Transmission-based Precautions #3: Airborne precautions

The final stop on our journey into transmission-based precautions is the application of airborne precautions.  

Before we finish off, let us briefly go back to basics. 

A refresher on infection control procedures

Standard precautions are our overarching infection prevention and control measures, used for each person, for every interaction, in any clinical setting.  

Transmission-based precautions add an additional layer to standard precautions. They allow clinical and non-clinical staff to provide care for a person who has a known or suspected infectious illness.  

The infectious illness will require the staff to apply one of three protective methods: contact precautions, droplet precautions, or airborne precautions.  

The choice of transmission precaution is determined by pathogen and patient factors. A risk assessment is required on a case-by-case basis. How is the infectious pathogen transmitted? Is the patient able to perform respiratory etiquette? Is the patient able to wear a mask? Is the patient incontinent?   

By applying the correct protective infection control measures (PPE), the chain of infection is interrupted, and the infection is contained at the source.  

Airborne Precautions  

Airborne precautions are the most protective of the three PPE options. When airborne precautions are indicated, your facility may consult with the local public health unit to ensure the facility receives adequate support in containing the infectious agent and making clinical decisions around resident care.   

Airborne precautions are implemented when there is a known or suspected infection able to be transmitted in and through the air. Airborne particles are less than <5 micrometres in size, making them so light they suspended in the air for long periods of time and travel great distances with airflow. Airborne particles can be made up of fine mist, dust, liquids, and aerosols (biological or man-made gas, mist, fog).  

Infections that are known to be transmitted via airborne route include gastro viruses, influenza, measles and chickenpox. The most recent pathogen thought to have airborne capacity is COVID-19.  

It is recognised that droplet and airborne transmission can occur at the same time. A sneeze or cough will contain particles of varying sizes, with larger droplets falling quickly from the air and smaller sized (airborne) particles remaining suspended.  

Research into airborne particles suggest they may be resuspended into the air, depending on the airflow and activities taking place in the room, while it is less likely for droplets to resuspend due to their weight. Infectious particles that fall onto the surrounding environment make way for indirect transmission via fomites.  

There are several clinical procedures and equipment known to produce aerosols (CPAP, BiPAP, suctioning, spirometry). Current research is moving towards an understanding that excessive coughing, expression of respiratory symptoms, laboured and even tidal breathing while infectious are likely to produce a range of respiratory particles, some of which may be airborne.

Patient placement 

When airborne precautions are indicated, if available, it is preferable to have a negative pressure and/or anteroom, where staff can don and doff their PPE. The next choice of placement for a resident requiring airborne precautions is a private or single room with ensuite. It is important the entry door remains closed. Open a window in the room if possible.  

Signage alerting staff to the required precautions and actions to be taken must be visible. Consult your local public health unit if there are concerns and questions around room placement.  

PPE for airborne precautions

Healthcare workers entering a room with airborne precautions require single-use gloves, long sleeve gown, and (P2) N95 Mask. Protective eye wear or face shield is recommended where there is a risk of potential splashes or body fluid exposure. Use of an (P2) N95 requires a fit test and seal check. Check in with your IPC lead for advice around the use of an (P2) N95.  

The patient should be fitted with a surgical mask if tolerated and encouraged to practice respiratory etiquette. Visitors are not recommended; however, any visitors should receive adequate education on donning and doffing practices and wear gloves, gown and a fitted (P2) N95 mask.  

While the fundamentals of airborne precautions may seem simple (if not comprehensive), it’s crucial that staff are educated and experienced in donning and doffing. Not only will inexperienced staff risk infecting themselves and others through improper PPE use, but they’ll also waste your PPE stores.

If your staff need refreshers on the basics of infection control (and who doesn’t from time to time?), contact Bug Control. Between our infection control policy and procedures manual, our membership and education platform and our in-person education sessions, we have something to help reduce infections in your facility.

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