Transmission-based precautions #2: droplet precautions

This week we continue with transmission-based precautions and take a closer look at the application of droplet precautions.

Note: This is part two in a series on transmission-based precautions. You can read our blog on contact precautions here.

 Droplet Precautions

Transmission-based precautions are applied when there is a known or suspected risk of an infectious pathogen. The type of transmission-based precautions used depends on the means of disease transmission. Droplet precautions are used to reduce the spread of microorganisms that can be transmitted by respiratory droplets. A person displaying respiratory symptoms (coughing, sneezing) expells respiratory droplets into the air where they are briefly suspended before falling onto nearby surfaces in the surrounding environment.

Examples of pathogens spread via droplets include influenza, RSV (Respiratory Syncytial Virus), pertussis (whooping cough) and coronaviruses such as COVID-19.

Droplets are categorised as being >5 μm (micrometers) in size, for context, a spider's web silk is 3-8 μm. This means that it is unlikely that you will see respiratory droplets, but they can carry disease and invade another person via facial orifices such as eyes, mouth, and nose. Because of this, droplet precautions include facial protection.

PPE for droplet precautions

Droplet precautions add a layer to contact precautions, with the addition of a surgical mask, alongside the use of gloves and a waterproof gown.

Protective eye wear or face shields are extra considerations in the application of droplet precautions. They are recommended when a procedure such as suctioning is taking place under droplet precautions or a person with the respiratory illness is experiencing frequent episodes of coughing or sneezing. Use a risk minimisation approach when considering protective eye wear/face shields. Ask whether there is likely to be an excess of mucous/saliva expressed during the task at hand. If there is, then it might be time to wear some goggles or apply a face shield!

When to use droplet precautions during clinical care

Infectious respiratory droplets are spread through coughing, sneezing and exhaling infectious particles. Droplets expelled can travel up to 3.5 metres from the infected person. These droplets may be directly inhaled by another person or land on items nearby, creating opportunities for indirect transmission via fomites (clinical equipment, bedside tables, pens, call bells etc.).

When a resident begins to display respiratory symptoms, it is important to apply droplet precautions promptly as viral loads can be higher in the initial stage of illness.

“In long-term care and other residential settings, make decisions regarding patient placement on a case-by-case basis after considering infection risks to other patients in the room and available alternatives”

https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

Recent studies have shown that influenza virus is present in particles expressed during tidal breathing. This evidence highlights the importance of mask use when a respiratory illness is known or suspected, not only for the healthcare professional or susceptible person, but also for the infectious individual when receiving care.

Things to remember:

The specific process for applying transmission-based precautions may differ between regions and facilities but the underpinning principles are the same.

  • To reduce transmission, those with a respiratory illness should be encouraged to practice social distancing and mask wearing. Mask wearing by an infectious person can suppress infectious droplets from contaminating the air and nearby surfaces.
  • Masks should never be touched or adjusted once in place.
  • Masks are single-use, disposable items and must never be reused in the clinical setting.
  • Reprocess reusable eye protection according to the manufacturer's instruction and best practice. Generally, clean eye protection with an approved two-in-one disinfectant, then rinse and ensure it is dry before reuse. If not reusable, discard in an appropriate receptacle.

While the principles of infection control are simple, execution in the aged care setting can be difficult. If you want to give your facility or IPC Lead an infection control booster shot, contact Bug Control. Between our membership and education platform, and our regularly updated IPC eManual, you’ll be ready for anything.