Which patients should be considered infectious

The following are the routes of transmission. TBPs should be tailored to the particular infectious agent involved and the mode of transmission. To minimise the exposure time of other people in office-based practices or hospital waiting rooms, people identified as at risk of transmitting droplet or airborne diseases for example, a child with suspected chickenpox should be attended to immediately and placed into appropriate transmission-based precautions to prevent further spread of disease.

Table 1 outlines the TBPs to be taken for infections with airborne, droplet or contact transmission. Table 1: Transmission-based precautions required according to route of transmission. For information on infection prevention and control precautions required for carbapenemase-producing Enterobacteriaceae CPE see the Victorian guideline on CPE for health services or Victorian guideline on CPE for long-term residential care facilities For information on infection prevention and control precautions for other multi-resistant organisms see the Patient-centred risk management strategy for multi-resistant organisms For more information regarding which other infectious agents require transmission-based precautions, see the NHMRC Australian guidelines for the prevention and control of infection in healthcare Signage should be positioned prominently outside the room of a patient in TBPs.

This is to ensure staff and visitors do not enter without appropriate PPE. Please consult local health service policies and procedures. Skip to main content. Home Public health Infectious diseases Infection control guidelines Infection control - standard and transmission-based precautions. Infection control - standard and transmission-based precautions. On this page. Key messages Standard precautions Transmission-based precautions.

Standard precautions All people potentially harbour infectious microorganisms. Standard precautions consist of the following practices: hand hygiene before and after all patient contact the use of personal protective equipment, which may include gloves, impermeable gowns, plastic aprons, masks, face shields and eye protection the safe use and disposal of sharps the use of aseptic "non-touch" technique for all invasive procedures, including appropriate use of skin disinfectants reprocessing of reusable instruments and equipment routine environmental cleaning waste management respiratory hygiene and cough etiquette appropriate handling of linen.

Hand hygiene Hand hygiene is considered one of the most important infection control measures for reducing the spread of infection. Gloves The use of gloves should not be considered an alternative to performing hand hygiene.

Hand hygiene is required before putting on gloves and immediately after removal. Sterile gloves are only required for certain invasive procedures, otherwise non-sterile gloves may be used if a aseptic non-touch technique is used. Change gloves between tasks and procedures on the same patient.

Gloves should be removed immediately after a procedure and hand hygiene performed so as to avoid contaminating the environment, other patients or other sites on the same patient.

Since SP was developed to integrate principles of UP and body substance isolation, 8 the infection prevention and control methods used under SP encompass what employers should already be implementing to protect workers against exposures under the BBP standard and its requirements for use of UP.

Table 1 outlines the body fluids and other materials to which each applies. Table 2 compares selected controls, actions and other measures for the protection of workers against exposure to blood and OPIM and for the protection of workers against exposure to material that is not blood or OPIM. Note that Table 2 discusses only selected provisions of the BBP standard, as well as only selected elements of SP and TBP, and is not intended to describe all provisions with which employers may need to comply.

Table 2. Employers always should train workers about sources of infectious agent exposure and appropriate precautions for preventing infections. Under the PPE standards, employers must provide training to workers required to use PPE, including training on what equipment is necessary, when and how they must use the equipment, and how to dispose of the equipment. In addition, where workers are exposed to blood or other potentially infectious materials, employers must provide the training required by the BBP standard, including information about how to recognize tasks that may involve exposure and the methods to reduce exposure, including appropriate engineering controls, work practices, and personal protective equipment.

See: CDC See footnote 1 for additional information about OPIM. Ebola viral disease outbreak—West Africa, Monitoring exposure to Ebola and health of US military personnel deployed in support of Ebola control efforts—Liberia, October 25, —February 27, For example, Fourcade et al.

See: Fourcade, C. Viral load kinetics of Zika virus in plasma, urine and saliva in a couple returning from Martinique, French West Indies. Unsafe practices that have led to patient harm include 1 use of a single syringe — with or without the same needle — to administer medication to multiple patients, 2 reinsertion of a used syringe — with or without the same needle — into a medication vial or solution container e.

However, because of reports of transmission of infectious diseases by inappropriate handling of injectable medications, CDC now considers safe injection practices to be a formal element of Standard Precautions. Complete guidance on safe injection practices can be found in the Guideline for Isolation Precautions pdf icon [PDF — 1. Additional materials, including a list of frequently asked questions from providers and a patient notification toolkit , are also available.

If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area e. If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use.

Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a shorter or longer date for that opened vial. Ensure that the dental cartridge syringe is appropriately cleaned and heat sterilized before use on another patient.

Instrument processing requires multiple steps using specialized equipment. Each dental practice should have policies and procedures in place for containing, transporting, and handling instruments and equipment that may be contaminated with blood or body fluids. Most single-use devices are labeled by the manufacturer for only a single use and do not have reprocessing instructions.

Use single-use devices for one patient only and dispose of appropriately. Cleaning, disinfection and sterilization of dental equipment should be assigned to DHCP with training in the required reprocessing steps to ensure reprocessing results in a device that can be safely used for patient care.

Training should also include the appropriate use of PPE necessary for safe handling of contaminated equipment.

Patient-care items e. Note: Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials.

Digital radiography sensors are also considered semicritical and should be protected with a Food and Drug Administration FDA -cleared barrier to reduce contamination during use, followed by cleaning and heat-sterilization or high-level disinfection between patients. If the item cannot tolerate these procedures then, at a minimum, protect with an FDA-cleared barrier. In addition, clean and disinfect with an Environmental Protection Agency EPA -registered hospital disinfectant with intermediate-level i.

Because these items vary by manufacturer and their ability to be sterilized or high-level disinfected also vary, refer to manufacturer instructions for reprocessing. Cleaning to remove debris and organic contamination from instruments should always occur before disinfection or sterilization. If blood, saliva, and other contamination are not removed, these materials can shield microorganisms and potentially compromise the disinfection or sterilization process.

Automated cleaning equipment e. After cleaning, dried instruments should be inspected, wrapped, packaged, or placed into container systems before heat sterilization. Packages should be labeled to show the sterilizer used, the cycle or load number, the date of sterilization, and, if applicable, the expiration date.

The ability of a sterilizer to reach conditions necessary to achieve sterilization should be monitored using a combination of biological, mechanical, and chemical indicators. Biological indicators, or spore tests, are the most accepted method for monitoring the sterilization process because they assess the sterilization process directly by killing known highly resistant microorganisms e.

A spore test should be used at least weekly to monitor sterilizers. However, because spore tests are only performed periodically e. Mechanical and chemical indicators do not guarantee sterilization; however, they help detect procedural errors and equipment malfunctions. Mechanical monitoring involves checking the sterilizer gauges, computer displays, or printouts; and documenting the sterilization pressure, temperature, and exposure time in your sterilization records.

Since these parameters can be observed during the sterilization cycle, this might be the first indication of a problem. Chemical monitoring uses sensitive chemicals that change color when exposed to high temperatures or combinations of time and temperature.

Examples include chemical indicator tapes, strips or tabs, and special markings on packaging materials. Chemical monitoring results are obtained immediately following the sterilization cycle and therefore can provide more timely information about the sterilization cycle than a spore test. A chemical indicator should be used inside every package to verify that the sterilizing agent e.

If the internal chemical indicator is not visible from the outside of the package, an external indicator should also be used. External indicators can be inspected immediately when removing packages from the sterilizer. If the appropriate color change did not occur, do not use the instruments. Chemical indicators also help to differentiate between processed and unprocessed items, eliminating the possibility of using instruments that have not been sterilized.

Note: A single-parameter internal chemical indicator provides information regarding only one sterilization parameter e. Sterilization monitoring e. Maintaining accurate records ensures cycle parameters have been met and establishes accountability.

In addition, if there is a problem with a sterilizer e. Ideally, sterile instruments and supplies should be stored in covered or closed cabinets. Wrapped packages of sterilized instruments should be inspected before opening and use to ensure the packaging material has not been compromised e. The contents of any compromised packs should be reprocessed i. Recommendations for the cleaning, disinfection, and sterilization of dental equipment can be found in the Guidelines for Infection Control in Dental Health-Care Settings— pdf icon [PDF — 1.

Recommendations for the cleaning, disinfection, and sterilization of medical equipment are available in the Guideline for Disinfection and Sterilization in Healthcare Facilities pdf icon [PDF — 1 MB] available at: www. Policies and procedures for routine cleaning and disinfection of environmental surfaces should be included as part of the infection prevention plan.

Cleaning removes large numbers of microorganisms from surfaces and should always precede disinfection. Disinfection is generally a less lethal process of microbial inactivation compared with sterilization that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms e. Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated with pathogens, including clinical contact surfaces e.

When these surfaces are touched, microorganisms can be transferred to other surfaces, instruments or to the nose, mouth, or eyes of DHCP or patients. Although hand hygiene is the key to minimizing the spread of microorganisms, clinical contact surfaces should be barrier protected or cleaned and disinfected between patients.

Disinfectant products should not be used as cleaners unless the label indicates the product is suitable for such use. DHCP should follow manufacturer recommendations for use of products selected for cleaning and disinfection e. Facility policies and procedures should also address prompt and appropriate cleaning and decontamination of spills of blood or other potentially infectious materials.

Housekeeping surfaces, e. Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean e. Clean and disinfect clinical contact surfaces that are not barrier-protected with an EPA-registered hospital disinfectant after each patient. Use an intermediate-level disinfectant i.