Which client diagnosis would require the nurse to initiate droplet precautions?

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  5. Infection Control and Prevention - Transmission-based precautions

Transmission-based precautions are used in addition to standard precautions when use of standard precautions alone does not fully prevent communicable disease transmission. There are three types of transmission-based precautions--contact, droplet, and airborne - the type used depends on the mode of transmission of a specific disease. Some diseases require more than one type of transmission-based precaution (e.g. SARS, which requires airborne and contact precautions as well as eye protection with all client contact).

Additional resources

Isolation Precautions CDC Guidelines

Contacts

Healthcare-Associated Infection (HAI) Prevention Program
Division of Public Health
Bureau of Communicable Diseases
Phone 608-267-7711
Fax 608-261-4976

  • Contact Precautions
    • Use the following measure in addition to standard precautions when in contact with individuals known or suspected of having diseases spread by direct or indirect contact (examples include norovirus, rotavirus, draining abscesses, head lice).
    • Wear gloves and gown when in contact with the individual, surfaces, or objects within his/her environment.
    • All re-usable items taken into an exam room or home should be cleaned and disinfected before removed. Disposable items should be discarded at point of use.
  • Droplet Precautions

    In addition to standard precautions, wear a surgical mask when within 3 feet (6 feet for smallpox) of persons known or suspected of having diseases spread by droplets (examples include influenza, pertussis, meningococcal disease).

  • Airborne Precautions
    • Use the following measures in addition to standard precautions when in contact with individuals known or suspected to have diseases spread by fine particles dispersed by air currents (examples include tuberculosis, measles, and SARS).
    • Put on a NIOSH-certified fit-tested N-95 respirator just before entry to an area of shared air space and wear at all times while in the area of shared air space. Remove and discard respirator just after exiting area. The respirator may be discarded into the regular trash unless contact precautions must also be followed. In this case, place the respirator in a plastic zip-lock bag, seal and then discard into the trash. A powered air-purifying respirator (PAPR) may also be used (see PPE section).
    • If available, portable high efficiency particulate air (HEPA) filtration units may be operated in the area where the infected individual is located to filter out infectious particles. (Use of such a unit does NOT eliminate the need for employees to wear respiratory protection).
  • Eye Protection

    If eye protection is indicated, wear goggles or a face shield during ALL contact with the individual, not just when splashes or sprays are anticipated, as with standard precautions.

Last Revised: June 23, 2020

Precautions

  • Precautions Home
  • Standard Precautions
  • Contact Precautions
  • Droplet Precautions
  • Airborne Precautions
  • Full Barrier Precautions

Airborne Precautions

Airborne precautions are required to protect against airborne transmission of infectious agents.

Diseases requiring airborne precautions include, but are not limited to: Measles, Severe Acute Respiratory Syndrome (SARS), Varicella (chickenpox), and Mycobacterium tuberculosis. Airborne precautions apply to patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei.

Preventing airborne transmission requires personal respiratory protection and special ventilation and air handling.

Additional Personal Protective Equipment (PPE) for Airborne Precautions

Airborne precautions are in addition to Standard Precautions

PLUS

Masks and Respirators

  • Wear an N95 Respirator
    Prior fit-testing that must be repeated annually and fit-check / seal-check prior to each use.
    OR
    Powered Air-Purifying Respirator (PAPR)
  • The respirator should be donned prior to room entry and removed after exiting room

Additional Procedures

Room

  • Airborne Infection Isolation Room (AIIR)
    At a minimum, AIIR rooms must:
    • Provide negative pressure room with a minimum of 6 air exchanges per hour (existing facility in compliance with codes at time of construction) or 12 air changes per hour (new construction/renovation)
    • Exhaust directly to the outside or through HEPA (High Efficiency Particulate Air) filtration
  • If an AIIR is not available:
    • Provide a facemask (e.g., procedure or surgical mask) to the patient and place the patient immediately in an exam room with a closed door
    • Instruct the patient to keep the facemask on while in the exam room, if possible, and to change the mask if it becomes wet
    • Initiate protocol to transfer patient to a health care facility that has the recommended infection-control capacity to properly manage the patient

Patient

  • Have patient enter through a separate entrance to the facility (e.g., dedicated isolation entrance), if available, to avoid the reception and registration area
  • Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients , and practice respiratory hygiene and cough etiquette
  • Once the patient leaves, the exam room should remain vacant for generally one hour before anyone enters; however, adequate wait time may vary depending on the ventilation rate of the room and should be determined accordingly

How airborne transmission occurs:

Airborne transmission occurs through the dissemination of either:

  • airborne droplet nuclei (small-particles [5 micrometers or smaller] of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or
  • dust particles that contain an infectious agent

Microorganisms carried by the airborne route can be widely dispersed by air currents and may become inhaled by a susceptible host in the same room or over a long distance form the source patient – depending on environmental factors such as temperature and ventilation.

see also>>Personal Protective Equipment (PPE) for Infection Control
see also>>Respiratory Protection Progam

Last Updated: 10/04/2022