The infection control care of those known or suspected to have
Influenza in healthcare settings
- Droplet Precautions (part of Transmission Based Precautions)
Note: The following information is primarily aimed at those organisms that transmit via droplets including seasonal influenza. The principles of droplet precautions are also useful to understand when considering pandemic influenza, however, specific guidance on pandemic influenza must be referred to 'Pandemic flu Infection control guidelines for use in hospitals and primary care settings' (Scottish Government and HPS).
The Droplet Precautions Policy and Literature reviews can be found as part of the Transmission Based Precautions. Other policies (including both the Standard Infection Control Precautions and the Transmission Based Precautions) can be found as part of the Model Infection Control Policies.
The content of this is as follows:
Introduction
Infection control precautions are essential in the control and management of all infectious diseases. In the first instance wherever healthcare is being provided, Standard Infection Control Precautions must be adopted.
Influenza is spread primarily through droplets and as such additional, specific measures will be required to control this spread.
Background to transmission based precautions, including droplet precautions that should be adopted against transmission of Influenza
In 1996, Garner, as part of the Hospital Infection Control Practices Advisory Committee in the USA, published the Guideline for Isolation Precautions in Hospitals. Despite the very specific title of this publication, it detailed clear background information and guidance on the fundamental elements that make up the term Standard Precautions, or Standard Infection Control Precautions, and meet the infection control needs of our time. In addition, it featured guidance on transmission based, or 'isolation', precautions, and all of this information was based on the latest epidemiological information on the transmission of infections, specifically in the hospital setting.
Transmission based precautions are classified under the main recognised routes of transmission of micro-organisms including:
Precautions based on these routes intend to control micro-organisms/pathogens encountered that are known or suspected to be highly transmissible or epidemiologically important.
Principles of droplet precautions
This category of transmission based precautions is intended to reduce droplet transmission. Droplet transmission occurs when large-particle droplets (>5micron in diameter) from an infectious patient/client make contact with the mucous membranes of the nose, mouth, or conjunctivae of a susceptible patient/client or other. Droplets may be generated in the course of talking, coughing, or sneezing and during procedures involving the airway, such as intubation or bronchoscopy. Transmission via large-particle droplets differs from airborne transmission in that the former requires close contact between the source and recipient patients/clients as large droplets do not remain suspended in the air and can usually travel only short distances.
Specific measures to be adopted, in addition to Standard Infection Control Precautions, to try to protect those who may be exposed to the Influenza virus, particularly in healthcare settings
Summary of droplet precaution principles/elements:
Main mode of transmission |
Characteristics |
Prevention Strategy |
Droplet |
- Coughing, sneezing, talking
(limited distance 3 feet)
- Splashing during procedure
(could be further than 3 feet)
|
- Surgical mask for those with symptoms & healthcare workers (HCWs)
- Protective eyewear
- Space out patients/clients ± barriers, e.g. single rooms
- Other PPE for patient/client care and procedures
|
Where should I care for patients with known or suspect Influenza?
- Patients/clients should ideally be cared for in a single room. Special ventilation, e.g. negative pressure ventilation, is not specifically required in these cases due to the nature of transmission
- The doors to single rooms should be kept closed, however they can be opened if advised by the Infection Control Team/local policies
- A sign (not breaching patient/client confidentiality) can be placed on the door to alert all personnel to precautions to be adopted. Explanations and education should be given to any visitors, including visiting staff where required
- Limiting the number of visitors may be recommended by the local Infection Control Team
- The patient/client should leave the room only when necessary and should wear a surgical mask when doing so.
How should I provide safe care for a patient with known or suspected Influenza?
- Outer coats should ideally be removed before providing care/entering a patient/client room
- Personal protection equipment should be worn appropriately (see below)
- Hand hygiene must be carried out appropriately. This includes following
patient care, on removal of gloves, after contact with the patient/client's
immediate environment
- Facilities should be available to ensure these measures are carried out at appropriate times, in the most appropriate place, e.g. before/upon leaving a single patient/client room
- If you develop any signs or symptoms of Influenza you should report these immediately and avoid patient/client contact until advice is given
What personal protective equipment (PPE) should I use?
- A surgical mask (or a respiratory device if advised by the local Infection Control Team) should be worn when within 3 feet of the patient/client. This is particularly important when conducting care that promotes respiratory secretions, e.g. nebulisers, suctioning, bronchoscopy
- Eye protection should be worn if there is a risk of splashing
- Gloves and aprons/gowns should be worn when providing care/carrying out patient/client procedures, as indicated under Standard Infection Control Precautions
- PPE should be changed following procedures/between patients/clients, and in addition if they become heavily contaminated or torn/split during a procedure
- PPE should be safely and appropriately disposed of following use and hand hygiene performed
How should I care for a patient/client's
surroundings and the equipment used within it?
- The patient/client room and equipment within it should be cleaned thoroughly with freshly prepared general purpose detergent and dried, daily and after discharge (an appropriate detergent recommended within hospital cleaning policies should be used. In addition, local Infection Control Teams may recommend an approved disinfectant to be used)
- Specific patient/client care equipment/environment decontamination may be carried out using approved disinfectants (of broad spectrum activity), as per hospital decontamination policies, following Infection Control Team advice. This may include on discharge of the patient/client, when surfaces have been known to be significantly contaminated with infectious agents (e.g. respiratory secretions) or where clear information about the microorganisms characteristics are not fully known
- Cleaning materials should not be shared with other areas and it is important that rooms are kept free from clutter for cleaning purposes
- Patient/client care equipment should not be shared with other patients/clients until it has been appropriately decontaminated. Dedicated equipment, e.g. non-disposable thermometer, may remain with the patient/client during the duration of their care, however, cleaning of this is still essential on a daily basis or immediately when contamination has occurred
- Disposable equipment should be used for cleaning, but where not available such equipment/items (e.g. mop heads) should be appropriately laundered at high temperatures (as per hospital laundering policy)
- Equipment requiring decontamination out with the patient/client area (e.g. sterilization department, laundry) should be sent promptly and transported safely to avoid further contamination
- Single use items must be used wherever possible
- As per Standard Infection Control Precautions, spillages that occur should be managed safely and immediately.
- Waste generated within the patient's area/room should be managed
safely and effectively, with attention paid to disposal of items that
have been contaminated with secretions/sputum, e.g. paper tissues,
in addition to other routine clinical and domestic waste management
- Linen utilized during the patient's care should be managed safely,
as per Standard
Infection Control Precautions. It should be placed into appropriate
receptacles immediately after being removed, should never be dropped
on the floor and should not be carried around or held against uniforms
or clothing.
Further information
The actions required in a pandemic influenza situation will be complex, not least due to the numbers involved and the resources available. Further information on infection control actions to be taken in these circumstances will be developed, including additional specific guidance for those patients presenting with Influenza in the community setting. A full literature review will be conducted on droplet precautions as part of the Model Infection Control Policies work being led by the Infection Control Team at HPS over the course of 2005.
Other micro-organisms primarily spread via the droplet route include:
- Diphtheria
- Meningococcal disease
- Mumps
- Whooping cough
Reference
Garner J. Guideline for Isolation Precautions in Hospitals. Infection Control and Hospital Epidemiology 1996; 17(1): 54-80.
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