appendix A

• Perform hand hygiene before and immediately after performing a task or procedure.

• Clean gloves should be worn whenever touching blood, body fluids, secretions, and/or excretions is anticipated. They should also be worn when handling items or surfaces soiled with blood or body fluids and when performing venipuncture and/or vascular access. Gloves must be changed and hand hygiene performed after contact with each and every patient.

• Personal protective equipment (PPE) such as face masks, protective eyewear (goggles) and/or face shields, and fluid-repelling gowns should be worn for procedures that are likely to generate droplets of blood or exposure to body fluids, secretions, and/or excretions. If mouth-to-mouth resuscitation is needed, always use a resuscitation mask or bag-valve mask to prevent direct contact with the patient’s mucous membranes.

• All health care providers should take precautions to prevent injuries that can be caused from inappropriate handling of needles, scalpels, and other sharp instruments. After sharp items are used, they must be placed in PUNCTURE-RESISTANT containers nearby.

1. Airborne infection isolation (AII) precautions (5 micrometers [µm] or smaller) must be used whenever working with a patient who has pulmonary tuberculosis (TB), chickenpox (varicella), measles (rubeola), smallpox (variola), and specific respiratory infections. These infecting microorganisms can be inhaled by the health care provider or others in the room. Therefore N-95 respirator face masks must be worn, and special ventilation and air-handling protocols must be used to prevent transmission of the microorganism. Patients are placed in a private room, and specific air-circulation requirements and/or filtration of air particles must be done. All health care providers coming in contact with the TB-positive patient MUST be fitted for and wear an N-95 face mask or positive airway pressure respirator.

2. Droplet precautions (5 µm or larger) are used when the microorganism is spread through talking, coughing, or sneezing. Haemophilus influenzae type B, pertussis (whooping cough), scarlet fever, pneumonia, and rubella fall into this category. Transmission of these large droplets requires contact within 3 feet, because the large size does not stay suspended in the air for an extended period of time. Droplet precautions necessitate a separate room but do not necessitate special ventilation or air handling. When working within 3 feet of a patient with a droplet infection, using standard precautions and wearing a disposable face mask are recommended.

3. Contact precautions are used to reduce the spread of infectious organisms by direct or indirect contact. It is to be used when skin-to-skin contact may occur, such as turning or bathing a patient. When possible, these patients are placed in a private room or in a room with another patient who has the same infection. On entering the room, the health care provider should wear clean gloves and a fluid-resistant cover gown. While performing care on this patient, gloves should be changed after having any contact with blood, body fluids, secretions, or excretions that may have a high concentration of the infecting organism. Health care providers must be sure to remove their gloves and cover gown BEFORE leaving the patient’s room and to perform hand hygiene. They must be careful not to touch anything in the patient’s room as they leave.