Transmission-Based Precautions

Cytotoxic waste

This waste includes any residual cytotoxic drug following a patient’s treatment and the materials or equipment associated with the preparation, transport or administration of the drugs. Cytotoxic waste is hazardous to human health and the environment and is subject to the requirements of the South Australian Environmental Protection Act 1993. All cytotoxic waste should be placed into compliant bags or containers that are appropriately labelled and identified including: • Containers and bags must be purple/lilac. • The container must be marked with the ‘cell in late telophase’ symbol in white • The words CYTOTOXIC WASTE’ must be clearly displayed.

Standard precautions must be applied when caring for any patient regardless of their infectious disease status. Transmission-based precautions are applied to patients suspected or confirmed to be infected with agents transmitted by the contact, droplet or airborne routes. Transmission-based precautions are applied in addition to standard precautions and include the following.

Contact precautions

• Transmission occurs by either direct or indirect contact • Direct: involves close contact with a colonised/infected patient with transfer of the organism to the susceptible host, usually during patient care activities e.g. turning a patient. • Indirect: occurs if an infectious agent is transferred via a contaminated intermediate object (fomite) or person e.g. when contaminated patient-care devices are shared between patients without cleaning and/or disinfection between patients.

Droplet precautions

• Transmission occurs through large (i.e. >5 microns in size) respiratory droplets that are generated by an infected person who is coughing, sneezing or talking. The droplets do not remain suspended in the air and are propelled a short distance from the source (approximately 1 metre). There is also the potential for indirect contact transmission as the droplets settle on environmental surfaces.

Airborne precautions

• Transmission occurs when small (i.e. <5 microns) respiratory droplets which are carried through the air. The droplets can remain suspended in the air for long periods and can be dispersed by air currents.

Applying standard and transmission-based precautions

When a disease is unknown, applying standard and transmission-based precautions using risk based principles will reduce the risk of transmission to the health care worker, and to other patients. Refer to the examples below:

Symptom Management Vomiting and/or diarrhoea • Contact precautions - gloves, gown, fluid resistant surgical mask and eye protection • Inform healthcare facility patient has potentially infection vomiting and diarrhoea symptoms and will require transmission-based precautions

Fever, cough, sore throat, croup, respiratory symptoms • Droplet precautions - surgical mask and eye protection • Surgical mask for patient if tolerated • Gown and gloves if potential exposure to body fluids • Inform healthcare facility patient has potentially infection vomiting and diarrhoea symptoms and will require transmission-based precautions

Suspected or confirmed infectious patients

Transmission based precautions are recommended for suspected or confirmed infectious patients where standard precautions will not provide adequate protection. Refer to the Standard and Transmission Based Precautions Procedure for more information and SA Health Infection Control Management of Infectious diseases summary table below.

Type of precaution Examples of infectious agents Gloves Gown Mask Eye protection Equipment

Standard Standard precautions apply for all work practices to prevent the transmission of infection (PPR should be selected according to patient symptoms and degree of contact) Gloves, gown and eye protection should be worn if there is the potential for direct or indirect contact with blood or body substances. Contact MROs, C difficile, intestinal tract pathogens (e.g. norovirus), highly contagious skin infections (e.g. scabies) Surgical mask if in sputum When there is potential for exposure of splashes or sprays of blood or body substances Single use, otherwise, ensure reprocessing Droplet Influenza, PSV, norovirus, before next pertussis (whooping cough), patient use. meningococcus If potential for direct or indirect contact with blood or body substances (as per standard precaution)  Surgical Airborne Pulmonary TB, chickenpox (varicella), measles (rubeola), SARS, pandemic influenzas  P2 (N95)

In the pre-hospital environment, patients with a known or suspected infectious agent requiring additional transmission-based precautions may also require additional cleaning, refer to the SAAS Infection Control Precautions and Cleaning sticker for requirements for specific infectious diseases or SA Health Infection Control Management of Infectious diseases summary table.

Clinical Tool – SAAS Infection Control Precautions and Cleaning [CTL-014]

SA Health Infection Control Management of Infectious diseases summary table