List two types of legislation you will need to follow when applying the additional precautions

In a healthcare setting, additional precautions should be applied when patients have a known or suspected infectious agent that may not be contained using Standard Precautions alone. These additional precautions should be tailored based on the infectious agent involved and the mode of transmission. For patients in a hospital setting in the United States with suspected or known EVD, the CDC recommends the addition of contact and droplet precautions, which are both transmission-based precautions. Further precautions may also be indicated based on any additional conditions or illnesses that are suspected or diagnosed in a particular EVD patient, such as airborne precautions if tuberculosis is suspected/known.

A combination of standard, contact, and droplet precautions to prevent the transmission of EVD in hospitals must be used. Some of the critical elements include:

• Placing the patient in a private room with a private bathroom. The door to the room should remain closed and a log should be maintained of all persons who enter.
• Using appropriate personal protective equipment (PPE) on a consistent basis by all personnel entering the patient's room.
• Using dedicated medical equipment that is disposable whenever possible.
• Limiting the use of needles and sharps. This includes limiting phlebotomy, procedures, and other laboratory testing to ONLY testing that is essential to the diagnostic evaluation and medical care of the patient.
• Avoiding procedures that produce aerosols (eg, sputum induction, bronchoscopy, open suctioning of airways).
• Performing frequent hand hygiene using soap and water or alcohol-based rubs. Hand hygiene should always be performed before and after patient contact, before putting on and after removing PPE, and when hands are visibly soiled (using only soap and water in this situation).
• Monitoring and managing potentially exposed personnel and visitors according to facility policies.

There are 5 major components to routine practices. They are risk assessment, hand hygiene, personal protective equipment, environmental and administrative controls.

Risk Assessment

Before any task is performed, conduct a risk assessment to evaluate the risk of disease transmission. The risk assessment should take into account the following:

• Time it takes to complete the task.
• Type of body fluids that the worker may come into contact with.
• Presence of microorganisms in the bodily fluids.
• Route of potential exposure to these microorganisms.
• Susceptibility of the worker to these microorganisms.
• Environment in which the task is carried out.

Appropriate strategies such as hand hygiene, waste management, and the use of personal protective equipment are then selected to reduce the risk of exposure and disease transmission.

The Ontario Ministry of Health and Long-Term Care suggest the following questions for healthcare providers to ask while assessing the risk:

1. What task am I going to perform?

2. What is the risk of exposure to:

• Blood and body fluids including respiratory secretions?
• Non-intact skin?
• Mucous membranes?
• Body tissues?
• Contaminated equipment?

3. How competent/experienced am I in performing this task?

4. Will the patient be cooperative while I perform the task?

Hand Hygiene

Hand hygiene is the act of removing or destroying microorganisms on the hands while maintaining good hand integrity (keeping the skin healthy). Hand hygiene can be performed with an alcohol-based hand sanitizer (when hands are not visibly soiled) or with soap and water (especially when hands are visibly soiled).

In healthcare settings, alcohol-based hand sanitizer is preferred when hands are not visibly soiled. For healthcare providers, using sanitizer is said to take less time than hand washing, and the mechanical rubbing action is important to kill transient bacteria. The sanitizer is also less drying to the skin when hands are cleaned repetitively. The sanitizer should contain between 70 and 90% alcohol.

Please see the OSH Answers document for more information about general hand washing.

Personal Protective Equipment (PPE)

PPE includes gloves, gowns, lab coats, shoe covers, goggles, glasses with side shields, masks, and resuscitation bags. PPE is particularly needed when disease transmission may occur through touching, spraying, aerosolization, or splashing of blood, bodily fluids, mucous membranes, non-intact skin, body tissues, and contaminated equipment and surfaces. PPE can help create a barrier between the exposed worker and the source of microorganisms.

Gloves

Gloves are for single-patient and single-procedure use only. Only disposable gloves should be used in the prevention of disease transmission. Gloves must be removed and replaced when they become heavily soiled and when working between patients and between dirty and clean tasks. Gloves should always be removed using a glove-to-glove or skin-to-skin technique which will prevent contaminating the hands.

The use of gloves does not replace the need for hand hygiene. Gloves often create a moist environment that facilitates the growth of microorganisms. Hands should be properly washed before the gloves are put on and after the gloves are removed. Hand hygiene is also needed before and after the replacement of gloves during a procedure or in between tasks.

Gowns

Gowns can be either reusable or disposable. These steps of gown donning and removal should be followed:

Gown Donning

1. Perform hand hygiene.
2. Put gown on, opening to the back.
3. Fasten both the neck and waist ties.

Gown Removal

1. Unfasten ties and peel gown away from neck.
2. Slip fingers of one hand under the wrist cuff and pull hand inside.
3. With inside hand, push sleeve off with the other arm.
4. Fold dirty-to-dirty and roll into bundle (do not shake).
5. Discard in hamper.
6. Perform hand hygiene.

Face Protection

Face protection can provide an effective barrier to protect a worker’s eyes, nose or mouth from coming into contact with sprays or aerosolized body fluids. There are different types and combinations of face protection, such as a mask with safety glasses, goggles, face shield (with safety glasses or goggles), or a mask with an attached visor (and safety glasses or goggles).

Steps to remove PPE

The proper steps when removing PPE are critical to prevent contamination of the worker with soiled PPE. The removal of PPE should be performed in the following order:

1. Remove gloves.
2. Remove gown.
3. Perform hand hygiene.
4. Remove eye protection.
5. Remove mask.
6. Perform hand hygiene.

Environmental Controls

Environmental control refers to controlling and minimizing the level of microorganisms in the environment. Environmental control measures include:

• Consistent and stringent equipment and work area cleaning, including laundry protocols and schedules.
• Proper disposal of waste such as sharps, biomedical, and pathological waste.
• Appropriate ventilation and other engineering controls.
• Installation of easily accessible and clearly identified waste containers, hand hygiene product dispensers, and dedicated hand wash sinks.
• Effective placement and segregation of sources of contamination - This control includes using single room and private toileting for patients who soil the environment, or using a "blood work only" biological cabinet for laboratory work associated with blood samples.

Administrative Controls

Administrative controls include employee training, supervisory competency, immunization, cough etiquette, workplace policies and procedures that are strictly enforced, and sufficient staffing. Administrative controls are critical to ensure that the principles of routine practices are effectively and properly executed in the workplace.

What precautions should be taken for additional precautions?

What are the 2 main aspects of Standard Precautions?

When you would need to use additional precautions and why?

What does additional precaution include?