Transmission-Based Precautions and Protective Equipment

This is Unit Eight of Medical Assistant Prep. Unit Seven set out the precautions used for every patient. This unit adds the extra layer for infections that spread easily, the protective equipment that layer calls for, and the order in which that equipment goes on and comes off. Carry one idea through this lecture. Extra precautions start on suspicion, not diagnosis, and protective equipment protects only when it goes on and comes off in the right order. Two constructed cases at the end show both halves. By the end you will be able to match contact, droplet and airborne precautions to how a germ travels. To put on and take off protective equipment in order. To protect a vulnerable patient and yourself from radiation. And to begin precautions before anyone knows the diagnosis.

Eight entries on transmission-based precautions: contact, droplet and airborne, with tuberculosis and moving a patient.

Added, never a replacement.

MAS 176 When Standard Precautions Are Not Enough

Transmission-based precautions are added on top of standard precautions for patients with a known or suspected infection that spreads easily. There are three categories, named for how the germ travels: contact, droplet and airborne. These precautions add to standard precautions; they never replace them, so hand hygiene still comes first.

Gloves and gown.

MAS 177 Contact Precautions

Contact precautions are used for infections spread by touch, such as from draining wounds or resistant organisms like MRSA. Wear gloves and a gown for contact with the patient and their surroundings; other germs handled this way include C. difficile, VRE and RSV. Your clothing touches the patient's surroundings too, which is why the gown matters.

Equipment that stays.

MAS 178 Dedicated Equipment

Under contact precautions, equipment is dedicated to the patient whenever possible. A stethoscope or blood pressure cuff that stays with one patient cannot carry that patient's germs to the next. When equipment must be shared, clean and disinfect it before it is used on anyone else.

Soap and water.

MAS 179 Soap and Water for C. difficile

For patients with C. difficile infection, clean your hands with soap and water rather than alcohol rub. This is one of the few times the usual preference for alcohol rub is reversed, and the reason is the germ itself. Follow the posted precautions and the practice's policy each time; do not rely on habit.

Large and short-range.

MAS 180 Droplet Precautions

Droplet precautions are used for germs carried in large respiratory droplets from coughing, sneezing or talking. Influenza, coronavirus and pertussis are examples; staff wear a mask, plus goggles or a face shield when indicated. Large droplets fall within a short distance, so close contact carries the greatest risk.

Tiny particles that linger.

MAS 181 Airborne Precautions

Airborne precautions are used for germs carried in tiny particles that stay in the air, such as measles. Staff wear a fit-tested N ninety-five respirator or a powered air-purifying respirator, and the patient goes in an airborne infection isolation room with the door closed. Entry is limited, and staff who are not immune should not go in.

Suspicion is enough.

MAS 182 Tuberculosis and Airborne Precautions

Tuberculosis is handled with airborne precautions under federal isolation guidance. So a patient with suspected tuberculosis is handled like any airborne case: a separate room with the door closed, and staff wearing fitted respirators. Suspicion is enough to start precautions. Do not wait for a test result to protect others.

Only when essential.

MAS 183 Moving a Patient on Precautions

Patients on transmission-based precautions are moved only for essential purposes, such as a test that cannot be done in the room. When they must move, the patient wears barriers that fit the route of spread, such as a mask, and the receiving staff are told about the precautions in advance. The receiving area cannot protect itself from a risk no one mentioned.

Five entries on protective equipment: putting it on, taking it off, and the gown, respirator and eye protection.

Gloves last.

MAS 184 Putting On Protective Equipment

Protective equipment goes on in a set order so each item covers what it should. Check the ordered precautions, gather the equipment and clean your hands. Put on the gown, covering your clothing, sleeves to the wrists, ties fastened at neck and waist. Put on the mask or respirator, fitted at nose and chin. Add goggles or a face shield when called for. Gloves go on last, over the gown's cuffs. Put on first, they would leave a gap at the wrist and end up under the sleeves.

Dirtiest first.

MAS 185 Taking Off Protective Equipment

Equipment comes off in an order that keeps the dirtiest items off you. Gloves first, glove to glove and skin to skin. Then the gown: untie it, pull it from the shoulders, and roll it inside out away from your body. Clean your hands. Remove eye protection by the strap, then the mask or respirator by its straps or ties, never touching the front of either. Clean your hands again. The front of a mask, shield or gown is the contaminated part, and touching it can transfer exactly what the equipment kept from you.

Covers all, left in the room.

MAS 186 The Isolation Gown

The isolation gown is usually the first piece of protective equipment put on. It must cover all your outer clothing, and it is removed before you leave the patient's room so that it does not carry contamination outside. Gowns are single-use. Do not hang one up to reuse.

Only fitted respirators protect.

MAS 187 Fitting a Respirator

A respirator protects only when it seals to the face. Place the top strap on the crown of the head and the bottom strap at the base of the neck, then mold the nosepiece so that no air leaks around the edges. Respirators require fit testing, so use only the model and size you were fitted for.

Splash protection.

MAS 188 Eye Protection

Goggles or a face shield protect the eyes, a mucous membrane, from splashes and sprays. When you wear a respirator, choose eye protection that does not shift the respirator or break its seal. Remove eye protection by the strap, never by the front, which is the part that caught the splash.

Five entries on the edges of precautions: acting on suspicion, protecting vulnerable patients, radiation, and the practice's own policy.

Before the diagnosis.

MAS 189 Known or Suspected

Transmission-based precautions apply to a known or a suspected infection. A patient with signs of a respiratory infection can be masked, separated and reported to the provider before any diagnosis is made. The provider decides on the diagnosis and the final precautions; your job is to protect others until then.

Protecting the patient.

MAS 190 Protecting the Patient From Germs

Some precautions protect a severely immunocompromised patient from germs in the environment, rather than protecting others from the patient. Federal guidance describes a Protective Environment, with special air handling and room design, for certain transplant patients during their highest-risk period in hospitals. In the office, standard precautions and strict hand hygiene are the main protection for these patients.

Reverse isolation.

MAS 191 An Older Term: Reverse Isolation

Reverse isolation is an older term for isolating an immunocompromised patient to protect them from others. At least one regional infection-prevention authority calls it outdated, without evidence of benefit for hospitalized immunocompromised patients, and current federal guidance uses the narrower Protective Environment instead. Follow the practice's current policy, not an older label.

Three principles.

MAS 192 Radiation Safety: Time, Distance, Shielding

Protection from ionizing radiation rests on three principles: time, distance and shielding. Spend as little time near a source as possible; keep your distance, because exposure falls quickly as distance grows; and place an appropriate shield, such as lead, between you and the source. Follow posted radiation warnings and the practice's policy without exception.

The practice's method.

MAS 193 The Practice's Isolation Policy

Each practice sets its own procedures for isolation and for protective equipment, within federal guidance. More than one donning and doffing method can be acceptable, so train on the practice's method and practice it until it is automatic. Mistakes in removing equipment have infected health care workers, so practice before you need it.

Two constructed cases close the unit: contact precautions through a wound check, and airborne precautions at the front desk.

Contact precautions, step by step.

MAS 194 A Patient With a Draining Wound

A constructed wound check walks through contact precautions. The chart flags a resistant organism in a draining leg wound, so the assistant checks policy and the ordered precautions, and sets the room with a dedicated cuff and stethoscope. She cleans her hands, puts on a gown tied at neck and waist, then gloves over its cuffs, and takes his vital signs. Leaving, she removes gloves glove to glove, then the gown rolled away from her, then cleans her hands before the door handle. Every surface he touched is disinfected, and the dedicated equipment is cleaned before anyone else uses it. The weak points are transitions: walking out gowned, a gloved hand on the door, equipment not cleaned between patients. Doing the steps in order, every time, is what makes the precautions work.

A rash, a fever, and measles at daycare.

MAS 195 A Rash and a Fever at the Front Desk

A constructed case pays off the opening idea. A mother brings a child with a high fever and spreading rash, and mentions measles at daycare. The front desk assistant decides nothing about the diagnosis, but she acts. She masks child and mother, asks them to wait outside the busy waiting room, and alerts the clinical team. The provider sends the child to an airborne isolation room, or a private room with the door closed, entered only by immune staff in fitted respirators. She notes who else was in the waiting room and when, so the provider can follow up with anyone exposed. Masking and separating took moments and needed no diagnosis. Waiting would have exposed everyone in the room.

Look at what you can now do. You can match contact, droplet and airborne precautions to how a germ travels, and you know they add to standard precautions. You can put protective equipment on with gloves last, and take it off with the dirtiest items first. You can act on suspicion, protect immunocompromised patients, and apply time, distance and shielding. And you can carry precautions through a visit, from the front desk to the cleaned room. Unit Nine turns to the surfaces and instruments themselves: cleaning, disinfection and sterilization.