Reception or nursing staff should immediately notify the practitioner whenever a patient meets triage criteria suggesting the need for isolation precautions, and the practitioner should order precautions appropriate for the case.
Immediately implement precautions directed by the practitioner, which may include keeping the patient in an examining room, closing the examining room door, and placing a sign on the examining room door indicating what kinds of infection control precautions should be used. The isolation precautions are based on the ways that a particular infective agent is spread from person to person.
Spread of Infections: Some infections may be inapparent but nonetheless capable of spreading to others. Examples include infections such as HIV and chronic hepatitis B or C. It has therefore become a routine for healthcare workers everywhere to use Standard Precautions , techniques used with every patient that are designed to prevent spread from exposures to blood and bodily fluids that occur during routine care. Standard Precautions do not necessarily block the spread of infections by droplets, airborne contamination, or physical contact with sources of contamination. Therefore, additional precautions are sometimes needed.
Droplets (secretions or other materials that harbor microorganisms) are sufficiently heavy to be affected by gravity. They typically settle to the ground or nearby surfaces within a several-foot radius. If inhaled, they are generally trapped in nasal, throat or other upper airway sites, which may become portals for infection. Droplets that have fallen to surfaces can be picked-up by touch and then inoculated by contact into eyes, the nose, mouth or other sites. Examples of infections spread by droplets are influenza, mumps, rubella and bacterial infections such as meningococcal and invasive Type B Haemophilus influenzae disease. Biothreat diseases spread by droplets include pneumonic plague.
Airborne particles are very small (less than 5-microns in diameter). They are more affected by ambient air currents than by gravity and therefore do not settle to surfaces. They remain suspended in the air and may be propelled long distances by gentle currents. Such particles are so small that they bypass upper airway defense mechanisms, and some are the right size to lodge in alveoli, which become pulmonary portals for infections. Only a few infections are spread by airborne particles. Among the more common are varicella,, measles, and tuberculosis from patients with cavitary pulmonary disease. Anthrax , especially if prepared in a weapons-grade form, and smallpox , on occasion, can be spread by this mechanism.
Contact spread occurs when an object contaminated with pathogenic microorganisms - animate (for example, a person's wound) or inanimate surface (e.g., bedside table, endotracheal tube, foley catheter) -- serves as the source for spread. Hands contaminated at the source commonly carry infectious agents from patient to patient. Skin and wound infections, secretions and excretions provide a source for contact transmission. Patients harboring multiple antimicrobial resistant strains should also be treated with Contact Precautions. Viral hemorrhagic fevers are examples of biothreat diseases spread by direct contact.
Scrupulous handwashing between patient contacts and use of Standard Precautions for all patients are the most important infection control precautions that can be used to prevent the spread of infections and should be used with all patients.
Standard Precautions require all office personnel to:
Standard Precautions should be used with every patient, even if the patient has no symptoms or signs of infection.
Standard Precautions as well as the other isolation techniques are described in more detail at the CDC Guidelines and should be reviewed by those who are not already familiar with them.
For the small number of infections where person-to-person spread occurs by contact, airborne or droplet spread, simple infection control precautions, such as those used in hospitals, are highly effective in preventing transmission from one person to another.
The typical office already has most of the supplies needed to implement infection control precautions: non-sterile gloves, surgical masks and disposable gowns. Face masks (or protective goggles) are needed in some settings, but offices that perform invasive procedures should already be equipped with those devices.
Hospital isolation rooms designed to prevent airborne spread can be placed at negative pressure in relation to surrounding rooms and corridors. Most offices do not have such facilities. When necessary, airflow can be improved by closing supply (incoming) air vents, opening return (outgoing) vents in the room and maintaining forced air ventilation in other areas.
Droplet Precautions should be identified by warning signs on exam room doors and elsewhere as needed:
Contact Precautions should be identified by warning signs on exam room doors and elsewhere as needed:
Airborne Precautions should be used for the small number of infections that can be spread by the airborne route. Masks should be placed outside door, and the room should have sign describing precautions are in place.