precaution nursing

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1. standard precaution

  • all body fluids, secretions, and excretions except sweat (regardless of whether or not they contain visible blood)
    ex) salmonella 등 식중독에 걸려서 diarrhea 시 standard precaution 중 enteric precaution을 적용함.
  • blood
  • mucous membranes
  • non-intact skin
  • Use standard precautions for the care of all patients.
  • handwashing: Wash hands between patients, after removing gloves, and if hands are contaminated with body fluids.
  • application (before room): ① gown → ② mask, face shield → ③ gloves
  • ① gown, apron: Wear a fluid-resistant cover gown or apron to protect uniforms or clothing if contamination is likely. Change the gown between patients.
  • ② mask, face shield, eye protection: Wear a mask, face shield, or eye protection whenever fluid splashing to the face is likely.
  • ③ gloves: Wear gloves when handling body fluids. Change gloves between patients or before touching environmental surfaces. Wash hands after gloves are removed.
  • removal: gloves → face shield → gown → (after getting out of the room) mask
  • Equipment: Critical patient care equipment (such as surgical instruments) must be sterilized, and semi-critical equipment can be clean, disinfect, and/or sterilize it as appropriate.
  • dishes, glasses, cups, eating utensils: No special precautions are needed for dishes, glasses, cups, or eating utensils. The combination of hot water and detergent used in hospital dishwashers is sufficient to decontaminate dishes, glasses, cups, and eating utensils.
  • linen: Place soiled linen in leak-proof containers.
  • occupational health: Never recap needles. Place needles in puncture-proof containers. Use mouth-pieces or resuscitation bags instead of traditional mouth-to-mouth resuscitation whenever possible. Report all injuries regardless of perceived significance.
  • ex) PCP pneumonia pt. care 시 suction 시 고글, 마스크, 장갑 착용해야 함. (○) Perineal care 시 장갑 착용해야 함. (○)
  • 집에서 가져온 음식을 나누어 먹음. Bite를 sharing 하는게 아니라면 가능함. (○)
  • Linen change 시 보호가운 입기 (ⅹ)

2. airborne-transmission based precautions (with standard precautions)

  • airborne droplet nuclei, 5 ㎛ or smaller in size
  • Special air handling and ventilation are required to prevent airborne transmission.
  • measles
  • varicella (including disseminated zoster) : airborne + contact
  • TB
  • SARS: airborne + contact
  • MERS: airborne + contact
  • private room: negative air pressure, 6 to 12 air changes per hour, high-efficiency filtration of room air before the air is circulated to other areas, keep the room door closed and the patient in the room
    When a private room is not available, place the patient in a room with a patient who has an active infection with the same microorganism.
  • respiratory protection: Wear respiratory protection (N95 respirator) when entering the room of a patient with known or suspected infectious pulmonary tuberculosis. Susceptible persons should not enter the room of patients known or suspected to have measles (rubeola) or varicella (chickenpox) if other immune caregivers are available. Persons immune to measles or varicella don’t need to wear respiratory protection.
  • patient transport: Limit the movement and transport. If movement or transport is necessary, place a surgical mask on the patient.

3. droplet-transmission based precautions (with standard precautions)

  • involves contact of the conjunctiva or the membrane of the nose or mouth of a susceptible person with large-particle droplets,
    larger than 5 ㎛ in size, travel only short distances, usually 3 ft or less, through the air
  • coughing, sneezing, or talking and during the performance of certain procedures such as suctioning and bronchoscopy
  • Special air handling and ventilation are not required to prevent droplet transmission.
  • invasive HIB (Haemophilus Influenza type B disease) including meningitis, pneumonia, epiglottitis, and sepsis
  • invasive Neisseria, including meningitis, pneumonia, and sepsis.
  • streptococcal pharyngitis, pneumonia, or scarlet fever in a child
  • others: diphtheria, pertussis, mycoplasma pneumonia, pneumonic plague
  • viral infections: adenovirus, parvovirus B 19, mumps, rubella, influenza
  • private room: Maintain spatial separation of at least 3 ft between the infected patient and other patients and visitors. Special air handling and ventilation are not required, and the door may remain open. Active infection with the same microorganism but with no other infection (cohort),
  • respiratory protection: Wear a mask, when working within 3 fits of the patient.
  • patient transport: Limit the movement and transport. If movement or transport is necessary, place a surgical mask on the patient.

4. contact-transmission based precautions (with standard precautions)

  • direct contact transmission / indirect contact transmission
  • gastrointestinal, respiratory, skin, or wound infections
  • colonization with multi-drug resistant bacteria judged by the infection control program
  • (for diapered or incontinent patient) enteric infections including clostridium difficile, enterohemorrhagic escherichia coli O157: H7, Shigella, hepatitis A, rotavirus
  • RSV (Respiratory Syncytial Virus), parainfluenza virus, or enteroviral infections in child
  • skin infections that are highly contagious or that may occur on dry skin, including (cutaneous) diphtheria, (neonatal or mucocutaneous) herpes simplex virus, (disseminated or immunocompromised host) zoster, impetigo, scabies, pediculosis, staphylococcal furunculosis in infants and young children
  • major non-contained abscesses, cellulitis, or decubiti
  • viral hemorrhagic conjunctivitis
  • viral hemorrhagic infections: ebola, Lassa, or Marburg
  • Active infection with the same microorganism but with no other infection (cohort). Consider the epidemiology of the microorganism and the patient population.
  • Wear gloves before entering the room (clean and nonsterile gloves are adequate), Remove gloves before leaving the patient’s room and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent (알코올 젤로는 부족함). Wear gown before entering the room (clean and nonsterile gown is adequate), Remove the gown before leaving the patient’s environment.
  • When possible, dedicate the use of non-critical patient care equipment to a single patient to avoid sharing between patients. If the use of common equipment or items is unavoidable, then adequately disinfect them before use for another patient.
  • patient transport: Limit the movement and transport. If the patient is transported, minimize the risk of transmission of microorganisms (closed dressing, gowning the patient).

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