Precautions, Bloodborne, Contact, and Droplet

Definition/Introduction

The Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA) are the regulating bodies of infection control, prevention, and awareness. 

Precautions are preventative steps needed to be taken by healthcare team members and staff at healthcare facilities to prevent the spread of infections. There are universal standard precautions are the minimum infection prevention steps defined by the CDC as[1]:

• Hand hygiene, proper washing of hands before and after patient contact
• Use of appropriate protective equipment (i.e., gloves) before patient contact
• Respiratory hygiene (i.e., covering your cough and sneeze)
• Injection and sharp object safety and proper disposal
• Cleaning of supplies and disposal of waste

In addition to universal standard precautions, the Center for Disease Control (CDC) defines additional types of proper personal protective equipment (PPE) required for each kind of precaution. Signs defining the precaution category should be easily visible and placed on each patient's room explaining the PPE needed and the type of isolation in effect.

The main types of transmission-based precautions defined by the CDC result from direct or indirect patient contact, bloodborne products, droplet, and airborne. Each kind of transmission-based precaution is dependent on the type of infection or pathogen the patient or source has, as outlined as follows: 

1. Contact precautions:

• Defined as direct or indirect contact with a patient and/or his or her environment including person's room or objects in contact with the person, that has an infection with an organism transmitted fecal-orally, such as Clostridium difficile, or wound and skin infections, or multi-drug resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).[1]
• PPE defined by the CDC required before entering a contact precaution designated room is always gloves and a gown.[2]
  • Mask and eye protection are additionally required if contact with bodily secretions is possible.

2. Bloodborne precautions: 

• Blood-borne transmission of pathogens is largely due to percutaneous injuries, which can be prevented using changes in technique, experience, and safety devices.[3][4]
• According to the OSHA database, HIV, hepatitis B and C, malaria, measles, herpes, chickenpox, and various other bacterial infections are known for being transmitted through blood-containing fluids and products. 
• Blood-borne precautions include wearing gloves, a face mask, protective eyewear or goggles, and proper handling of sharp objects with appropriate disposal.[2]
• Sharps disposal should be in an approved puncture-proof "sharp-only" locked and secured bin. 
  • All sharps should not be re-capped.
  • All sharps should not be bent or broken.
  • Safety devices should be implemented to prevent contact with needles and other sharps.
• These precautions apply to any blood-containing fluids, including cerebrospinal fluid, pericardial fluid, pleural fluid, and peritoneal fluid.
• Sputum, vomit, sweat, feces, and nasal secretions do not require blood-borne precautions unless there is visible blood noted.
• If contact with blood-containing fluids or products occurs, it is important to immediately wash the affected area with soap and water and obtain bloodborne infection status and immunization history from the patient.[5]

3. Droplet precautions: 

• Droplet precautions are necessary when a patient infected with a pathogen, such as influenza, is within three to six feet of the patient. 
• Infections are transmittable through air droplets by coughing, sneezing, talking, and close contact with an infected patient's breathing. Droplets are about 30 to 50 micrometers in size.
• Patients should be placed in individualized rooms, if possible.
• In addition to standard precautions, personnel should wear protective surgical masks should always before interacting between an infected patient or his/her environment.[6]

4. Airborne precautions:

• Airborne precautions are required whenever entering a patient's room or environment who has been diagnosed with or is being tested for with high suspicion of anthrax, tuberculosis, measles, chickenpox, or disseminated herpes zoster or other pathogens that can be transmitted through airflow that are 5 micrometers or smaller in size and remains in the environment for long periods of time.[1][6]
• In addition to standard precautions of wearing gloves and a gown, the CDC requires additional PPE of an approved N95 respirator mask properly fitted for each person working in the healthcare environment.[7] 
• The CDC also strongly recommends placing patients diagnosed with or receiving testing for, with high suspicion of an infectious airborne organism in a single room known as an airborne infection isolation room (AIIR). These are negative pressure rooms that provide air filtration and 6 to 12 air exchanges per hour to reduce the risk of transmission. 

Whenever interacting with any patient in a healthcare facility, healthcare team members and visitors need to adhere to and comply with PPE and infection control signs. It is also essential to wash hands thoroughly with soap and water before and when leaving a patient's room to ensure the safety of the patient and oneself. 

Issues of Concern