The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [81]
providing care in a suitably clean environment with adequately decontaminated equipment
the safe disposal of waste
the safe management of used linen.
Transmission-based precautions
Additional infection control precautions taken with patients known or strongly suspected to be infected or colonized with organisms that pose a significant risk to other patients. The precautions will vary depending on the route by which the organism travels from one individual to another, but there will be common elements. Transmission-based precautions can be divided into:
contact
enteric
droplet
airborne.
Contact precautions
Additional infection control precautions to be taken with patients known or strongly suspected to be infected or colonized with pathogenic micro-organisms that are mainly transmitted through touch or physical contact. Contact precautions normally consist of isolation of the patient in a single room, where possible, and use of gloves and apron for any procedure involving contact with the patient or their immediate environment (Siegel et al. 2007).
Enteric precautions
Additional infection control precautions to be taken with patients suffering symptoms of infectious gastroenteritis, that is diarrhoea or vomiting that does not have an obvious mechanical or non-infectious cause. Enteric precautions should be taken from the first instance of diarrhoea or vomiting, regardless of whether a causative organism has been identified, until there is a definitive diagnosis that the symptoms do not have an infectious cause. Enteric precautions consist of prompt isolation of the patient in a single room with the door closed and use of gloves and apron for any procedure involving contact with the patient or their immediate environment (Chadwick et al. 2000, DH/HPA 2008).
Droplet precautions
Additional infection control precautions taken with patients known or strongly suspected to be infected or colonized with pathogenic micro-organisms that are mainly transmitted via droplets of body fluid expelled by an infected person. These are most often respiratory secretions expelled during coughing and sneezing but can include droplets from other sources such as projectile vomiting or explosive diarrhoea. The droplets are relatively large (>5 micrometres diameter) and do not remain suspended in the air for long so special ventilation is not normally required. Droplet precautions consist of isolation of the patient in a single room with the door closed and use of gloves and apron for any procedure involving contact with the patient or their immediate environment. Staff entering the room should wear a mask (Siegel et al. 2007).
Airborne precautions
Additional infection control precautions taken with patients known or strongly suspected to be infected or colonized with pathogenic micro-organisms that are mainly transmitted through the airborne route. These organisms are present in smaller droplets expelled by an infected person and so remain suspended in the air. Droplet precautions consist of prompt isolation of the patient in a single room, if possible with negative pressure ventilation or a positive pressure lobby, with the door closed, and use of gloves and apron for any procedure involving contact with the patient or their immediate environment. Staff entering the room should wear a fitted respirator (Siegel et al. 2007).
Some guidelines merge droplet and airborne precautions in order to provide a single set of instructions for staff caring for patients with any respiratory or airborne infection.
Isolation
Isolation is the practice of nursing a patient in a single-occupancy room to reduce the risk of spread of pathogens and to reinforce and facilitate additional infection control precautions.
Source isolation
The practice of isolating a patient for the main purpose of preventing the spread of organisms from that patient.
Protective isolation
The practice of isolating a patient for the main purpose of preventing the spread of organisms to that patient, normally used for patients with impaired immune systems.