Isolation Precautions: Airborne (Ambulatory) - CEALERTDon appropriate PPE based on the patient’s signs and symptoms and indications for isolation precautions. Show
Avoid physical contact with the patient with suspected or confirmed tuberculosis (TB) or other airborne pathogen before donning appropriate personal protective equipment (PPE). A patient in airborne isolation need a to be placed in a negative-pressure airborne infection isolation room (AIIR). If an AIIR is not available, place a surgical mask on the patient.undefined#ref4">4 Airborne precautions are the highest level of isolation. Until an airborne-transmitted illness is diagnosed, airborne precautions represent the safest precautions. Perform hand hygiene with soap and water or use an alcohol-based hand rub (ABHR) immediately after removing all PPE. OVERVIEWInfection prevention and control measures help to ensure the protection of patients in a range of settings who may be vulnerable to acquiring an infection. Infection-control practices that reduce and eliminate sources of infection transmission help to protect patients and health care team members from disease. The health care team member is responsible for educating a patient about infection control. Knowledge of the infectious process, disease transmission, and critical-thinking skills associated with use of aseptic techniques and barrier protection is essential for both health care team members and patients. One of the most common airborne pathogens is TB. Current guidelines for preventing and controlling TB focus on detecting the infection early, preventing close contact with a patient who has active TB, and applying effective infection-control measures in the health care setting.1 Other airborne pathogens include chicken pox and Rubeola (i.e., measles). Shingles, also a varicella infection, does not require airborne isolation precautions. TB should be suspected in any patient who has a persistent cough lasting longer than 3 weeks1 accompanied by chest pain, bloody sputum, unexplained weight loss or loss of appetite, fever, chills, night sweats, malaise, or fatigue. Isolation for a patient with suspected or confirmed TB includes being placed on airborne precautions in a negative-pressure AIIR with special air-handling and ventilation capacity.5 The advantages of the QuantiFERON®-TB Gold (QFT-G) blood test in place of the traditional tuberculin skin test (TST) are that it does not boost responses measured by subsequent tests and that the results are not subject to reader bias. QFT-G can be used in place of, but not in addition to, the TST. A patient who has a positive QFT-G result, regardless of signs or symptoms, should be evaluated for TB disease before latent TB infection is diagnosed. At minimum, a chest radiograph should be examined for abnormalities consistent with TB. Health care team members who care for patients with suspected or confirmed TB should wear nonpowered air-purifying respirators (i.e., N95 respirator [Figure 1]).2,5 These respirators are high-efficiency particulate masks that have the ability to filter particles at a 95% or better efficiency.2,5 Health care team members who use these respirators must be fit-tested in a reliable way to determine which size mask is appropriate and to ensure that the wearer knows when a good seal is achieved. Fit-testing must be performed before health care team members are required to wear the respirator in the workplace and must be repeated at least annually.3 Fit-testing must also be conducted whenever respirator design or facial changes that may affect a proper fit take place.3 A respirator that has not been fitted properly may leave unprotected gaps between it and the face, impairing its effectiveness. If facial hair or unusual facial features make fitting a mask-type respirator properly difficult, a powered air-purifying respirator (PAPR) may be used (Figure 2). A PAPR has the same filtering properties as the mask-type respirator and is approved by national organization guidelines.1 This type of respirator covers the head and uses a blower to move air through the filter and into the face piece, helmet, or hood. A PAPR does not require fit-testing before use. N95 respirators are disposable, but the same individual may use them more than once. N95 respirators should be stored between uses in a clean, breathable receptacle (e.g. paper bag), in a dry place, and out of direct sunlight.2 The respirator should be discarded if it becomes wet or damaged. Using a respirator does not, on its own, fully protect health care team members from acquiring an airborne infection. Other infection-control practices, such as performing hand hygiene, isolating an infected patient, and using appropriate coughing etiquette are also important to minimize the risk of infection. All organizations should have a procedure for donning and doffing the organization’s specific N95 or PAPR and preparing equipment for reprocessing (e.g., bagging for temporary storage before reprocessing, immediate reprocessing in the doffing area). EDUCATION
PROCEDURE
PAPR OptionDonning PPE
Doffing PPE
N95 Respirator OptionDonning PPE
Doffing PPE
EXPECTED OUTCOMES
UNEXPECTED OUTCOMES
DOCUMENTATION
PEDIATRIC CONSIDERATIONS
OLDER ADULT CONSIDERATIONS
REFERENCES
*In these skills, a "classic" reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. Elsevier Skills Levels of Evidence
Which of the following is the proper sequence for removal of isolation apparel?The order for removing PPE is Gloves, Apron or Gown, Eye Protection, Surgical Mask. Perform hand hygiene immediately on removal. All PPE should be removed before leaving the area and disposed of as healthcare waste.
Which of the following is the most important procedure in the prevention of disease?Hand hygiene is the most important measure to prevent the spread of infections among patients and DHCP. Education and training programs should thoroughly address indications and techniques for hand hygiene practices before performing routine and oral surgical procedures.
When exiting an isolation room which item of PPE must be removed outside the room?Before entering the isolation area, remove practice outerwear (e.g., laboratory coat) and any equipment (e.g., stethoscope, scissors, thermometer, watch, cell phone) and leave outside the isolation unit/anteroom. Gather any necessary supplies and medications before putting on PPE.
Which of the following is a factor that increases a host's susceptibility in the chain of infection?Factors that may increase susceptibility to infection by disrupting host defenses include malnutrition, alcoholism, and disease or therapy that impairs the nonspecific immune response.
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