Additional precautions in infection control are specific measures taken beyond standard precautions to prevent the spread of infection based on how infectious agents are transmitted. These precautions are implemented when standard precautions alone are insufficient to control the spread of a known or suspected infection.
Here's a breakdown of the three main categories of additional precautions:
1. Contact Precautions
Contact precautions are used when infections can spread through direct or indirect contact. This is the most common type of additional precautions.
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Conditions requiring contact precautions: Clostridium difficile (C. diff), Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE), scabies, and other infections spread by contact.
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Measures to take:
- Private Room: Patients should be placed in a private room whenever possible.
- Gloves: Wear gloves when entering the patient's room and change gloves after contact with infective material. Remove gloves before leaving the room.
- Gown: Wear a gown if you anticipate that your clothing will have contact with the patient or potentially contaminated surfaces or items in the patient's environment. Remove the gown before leaving the room.
- Hand Hygiene: Perform hand hygiene (using soap and water or an alcohol-based hand rub) immediately after removing gloves and gowns.
- Dedicated Equipment: Use dedicated equipment (e.g., stethoscope, blood pressure cuff) for the patient. If equipment is shared, clean and disinfect it thoroughly between patients.
- Limit Transport: Limit the transport of patients outside of the room. If transport is necessary, ensure the patient is appropriately covered and that precautions are taken to prevent contamination of surfaces.
2. Droplet Precautions
Droplet precautions are used when infections spread through large respiratory droplets produced by coughing, sneezing, or talking.
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Conditions requiring droplet precautions: Influenza, respiratory syncytial virus (RSV), pertussis (whooping cough), adenovirus, rhinovirus, Neisseria meningitidis, and Streptococcus pneumoniae.
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Measures to take:
- Private Room: Patients should be placed in a private room whenever possible. Cohorting (grouping patients with the same infection) may be considered if private rooms are not available.
- Mask: Wear a surgical mask when within 6 feet (approximately 2 meters) of the patient. Some facilities may require masks for anyone entering the room, regardless of distance.
- Eye Protection (Goggles or Face Shield): Consider eye protection, especially if there is a risk of splashes or sprays of respiratory secretions.
- Limit Transport: Limit the transport of patients outside of the room. If transport is necessary, the patient should wear a surgical mask.
3. Airborne Precautions
Airborne precautions are used when infections spread through tiny airborne particles that can remain suspended in the air for extended periods.
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Conditions requiring airborne precautions: Tuberculosis (TB), measles, varicella (chickenpox), and disseminated herpes zoster (shingles). COVID-19 also necessitates airborne precautions, especially during aerosol-generating procedures.
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Measures to take:
- Airborne Infection Isolation Room (AIIR): Patients must be placed in an AIIR, which is a single-patient room with negative pressure ventilation. This means that air is drawn into the room and then exhausted directly to the outside or filtered through a high-efficiency particulate air (HEPA) filter before being recirculated.
- Respiratory Protection (N95 Respirator): Wear an N95 respirator (or higher level of protection) when entering the room. The respirator must be fit-tested to ensure a proper seal.
- Limit Transport: Limit the transport of patients outside of the room. If transport is necessary, the patient must wear a surgical mask.
- Door Kept Closed: The door to the AIIR must remain closed to maintain negative pressure.
Summary Table
| Precaution Type | Transmission Route | Key Measures | Examples |
|---|---|---|---|
| Contact | Direct/Indirect | Private room; gloves; gown; hand hygiene; dedicated equipment; limit transport. | C. diff, MRSA, VRE, scabies |
| Droplet | Large Respiratory Droplets | Private room; mask (within 6 feet); eye protection; limit transport (patient wears mask). | Influenza, RSV, pertussis |
| Airborne | Airborne Particles | AIIR (negative pressure); N95 respirator; limit transport (patient wears mask); door kept closed. | Tuberculosis (TB), measles, varicella, disseminated herpes zoster, COVID-19 (especially during aerosol-generating procedures) |
It is crucial to follow the specific guidelines and protocols established by healthcare facilities and public health authorities to ensure effective infection control and prevent the spread of infectious diseases. These guidelines are regularly updated to reflect new scientific evidence and emerging threats.
