When it comes down to controlling the spread of pathogens in a healthcare setting, it is the combined effort of all individuals (patients, visitors and healthcare workers) correctly performing the essential infection control practices that can make a difference for the better (World Health Organisation 2007).

Standard Precautions

The primary level of defence is standard precautions, whereby healthcare workers are responsible for implementing infection control measures across everyday work practices. Based on the Infection Prevention and Control Policy (NSW Government, Department of Health 2017), standard precautions are necessary for all patient interactions and patient care activities, including the handling of all body substances, secretions, excretions, non-intact skin, and mucosal membranes.

Furthermore, standard precautions should be applied to the following practices (World Health Organisation 2007; NSW Government, Department of Health 2017):

Transmission-Based Precautions

Comparatively, transmission-based precautions provide an additional level of protection for healthcare workers, who cannot effectively reduce infectious agents with only standard precautions. As highlighted in the Australian Guidelines for the Prevention and Control of Infection in Healthcare (National Health and Medical Research Council 2010), infectious agents can be transmitted through contact (indirect or direct), droplet and airborne.

By reviewing the route of transmission for each patient case and the associated precautions, healthcare workers can effectively treat their patient whilst staying protected. Comparatively, when a patient presents with a condition that involves multiple routes of transmission, healthcare workers must apply more than one transmission-based precaution category (Victoria State Government 2018).

Choosing the Right Personal Protective Equipment

For different patient situations, having access to and wearing the right personal protective equipment (PPE) can be the determining factor of your safety and the safety of the patient that you are responsible for. When choosing the right level of PPE protection, it is important for healthcare workers to consider how best they can protect themselves and teach their patients to do the same (refer to Table 1).

Table 1: Individual Actions for Reducing Risk and PPE Considerations

How To Stay Ahead Of InfectionKey Considerations
Protect Yourself• Stay up to date with your mandatory full immunisation against vaccine-preventable diseases
Stay Informed• Remember to apply transmission-based precautions as well as standard precautions

• Learn about local policy on the appropriate PPE, such as when to don and doff PPE when caring for patients on contact, droplet and airborne precautions

• Know which type of mask is required for different precautions and how to perform fit checking

• Before patient transfers, always contain infected areas of a patient with contact precautions
Keep Your Patients Educated• Keep patients informed about why certain measures are needed for infection control and its importance in preventing the spread of infection
Ask Your Patients To Help• During transfers, ask patients (with droplet or airborne precautions) to wear a surgical mask and perform respiratory hygiene and cough etiquette

Adapted from the findings of the National Health and Medical Research Council (2010) and Victoria State Government (2018), the following tables outline how airborne, contact and droplet precautions should be applied by all individuals within a healthcare setting (click each tab for more information).

Table 2: Transmission-based precautions for personal protective equipment and hand hygiene

  • Staff must wear a P2 (N95) respirator that has been correctly fitted to their face (unless immune to the infectious agent). Once fit testing and fit checking is complete and on, staff cannot touch the respirator
  • Gloves, gowns and eye protection to be worn as required
  • Before handling the patient, staff must perform hand hygiene
  • During transfers, patients must wear a surgical face mask and perform respiratory hygiene, cough etiquette and cover skin lesions associated with their condition
  • Outside patient-care area, correctly remove and dispose of personal protective equipment before performing hand hygiene

    • Staff must wear a gown and gloves and perform hand hygiene before entering patient-care area
    • Staff may need to wear a surgical mask if infectious agent is isolated in sputum
    • Eye protection to be worn as required
    • Before handling the patient, staff must put on a clean gown and gloves
    • Before transferring patient, remove contaminated personal protective equipment and perform hand hygiene
    • Before leaving patient-care area, correctly remove and dispose of personal protective equipment and then perform hand hygiene

    • Staff must wear a surgical face mask and perform hand hygiene before entering patient-care area
    • Gloves, gowns and eye protection to be worn as required
    • Before handling the patient, staff must perform hand hygiene
    • During transfers, patients must wear a surgical face mask and perform respiratory hygiene and cough etiquette
    • Before leaving patient-care area, correctly remove and dispose of personal protective equipment and then perform hand hygiene

Table 3: Transmission-based precautions for patient-care equipment

      • When caring for one patient, use patient-dedicated equipment or single-use non-critical patient care equipment
      • Clean equipment and allow to dry before use with another patient
      • When caring for one patient, use patient-dedicated equipment or single-use non-critical patient care equipment
      • Clean equipment and allow to dry before use with another patient
      • When caring for one patient, use patient-dedicated equipment or single-use non-critical patient care equipment
      • Clean equipment and allow to dry before use with another patient

Table 4: Transmission-based precautions for patient placement

      • Patients must be placed in a single room with negative pressure or one with no air circulation to other areas
      • If not in a single-patient room, advise patient to wear a surgical mask
      • Keep the door closed and clearly labelled with airborne precautions
      • Only staff or visitors immune to the infectious agent can enter the room
      • Non-immune staff should be provided with appropriate PPE
      • Single-patient rooms are recommended
      • If a shared patient room is necessary, consult with infection control experts to assess all associated risks
      • Avoid placing (not infected) patients with a higher risk of an adverse outcome in same room as the infected patient
      • If this cannot be avoided, change PPE and perform hand hygiene between contact with both patients in same room
      • Keep the door closed and clearly labelled with contact precautions
      • Keep patient notes and bedside charts outside room
      • Disinfect hands after leaving room and after writing in the chart
      • Single-patient rooms are recommended
      • Prioritise patients presenting excessive cough and sputum in single-patient rooms
      • If a shared patient room is necessary, place patients infected with the same pathogen together
      • Avoid placing patients (with a different infection) and a higher risk of an adverse outcome in same room as the infected patient
      • If this cannot be avoided, minimise close contact between patients (with different infections) by separating their beds (over 1 metre) and drawing curtains

Real World Scenarios

Dental-Surgical-Procedure

1. Dental Surgical Procedures

When performing gum surgery, a dental surgeon must wear sterile gloves, a surgical gown, surgical face mask to prevent exposure to blood and saliva from the patient, and make sure to utilise sterile equipment.

Lumbar-Puncture-Procedure

2. Lumbar Puncture Procedure

For maximum safety, all surgical staff are required to wear synthetic gloves, such as polyisoprene, a surgical gown and surgical face mask.

Gastro-Patient

3. Gastroenteritis

If a patient presents symptoms of gastroenteritis, a healthcare worker must wear disposable gloves, a disposable gown and single-use face mask when touching the patient to prevent the spread of the patient’s bodily fluids (National Health and Medical Research Council 2013).

MRSA-Patient

4. Methicillin-resistant Staphylococcus aureus (MRSA)

When caring for MRSA-infected patients a healthcare worker must wear personal protective equipment that covers their hands and body during personal care activities, and when handling their linen to prevent the spread of infection via direct and indirect contact (National Health and Medical Research Council 2013).

References

      1. National Health and Medical Research Council (NHMRC) 2010, Australian Guidelines for the Prevention and Control of Infection in Healthcare, viewed 24 May 2019, <https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2010>
      2. National Health and Medical Research Council (NHMRC) 2013, Prevention and control of infection in residential and community aged care, viewed 24 May 2019, <https://www.nhmrc.gov.au/about-us/publications/prevention-and-control-infection-aged-care>
      3. NSW Government, Department of Health 2007, Infection Prevention and Control Policy, viewed 24 May 2019, <https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2017_013.pdf>
      4. Victoria State Government 2018, Infection control – standard and transmission-based precautions, viewed 27 May 2019, <https://www2.health.vic.gov.au/public-health/infectious-diseases/infection-control-guidelines/standard-additional-precautions>
      5. World Health Organisation 2007, Standard precautions in healthcare, WHO, Geneva, viewed 24 May 2019, <https://www.who.int/csr/resources/publications/EPR_AM2_E7.pdf>