Contact precautions and other transmission-based precautions are an essential part of infection control. But when we hear phrases like “transmission-based precautions” and “resident in isolation”, we might not feel this way. In fact, we may immediately think of PPE and the additional pressure this can add to a busy clinical workload.
And while donning and doffing is both a task and skill, perhaps it is time to reframe our mindset towards transmission-based precautions. Rather than focusing on how much extra effort these precautions take, we must understand how this practice actually reduces our workload and improves the health outcomes of our residents and staff.
This week, we shift the lens to the clinical practice of transmission-based precautions, looking at the application and benefits of contact precautions.
The chain of infection
The chain of infection illustrates how a pathogen transfers from one host to another.
Transmission-based precautions are intended to break the chain at the link between the “exit portal” or “mode of escape” and the “mode of transmission”. As healthcare providers, we have many opportunities to help or hinder this process. There are three types of transmission-based precautions: contact precautions, droplet precautions and airborne precautions. Unfortunately, some studies suggest nursing staff adhere to appropriate transmission-based precautions only a third of the time.
Contact precautions reduce the risk of spreading microorganisms to or from a resident or their surroundings by direct or indirect contact.
Contact precautions consist of gloves, with the addition of an apron or waterproof gown. Once used, PPE is disposed of in the appropriate receptacle. Hand hygiene is preformed prior to and post-PPE removal.
When to use contact precautions during clinical care
Contact precautions are suitable when there is a known or perceived risk of infection transmission via a direct or indirect contact route, or there is a risk of blood and body fluid exposure. Some basic situations where contact precautions are suitable include handling infectious wounds, wound dressing changes, or known skin infections. They should also be used during catheter cares, toileting of residents, incontinence, and for some residents known to be colonised with MDROs.
So, what is the difference between applying contact precautions (gloves and apron) for one-off care provision and applying them for every interaction? Knowing when and how to apply contact precautions requires a risk management assessment.
- A resident requiring toileting and hygiene assistance would require a caregiver to wear gloves and apron, preceded and followed by hand hygiene. This is a one-off application of contact precautions for the purpose of toileting and applies to any resident needing this type of assistance.
- A resident with a known MDRO, who is incontinent or has a heavily discharging wound, would require contact precautions for each interaction. This resident would require ongoing contact precautions.
- Remember, preventing transmission requires a break in the chain of infection. To break the chain, we must understand how to interrupt the links.
- When a resident requires transmission-based precautions, ensure signage is clear.
- When a resident has ongoing contact precautions applied, clinical equipment should be dedicated for their sole use, where possible. “It is suggested that patient-dedicated equipment or single-use patient-care equipment be used for patients on contact precautions.” If individual use cannot be achieved, it is important to ensure equipment is cleaned, disinfected, and dried between residents.
- Fresh aprons/gowns and gloves must be applied for each encounter requiring contact precautions. Aprons/gowns and gloves are single-use items, to be used once and disposed of, followed by hand hygiene, before leaving the room.
- PPE is always preceded and followed by hand hygiene, before leaving the room.
- The benefit of using appropriate transmission-based precautions outweighs the cost associated with PPE as infections and outbreaks create burdens for facilities, residents, and families.
- Apron or gown? This requires another risk assessment before entering the resident's environment. Stop and consider: Stop and consider: is there an excess of body fluid or splash anticipated? Or is the resident simply requiring assistance with routine toileting.
- Gloves are not a substitute for hand hygiene. Complete hand hygiene before applying gloves. Make sure not to contaminate hands, forearms and clothing when removing gloves and wash hands immediately following glove removal.
Proper application of transmission-based precautions is vital. So is training your staff in knowing when to apply them, and how to do it properly. If you want to better prepare your staff and IPC Lead for success, sign up for Bug Control membership. With access to our staff training resources, and our clinicians, it's never been easier to improve your infection control outcomes.
- Frequently asked questions about PPE and Covid-19
- Patient-centred risk management strategy for multi-resistant organisms
- Improving healthcare worker adherence to the use of transmission-based precautions through application of human factors design: a prospective multi-centre study