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

Section 5_ Additional Precautions_approved April 28, 2008 1

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.



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.



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 facility-

approved 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.



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:



• 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



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.



*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



• 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)



5. Contact Precautions

5.1 Introduction

Contact Precautions are required for residents diagnosed with, or suspected of having infectious microorganisms transmitted by the contact route. For a description of direct and indirect contact transmission reference section 3 page 4.

Contact Precautions are followed in addition to Routine Practices. Routine Practices shall be adhered to at all times by all healthcare workers.

5.2 Indications for Contact Precautions

Contact 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). Contact Precautions may be indicated for certain organisms when Routine Practices are not sufficient to control transmission. Use contact precautions for: • Acute diarrhea of likely infectious cause if uncontrolled (incontinent,

stool cannot be contained in incontinent products) • Extensive desquamating skin disorder with known or suspected

infection or significant colonization • Skin rash compatible with scabies • Draining infected wound in which drainage cannot be contained by a

dressing.



5.3 Accommodation

• Maintain a one metre spatial separation between the infected resident and other residents and visitors.

• Restrict participation in group activities until the symptoms are resolved/treated. Exceptions should be discussed with the Infection Prevention & Control Practitioner/designate.

• Roommates and visitors must be aware of precautions to follow. • A single room is preferable. No special air handling and ventilation are

necessary. The door may remain open Room should have dedicated toilet, hand hygiene, and bathing

facilities. • In instances where there are not a sufficient number of single rooms,

cohort residents with the same microorganism together. This shall be done in consultation with the Infection Prevention & Control Practitioner/designate.

• If a single room is not available and cohorting is not possible, consult the Infection Prevention & Control Practitioner/designate.

Maintain a separation of at least one metre between infected resident and other residents and visitors

Inform roommates and all visitors of precautions to follow Select roommates for their ability, and that of their visitors, to

comply with Contact Precautions. Roommates should be at low risk for acquiring an infection:

- No open wounds - No decubitus ulcers - No urinary catheter, feeding tube or other invasive

devices - No debilitated or bed bound residents requiring extensive

hands on care. - Not receiving dialysis, chemotherapy, or radiation

treatments

5.4 Hand Hygiene

• Remove gloves and gown. Perform hand hygiene before leaving the room/designated bed space.

• After hand hygiene, take care not to contaminate hands before leaving the room.



5.5 Personal Protective Equipment (PPE)

Gloves • Wear gloves if direct contact with the resident is required or if direct

contact with frequently touched environmental surfaces is anticipated and significant contamination of the environment is occurring (uncontrolled diarrhea, uncontained wound drainage, excessive skin desquamation).

• Remove gloves before leaving the room or the resident’s designated bed space. Refer to Removal of Personal Protective Equipment (Section 4, Appendix 4E).

• Perform hand hygiene after removing gloves. Gowns

• Wear gowns if direct contact with the resident is required or if direct


• Remove gowns before leaving the room or the resident’s designated bed space. Refer to Removal of Personal Protective Equipment (Section 4, Appendix 4E).

• Perform hand hygiene after removing gown. 5.6 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 control Precautions. Document on the Regional Health Authorities of Manitoba Transfer/Referral form.

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

5.7 Equipment and Environment

• Resident care equipment (e.g., thermometers, blood pressure cuffs,

lifts/slings) should be dedicated for the resident’s use, identified, and stored in a manner that prevents use by another resident. Clean and disinfect before reuse with another resident.

• Discard disposable resident care equipment and supplies. • Do not share toys and personal effects with other residents. • Clean all horizontal and frequently touched surfaces daily and

immediately when visibly soiled.



5.8 Resident/Family/visitors

• Educate the resident and/or family/visitor 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/Visitors Information Sheet on Contact Precautions (Appendix 5 G).

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

• Instruct the resident and family/visitor how to perform hand hygiene and the importance of performing hand hygiene.

• If indicated, instruct the family/visitor about the appropriate use of gowns, gloves, and other precautions.



6. Airborne/Contact Precautions

6.1 Introduction

Airborne/Contact Precautions are required for residents diagnosed with, or suspected of having an infectious microorganism transmitted by the airborne and contact routes. For a description of airborne transmission and direct and indirect contact transmission refer to section 3, page 4 & 5. Airborne/Contact Precautions are followed in addition to Routine Practices. Routine Practices shall be adhered to at all times by all healthcare workers.

6.2 Indications for Airborne/Contact Precautions

Airborne/Contact 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. Ideally residents on Airborne/Contact Precautions should be placed in a negative pressure room or transferred to an acute care facility as soon as possible. Negative pressure rooms may be available in long term care facilities, but are generally not available in personal care homes. See Implementation of Additional Precautions (Section 5, page 2).

Varicella (Chickenpox) or Disseminated Herpes Zoster (Shingles) • Airborne/Contact Precautions are required unless:

All other residents and all health care workers are immune to varicella, and



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 the resident in the room until all lesions have crusted. • Susceptible health care workers and visitors are not to enter the room.

If exceptional circumstances make this necessary the health care worker must wear a fit tested N95 respirator. Susceptible visitors are to wear a seal checked N95 respirator.

• If the resident is on Airborne/Contact Precautions, the resident should leave the room for essential purposes only.

• If the resident must leave the room, the resident is to wear a surgical/procedure mask and have skin lesions covered when out of the room.

• Determine the immune status of exposed roommates and other close contacts and if they are susceptible consult the Infection Control Practitioner/designate.

. 6.3 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. chickenpox, measles) 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.

6.4 Hand Hygiene

• Remove gloves and gown and perform hand hygiene before leaving

the isolation room. After hand hygiene, take care not to contaminate hands before leaving the room.

• Perform hand hygiene after removal of the fit tested N95 respirator. • To remove gown, gloves and respirator refer to Removing Personal

Protective Equipment (Section 4, Appendix 4E).

6.5 Personal Protective Equipment

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.

chickenpox, measles) 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/designate and seal checked by healthcare workers prior to each use.

• N95 respirators worn by visitors will be seal checked only. • 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. To

remove the N95 respirator refer to Removal of Personal Protective Equipment (Section 4, Appendix 4F).

• Remove the N95 respirator immediately after exiting the isolation room

Note: Never have the N95 respirator dangle around the neck. *N95 respirators shall be certified by the National Institute of Occupational Safety and Health (NIOSH) with an N95 efficiency rating or better.

Gloves

• Wear gloves if direct contact with the resident is required or if direct



• Perform hand hygiene after removal of gloves. Gowns


contact with frequently touched environmental surfaces is anticipated



and significant contamination of the environment is occurring (uncontrolled diarrhea, uncontained wound drainage, excessive skin desquamation).


• Perform Hand hygiene after removal of gown. 6.6 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 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/Contact Precautions while the resident is outside the isolation room.

• Healthcare workers wear 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, disseminated herpes zoster shall have them securely covered.

• Consult Respiratory Therapy if the resident has an artificial airway.


• Resident -care equipment (e.g., thermometers, blood pressure cuffs, • lifts/slings) should be dedicated for the resident’s use, identified, and

stored in a manner that prevents use by another resident. Clean and disinfect before reuse with another resident.



6.8 Resident/Family/Visitor

• Educate the resident, and/or family/visitor 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/Visitor Information Sheet on Airborne/Contact Precautions (Appendix 5H).



• Instruct the resident /family/visitor regarding Respiratory Hygiene/Cough Etiquette:

When coughing or sneezing, cover his/her nose and mouth with a tissue, or cough into his/her shoulder

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

Perform hand hygiene. See Cover Your Cough pamphlet (Section 4, Appendix 4G).

• Instruct the resident/family/visitor about the appropriate use and management of PPE:

How to correctly apply and wear a surgical/procedure mask How to remove the surgical/procedure mask without

contaminating oneself How to perform hand hygiene and the importance of hand

hygiene prior to leaving the room and following removal of the surgical/procedure mask.

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

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

• The nurse shall: Talk with family/ 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 family/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)



7. Droplet Precautions

7.1 Introduction

Droplet Precautions are required for residents diagnosed with, or suspected of having infectious microorganisms transmitted by the droplet route. For a description of droplet transmission refer to section 3, page 5).

Droplet Precautions are followed in addition to Routine Practices. Routine Practices shall be adhered to at all times by all healthcare workers.

7.2 Indications for Droplet Precautions

Droplet 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 (page 2).

7.3 Accommodation

• A single room is preferable. No special air handling and ventilation

are necessary. • The door may remain open. • Room should have dedicated toilet, hand hygiene, and bathing

facilities. • In instances where there are not a sufficient number of single rooms,

cohort residents with the same microorganism together in consultation with the Infection Control Practitioner/designate.



• If a single room is not available and cohorting is not possible consult the Infection Prevention and Control Practitioner/designate.

• Select roommates for their ability, and that of their visitors, to comply with Droplet Precautions

Roommates should be at low risk for acquiring an infection: (e.g., no chronic lung disease, severe congenital heart disease, or immunodeficiency).

• Maintain a separation of at least one metre between residents and from visitors.

• Inform roommates and all visitors of precautions to follow.

7.4 Hand Hygiene

• Remove surgical/procedure mask. Perform hand hygiene before leaving the resident’s room /designated bed space. After hand hygiene, take care not to contaminate hands before leaving the room.


Masks • All health care workers are to wear a surgical/procedure mask when

within one metre of resident, and for procedures that may result in coughing, splashing, and aerosol production.

• For care of residents with Rubella or Mumps, immune persons do not need to mask. Non-immune persons shall enter the room only if absolutely necessary and shall wear a surgical/procedure mask

• Wear a mask once only. • Change mask when it is wet, if the front of the mask has been touched

and/or contaminated with residents secretions. • Remove mask and discard it in a manner to prevent contamination

after leaving the room/designated bed space of resident on isolation. See Removal of Personal Protective Equipment (Section 4, Appendix 4F).

• Never have the mask dangling around the neck.

Eye Protection

• Goggles, glasses, or face shields are worn when within one metre of a coughing resident with symptoms of respiratory infection, and for procedures that may result in coughing, splatter, and/or aerosols

• Remove goggles, glasses or face shields in a manner preventing contamination. Refer to Removal of Personal Protective Equipment (Section 4, Appendix 4F).



• If reusable, send the eye protection for cleaning and disinfection according to facility policy

7.6 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 control precautions.


• Educate the resident and/or family/visitor 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/visitor Information Sheet on Droplet Precautions (Appendix 5I).

• Instruct the resident /family regarding Respiratory Hygiene/Cough • Etiquette:

When coughing or sneezing, cover the nose and mouth with a tissue, or cough into his/her upper sleeve

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

Perform hand hygiene. Refer to the Cover Your Cough Pamphlet (Section 4, Appendix 4G).

• Instruct the family/visitor about the appropriate use and management of PPE.

How to correctly apply and wear a surgical/procedure mask How to remove the surgical/procedure mask without

contaminating oneself How to perform hand hygiene and the importance of hand

hygiene prior to leaving the room and following removal of the surgical/procedure mask

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



8. Droplet/Contact Precautions

8.1 Introduction

Droplet/Contact Precautions are required for residents diagnosed with, or suspected of having infectious microorganisms transmitted by the droplet route and contact routes. For a description of droplet transmission and direct and indirect contact transmissions refer to section 3, pages 4 & 5.

Droplet/Contact Precautions are followed in addition to Routine Practices. Routine Practices shall be adhered to at all times by all healthcare workers.

8.2 Indications for Droplet/Contact Precautions

Droplet/Contact 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. See implementation of Additional Precautions page 2.

8.3 Accommodation

• A single room is preferable. No special air handling and ventilation are necessary.

• The door may remain open. • Room should have dedicated toilet, hand hygiene, and bathing

facilities.



• In instances where there are not a sufficient number of single rooms, cohort residents with the same microorganism together in consultation with the Infection Control Practitioner/designate.

• If a single room is not available and cohorting is not possible consult the Infection Prevention and Control Practitioner/designate.

• Select roommates for their ability, and that of their visitors, to comply with Droplet Precautions

Roommates should be at low risk for acquiring an infection: (e.g., no chronic lung disease, severe congenital heart disease, or immunodeficiency).

• Maintain a separation of at least one metre between residents and from visitors.

• Inform roommates and all visitors of precautions to follow.

8.4 Hand Hygiene

• Remove gloves and gown and perform hand hygiene before leaving the room/designated bed space. After hand hygiene take care not to contaminate hands before leaving the room.

• Perform hand hygiene after removal of the surgical/procedure mask. • Refer to Removing Personal Protective Equipment (Section 4,

Appendices 4E & 4F).


Masks • All health care workers are to wear a surgical/procedure mask when

within one metre of resident, and for procedures that may result in coughing, splashing, and aerosol production.

• For care of residents with Rubella or Mumps, immune persons do not need to mask. Non-immune persons shall enter the room only if absolutely necessary and shall wear a surgical/procedure mask.

• Wear a mask once only. • Change mask when it is wet, if the front of the mask has been touched

and/or contaminated with residents secretions. • Remove mask and discard it in a manner to prevent contamination

after leaving the room/designated bed space of resident on isolation. See Removal of Personal Protective Equipment (Section 4, Appendix 4F).

• Never have the mask dangling around the neck.



Eye Protection • Goggles, glasses, or face shields are worn when within one metre of a

coughing resident with symptoms of respiratory infection, and for procedures that may result in coughing, splatter, and/or aerosols.

• Remove goggles, glasses or face shields in a manner preventing contamination. Refer to Removal of Personal Protective Equipment (Section 4, Appendix 4F).

• If reusable, send the eye protection for cleaning and disinfection according to facility policy.

Gloves

• Wear gloves if direct contact with the resident is required or if direct



• Perform hand hygiene after removing gloves. Gowns




• Perform hand hygiene after removing gown.

8.6 Patient 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 control precautions. Document on the Regional Health Authorities of Manitoba Transfer/Referral form.

• Notify transport services of the necessary infection control precautions.




• Resident care equipment (e.g., thermometers, blood pressure cuffs, lifts/slings) should be dedicated for the resident’s use, identified, and stored in a manner that prevents use by another resident. Clean and disinfect before reuse with another resident.




• The resident and/or family/visitor should be educated 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/Visitor Information Sheet on Droplet/Contact Precautions (Appendix 5J).

• Instruct the resident /family/visitor regarding Respiratory Hygiene/Cough Etiquette:

When coughing or sneezing, cover the nose and mouth with a tissue, or cough into his/her upper sleeve.

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

Perform hand hygiene Refer to the Cover Your Cough Pamphlet (Section 4, Appendix 4G). • Instruct the family/visitor about the appropriate use and management

of PPE. • Instruct the resident and family/visitor about preventing transmission of

the infectious disease to his/her family, and friends. • Instruct the resident and family/visitor about the procedure, and

importance of hand hygiene.

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