1. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Transmission-based Precautions (formerly referred to as “isolation”) Transmission-based precautions are a method of caring for residents with easily transmitted diseases. The term “isolation” means “separated or set apart.” Purposes Transmission-based precautions are used to prevent the spread of disease-producing germs (pathogens). They protect the infected resident from further infection. They protect uninfected residents/visitors and staff from being infected. They protect the resident with a weakened immune system form being exposed to infection by staff or visitors. Body Substance Precautions do not eliminate the need for transmission-based precautions.

2. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Transmission-based Precautions Type of transmission-based precautions depends upon the type of infection. A “Stop Sign Alert” card is placed on the door of the resident’s room to identify the need to check with the charge nurse before entering. (See Figure 4.1.) Figure 4.1 – Stop Sign Alert

3. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Resident’s Feelings About Being on Transmission-based Precautions Resident may feel lonely, rejected, frightened, or “dirty.” Assist the resident in dealing with being placed on transmission-based precautions. Explain to the resident the reason for transmission-based precautions. Point out that this speeds up recovery and prevents the spread of the germs that caused the disease. Check the resident at regular intervals so he/she does not feel isolated from the rest of the world. Make sure other staff members know how important it is to check on the resident. Listen to the resident’s concerns. Provide assurance to the resident. Make certain the resident has contact with staff and visitors. The need still exists for communication, stimulation, and touch.

4. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Types of Transmission-based Precautions Airborne precautions Used to prevent spread of disease by air currents and pathogens that are small and light and suspended on dust particles in the air. Examples – chicken pox, mumps, tuberculosis, shingles Droplet precautions Used for diseases that are spread by means of large droplets in the air from sneezing, coughing, talking, singing. Droplets do not usually travel more than 3 feet, e.g., influenza.

5. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Contact precautions Used with infections that are spread by coming in direct contact or indirect contact Types of Transmission-based Precautions Protects others from germs in resident’s wounds and heavily contaminated articles Examples – impetigo, infected pressure ulcers (decubiti), gastroenteritis, scabies Protective precautions (reverse) Used with persons who have a seriously decreased ability to resist disease Protects resident from other people’s germs Examples – leukemia, burns, resident on chemotherapy See Table 4.1 for transmission-based precautions types and the requirements for each.

6. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions

7. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Key Points in Transmission-based Precautions Mask Make certain your hands are clean before putting on mask or taking mask off. Masks are effective for only 30 minutes because normal respiration is moist. Use only once and throw away. If mask becomes wet, change it. Never let a mask hang around your neck. Mask must fit snugly over mouth and nose. Use an N-95 or HEPA mask with tuberculosis patients. Mask must be fit-tested according to manufacturer’s directions each time you wear it.

8. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Key Points in Transmission-based Precautions Gown Use only once and discard. If reusable, send to laundry. Gown must completely cover your uniform. If you are wearing a uniform with long sleeves, roll sleeves above your elbows before gowning. Serving food You may not be required to wear a gown when serving food. Make certain your uniform does not become contaminated. Wear gown if you assist resident with eating (per care plan). Uneaten food is considered contaminated. Dispose of disposable dishes and tray in trash container in resident’s room. Not all precautions/facilities require disposable dishes.

9. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Key Points in Transmission-based Precautions Double bagging (Follow facility policy.) Double bagging requires two people, one inside the room and one outside the room. Contaminated items are placed in an appropriate container inside the room and the container is sealed. Sealed bag is placed inside another bag outside the room, which is held by second gloved person.

10. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Important Factors Completely cover articles or linens with a noncontaminated container when removing them from a room where the resident has been on transmission- based precautions. The thermometer and blood pressure apparatus should be left in the room and not taken out of the room until the precautions are discontinued and the items are disinfected.

11. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Terminal Disinfection Terminal disinfection is a thorough cleaning of the room with disinfectant solution after transmission-based precautions are discontinued.

12. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Conclusion Transmission-based precaution techniques are used to prevent specific types of infectious diseases. Be sure to protect yourself, the resident, and coworkers by using masks and gowns correctly and by double bagging as per facility policy. When transmission-based precautions are used to care for a resident, you should help him/her from feeling isolated or rejected.

13. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Steps of Procedure for Putting On and Removing Daily Care Nonsterile Gloves Putting on gloves: 1.Wash and dry hands. 2.Remove gloves from box, one at a time. 3.Place your hand through opening and pull the glove up to the wrist. 4.Repeat with second glove. 5.Adjust gloves to cover your wrists or cuffs of gown. 6.Complete resident care. CAUTION: Do not touch any part of your body with gloved hands.

14. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Steps of Procedure for Putting On and Removing Daily Care Nonsterile Gloves Removing gloves: 7.Grasp one glove on the inside of wrist at ½ inch below band of dirty side of glove without touching your skin. 8.Pull down glove, turning it inside out, and pull off hand. Hold the glove with the still-gloved hand. 9.Insert fingers of ungloved hand under the cuff of the glove on the other hand (on inside of cuff). 10.Pull down glove until it is inside out, drawing it over the first glove. 11.Discard both gloves by dropping them in appropriate container. 12.Wash hands.

15. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Steps of Procedure for Putting On and Removing Mask Putting on mask: 1.Wash hands. 2.Pick up mask. 3.Adjust mask over your nose and mouth. 4.Tie top string behind head or adjust elastic band. 5.Tie lower string behind head or adjust elastic band. 6.Complete patient care. NOTE: Replace mask if it becomes moist.

16. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Steps of Procedure for Putting on and Removing Daily Care Nonsterile Gloves 8.Untie bottom string or remove elastic band(s). 9.Untie top string or remove elastic band(s). 10.Remove by holding top strings. 11.Discard by dropping mask in approved container in resident’s room. 12.Wash hands. Removing Mask:Follow manufacturer’s directions for using a HEPA or N-95 mask. 7.Wash hands. NOTE:If wearing gloves, remove them before washing hands.

17. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Steps of Procedure for Putting On and Removing Nonsterile Gown 1.Remove wristwatch and place on clean side of a paper towel on a dry surface. 2.Wash hands. 3.Put on mask if necessary for procedure. 4.Unfold gown with opening at the back. Putting on Gown: 5.Put on gown by slipping arms into sleeves. 6.Slip fingers into neck band. 7.Tie neck tie or fasten strips in back. 8.Grasp waist ties in front and bring to back. 9.Reach behind and overlap edges of gown.

18. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Steps of Procedure for Putting On and Removing Nonsterile Gown 10.Bring waist ties around in front and tie if long enough to do so; otherwise, tie or fasten the gown in the back. 11.Put on gloves. 12.Complete patient care. 13.Untie or unfasten waist tie. 14.Remove gloves and dispose of in appropriate container in the room. 15.Turn on faucet with clean, dry paper towel. 16.Wash and dry hands. Removing Gown: 17.Turn off faucet with clean, dry paper towel.

19. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Steps of Procedure for Putting On and Removing Nonsterile Gown 18.If wearing mask, remove mask, holding it by ties/elastic only, and discard in approved container. 19.Untie ties or fasteners at neck and loosen gown at neck. 20.Slip fingers of one hand inside the cuff of the other hand. Note: Do not touch the outside of the gown. 21.Pull down gown over hand. 22.With gown-covered hand, pull down gown over the other hand. 23.Fold gown away from your body with contaminated side inward. 24.Roll gown into a ball.

20. Nurse Assistant In a Long-Term Care Facility Unit III: Safety Lesson Plan 4: Transmission- based Precautions Steps of Procedure for Putting on and Removing Nonsterile Gown 25.Discard gown in proper receptacle. 26.Turn on faucet with clean paper towel. 27.Wash hands. 28.Turn off faucet with clean, dry paper towel. 29.Remove wristwatch from clean side of paper towel. 30.If using transmission-based precautions, open door with paper towel. Use toe to keep door open while discarding towel in trash receptacle before leaving resident’s room. 31.Wash hands.