INFECTION CONTROL

By
Thippeswamy D M
 -INFECTION CONTROL
• 1-HAND HYGIENE
• 2-PERSONAL PROTECTIVE EQUIPMENT
• 3-PERSONAL PROTECTIVE PRACTICES
• 4-DECONTAMINATION AND CLEANING OF
EQUIPMENTS
• 5-DISINFECTION AND STERLIZATION OF
INSTRUMENTS
• 6-SPILL MANAGEMENT
 INFECTION CONTROL
• 7-ISOLATION AND BARRIER NURSING
• 8-INFECTION CONTROL PROGRAM
• 9-HOSPITAL ACQUIRED INFECTION
SURVEILLANCE
• 10-ENVIRONMENTAL CONTROL
 7 ISOLATION & 1 HAND HYGIENE
BARRIER NURSING

Infection Control

3 PERSONAL 2 PERSONAL
PROTECTIVE PROTECTIVE
PRACTICES EQUIPMENT

04/23/2025 QI NHSRC
ISOLATION PRECAUTIONS
Hand washing:
 What is Hand Hygiene
• Hand hygiene could be defined as any method that removes
or destroys microorganisms on hands.
• The WHO considers ‘Hygienic Hand Antisepsis’ as treatment
of hands with either an antiseptic hand-rub or antiseptic
hand wash to reduce the transient microbial flora without
necessarily affecting the resident skin flora”.

To promote practice of hand-hygiene, World Health

Organisation started 15th October as ‘ Global
Handwashing Day’. This year’s theme is ‘Save Lives: Clean
your hands’
Father of hand hygiene- Ignaz Semmelweis
During the 19th century, women in childbirth were
dying at alarming rates in Europe and the United
States. Up to 25% of women who delivered their
babies in hospitals died from childbed fever
(puerperal sepsis), later found to be caused by
Streptococcus pyogenes bacteria.

In the late 1840's, Dr. Ignaz Semmelweis was an

assistant in the maternity wards of a Vienna hospital.
There he observed that the mortality rate in a delivery
room staffed by medical students was upto three
times higher than in a second delivery room staffed by
midwives. In fact, women were terrified of the room
staffed by the medical students. Semmelweis observed
that the students were coming straight from their
lessons in the autopsy room to the delivery room. He
postulated that the students might be carrying the
infection from their dissections to birthing mothers.
He ordered doctors and medical students to wash
their hands with a chlorinated solution before
examining women in labor.
 Transmission of Hospital Acquired Infections (HAI) through
Hands

Transmission of health care associated pathogens takes place through direct

and indirect contact, droplets, air and a common vehicle (e. g. contaminated
bedding, Unsterilized instruments, colonization of common flora etc).
Transmission through contaminated hands of Hospital staff is the most common
pattern in most settings and require following five sequential steps for their
transmission:
 Presence of Microorganism on the patient’s skin/ inanimate objects in
immediate surrounding the patient;
 Transferred to the hands of HCWs;
 Organisms must be capable of surviving for at least several minutes on HCWs’
hands;
 Inadequate Hand washing or hand antisepsis by the Hospital Staff; and
 The contaminated hand or hands of the caregiver must come into direct
contact with another patient or with an inanimate object that will come into
direct contact with the patient.
D1 Hand Hygiene

D1.1 Availability of Sink and Check washbasin – functional tap, soap &
running water at point of running water.
use. At all points of use.
D1.2 Display of Hand washing Hand washing posters
Instructions At all points of use

D1.3 Adherence to 6 steps of Demonstration.

Hand washing Normal Hand wash

D1.4 Availability of Alcohol Check Availability.

Based hand rub. Ask staff about regular supply
D1.5 Staff is aware of when to Staff Interview.
hand wash. 5 moments of hand washing.

Weightage- 5 Checkpoints and 10 Marks

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How to do Hand washing (Steps)
Moments of Hand Washing
 Indications
Alcohol Based Hand rub Soap & Water

• Routine hand antisepsis, if hands are not • Hands are visibly dirty or visibly
visibly soiled. soiled with blood or other body
• Before and after touching a patient fluids
• Before handling an invasive device for • After using the toilet.
patient care, regardless of whether or
not gloves are used • If exposure to potential spore-
• If moving from a contaminated body site forming pathogens is strongly
to another body site during care of the suspected or proven,
same patient. • Before handling medication or
• After contact with inanimate surfaces preparing food perform hand
and objects (including medical hygiene using an alcohol-based
equipment) in the immediate vicinity of handrub or wash hands with either
the patient. plain or antimicrobial soap and
• After removing sterile or non-sterile water.
gloves.
• If Water contamination is suspected
Points to be remembered
D2 Personal Protective Equipment

D2.1 Use of Gloves during Check.

procedures and examination Used during examination and procedure.
D2.2 Use of Masks and Head cap Check.
Used in patient care & procedure areas.
D2.3 Use of Heavy duty Gloves Check.
and gumboot by waste Housekeeping staff and waste handlers
handlers. both PPE.
D2.4 Use of aprons/ Lab coat by Check
the clinical staff. Apron – Doctors & Nurses.
Lab coat – technicians.
Gown – OT staff.

D2.5 Adequate supply of PPE. Check supply

Interview staff
Record – stock out register

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Personal protecting equipment's
Personal Protective Equipments
Improve personnel safety in the healthcare environment through appropriate
use of PPE.

Definition

“specialized clothing or equipment worn by an employee for protection against

infectious materials” (OSHA)
PPE Use in Healthcare Settings:
Objectives
• Provide information on the selection and use of
PPE in healthcare settings
• Practice how to safely don and remove PPE
Types of PPE used in Healthcare
• Gloves – protect hands
• Gowns/aprons – protect skin and/or clothing
• Masks and respirators– protect mouth/nose
– Respirators – protect respiratory tract from airborne infectious agents
• Goggles – protect eyes
• Face shields – protect face, mouth, nose, and eyes
Factors Influencing PPE Selection
• Type of exposure anticipated
– Splash/spray versus touch
– Category of isolation precautions
• Durability and appropriateness for the task
• Fit
 Key Points About PPE
• Don before contact with the patient, generally before entering the
room
• Use carefully – don’t spread contamination
• Remove and discard carefully, either at the doorway or immediately
outside patient room; remove respirator outside room
• Immediately perform hand hygiene
 Sequence* for Donning PPE
• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves

*Combination of PPE will affect sequence – be practical

 How to Don a Gown

• Select appropriate type and size

• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two gowns
– Gown #1 ties in front
– Gown #2 ties in back
 How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit
How to Don a Particulate Respirator
• Select a fit tested respirator
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with elastic
• Adjust to fit
• Perform a fit check –
– Inhale – respirator should collapse
– Exhale – check for leakage around face
How to Don Eye and Face Protection
• Position goggles over eyes and secure to
the head using the ear pieces or
headband
• Position face shield over face and secure
on brow with headband
• Adjust to fit comfortably
How to Don an Non - sterile Glove
How to Remove a Non - Sterile Glove
How to Don Sterile Gloves
How to Don Sterile Gloves Cont..
How to Remove Sterile Glove
How to Remove Sterile Glove Cont…
 How to Safely Use PPE
• Keep gloved hands away from face
• Avoid touching or adjusting other PPE
• Remove gloves if they become torn; perform hand
hygiene before donning new gloves
• Limit surfaces and items touched
 Removing of PPE
“Contaminated” and “Clean” Areas of PPE

Contaminated – outside front

• Areas of PPE that have or are likely to have been in
contact with body sites, materials, or environmental
surfaces where the infectious organism may reside
Clean – inside, outside back, ties on head and
back
• Areas of PPE that are not likely to have been in contact
with the infectious organism
 Sequence for Removing PPE
 Gloves
 Face shield or goggles
 Gown
 Mask or respirator
 Where to Remove PPE
 At doorway, before leaving patient room or in anteroom*
 Remove respirator outside room, after door has been
closed*

* Ensure that hand hygiene facilities are available at the

point needed, e.g., sink or alcohol-based hand rub
 Remove Goggles or Face Shield
• Grasp ear or head pieces with
ungloved hands
• Lift away from face
• Place in designated receptacle for
reprocessing or disposal
 Removing Isolation Gown
• Unfasten ties
• Peel gown away from
neck and shoulder
• Turn contaminated
outside toward the
inside
• Fold or roll into a bundle
• Discard
 Removing a Mask
• Untie the bottom, then top, tie
• Remove from face
• Discard
Standard Precautions
 Standard Precautions

• Standard Precautions are the

minimum infection prevention
practices that apply to all patient
care, regardless of suspected or
confirmed infection status of the
patient, in any setting where health
care is delivered.
 Standard Precautions
• Previously called Universal Precautions
• Assumes blood and body fluid of ANY patient could be
infectious
• Recommends PPE and other infection control practices to
prevent transmission in any healthcare setting
• Decisions about PPE use determined by type of clinical
interaction with patient
PPE for Standard Precautions (1)
• Gloves – Use when touching blood, body fluids, secretions,
excretions, contaminated items; for touching mucus
membranes and non-intact skin
• Gowns – Use during procedures and patient care activities
when contact of clothing/ exposed skin with blood/body
fluids, secretions, or excretions is anticipated
• Mask and goggles or a face shield – Use during patient
care activities likely to generate splashes or sprays of
blood, body fluids, secretions, or excretions
 What Type of PPE Would You Wear?
Situation PPE
Giving a bed bath? Generally none
Suctioning oral secretions? Gloves and mask/goggles or a face
shield – sometimes gown
Transporting a patient in a wheel chair? Generally none required
Responding to an emergency where blood is Gloves, fluid-resistant gown,
spurting? mask/goggles or a face shield
Drawing blood from a vein? Gloves

Cleaning an incontinent patient with diarrhea? Gloves and gown

Irrigating a wound? Gloves, gown, mask/goggles or a face
shield
Taking vital signs Generally none
 Use of PPE for Expanded Precautions
• Contact Precautions – Gown and gloves for contact with
patient or environment of care (e.g., medical equipment,
environmental surfaces)
• In some instances these are required for entering
patient’s environment
• Droplet Precautions – Surgical masks within 3 feet of
patient
• Airborne Infection Isolation – Particulate respirator*

*Negative pressure isolation room also required

ISOLATION
 ISOLATION
• The term “Isolation” is the use of Infection
Prevention and Control precautions aimed at
controlling and preventing the spread of
infection. There are two types of isolation –
Source Isolation (barrier nursing) where the
patient is the source of infection and
Protective Isolation (reverse barrier nursing)
where the patient requires protection i.e. they
are immunocompromised.
 Source Isolation
• Source isolation is designed to prevent the spread of
pathogens from an infected patient to other patients,
hospital personnel and visitors.
• This has previously been known as barrier nursing.
• The need for isolation is determined by the way the
organism or disease is transmitted.
• Source isolation can be achieved by placing patients
in: Single rooms on general ward Isolation units with
isolation rooms with negative pressure ventilation
with an anteroom and ensuite facilities.
 Source Isolation…cont
• Examples of organisms requiring source isolation
may include:
• Pulmonary Tuberculosis
• Chickenpox
• Meticillin Resistant Staphylococcus aureus (MRSA)
• Viral diarrhoea and vomiting
• Other multi resistant organisms
• H1N1
• influenza
 Source Isolation…cont
• When single rooms or isolation rooms are not
available and where several patients with the
same confirmed organism have been
identified these patients may be nursed
together in a bay or ward. This is called Cohort
nursing. Examples may include diarrhoea and
vomiting, Clostridium difficile diarrhoea,
norovirus and influenza.
 Criteria for Source Isolation
• Patients admitted with the following symptoms must
be isolated on admission
• Known or suspected communicable infection /disease
e.g. Pulmonary Tuberculosis,
• Chicken Pox Unexplained rash if considered to be of an
infectious cause
• Multi-Resistant organism’s e.g. MRSA
• Diarrhoea and/or vomiting until microbiologically proven
negative or symptoms subside. Clostridium difficile
• Symptomatic of influenza
 The following factors will be considered:
• The classification of the pathogen and the ability to protect
against or treat individual infections
• The probable route of transmission and evidence of
transmission
• Susceptibility of the other patients near to the infected
patient in the same bay i.e. do the other patients have
open wounds or an invasive device
• Whether the organism is antibiotic resistant.
• Possible detrimental effects of isolation to the patient i.e.
risk of falls, confusion or depression weighed against
severity of the risk of transmission to other patients.
 Procedure for Source Isolation
• Preparation of the isolation room/bed space
• Place an isolation sign outside the door or a
reminder sign over the bed space.
• Consider what equipment and supplies are
required for the area and the patients care.
• Remove all non-essential furniture. The
remaining furniture should be easy to clean
and should not conceal or retain dirt or
moisture either within or around it
 Procedure for Source Isolation….cont
• Ensure that the hand basin has sufficient soap
and paper towels for staff use.
• Ensure Alcohol hand gels are full.
• Place yellow clinical waste bag in the room on
a foot-operated bin. The bag must be sealed
before it is removed from the room. For
patients isolated in main bays clinical waste
should be placed into a small yellow waste bag
and taken to the nearest clinical waste bin
 Procedure for Source Isolation….cont
• Keep the patient's personal property to a minimum. All
belongings should be washable, cleanable or
disposable.
• As far as is reasonably possible provide the patient
with his/her own equipment i.e. commodes,
sphygmomanometer etc., and all items necessary for
attending to personal hygiene. Use disposable items
whenever possible i.e. disposable hoist sling,
disposable blood pressure cuffs, wash bowls. Reusable
equipment must be thoroughly decontaminated
before being used for another patient
 Procedure for Source Isolation….cont
• Keep dressing solutions, creams and lotions
etc., to a minimum and store them within the
room. These must be single patient use only
• Glove and Apron dispensers on a ward, be
stocked with gloves and yellow aprons at the
entrance to the isolation room. Avoid the use
of trolleys as they collect dust and can be easily
contaminated. If a trolley is used this must be
emptied daily and cleaned with Chlorclean
 Protective isolation
• Protective isolation or reverse
isolation denotes the practices used for
protecting vulnerable persons for contracting
an infection. When people with
weakened immune systems are exposed to
organisms, it could lead to infection and
serious complications. It is sometimes
practiced in patients with severe burns and
leukemia, or those undergoing chemotherapy
Decontamination of equipment and unit
 Decontamination of Equipment and Unit

• The term decontamination refers to a

process, which removes or destroys
contamination.
• Consequently micro-organisms (or other
contaminants) are prevented from reaching a
susceptible site, in sufficient numbers
necessary to initiate infection or any harmful
response.
 Decontamination Process
• All instruments that have come into contact with oral and other
bodily fluids must be thoroughly cleaned and sterilised after
use. Even if instruments are selected for a treatment session,
but not used, they should be viewed as contaminated.

• The key stages of the decontamination process are:

 pre-sterilisation cleaning
 disinfection
 inspection
 sterilisation
 storage
 Pre-sterilisation cleaning and
disinfection

• Used instruments must be thoroughly cleaned by hand, in

an ultrasonic bath or using an instrument
washer/disinfector before sterilisation. Hand cleaning is
the least effective of the options.

• By hand – If hand-cleaning is used, thick rubber gloves

should be worn and the instruments should be fully
immersed in detergent in a deep sink to prevent splashes.
A long-handled brush should be used to clean the visible
debris off the instruments. All instruments should be
carefully visibly scrutinised to ensure they are free from
debris. The brush that has been used for cleaning should
itself be cleaned and autoclaved regularly and stored dry.
Brushes used for this purpose should be replaced weekly.
 Pre-sterilisation cleaning and disinfection…
cont

• Ultrasonic cleaners – These cleaners should contain

detergent which should be disposed of at the end of every
clinical session and more often if necessary. Once the
cleaning cycle has been started, it must be left
uninterrupted until it has finished. At the end of each day
the ultrasonic cleaner should be emptied, cleaned and left
completely dry.

• Washer/disinfectors – these are the best of all the options

for pre-sterilisation cleaning because they include a
disinfection phase that makes the instruments safe for
handling and inspection, but they do not replace proper
sterilisation of instruments. Always follow the
manufacturer’s recommendations for use, cleaning and
maintenance.
 Inspection

• After cleaning, instruments should be

inspected for cleanliness and checked for
damage before sterilisation. If
instruments are damaged or still
contaminated they should be rejected
and re-cleaned.
 Sterilisation

• The best way to sterilise dental instruments is

autoclaving. It should be run at the highest
temperature given the load (134-137 degree
centigrade for 3-3.5 minutes). All instruments
should be placed in the machine in such a way
that steam can freely circulate around them and
you should carefully follow the manufacturer’s
recommendations for use, cleaning and servicing.
Newer models should have an integral printer to
allow the user to check that sterilisation values
have been achieved and to record and monitor
the equipment’s use.
 Storage

• Sterilised instruments should be stored in clean,

dry, covered conditions. The instruments
required for a treatment should be selected
prior to the session and as previously
mentioned, even if they are not used, they
should be treated as if contaminated.
Transportation of infected patients
 Transportation of infected patients

• Policy
 Category specific barrier techniques shall be utilized for any patient in isolation
throughout their transportation.
 The receiving area shall be notified of the patient’s category of isolation prior to the
patient’s arrival.
 The transporter shall be informed of the patient’s category of isolation prior to the
transport time.
 The Standard Precautions Policy will be followed for contact with any and all blood
and body fluids.
 Transportation of infected patients
….cont
• Nursing Personnel or Sending Department
•  Notify the transportation department regarding all patients
on isolation who require transport. This should be done when
telephoning the transportation department to request
transportation.
•  Place a notice on the front of the chart indicating the type
of isolation the patient requires.
•  Notify the receiving area by telephone prior to transport of a
patient on isolation.
 Transportation of infected patients
….cont
• Transportation Department
•  Follow all isolation procedures for the type of isolation
involved (see policy: Isolation).
•  Transport patients by the most direct routes to their
destination. Avoid contact with employees and visitors as
much as possible.
•  Disinfect wheelchairs and stretchers with a hospital-grade
disinfectant after use for a patient on isolation and prior to
returning the wheelchair/stretcher to service.
 Transportation of infected patients
….cont
• Transportation Department ….cont
•  Cleaning of wheelchairs will be focused on the seat, arm rest,
and back rest. The metal portion of the wheelchair will be
inspected for contamination with blood and other body fluids
and once removed, all surfaces decontaminated with a hospital
grade disinfectant.
•  Cleaning of the stretchers will focus on the upper and lower
surface of the stretcher pad. The metal portion of the stretcher
will be inspected for contamination with blood and body fluids
and once removed, all surfaces decontaminated with a hospital
grade disinfectant.
 Transportation of infected patients
….cont
• Transportation of Patients on Contact Precautions
• Patients on Contact Precautions must be transported on a stretcher or
wheelchair covered with a sheet or other physical barrier.
•  The transporter should wear a gown and gloves to assist the patient into
and out of the wheelchair/stretcher. Gowns and gloves are available on
the nursing unit.
•  The hands of the transporter should be washed with an antimicrobial
soap or an alcohol hand rub should be applied after gloves are removed.
•  Gowns and gloves are not required during transportation and
ambulating the patient. Transportation of Patients on Airborne or Droplet
Precautions
Transmission-Based Precautions
 Transmission-Based Precautions

• Transmission-Based Precautions are

the second tier of basic infection
control and are to be used in addition
to Standard Precautions for patients
who may be infected or colonized with
certain infectious agents for which
additional precautions are needed to
prevent infection transmission.
Source:
 Transmission-Based Precautions….CONT

• Contact Precautions
• Ensure appropriate patient placement in a single
patient space or room if available in acute care hospitals.
In long-term and other residential settings, make room
placement decisions balancing risks to other patients. In
ambulatory settings, place patients requiring contact
precautions in an exam room or cubicle as soon as
possible.
• Use personal protective equipment (PPE)
appropriately, including gloves and gown. Wear a gown
and gloves for all interactions that may involve contact
with the patient or the patient’s environment. Donning
PPE upon room entry and properly discarding before
exiting the patient room is done to contain pathogens.
 Transmission-Based Precautions….CONT

• Limit transport and movement of patients outside of the

room to medically-necessary purposes. When transport or
movement is necessary, cover or contain the infected or colonized
areas of the patient’s body. Remove and dispose of contaminated
PPE and perform hand hygiene prior to transporting patients on
Contact Precautions. Don clean PPE to handle the patient at the
transport location.
• Use disposable or dedicated patient-care equipment (e.g.,
blood pressure cuffs). If common use of equipment for multiple
patients is unavoidable, clean and disinfect such equipment
before use on another patient.
• Prioritize cleaning and disinfection of the rooms of patients
on contact precautions ensuring rooms are frequently cleaned and
disinfected (e.g., at least daily or prior to use by another patient if
outpatient setting) focusing on frequently-touched surfaces and
equipment in the immediate vicinity of the patient.
 Transmission-Based Precautions….CONT

• Droplet Precautions
• Ensure appropriate patient placement in a single
room if possible. In acute care hospitals, if single rooms
are not available, utilize the recommendations for
alternative patient placement considerations in the
Guideline for Isolation Precautions. In long-term care and
other residential settings, make decisions regarding
patient placement on a case-by-case basis considering
infection risks to other patients in the room and available
alternatives. In ambulatory settings, place patients who
require Droplet Precautions in an exam room or cubicle
as soon as possible and instruct patients to follow
Respiratory Hygiene/Cough Etiquette recommendations.
 Transmission-Based Precautions….CONT

• Droplet Precautions….CONT
• Use personal protective equipment
(PPE) appropriately. Don mask upon entry
into the patient room or patient space.
• Limit transport and movement of
patients outside of the room to medically-
necessary purposes. If transport or
movement outside of the room is necessary,
instruct patient to wear a mask and follow
Respiratory Hygiene/Cough Etiquette.
 Transmission-Based Precautions….CONT

• Airborne Precautions
• Ensure appropriate patient placement in an
airborne infection isolation room
(AIIR) constructed according to the Guideline for
Isolation Precautions. In settings where Airborne
Precautions cannot be implemented due to
limited engineering resources, masking the
patient and placing the patient in a private room
with the door closed will reduce the likelihood of
airborne transmission until the patient is either
transferred to a facility with an AIIR or returned
home.
 Transmission-Based Precautions….CONT

• Airborne Precautions…cont
• Restrict susceptible healthcare
personnel from entering the
room of patients known or
suspected to have measles,
chickenpox, disseminated zoster, or
smallpox if other immune healthcare
personnel are available.
 Transmission-Based Precautions….CONT

• Airborne Precautions…cont
• Use personal protective equipment (PPE)
appropriately, including a fit-tested NIOSH-approved
N95 or higher level respirator for healthcare personnel.
• Limit transport and movement of patients outside of
the room to medically-necessary purposes. If transport or
movement outside an AIIR is necessary, instruct patients
to wear a surgical mask, if possible, and observe
Respiratory Hygiene/Cough Etiquette. Healthcare
personnel transporting patients who are on Airborne
Precautions do not need to wear a mask or respirator
during transport if the patient is wearing a mask and
infectious skin lesions are covered.
 Transmission-Based Precautions….CONT

• Airborne Precautions…cont
• Immunize susceptible persons as
soon as possible following
unprotected contact with vaccine-
preventable infections (e.g., measles,
varicella or smallpox).
Barrier nursing
 Barrier nursing
• Barrier nursing is a set of stringent infection control
techniques used in nursing.
• The aim of barrier nursing is to protect medical staff against
infection by patients and also protect patients with highly
infectious diseases from spreading their pathogens to other
non-infected people.
• Barrier nursing was created as a means to maximize
isolation care. Since it is impossible to isolate a patient from
society and medical staff while still providing care, there are
often compromises made when it comes to treating infectious
patients. Barrier nursing is a method to regulate and minimize
the number and severity of compromises being made in
isolation care, while also preventing the disease from spreading
 Uses
• Care and treatment of patients with deadly,
contagious diseases which have no
treatment options; giving control the main
purpose of this practice.
• Provides protection for other patients and
medical personnel; not infected with the
virus.
 Directions
•  Nurse wears pressurised PPE (Personal
Protective Equipment) suit with breathing
apparatus and body protection material.
•  Gloves are worn for routine care; to be
disposable.
•  Transport of patient should be minimal;
covering colonised/contaminated areas and
cleaning surfaces is required.
•  Protective face-masks required for airborne
germs
 Simple vs strict barrier nursing

• Simple barrier nursing

• Simple barrier nursing is used when an infectious
agent is suspected within a patient and
standard precautions aren't working.
• Simple barrier nursing consists of utilizing sterile:
gloves, masks, gowns, head-covers and eye
protection.Nurses also wear personal protective
equipment (PPE) to protect their bodies from infectious
agents. Simple barrier nursing is often used for
marrow transplants, human Lassa virus transmission,
viral hemorrhagic fever and other virulent diseases.
 Simple vs strict barrier nursing
• Strict Barrier Nursing
• Strict barrier nursing, which is also known as "rigid barrier
nursing", is used for the rarer and more specific deadly viruses
and infections: Ebola and rabies.
• Strict barrier nursing is a lot more demanding in terms of safety
measure requirements because of the catastrophic effects that
can occur if the disease or virus is allowed through the barrier.
• If patients cannot be isolated from one another completely,
they have to at least be isolated from the rest of the patients
within the hospital. In strict barrier nursing the patients and staff
are usually isolated from the common population, and every
attempt is made to establish a barrier between the inside and
outside of the ward.
 Simple vs strict barrier
nursing
• The staff going on duty have to remove all outer clothing, pass through
an airlock and put on a new set of PPE. When a staff member is going
off duty, they are required to take a thorough shower and leave
everything that was taken into the room to be disinfected or destroyed.
• While strict barrier nursing methods cannot always be enforced,
especially in lower income areas and countries, any modifications made
must be based on sound principles. Since infection can be spread
through fomites, clothes or oxygen, all efforts must be made to limit the
spread of these vessels.
• The doctor's or nurse's hands must be thoroughly washed after
touching anything in the cubicle. Taps and door-handles should be
elbow- or foot-operated. Hands should be washed in the cubicle and
dried outside to eliminate contamination from paper or cloth towels. In
addition, antiseptic hand-cream, dispensed from a foot-operated wall
container would also serve as an additional precaution
 Transmission-Based Precautions

• Transmission-Based Precautions are

the second tier of basic infection
control and are to be used in addition
to Standard Precautions for patients
who may be infected or colonized with
certain infectious agents for which
additional precautions are needed to
prevent infection transmission.
 Contact precautions
• Ensure appropriate patient placement in a single patient space or room if available in
acute care hospitals. In long-term and other residential settings, make room placement
decisions balancing risks to other patients. In ambulatory settings, place patients requiring
contact precautions in an exam room or cubicle as soon as possible.
• Use personal protective equipment (PPE) appropriately, including gloves and gown.
Wear a gown and gloves for all interactions that may involve contact with the patient or the
patient’s environment. Donning PPE upon room entry and properly discarding before exiting
the patient room is done to contain pathogens.
• Limit transport and movement of patients outside of the room to medically-necessary
purposes. When transport or movement is necessary, cover or contain the infected or
colonized areas of the patient’s body. Remove and dispose of contaminated PPE and perform
hand hygiene prior to transporting patients on Contact Precautions. Don clean PPE to handle
the patient at the transport location.
• Use disposable or dedicated patient-care equipment (e.g., blood pressure cuffs). If
common use of equipment for multiple patients is unavoidable, clean and disinfect such
equipment before use on another patient.
• Prioritize cleaning and disinfection of the rooms of patients on contact precautions
ensuring rooms are frequently cleaned and disinfected (e.g., at least daily or prior to use by
another patient if outpatient setting) focusing on frequently-touched surfaces and equipment
in the immediate vicinity of the patient.
 Droplet precautions
• Source control: put a mask on the patient.
• Ensure appropriate patient placement in a single room if possible.
In acute care hospitals, if single rooms are not available, utilize the
recommendations for alternative patient placement considerations in
the Guideline for Isolation Precautions. In long-term care and other
residential settings, make decisions regarding patient placement on a
case-by-case basis considering infection risks to other patients in the
room and available alternatives. In ambulatory settings, place patients
who require Droplet Precautions in an exam room or cubicle as soon as
possible and instruct patients to follow Respiratory Hygiene/Cough
Etiquette recommendations.
• Use personal protective equipment (PPE) appropriately. Don
mask upon entry into the patient room or patient space.
• Limit transport and movement of patients outside of the room to
medically-necessary purposes. If transport or movement outside of the
room is necessary, instruct patient to wear a mask and follow
Respiratory Hygiene/Cough Etiquette.
 Airborne precautions
• Source control: put a mask on the patient.
• Ensure appropriate patient placement in an airborne infection isolation room
(AIIR) constructed according to the Guideline for Isolation Precautions. In settings
where Airborne Precautions cannot be implemented due to limited engineering
resources, masking the patient and placing the patient in a private room with the door
closed will reduce the likelihood of airborne transmission until the patient is either
transferred to a facility with an AIIR or returned home.
• Restrict susceptible healthcare personnel from entering the room of patients
known or suspected to have measles, chickenpox, disseminated zoster, or smallpox if
other immune healthcare personnel are available.
• Use personal protective equipment (PPE) appropriately, including a fit-tested
NIOSH-approved N95 or higher level respirator for healthcare personnel.
• Limit transport and movement of patients outside of the room to medically-
necessary purposes. If transport or movement outside an AIIR is necessary, instruct
patients to wear a surgical mask, if possible, and observe Respiratory Hygiene/Cough
Etiquette. Healthcare personnel transporting patients who are on Airborne Precautions
do not need to wear a mask or respirator during transport if the patient is wearing a
mask and infectious skin lesions are covered.
• Immunize susceptible persons as soon as possible following unprotected
contact with vaccine-preventable infections (e.g., measles, varicella or smallpox).
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