Standard PrecautionsTo be used for all patients |
|
Contact PrecautionsPatient is confirmed or suspected of having an infection that is spread by the contact route |
|
Droplet & Airborne PrecautionsPatient is confirmed or suspected of having an infection that is spread by droplets, aerosols, or by the airborne route
During OHCA - Chest compressions and defibrillation can be commenced without the need for airborne precautions until other staff can take over |
|
Surgical mask (patient) | P2/N95 respirator (staff) | Eye Protection | Coverall/gown | Gloves | |
---|---|---|---|---|---|
Standard Precautions | ❌ | ✱ | ✱ | ✱ | ✱ |
Contact Precautions | ❌ | ✱ | ✱ | ✱ | ✱ |
Droplet and Airborne Precautions (includes AGPs and AGBs) | ✅ | ✅ | ✅ | ✱ | ✅ |
OHCA# | ❌ | ✅ | ✅ | ✱ | ✅ |
✅ Yes
❌ No
✱ Risk assess
# Chest compressions and defibrillation can be commenced without the need for airborne precautions until other staff can take over, if respiratory illness not suspected.
The information in the table below provides a summary of diseases and the precautions which may be required.
Disease | Infective Material | Precautions |
---|---|---|
Anthrax (pulmonary, systemic and cutaneous expressions of the disease) | Respiratory secretions, blood, wound exudate depending on disease symptoms | Contact Precautions (cutaneous cases) |
Bronchiolitis | Respiratory secretions | Contact Precautions Droplet/Airborne Precautions |
Chickenpox and shingles (Varicella-Zoster Virus) | Respiratory secretions and exudate from lesions | Contact Precautions for shingles
Droplet/Airborne Precautions for chickenpox & disseminated shingles |
Clostridioides (Clostridium) difficile | Faeces | Contact Precautions |
Conjunctivitis | Purulent exudate | Contact Precautions |
COVID-19 and similar severe respiratory outbreaks (MERS, SARS) | Respiratory secretions | Contact Precautions Droplet/Airborne Precautions |
Dengue Fever | Not transmitted person to person | Standard Precautions |
Gastroenteritis – bacterial & parasitic (Salmonella, Shigella, Campylobacter, Giardia) | Faeces | Contact Precautions |
Gastroenteritis - viral (Rotavirus, Adenovirus, Norovirus) | Faeces, Aerosolised vomit | Contact Precautions Droplet/Airborne Precautions (if person is vomiting) |
Glandular fever (Infectious mononucleosis) | Saliva | Contact Precautions |
Guillian- Barré syndrome | NOT INFECTIOUS | Standard Precautions |
Hand, foot and mouth disease | Respiratory secretions, faeces, lesions | Contact Precautions Droplet/Airborne Precautions |
Hepatitis A | Faeces | Standard Precautions |
Hepatitis B and C | Blood and body fluids | Standard Precautions |
Human Immunodeficiency Virus (HIV) | Blood and body fluids | Standard Precautions |
Impetigo (Staphylococcus aureus, Streptococcus pyogenes) | Exudate from lesions | Contact Precautions |
Influenza | Respiratory secretions | Contact Precautions Droplet Precautions |
Legionellosis (Legionnaires’ Disease) | Inhalation of aerosolised contaminated water (not person to person) | Standard Precautions |
Lice - Head (Pediculosis) | Eggs and lice (nits) in hair, clothing and headgear | Contact Precautions |
Lice - Body (Pediculosis) | Eggs and lice (nits) in hair, clothing and headgear | Contact Precautions |
Measles | Respiratory secretions | Airborne Precautions |
Meningococcal infection – Bacterial (Neisseria meningitidis) | Respiratory secretions | Contact Precautions Droplet/Airborne Precautions |
Methicillin-resistant Staphylococcus aureus | Purulent discharge, direct contact with a person with asymptomatic carriage | Contact Precautions Droplet/Airborne Precautions for patients with MRSA in the respiratory tract |
Mumps | Respiratory secretions, Saliva | Contact Precautions Droplet/Airborne Precautions |
Pertussis (whooping cough) | Respiratory secretions | Contact Precautions Droplet/Airborne Precautions |
Rubella | Respiratory secretions | Contact Precautions Droplet/Airborne Precautions |
Scabies | Skin parasite | Contact Precautions |
Tuberculosis | Respiratory secretions | Airborne Precautions |
Vancomycin-resistant Enterococcus | Faeces | Contact Precautions |
Successful infection prevention and control involves implementing everyday work practices that prevent the transmission of infectious agents through a two-tiered approach:
These are work practices that apply to everyone, regardless of their perceived or confirmed infectious status, and ensures a basic level of infection prevention and control. It is essential that standard precautions are applied at all times as:
Standard precautions consist of:
Standard precautions should also be used in the handling of:
Transmission-based precautions, used in addition to standard precautions, are extra work practices recommended for situations where standard precautions alone may be insufficient to prevent transmission.
Transmission-Based precautions are used for patients known or suspected to be infected or colonised with epidemiologically important or highly transmissible pathogens. They are tailored to the particular infectious agent involved and the mode of transmission, and may include one or any combination of the following:
Transmission based precautions consist of:
Contact precautions are used when there is a known or suspected risk of direct or indirect contact transmission of infectious agents that are not effectively contained by standard precautions alone.
A number of infectious agents can be transmitted through respiratory droplets (i.e. large particle droplets ≥ 5 microns) that are generated by a patient who is coughing, sneezing or talking. Transmission requires close contact as the droplets do not remain suspended in the air and only travel over short distances due to gravity (around 1.5 metres). They can however, contaminate surfaces close to the patient, and the hands of Ambulance personnel can become contaminated through contact with those surfaces.
Droplet precautions aim to prevent the inhalation of the infectious microorganisms, and also contact with mucous membranes.
Masks protect the wearer from droplet contamination of the nasal or oral mucosa. Eye protection protects against conjunctival contact.
Physical proximity of less than one metre has been associated with an increased risk for transmission of some infections via the droplet route.
Placing surgical masks on coughing patients can reduce the spread of respiratory secretions.
Certain infectious agents are disseminated through airborne droplet nuclei or small particles that remain infective over time and distance when suspended in the air. Airborne precautions aim to prevent the inhalation of the infectious microorganisms.
The use of recommended vehicle airflow procedure may assist in the reduction of risk of transmission.
Placing surgical masks on coughing patients can reduce the spread of respiratory secretions.
For known or strongly suspected infections, refer to the table (Type of Precautions Required for Specific Diseases) for level of precautions required.
If unknown, perform an initial distanced assessment from >1.5 m away, and assess for:
If YES to any of the above questions, risk assess the need for transmission-based precautions and the don the appropriate PPE. The selections of PPE should be guided by the anticipated type and amount of exposure to blood and body fluids and the likely transmission route of the suspected pathogen.
If a patient requires immediate attention or is unable to accurately report on symptoms, eye protection and P2/N95 respirator before gap to patient is closed. Risk assess need for other PPE. If in doubt, full PPE should be worn.
Refer to Infection Prevention & Control Guideline – Personal Protective Equipment (PPE).
An aerosol generating procedure (AGPs) is any procedure that provokes coughing or stimulates generation of fine airborne particles, <5 microns, creating the risk of airborne transmission. AGPs in the prehospital setting include;
The risk of transmission from these procedures is informed by the patient’s clinical presentation and the nature of the procedure. A risk assessment should be undertaken to determine the level of PPE required ideally before beginning a procedure.
There is an increased risk of aerosol generation of respiratory secretions with patients with challenging behaviours such as aggression, shouting, crying and screaming.
Defibrillation is not considered an AGP and there is little evidence to show aerosol generation from isolated chest compressions.
As early defibrillation and quality chest compressions are the key to survival in OHCA, donning of PPE should
not delay chest compressions or defibrillation.
If able, don airborne PPE prior to patient contact, however a single officer can commence performing chest compressions and defibrillation for a short time frame, until other staff in correct PPE can takeover. The initial member should then retreat and don PPE.
When managing the airway, airborne precautions are required.
National Health & Medical Research Council and the Australian Commission on Safety and Quality in Healthcare. (2021). Australian guidelines for the prevention and control of infection in healthcare. Canberra, Australia: Commonwealth of Australia.
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