds caused by M. tuberculosis shall have them securely covered

? Consult Respiratory Therapy if the resident has an artificial airway

4.8 Resident/Family Educate the resident, and/or family about: ? The nature of the resident's infectious disease ? The precautions to adhere to, and ? The length of time the precautions will be in place. Refer to the `Resident /Family Information Sheet on Airborne Precautions' (Appendix 5F)

Instruct the resident /family regarding Respiratory Hygiene/Cough Etiquette as per Cover Your Cough pamphlet (Appendix 4G):

? When coughing or sneezing, cover nose and mouth with a tissue, or cough into shoulder

? Immediately dispose of the tissue in the appropriate waste receptacle, and,

? Perform hand hygiene

Instruct the resident about the appropriate use and management of PPE: ? How to correctly apply and wear a surgical/procedure mask

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Winnipeg Regional Health Authority Personal Care Home/Long Term Care Facility Infection Prevention & Control Manual

? How to remove the surgical/procedure mask without contaminating oneself

? Know the procedure and the importance of hand hygiene prior to leaving the room and following removal of the surgical/procedure mask

Instruct the family about the appropriate use and management of PPE.

If required, instruct the family about assisting with application of the surgical/procedure mask for the resident and how to correctly apply a N95 respirator, including seal check.

Instruct the resident and family about preventing transmission of the infectious disease to his/her family, and friends.

Instruct the resident and family about the procedure, and importance of performing hand hygiene

4.9 Visitors

Inform visitors of the necessary precautions.

Instruct visitors about the procedure, and importance of performing hand hygiene.

If susceptible to the airborne microorganism requiring Airborne Precautions, visitors should not visit unless there are exceptional circumstances. If this is the case, consult Infection Prevention and Control/designate prior to the visit

? The nurse shall: Talk with visitors before they enter the isolation room, and assess risk to the health of the visitor and the risk of the visitor transmitting infection Instruct the visitor about the appropriate use of respirators and other precautions Keep the number of visitors to a minimum (at the discretion of the unit staff)

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