National Respiratory InfectionControl Program

Dr KK Aggarwal

Droplet precautions:- Droplets are particles of respiratory secretions ≥5 microns and remain suspended in the air for limited periods. Transmission is associated with exposure within three to six feet (one to two meters) of the source.

Droplet precautions are used for the care of patients with suspected or confirmed infections with Neisseria meningitidis, Bordetella pertussis, influenza, parainfluenza, adenovirus, Haemophilus influenzae type b, Mycoplasma pneumoniae, rubella, COVID 19.

1.Respiratory viruses (such as parainfluenza virus and COVID 19) can be transmitted by contact and/or via droplets; both contact and droplet precautions should be implemented

2.Respiratory syncytial virus (RSV) may be transmitted by the droplet route but is primarily spread by direct contact with infectious respiratory secretions. Therefore, the most important intervention for prevention of RSV transmission in health care settings is adherence to contact precautions (plus standard precautions).

3.The CDC does not recommend droplet precautions for RSV however, droplet precautions are warranted if the infecting agent is not known, if the patient may be coinfected with other pathogens that require droplet precautions, and/or if there is a chance of exposure to aerosols of infectious respiratory secretions.

4.Health care workers caring for patients on droplet precautions should wear a surgical mask when they are within six feet of patients.5.

5.No special air handling systems or higher-level respirator masks are required for the care of patients with known or suspected infection due to organisms capable of droplet transmission.

6.The doors of rooms used to house these patients may remain open (in contrast with airborne precautions).

Contact precautions:-Contact precautions are used for the care of patients with selected multidrug-resistant bacteria and various enteric and viral pathogens.

Patients who require contact precautions should be in a private room or in a cohort with other patients who have the same indication for contact precautions.

Some respiratory viruses (such as parainfluenza virus) can be transmitted by contact and/or via droplets. Thus, both contact and droplet precautions should be implemented for patients with known or suspected infection due to such organisms.

Health care workers should perform hand hygiene and wear gloves upon room entry, even if no direct patient contact is anticipated. Gowns should be worn even if direct contact with the patient or infective material is not anticipated.

Upon room exit, gowns and gloves should be removed and hand hygiene should be performed immediately since hands predictably become contaminated during glove removal.

Medical equipment should be dedicated to a single patient when possible in order to avoid transfer of pathogens via fomites. Equipment that is not dedicated to a single patient must be cleaned and disinfected before reuse.

Airborne precautions:-Airborne droplet nuclei are particles of respiratory secretions <5 microns. Droplet nuclei can remain suspended in the air for extended periods and thus can be a source of inhalational exposure for susceptible individuals.

Airborne precautions are warranted for the care of patients with suspected or confirmed tuberculosis, measles, varicella, smallpox, and severe acute respiratory syndrome (SARS).

Patients on airborne isolation precautions should be placed in a private room with negative air pressure that has a minimum of 6 to 12 air changes per hour.

Doors to the isolation rooms must remain closed, and all individuals who enter must wear a respirator with a filtering capacity of 95 percent that allows a tight seal over the nose and mouth.

In the setting of herpes zoster, airborne and contact precautions are warranted for all patients with disseminated zoster and for immunocompromised patients with localized zoster. Immunocompetent patients with localized zoster that can be contained/covered may be managed with standard precautions. Susceptible health care workers should not provide direct care to these patients if immune caregivers are available.

COVID 19 is transmitted predominantly by droplet spread and direct contact, although airborne transmission may also occur, especially during aerosol-generating procedures like endotracheal intubation; therefore, both airborne and contact precautions are warranted.

Patients in respiratory isolation who require transport outside their isolation rooms for medical procedures should wear surgical masks that cover the mouth and nose during transport. Procedures for these patients should be scheduled at times when they can be performed rapidly and when occupation of waiting areas is minimal. [uptodate dot com]