Standard, Transmission and Protective Based

Precautions

Document ID CHQ-PROC-63110 Version no. 5.0 Approval date 05/02/2020

Executive sponsor Executive Director Medical Services Effective date 05/02/2020

Author/custodian CNC Infection Management & Prevention Service Review date 05/02/2022

Supersedes 4.0

Applicable to All CHQ HHS staff

Authorisation Executive Director Clinical Services (QCH)

Purpose

There are approximately 200, 000 healthcare-associated infections (HAIs) in Australian acute health care

facilities each year 1. Knowing how and when to apply basic principles of infection control and prevention is

critical, and the responsibility of everybody working and visiting a healthcare facility 1.

To prevent HAIs and protect all staff and patients in QCH, standard precautions will be employed for the care

of all patients regardless of diagnosis or presumed infectious status.

For those patients who are infected or colonised with pathogens spread via airborne, droplet or contact

routes, additional transmission-based precautions will be employed. Protective isolation and precautions are

utilised to provide additional protection to patients with severe immunosuppression.

Scope

• To give guidance to all staff to implement standard and additional transmission-based precautions

• To provide a high level of protection for all people in the health care setting against transmission of infection

Procedure

Standard Precautions

All people potentially harbour infectious agents. Standard precautions refer to those work practices that are

applied to everyone, regardless of their perceived or confirmed infectious status and ensure a basic level of

infection prevention and control. Implementing standard precautions as a first-line approach to infection

prevention and control in the healthcare environment minimises the risk of transmission of infectious agents

from person to person, even in high-risk situations.1

CHQ-Proc-63110 – Standard and Transmission Based Precautions

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Standard precautions include:

• Hand hygiene

• Use and management of sharps, safety engineered devices and medication vials

• Routine management of the physical environment

• Reprocessing of reusable medical devices

• Respiratory hygiene and cough etiquette

• Aseptic Technique

• Waste Management

• Handling of linen

• Use of personal protective equipment (PPE) in clinical practice where appropriate

Transmission based precautions

Transmission-based precautions are recommended as additional work practices in situations where standard

precautions alone may be insufficient to prevent transmission. Transmission-based precautions are

implemented for patients known or suspected to have an infection or be colonised with epidemiologically

important or highly transmissible pathogens that can cause infection.

Types of transmission-based precautions include:

• Contact precautions

Transmission is via direct touch or indirect contact with skin or contaminated surfaces. For example,

organisms that causes diarrhoea, skin lesions, and multi-resistant organisms (MROs).

• Contact precautions are used when there is a risk of transmission of agents that are not contained by Standard Precautions. There is potential for these organisms to be transmitted by surfaces and contaminated shared equipment, for example C. difficile, skin infestation, multi-resistant organisms (MROs)

• Droplet precautions

Transmission is via large droplets. Organisms transmitted via droplet transmission are large and do

not remain suspended in the air, generally only travelling short distances (approximately 1 metre), for

example mumps, rubella, pertussis, influenza, respiratory syncytial virus (RSV) and other respiratory

viruses. Therefore, close contact with patient is required for transmission.

• Large particle droplets > 5 microns in size are generated by a patient who is talking, coughing, sneezing

• There is also potential for these droplets to be transmitted by contact with surfaces in the environment that are contaminated e.g. door handle

• Airborne precautions

Transmission is by airborne droplets. Organisms transmitted via airborne transmission are very small

in size (<5 microns) that remain suspended in the air and can be dispersed widely by air currents

within a room or over a long distance. Airborne illnesses include measles, varicella and pulmonary

mycobacterium tuberculosis (TB). Patient with airborne illnesses require placement in negative

pressure isolation rooms.

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Additional Transmission-based precautions practiced at QCH

• Pink precautions Level 1 and Level 2

Patients with Cystic Fibrosis (CF) are at risk of patient-to-patient and environment-to-patient

transmission of epidemiologically and clinically significant respiratory pathogens through contact,

droplet or airborne mechanisms. This is particularly important for those organisms of significance to

patients with CF which includes multi-drug resistant organisms. Pink precautions Level 1 and Level 2

have been developed to minimise the risk of infection to and between patients with CF and are to be

used in conjunction with existing infection control precautions.

Refer to the Management of patients with cystic fibrosis procedure for further detailed information -

CHQ-PROC-63223 Management of patients with cystic fibrosis

• Protective precautions

Protective precautions are implemented for patients who require enhanced protection due to severe

immunodeficiency. The requirement for protective precautions and PPE use is dependent on the

patient condition and determined by the patient’s treating team. Restriction of patient’s movement

within the hospital, and visitors entering patient rooms may be required.

Patients who may require protective precautions include patient with conditions such as severe

combined immunodeficiency (SCID), T cell primary immune deficiency, DiGeorge syndrome and/or

patients who are undergoing bone marrow transplant.

• Pandemic precautions

Additional precautions may be required for patients known or suspected to be infected with

microorganisms transmitted by airborne droplet nuclei if there is high morbidity or mortality of disease,

for example pandemic respiratory illnesses such as Middle East respiratory syndrome (MERS),

Severe acute respiratory syndrome (SARS), avian influenza as well as rare infectious organisms such

as Ebola Haemorrhagic fever (EVD). In these instances, respiratory precautions apply in combination

with other precautions such as contact precautions.

Specific procedures are provided for the management of Ebola and MERS;

• CHQ-PROC-63309 Assessment of a Child with Suspected Ebola Virus

• CHQ-PROC-63002 Infection Control Guidelines for the Management of Coronavirus (MERS,

SARS or Novel Coronavirus)

ALERT

Awareness has grown regarding the potential for unintended negative consequences of isolation precautions for patients.

Several studies demonstrate that patients under isolation:

• are seen less by their HCWs compared to non-isolated patients

• are at risk of incomplete documentation/observations, extended fasting times, fewer

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Strategy Evidence/Resources Link/s

Admission

screening and

safe patient

placement

Staff are to assess and determine appropriate placement of patients

dependent on their condition, symptoms and known infectious status.

Once screening assessment is complete, and precautions are

determined, place appropriate signage to room and/or curtain entry.

Posters can be accessed from the QCH IMPS Intranet site -

https://qheps.health.qld.gov.au/childrenshealth/html/chq-infection

CHQ-PROC-63210

Admission

Screening and

Safe Patient

Placement

including Cohorting

Risk Management

Hand Hygiene

and Bare

Below the

Elbow

Hand hygiene is the single most important practice in reducing the transmission of infectious agents in healthcare settings. All staff must perform hand hygiene appropriate to their role within the organisation. The minimum requirements for hand hygiene are as per the 5 Moments for Hand Hygiene:

Bare below the elbows is a requirement for effective hand hygiene.

NB: The wearing of wrist braces, plaster casts, strapping or splints on

Procedure

CHQ-PROC-63505

Hand Hygiene

Website

Hand Hygiene

Australia

CHQ HH Posters

https://qheps.healt

h.qld.gov.au/__dat

a/assets/pdf_file/00

25/737701/five-

moments-

poster.pdf

https://qheps.healt

h.qld.gov.au/__dat

a/assets/pdf_file/00

27/733761/wash-

hands-poster.pdf

CHQ It’s OK to ask

Poster

https://qheps.healt

treatments and education sessions and follow up reviews

• are at a higher risk of adverse events such as falls and pressure areas

• experienced increased symptoms of anxiety and depression (both patients and families)

• experience and report a decreased satisfaction with their care

Measures should be included in the patient’s care to minimise the negative consequences outlined above. These may include:

• adequate health care worker resources to support the additional precautions activities

• adequate patient safety rounds and active monitoring for adverse outcomes

• consideration of additional psycho-social support.

• additional patient and family education

CHQ-Proc-63110 – Standard and Transmission Based Precautions

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hands or forearms is not permitted for staff undertaking clinical duties

involving patient contact, as adequate hand hygiene cannot be

performed.

h.qld.gov.au/__dat

a/assets/pdf_file/00

23/2211872/cychs-

its-ok-to-ask-

poster.pdf

CHQ BBE Poster

https://qheps.healt

h.qld.gov.au/__dat

a/assets/pdf_file/00

33/1808187/chq-

bare-below-elbow-

a4.pdf

Personal

Protective

Equipment

(PPE)

PPE refers to the protective barriers used to protect health care workers (HCW skin, mucous membranes, airways and clothing from contact with patient’s microorganisms.

Examples include:

Gloves: for contact with blood or bodily fluids, non-intact skin or mucous membranes.

NB: Gloves are not a substitute for hand hygiene.

Plastic apron/fluid impervious gown: when anticipating risk of splash or direct clothing contact with body fluid.

Protective Eyewear/Face-shield/Surgical Mask: when anticipating risk of splash or spray of body fluid to the face and/or eyes. Face shields may be used in addition to surgical masks or an alternative to eyewear.

N95 or P2 mask: for airborne precautions e.g. measles, active TB and/or chicken pox.

Poster CHQ_Sequence for putting on and removing PPE Poster CHQ_Sequence for putting on and removing PPE for suspected/confirmed MERS

Aseptic non-

touch

technique

(ANTT)

Aseptic technique protects patients during invasive clinical procedures by employing measures that minimise the presence of pathogenic microorganisms.

Poster CHQ_The ANTT Approach

Processing of reusable medical equipment and instruments

Reusable medical equipment and instruments must be reprocessed to a level appropriate for their intended use.

Procedure

CHQ-PROC-

12001_Reprocessi

ng of Reusable

Medical Devices

Cleaning shared patient care equipment

The cleaning of clinical equipment is the responsibility of clinical staff. Reusable patient equipment e.g. stethoscopes, blood pressure cuffs, tourniquets, commodes, intravenous pumps and poles must be appropriately cleaned by clinical staff in between each patient. Toys must be wiped down after each use. Toys that cannot be wiped down must not be used.

Procedure CHQ-PROC-63650 Health Service Environment Cleaning Procedure Environmental Routine environmental cleaning of health care facilities is required to

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cleaning

minimise the number of micro-organisms in the environment. CHQ_PROC_65660_Toy Hygiene and Play Area Use Poster CHQ IMPS Which Wipes?

Spills When blood and body substance spills occur, the spill must be contained and decontaminated without delay, using standard precautions.

• Blood and Body Fluid Spill Kits are available in the dirty utility rooms of clinical areas.

• For large spills on the floor or other surfaces, the health care worker contains the spill, removes bulk of substance with paper towelling or other disposable product and notifies Medirest personnel to complete surface cleaning.

Work Instruction https://qheps.health.qld.gov.au/__data/assets/pdf_file/0037/2047978/wi-63652.pdf

Sharps management

The use of sharps devices exposes HCWs to the risk of injury and potential exposure to blood borne infectious agents. The person who has used a sharp instrument or equipment must be responsible for its safe management and immediate disposal after use. Safety devices and retractable equipment should be used when available.

Management of Exposure to Blood and Body Fluids

Standard precautions remain the first line of protection for health care workers against occupational exposure to blood and body fluids however there are instances where exposures occur. Prompt management and assessment is necessary to minimise the risk of disease transmission including Hepatitis B (HBV), Hepatitis C (HCV) and human immunodeficiency virus (HIV). All CHQ persons are to notify their supervisor of an exposure and to complete a clinical incident form.

Procedure

CHQ-PROC-63311_Management of Exposure to Blood and Body Fluids

Waste management

Waste management includes both general waste and clinical and related waste.

• Segregation should occur at the point of generation.

• Not all waste generated from patients under transmission-based precautions needs to go into a clinical ‘yellow’ waste bin. It should be assessed as per the waste management procedure and then disposed of accordingly.

• Waste should be placed in the appropriate receptacle (identified by colour and label).

• Receptacles are not to be overfilled or compacted by hand. Hand hygiene must be performed following the handling of waste.

Procedure

CHQ-PROC-67073_QCH Waste Management

Linen Clean linen is stored away from traffic, clean and dry. Used linen will be placed in a linen bag to be collected for laundry services.

• Handle and transport used linen soiled with blood/body substance in a manner that prevents skin, mucous membrane exposures, contamination of clothing and avoid transfer of microorganisms in the environment.

All persons handling soiled linen should ensure:

• Handling is carried out with minimum agitation to prevent contamination of air and persons handling the linen.

• Special care should be taken with linen visibly soiled with blood and body substances.

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• Linen must be rolled and enfolded to contain soil (do not shake used linen).

Linen which is heavily soiled with blood or body substances or other fluids must be placed in a purpose specific clear plastic alginate bag before being loaded into a linen bag.

Customer own goods (COG)

• This is laundry that requires special washing: e.g. patient hoist slings

• These items should be placed in green COG bags provided by the linen service

• Complete a COG docket including QCH and ward to enable item to be returned

• Do not put these items in the red linen bags. Parent and Patient’s Own Clothes

• Patient laundering facilities are provided in 8B and 11B (oncology patients only)

Staff Immunisation

All employees should be aware of their requirements for immunisation

against vaccine preventable diseases. Vaccination records should be

emailed to CHQ_StaffIMMS@health.qld.gov.au for assessment.

Staff Health

Employees with acute infections or signs and symptoms of a potentially infectious illness must notify their Line Manager and must not come to work for the specified exclusion periods. If employees are diagnosed with a communicable disease that may be a risk to patients, the employee must notify their line management and Infection Management and Prevention Service immediately. Health care workers that are not able to perform a high standard of hand hygiene due to cuts, skin breaks or wounds that cannot be covered, must inform their Line Manager, Infection Management and Prevention Service and Workplace Health and Safety.

Procedure

CHQ-PROC-60812_Protection of Health Care Workers (HCW)

Procedure

CHQ-PROC-60816_Pregnant Staff Infection Prevention Guidelines

Patient Education

Patients and their families who are unwell – have a fever, cough and/or gastroenteritis symptoms should advise their nurse as soon as possible. All staff have the responsibility to provide education to al patients and their families about cough etiquette and hand hygiene.

Poster

CHQ Help protect our patients

Supporting documents

Authorising policy and standard(s)

• NHMRC Australian Guidelines for the Prevention and Control of Infections in Healthcare 2019

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Consultation

Key stakeholders who reviewed this version:

• CNC Infection Management & Prevention Service

• Director Infection Management & Prevention Service

• Director of Nursing Clinical Support

• CHQ IMPS Committee

• CHQ IMPS Nursing team

• Safety and Wellbeing representative

Audit/evaluation strategy

Level of risk High

Strategy Annual review of practices – audit and ongoing surveillance

Audit/review tool(s)

attached

IMPS CNC

Audit/Review date Annual Review

Review responsibility CNC Infection Management and Prevention Service

Key elements /

Indicators / Outcomes

Standard precautions are employed for the care of all patients regardless of

diagnosis or presumed infectious status.

Transmission based precautions are employed when caring for patients who are

infected or colonised with pathogens spread via airborne, droplet or contact

routes.

Procedure revision and approval history

Version No. Modified by Amendments authorised

by

Approved by

1.1 Patient Safety & Quality Unit District Patient Safety & Quality Committee

Chief Operating Officer

2.0 CNC IMPS District Patient Safety & Quality Committee

Chief Operating Officer

3.0

11/05/2016

CNC IMPS Divisional Director, Clinical Support

Executive Director Hospital Services

4.0

17/10/2019

Legal Governance and Risk – update review date

Divisional Director Clinical Support

Executive Leadership Team

5.0

05/02/2020

CNC- Infection Management and Prevention Service

Nursing Director, Division of Clinical Support

Executive Director Clinical Support (QCH)

CHQ-Proc-63110 – Standard and Transmission Based Precautions

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Keywords precautions, isolation, transmission, standard, infection, protection, linen, cleaning,

equipment, special effects, occupational exposure, needle-stick, blood, sharps,

injury, splash, spills, organisms, contamination, droplet, contact, airborne, MRO,

soiled, infectious, 63110

Accreditation

references

NSQHS Standards (1-8): Standard 3 – Preventing and Controlling Healthcare

Associated Infections

ISO 9001:2015 Quality Management System (4-10)

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Appendix 1

Summary of Standard and Transmission Base precautions, and safety and operational considerations

Table 1

Standard Precautions

Process Safety and Operational Considerations

Hand Hygiene CHQ-PROC-63505 Hand Hygiene

• Hand hygiene is the most important aspect of care in reducing risks of infection.

Preparation of the standard room

• The room or cubicle should have an accessible clinical hand wash basin.

• Air conditioning in balance with main ward.

• Unnecessary furniture removed before admitting patient.

• Mattresses and pillows should have non-permeable covers.

Essential items include:

• Medical equipment; mobile sharps bin to be taken into the room as required

• Waste bin lined with a plastic bag

• Hospital approved skin antiseptic for hand washing in an approved dispenser.

Visitors • Entry and exit hand-washing.

• Must not be at risk of transmitting infection e.g. respiratory or gastrointestinal

infection

Personal Protective Equipment

Disposable Plastic Apron or Gown (long sleeved)

B1.2.3 Aprons and gowns - National Health and Medical Research Council.

• Gowns should be worn as single use items, for one procedure or episode of

patient care. If used, non-disposable gowns should be sent for laundering after

each use.

• The type of apron or gown required depends on the degree of risk, anticipating

the degree of contact with infectious material and the potential for exposure to

blood and body fluids.

Masks / Eye Protection / Face Shields

• Equipment used depends of degree of risk as determined by clinician.

• Masks used to prevent splashes or sprays from reaching the mouth and nose

of person wearing them.

• While effective as eye protection, googles do not provide splash or spray

protection to other parts of the face.

• Face shields may be used in addition to surgical masks or an alternative to

eyewear.

• A surgical mask and protective eyewear must be worn during procedures that

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Standard Precautions

Process Safety and Operational Considerations

generate splashes or sprays of blood, body substances, secretions or excretions

into the face and eyes

B1.2.4 Face and eye protection | National Health and Medical Research Council

Gloves

• Change gloves between tasks on the same patient after contact with material

that may contain a high concentration of micro-organisms.

• Change gloves between procedures.

• Remove gloves promptly after use, before touching non-contaminated items

and environmental surfaces, and before going to another patient, and wash hands

immediately to avoid transfer of microorganisms to other patients or environments.

B1.2.5 Gloves | National Health and Medical Research Council.

Disposal of potentially infected items

Waste Management

When handling waste:

- Apply standard precautions to protect against exposure to blood and body substances during handing of waste; wash hands following procedure.

- Segregation should occur at point of generation

- Waste should be contained in appropriate containers and disposed of according to QCH Waste Management Procedure

Spills B1.4.3 Management of blood and body substance spills National Health and Medical Research Council

When blood and body substance spills occur, the spill must be contained and decontaminated without delay, using standard precautions.

• For large spills on the floor or other surfaces, the health care worker contains

the spill, removes bulk of substance with paper towelling or other disposable

product and notifies Medirest personnel to complete surface cleaning.

• If Medirest personnel are not immediately available, the health care worker is

responsible for cleaning up the spill.

The following products are used to contain and clean and decontaminate spills:

• Alcohol swabs (70%) may be used for cleaning up small drops of blood.

• At Ellen Barron Family Centre specialised vomitus clean up kits exists for use

in public areas.

• For final clean use neutral detergent or disinfectant e.g. if vomitus Clinell green

wipesTM. Advice may be sought from the Helpdesk (ext 4357)

• Where a spill occurs on a carpet, steam clean or shampoo as soon as possible

– do not use disinfectant. This is arranged at QCH by contacting the Helpdesk. In

waiting rooms or patient treatment areas, blood and body substance spills should

be dealt with immediately to reduce risks.

Operating rooms or in circumstances where medical procedures are underway, spills should be attended to as soon as it is safe to do so.

Body • Urinals and bedpans are washed by a pan sanitiser (including potties).

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Standard Precautions

Process Safety and Operational Considerations

substances • Use single use disposable vomit bags if possible which seal, and dispose of

vomit bowls in a manner which contains risk of droplet spread.

Linen Clean linen is stored away from traffic, clean and dry.

Used linen will be placed in a linen bag to be collected for laundry services.

• Handle and transport used linen soiled with blood/body substance in a manner

that prevents skin, mucous membrane exposures, contamination of clothing and

avoid transfer of microorganisms in the environment.

All persons handling soiled linen should ensure:

• Handling is carried out with minimum agitation to prevent contamination of air

and persons handling the linen.

• Special care should be taken with linen visibly soiled with blood and body

substances.

• Linen must be rolled and enfolded to contain soil (do not shake used linen).

Linen which is heavily soiled with blood or body substances or other fluids must be

placed in a purpose specific clear plastic alginate bag before being loaded into a linen

bag.

Soiled linen has been identified as a source of potential pathogenic micro-organisms; however, the risk of actual disease transmission is negligible.

Customer own goods (COG)

This is laundry that requires special washing: e.g. patient hoist slings

• These items should be placed in green COG bags provided by the linen

service

• Complete a COG docket including QCH and ward to enable item to be

returned

• Do not put these items in the red linen bags.

Parent and Patient’s Own Clothes

• Clean clothes are to be kept separate from unclean clothes to prevent

contamination by soiled linen, or other matter, including equipment.

• Patient laundering facilities are provided in 8a and 11b (oncology patients only)

Needles, disposable syringes and all sharp items

• Refer to CHQ-PROC-63311 Management of Exposure to Blood & Body Fluids

- Needle stick/sharps injuries blood/body fluids exposure.

• All sharps are placed in a hospital approved puncture resistant sharps

container for incineration / reprocessing. Where there is no easily accessible sharps

container, mobile sharps containers are to be taken to the patients’ rooms when

sharps are to be used at the bedside to ensure point of use disposal.

• All staff should be educated regarding the safe use, handling and disposal of

sharps.

• People using a sharp object are responsible for safe disposal of the item,

preferably directly at the point of use. The task should only be delegated in special

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Standard Precautions

Process Safety and Operational Considerations

circumstance such as the operating room environment.

• Contaminated sharps should not be broken or bent, removed from disposable

syringes prior to disposal or passed by hand between health care workers except in

in special circumstance such as the operating room environment.

• Do not re-sheath safety equipment such as puncture-resistant needle

mats/trays. Re-sheathing devices may be used but they must be assessed by

Infection Management and Prevention Service prior to purchase, approved by the

facility, and develop a plan to educate staff on use of device.

• Eliminate risk of sharps injury whenever possible by using safety devices e.g.

retractable needle/syringes, needle-less access devices, blood taking devices.

• In the case of locating an inappropriately disposed sharp(s), facilitate remedial

action immediately. It is recommended that a sharps container be taken to the

location, the sharp handled and disposed of in a manner to avoid injury, and hands

washed following disposal. Report inappropriate disposal in an incident report form.

Food Handling

Crockery and cutlery

• Good hygienic practices should be instituted during the handling of the meals.

• All trays are returned to the kitchen on a covered trolley.

• Safe practices will be adhered to during all storage of food in Operational

Services, loading docks, and in ward food cupboards and refrigerators.

• Disposable crockery and cutlery should not be necessary, unless as directed

by Infection Management Prevention Service/CNC Infection Control. Ward patient's

utensils can be included in the general dishwasher, provided this is carried out

using detergent and water temperature.

Equipment and cleaning

• Follow hospital procedures for the cleaning, disinfecting, sterilisation and

reprocessing of equipment.

• Re-useable equipment once used should be returned to CSD for reprocessing

as per required transport processes.

• Daily cleaning with neutral detergent applies throughout all the Hospital clinical

environments CHQ-PROC-63650 Health service Environment Cleaning.

Transporting Patients

• Disposable gloves, plastic aprons and wash cloths (e.g. spill kit) should be

available in case of spillage of body fluid during transport.

Cleaning after discharge of patient

• The HCW is responsible for stripping the bed.

• Cleaning medical / allied health equipment is a nursing / allied health worker/

assistant responsibility.

• Cleaning of the bed, furniture and surroundings will be attended to by

operational contractor Medirest as per their procedures and the QCH Cleaning

Matrix.

• See also CHQ-PROC-63650 LCCH Environmental Cleaning

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When patient requires transmission based precautions: Apply standard precautions and add transmission based precautions based on the organism.

Contact Precautions

Infection Control Process

Infection Control Safety and Operational Issues

Patient Placement

• Apply contact precautions signage to room entry.

• Place the patient in a single room with own ensuite.

• When a single room is not available, place the patient in a room with a

patient(s) who has active infection with the same microorganisms, but with no

other infection (cohorting).

• CHQ-PROC-63210 Admission Screening and Safe Patient Placement.

Personal Protective Equipment (PPE)

In addition to using Standard Precautions, gloves and an apron or gown should always be worn when entering patient room.

Strict adherence to hand hygiene is paramount – see CHQ-PROC-63505 Hand Hygiene and Bare Below the Elbow

Aprons or Gowns:

• A single use apron should be donned prior to entering the patient room and

removed prior to exiting the patient room.

• Staff who will be performing patient care activities involving extensive patient

contact should wear a gown (extensive patient contact is described as direct

contact with the areas not covered by the apron, for example, contact with staff

forearm).

• Ensure that clothing does not contact potentially contaminated environmental

surfaces to avoid transfer of microorganisms to other patients or environments.

Patient Transport • Limit the movement and transport of the patient from the room to essential

areas only.

• If the patient is transported out of the room, ensure that precautions are

maintained.

Patient-Care-Equipment

• When possible, dedicate the use of noncritical patient-care equipment to a

single patient (or cohort of patients infected or colonised with the pathogen

requiring precautions) to avoid sharing between patients.

• If use of common equipment or items is unavoidable, then adequately clean

(e.g. with a disinfectant wipe) before use for another patient.

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Droplet Precautions

Infection Control Process

Infection Prevention Safety and Operational Considerations

Patient Placement

• Apply droplet precautions signage to room entry.

• Place the patient in a single room with own ensuite.

• When a single room is not available, place the patient in a room with a patient(s)

who has active infection with the same microorganisms, but with no other infection

(cohorting).

• When a single room is not available and cohorting is not achievable, consider the

epidemiological pattern of the microorganism and the patient population when

determining patient placement. Do not place with immunocompromised or high risk

respiratory patients such as those with cystic fibrosis or bronchiectasis. Consultation

with CNC Infection Management and Prevention Service or after hours the Infectious

Diseases Consultant on call is advised before patient placement.

• Special air handling and ventilation are not necessary and the door may remain

open.

• CHQ-PROC-63210 Admission Screening cohort and safe patient placement including

Cohorting Risk Management

Protective apparel

In addition to using Standard Precautions a gown/apron and face mask/shield must be worn. Risk assessment for personal protective apparel (PPE) Aprons or Gowns: • A single use apron should be donned prior to entering the patient room and removed

prior to exiting the patient room.

• A mask or face shield must be worn when staff are within 2 meters of an infectious

patient.

• Staff that will be performing patient care activities involving extensive patient contact

should wear a gown (i.e direct contact with the areas not covered by the apron, for

example, contact with staff forearm)

Patient Transport

• Limit the movement and transport of the patient from the room to essential areas

only.

• If possible, surgical masks should be worn by patients under droplet precautions

when moving around the hospital to minimise dispersal of droplet nuclei. Small

paediatric surgical masks or adult masks are available. A flowing oxygen mask if

medically indicated is also acceptable when leaving the room.

• If the patient does not require an oxygen mask or tolerate a surgical mask, lifts

should be quarantined to reduce the risk of transmission to other people sharing the

lift.

• Ensure that staff transporting the patient maintain precautions to minimise the risk of

transmission of microorganisms to their clothes, other patients and the environment.

• Staff should ensure any receiving department are informed of the additional

precautions required e.g. Radiology and Operating Theatres.

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Airborne precautions

Airborne illnesses include measles, varicella and pulmonary mycobacterium tuberculosis (TB). Patient with

airborne illnesses require placement in negative pressure isolation rooms.

See airborne plus precautions (below) for pandemic respiratory illnesses including MERS, SARS, avian

influenza and novel infectious organisms..

Infection Control Process

Infection Control Safety and Operational Issues

Patient Placement

• Apply airborne precautions signage to room entry.

Place the patient in a single room that has:

• Monitored negative air pressure

• 6 to 12 air changes per hour

• Ensure Negative pressure is on.

• Appropriate discharge of air outdoors or monitored high-efficiency filtration of

room air before the air is circulated to other areas in the hospital.

If this is not available, place the patient in a single room and keep the room door closed. If cohorting required, see CHQ Procedure 63210: Admission Screening and Safe Patient Placement including Cohorting

Protective Apparel

In addition to using standard precautions wear a gown and a particulate filter mask.(P2/ N95). A P2/N95 mask is a close-fitting (i.e. ‘duckbill’ style) particulate filter mask capable of

filtering 95% of particles 0.3 micron in size. Masks with this capability are designated

with the ‘N95’ certification.

• The P2 / N95 mask must be fit checked prior to entering the room. Please

refer to CHQ-PROC-63326 Respiratory Pandemic Sub-Plan Appendix 6 P2/N95

Respiratory – How to Perform a Fit Check.

• Susceptible persons should not enter the room of patients known or

suspected to have measles or varicella (chickenpox) if other immune caregivers

are available.

• Staff that will be performing patient care activities involving extensive patient

contact should wear a long sleeved gown (i.e direct contact with the areas not

covered by the apron, for example, contact with staff forearm)

Food service delivery / other ancillary services

Food service and other ancillary staff should request nursing staff to deliver and retrieve meals, crockery and cutlery to minimise staff required to don P2 / N95 and fit check masks

Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. If transport or movement is necessary:

• Minimise patient dispersal of droplet nuclei by placing a surgical mask on the patient, if possible.

• Ensure that staff maintain precautions to minimise the risk of transmission of microorganisms to other patients and environments.

• Quarantine the lift for patient transport if there is risk of transmission to others such as if the patient won’t tolerate a surgical mask.

For specific travel routes please refer to CHQ-PROC-63309 Assessment of a Child

with Suspected Ebola Virus and CHQ-PROC-63002 Infection Control Guidelines

for the Management of Coronavirus (MERS,SARS or Novel Coronavirus)

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Airborne Plus precautions

For pandemic respiratory illnesses including MERS, SARS, avian influenza, new and emerging respiratory

infections with unknown transmission.

In an outbreak or pandemic event, precautions and PPE advice may change depending on the State and

National recommendations.

Ebola and Viral Haemorrhagic Fever require additional PPE procedures, always refer to Procedure CHQ-

PROC-63309 Assessment of a child with suspected Ebola Virus - Identification and immediate

management of Ebola Virus Disease CHQ-PROC-63312 - Transporting a patient with suspected or

confirmed Ebola Virus Disease (EVD)

Specific procedures are provided for the management of Ebola and Coronavirus including; CHQ-PROC-

63309 Assessment of a Child with Suspected Ebola Virus and CHQ-PROC-63002 Infection Control

Guidelines for the Management of Coronavirus (MERS, SARS or Novel Coronavirus)

Infection Control Process

Infection Control Safety and Operational Issues

Patient Placement

• Apply airborne plus precautions signage to room entry.

Place the patient in a single room that has:

• Monitored negative air pressure

• 6 to 12 air changes per hour

• Appropriate discharge of air outdoors or monitored high-efficiency filtration of

room air before the air is circulated to other areas in the hospital.

If this is not available, place the patient in a single room and keep the room door closed. If cohorting required, see CHQ Procedure 63210: Admission Screening and Safe Patient Placement including Cohorting

Protective Apparel

In addition to using standard precautions wear a gown, eye protection (face shield

or googles), gloves and a mask (P2/ N95) should be worn.

A P2/N95 mask is a close-fitting (i.e. ‘duckbill’ style) particulate filter mask capable of

filtering 95% of particles 0.3 micron in size. Masks with this capability are designated

with the ‘N95’ certification.

• The P2 / N95 mask must be fit checked prior to entering the room. Please

refer to CHQ-PROC-63326 Respiratory Pandemic Sub-Plan Appendix 6 P2/N95

Respiratory – How to Perform a Fit Check.

• An observer is useful to aid fit testing of P2/N95 masks

• Before PPE is donned, maintain pockets are emptied e.g: remove phone, pens,

lanyard, name tag; and tie back hair. Males must have clean shaven faces.

Food service delivery / other ancillary services

Food service and other ancillary staff should request nursing staff to deliver and retrieve meals, crockery and cutlery to minimise staff required to don P2 / N95 and fit check masks Sign placed on the door to STOP See nursing staff before entering should be up.

Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. If transport or movement is necessary:

• Minimise patient dispersal of droplet nuclei by placing a surgical mask on the patient parent and visitor.

• Ensure that staff maintain precautions to minimise the risk of transmission of microorganisms to other patients and environments.

• Quarantine the lift for patient transport if there is risk of transmission to others such as if the patient won’t tolerate a surgical mask

• Refer to CHQ-PROC-63312 Transporting a Patient with Suspected or Confirmed

Ebola Virus Disease for patient travel routes.

CHQ-Proc-63110 – Standard and Transmission Based Precautions

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Pink precautions level 1 and 2

For all CF patients (level 1) and CF patients known to be infected / colonised Mycobacteria abscessus (M. abscessus) and / or Burkholderia cepacia (B. cepacia) (level 2) see CHQ-PROC-63223 Management of patients with cystic fibrosis

Infection Control Process

Infection Control Safety and Operational Issues

Visitors Visitors must speak with a nurse before entering the patient's room.

Patient Placement

Level 1

Single room with own bathroom preferred. Do not room with other CF patients, patients with MROs, burns, respiratory infections, or oncology and immunodeficient patients.

Siblings living in the same household may room together with parental consent and following discussion with the CF team.

Door must be closed

Children with CF may visit entertainment, play, school and pet areas providing no other children with CF are present in the same room at the same time. Equipment and furniture used by the child must be cleaned with a disinfectant wipe (e.g. Clinell green) after use.

Children with CF may leave the hospital to visit Southbank etc.

When CF patients leave the room, they should wear a mask.

Level 2 additional requirements

Negative pressure single room preferred but not essential. Single room with own bathroom essential. Emergency Department (ED) is not required to use a negative pressure room.

Patients are not permitted to visit entertainment, play, school and pet areas.

Children with CF may attend the gym or physiotherapy exercise areas if scheduled for the last session of the day and to be followed by an orange clean.

Protective apparel

Level 1 and 2

Staff to wear apron for minimal patient / environment contact

Long sleeved gown for extensive patient / environment contact

Staff – no mask required (unless staff member at risk)

Patient to wear surgical mask when outside room / treatment room / gym or in transit

to other areas.

Patient Transport Patient to wear surgical mask when outside room / treatment room / gym or in transit

to other areas. If the patient is transported out of the room, ensure that staff maintain

precautions to minimise the risk of transmission of microorganisms to other patients

and contamination of environmental surfaces or equipment e.g. place patient notes in

a plastic bag to prevent contamination during transport.

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Protective Precautions

For patients who • are undergoing bone marrow transplant (BMT) from admission until engrafted (white cell count >0.5

three days)

• have severe combined immunodeficiency (SCID)

• have T cell primary immunity deficiency

• have DiGeorge syndrome – Immunology Consultant to advise if there is concern regarding T cells and

the need for protective isolation. This condition can improve with maturity decreasing the need for

protective isolation

Infection Control Process

Infection Control Safety and Operational Issues

Visitors Visitors must speak with a nurse before entering the patient's room.

Patient Placement

Place the patient in a single room that has:

• Protective precautions signage (note there are two ; ‘airlock’ and ‘no airlock’)

• monitored positive air pressure in relation to the surrounding areas

• HEPA filtered air to the room

• Minimum 12 air changes per hour.

Positive pressure protective isolation rooms are situated in 11B (rooms 1-12) and 10B (room 5). There are also four positive pressure single rooms in PICU. These rooms are designed for protective isolation and cannot be used as negative pressure rooms. Similarly, negative pressure rooms for airborne isolation cannot be changed to positive pressure to use for protective isolation. If this is not available, place the patient in a single room and keep the room door closed.

Protective apparel

No visitors or staff should enter the room of any patient in protective isolation when

unwell, particularly with respiratory or gastrointestinal symptoms.

Implement Droplet, Contact and Airborne precautions in addition to Protective

precautions according to specific organism if required.

Protective isolation oncology (BMT) Gowns: • A single use long sleeved gown should be donned prior to entering the patient

room and removed prior to exiting the patient room. • Gowns should only be worn for one procedure or episode of patient care Protective isolation other patients Aprons or Gowns: • a single use apron or gown should be donned prior to entering the patient room and

removed prior to exiting the patient room. • Aprons and gowns should only be worn for one procedure or episode of patient

care. Staff that will be performing patient care activities involving extensive patient contact should wear a gown (extensive patient contact is described as direct contact with the areas not covered by the apron, for example, contact with staff forearm)

Patient Transport Limit the movement and transport of the patient from the room to essential purposes only. • Use staff lifts

• Quarantine the lift for patient transport

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