Precautions

AIRBORNE/AFB PRECAUTIONS (for M. tuberculosis and SARS (Severe Acute Respiratory Syndrome)) I. POLICY In addition to Standard Precautions, Airborne/AFB Precautions are required when a patient is suspected or known to have a disease transmitted by airborne droplet nuclei. These evaporated droplets contain microorganisms that remain suspended in the air and can be widely dispersed by air currents within a room or over a long distance. This category of precautions includes the following diseases or infections: tuberculosis (TB), SARS (Severe Acute Respiratory Syndrome) smallpox and complications from the smallpox vaccine (generalized vaccinia, erythema mulitforme, progressive vaccinia or eczemavaccinatum) and Hemorrhagic fevers (Ebola, Lassa, Marburg). II. HANDWASHING Strict handwashing after contact with patient or items contaminated with respiratory secretions is required. III. PERSONAL PROTECTIVE EQUIPMENT (PPE) A. Follow Standard Precautions B. Wear an OSHA approved mask for Tuberculosis, such as the N95 mask/respirator for which you have been fit-tested or PAPR. C. For patients who require 24-hour in-room observation (e.g., psychiatric or incarcerated patients), the in-room sitter must use a PAPR or a fit tested N-95 respirator. If the in-room sitter has been fit tested, they should bring their own N-95 respirator, or the unit will provide a PAPR. IV. PATIENT PLACEMENT A. Place patient in a private room with monitored negative air pressure in relation to surrounding areas, with a minimum of six (6) air exchanges per hour. B. Air from the room must be discharged outdoors or monitored with high efficiency filtration of room air before circulated to other areas in the hospital. 1. Use a designated negative pressure room whenever possible.

2. Nursing will notify Management when precautions are discontinued. C. The door to the patient's room must remain closed except for entry/exit. D. Windows must remain closed. E. Post "AFB/Airborne Precaution" Stop sign on or next to the door of the patient's room. DO NOT write "Tuberculosis" or "TB" on the sign. F. Obtain the Respiratory Protection cart from Material Services for placement outside the patient's room. G. Patients who are currently on isolation precautions for any infection may not be admitted to the Comfort Care Suites. Any question regarding this policy may be addressed to the Department of Hospital Epidemiology and Infection Control. V. ENVIRONMENT Waste disposal, spill management, linen and food trays are handled in the same way for all patients, regardless of precaution category. VI. PATIENT TRANSPORT/AMBULATION A. The patient must be confined to his/her room unless a procedure is necessary which must be performed at a location outside the room. B. The receiving department must be notified of the patient's diagnosis. C. The patient must wear a surgical mask outside of the room when transported to another department. D. Patients who are discharged from the hospital but still considered contagious must be instructed in the need for wearing a surgical mask. VII. VISITORS A. Visitors will wear a surgical mask that is secured and snugly fitted. B. Symptomatic household or other contacts of patient should not visit until medically cleared. If symptomatic contact must visit, mask will be donned before entering the hospital and worn continuously while in the facility. VIII. DISCONTINUATION OF PRECAUTIONS

The patient room is to be left vacant for one hour if the patient is considered to be infectious and was not covering cough.

References HICPAC (Hospital Infection Control Practices Advisory Committee), CDC: "Guideline for Isolation Precautions in Hospitals", American Journal of Infection Control, February 1996;24(1):24. Centers for Disease Control and Prevention. "Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities". MMWR, October 28, 1994;43:RR-13. Centers for Disease Control and Prevention Website, SARS Information Page