Although standard precautions are used when interacting with all patients, sometimes these precautions are not enough to stop the transmission of infections. Transmission based precautions are used as a second tier of precautions in patients who are suspected of being or known to be infected. This includes three type

A. Contact precautions

• When infectious agents –especially epidemiologically significant microorganisms like MRSA, VRE, Other multi drugs resistant gram-negative organisms are spread by direct or indirect contact with patients or patient’s environment, contact precautions should be used.
• Patients requiring contact precautions should be placed in single-patient rooms. If these are not available the health care workers should consult their Infection control officer to assess the risk of other patient placement options like cohorting, or keeping the patient with his or her existing roommates.
• HCWs caring for patients on contact precautions should always wear gloves and gown for all interactions with the patient or patient’s environment.
• PPE should be done upon room entry and removed before the exit to contain the pathogens and prevent transmission.

B. Droplet Precautions

• This type of precautionary measure is employed when there is a risk of transmissions such as Bordetella Pertussis or Influenza, Rhinovirus or Adenovirus pathogens.
• When Droplet precautions are employed the patient should be placed in a single room, HCWs should wear a mask when close contact with infected patients and should be donned before entering the patients unit.
• When patients on droplet precaution are moved out of the unit, they should wear a mask and follow respiratory hygiene and cough etiquette.

C. Airborne Precautions

• When patients infected with pathogens such as Varicella Virus (Chickenpox and Shingles), M.Tuberculosis and rubella that remain infectious over a long distance when suspended in air, airborne precautions must be employed.
• Patient should be placed in a single-patient room with negative air pressure.
• HCWs should wear N95 masks or higher level respirator when caring for such patients and the mask should be fit tested before use.

Isolation policy for special groups of organisms

Methicillin-Resistant Staphylococcus aureus (MRSA): The pathology department shall send an alert to the head of the concerned unit in case the microbiology report ascertains the existence of MRSA. Measures will be immediately ascertained by the HCCC for isolation of MRSA.

• Use respiratory (contact with mask) precautions
• Accommodate these patients away from those with open wounds or immune-compromised
• Hand washing is the single most important factor in controlling MRSA
• Linen – sheets, pillowcases, and blankets should be changed on a daily basis and more often if soiling occurs. Linen should not be shaken in order to prevent dissemination of micro-organisms into the environment. Linen should be autoclaved before being sent to the laundry. The same will apply to masks, gowns and gloves.

Pulmonary tuberculosis: Respiratory precautions should be taken for smear-positive tuberculosis patients

Precautions against transmission as per the type of transmission

Being tertiary cancer centre and non-availability of required all resources, patient may be transferred to that Govt. /Non-Govt. hospital, where that epidemic related management & treatment, is available. Even though the following precautions are elaborated in this manual till primary management.

Admission

Patients with HIV / HBV / HCV disease but presenting with unrelated illnesses may be admitted in any ward as per existing rules.  Confidentiality shall be maintained with appropriate precautions to prevent Nosocomial transmission.

Preparation of patients

• It is the responsibility of the attending physician to ensure that patients, testing positive are informed about the result and receive counselling.
• The nursing staff will explain to patients, attendants and visitors (when necessary), the purpose and methods of hand washing, body substance and excreta precautions, and other relevant precautions.

Specimens 

Adequate precautions are to be taken while collecting specimens. The specimens are to be transported in leak-proof containers placed inside a leak-proof plastic cover. Ensure that the cover and the outside of the container are not contaminated. Attach a ‘Biohazard’ label.

Waste disposal

A bin lined by a Red plastic bag is placed in the patient’s room for infectious waste. When the bag is 3/4^ths full it is sent for disposal.

Non-infectious waste does not require special precautions and is disposed of in a manner similar to non- infectious waste generated from any other patient.

Death of a patient

Those cleaning the body should use gloves and other protective gear. Before leaving the ward, the body is bagged as for any case.

Precautions Against Airborne Transmission

These precautions are designed to reduce the risk of airborne and droplet transmission of infectious agents and apply to patients known or suspected to be infected with epidemiologically important pathogens that can be transmitted by these routes.

Components of respiratory isolation:

1. Place the patient in a single/private room with closed doors. Patients with same illness (but no other infection) can be cohorted in one room.
2. Masks to be worn by those who enter the patient’s room. Susceptible persons should not enter the room of patients.
3. Gowns are not routinely necessary. Use gowns if soiling is likely.
4. Gloves are necessary while handling patients.
5. Hand must be washed after touching the patient or potentially contaminated articles and before taking care of another patient.
6. Articles contaminated with infective material must be discarded or bagged and labelled before being sent for decontamination and reprocessing.

Precautions Against Contact Transmission

Contact isolation precautions are recommended for specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact that occurs when performing patient – care) or indirect contact (touching) with contaminated environmental surfaces or patient-care items.

Components:

1. Gowns are indicated if soiling is likely.
2. Gloves are indicated for touching infected material/area
3. Hands must be washed after touching the patient or potentially contaminated articles and before taking care of another patient.
4. When possible, dedicate the use of non-critical patient – care equipment to a single patient (or cohort of patients infected or colonized with the pathogen requiring precautions) to avoid sharing between patients. If the use of common equipment or items is unavoidable, then adequately clean and disinfect them before use for another patient.
5. Articles contaminated with infective material must be discarded or bagged and labelled before being sent for decontamination and reprocessing.