Contact Precautions: You should know them forwards and backwards

One thing you are going to want to have down pat, is your contact precautions! Not only the PPE you should have on for each type of disease, but also what order to PPE off, what the patient should have on when being transported to another unit, what those transporting the patient should have on, the order in which you remove each piece of equipment, how often to perform hand hygiene and which diseases require which type of precaution. Nursing Students NCLEX Article

Updated:  

Standard Precautions

These are the safety measures that should be taken with all patients.

  1. Wash Your Hands - Most important step in infection control. It prevents nosocomial infections.
  2. DON Gloves - Before coming in contact with anything wet. ie. broken skin, mucous membranes, blood, body fluids, soiled instruments, contaminated waste materials
  3. Wash hands again upon removal of gloves and between patients.

Contact Precautions

Before entering

  1. Wash hands
  2. DON gown then gloves

Upon entering

  1. Use disposable equipment when possible
  2. When not available clean and disinfect all equipment before removing from room

Transporting patient

  1. PT should perform hand hygiene and wear a clean gown
  2. For direct contact with pt, nurse or care provider should wear a gown and gloves.
  3. Notify receiving area

Before leaving the patient's room

  1. Remove gloves then gown
  2. Wash hands

Contact Precautions Microorganisms

  1. Antibiotic Resistant Organisms (Methicillin resistant Staphylococcus aureu (MRSA), Extended spectrum beta-lactamase (ESBL), Penicillin resistant Streptococcus pneumoniae (PRSP), Multi-drug resistant Pseudomonas aeruginosa (MDRP))
  2. Scabies
  3. Herpes Zoster (Shingles) localized
  4. Diarrhea, Clostrididum difficile

Airborne Contact Precautions

Before entering

  1. Wash hands
  2. Don N95 Respirator (Mask)
  3. Don gown then gloves
  4. Negative Pressure Isolation Room KEEP DOOR CLOSED

Transporting patient

  1. Patient must wear a surgical or procedure mask and a clean gown
  2. Patient must wash hands
  3. For direct contact with pt, nurse or care provider should wear a gown and gloves.
  4. Notify receiving area

Before leaving pt's room

  1. Remove gloves then gown NOT N95 mask
  2. Wash hands

After leaving pt's room

  1. Shut door
  2. Wash hands
  3. Remove N95 mask
  4. Wash hands

Airborne Contact Precautions Microorganisms

  1. Measles (Rubeola)
  2. Tuberculosis (TB)
  3. Chicken Pox (Varicella-Zoster virus)
  4. Herpes Zoster (Shingles) disseminated

Droplet Contact Precautions

Before Entering

  1. Wash Hands
  2. DON Mask and Eye Protection
  3. DON Gown then Gloves

Patient Transport

  1. Pt must perform hand hygiene
  2. Pt must wear a surgical or procedure mask and a clean gown
  3. For direct contact with pt, nurse or care provider should wear a gown and gloves.
  4. Notify receiving area

Before Leaving Pt's Room

  1. Remove gloves then gown
  2. Wash Hands
  3. Remove eye protection and mask
  4. Wash Hands

Droplet Contact Precautions Microorganisms

  1. Influenza (Flu)
  2. Viral Respiratory tract infections (adenovirus, parainfluenza, rhinovirus, RSV)
  3. Streptococcus group A pharyngitis, pneumonia, scarlet fever
  4. Neisseria meningitidis invasive infections
  5. H. Influenzae type b invasive infections
  6. Pertussis
  7. Rubella
  8. Mumps

Happy Studying

 

Thank you soooo much for your help!!!!! I can't tell you how much I appreciate it :-) 70 hours till test time!!!!!

I am printing this out and memorizing right now!!! Thank you again.

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Good Luck NewAggieGrad09!!! You will do great!:yeah:

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I found this helpful but I have to say that I am even more confused now. I have referenced multiple sources on the donning and removal of PPE and they all differ. Can someone please clarify this for me? When putting on PPE is the order Gown, Mask, Eyewear and Gloves? When removing PPE is the order Gloves, Eyewear, Gown and Mask?

Thanks!

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that is the official way. don't change that order lol

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Specializes in OB, HH, ADMIN, IC, ED, QI.
mommycakers said:
I found this helpful but I have to say that I am even more confused now. I have referenced multiple sources on the donning and removal of PPE and they all differ. can someone please clarify this for me? when putting on PPE is the order gown, mask, eyewear and gloves? when removing PPE is the order gloves, eyewear, gown and mask?

thanks!

I know that the answer requested was a quick approval or other recommendation, but since new guidelines from the CDC in 2007 have somewhat changed things, it's important that you know about those, and I've included the information below, as very important!

This is a quote from CDC's 2007 guidelines:

"Differences in observed adherence have been reported among occupational groups in the same healthcare facility 641 and between experienced and nonexperienced professionals 645. In surveys of healthcare personnel, self-reported adherence was generally higher than that reported in observational studies. Furthermore, where an observational component was included with a self-reported survey, self-perceived adherence was often greater than observed adherence 657. Among nurses and physicians, increasing years of experience is a negative predictor of adherence 645 " so you new grads should have better adherence.

Note: "Understanding the scientific rationale for precautions will allow hcws to apply procedures correctly, as well as safely modify precautions based on changing requirements, resources, or healthcare settings."

"When putting on PPE is the order gown", (which you need to do up at your back, touching your uniform and hair)

(quote from mommycakers)

The wearing of isolation gowns and other protective apparel is mandated by the osha bloodborne pathogens standard. Clinical and laboratory coats or jackets worn over personal clothing for comfort and/or purposes of identity are not considered PPE. Clinical and laboratory coats or jackets worn over personal clothing for comfort and/or purposes of identity are not considered PPE." from CDC's 2007 guidelines

"Mask", (only necessary when body fluids might splash, or if droplet/respiratory precautions are indicated, additionally) and also

".....Placed on coughing patients to limit potential dissemination of infectious respiratory secretions from the patient to others (I.E., respiratory hygiene/cough etiquette). Masks may be used in combination with goggles to protect the mouth, nose and eyes, or a face shield may be used instead of a mask and goggles, to provide more complete protection for the face........"

From CDC

"Respiratory protection currently requires the use of a respirator with n95 or higher filtration to prevent inhalation of infectious particles. "

From CDC

Eyewear (goggles and attched full plastic face shield if splash in face is anticipated)

"Personal eyeglasses and contact lenses are not considered adequate eye protection (CDC - eye safety: eye protection for infection control - niosh workplace safety and health topic "

And gloves?

This is done inside the room, where used equipment/PPE is placed by the door in appropriate containers, before leaving room.

Also from CDC's 2007 guidelines:"When gloves are worn in combination with other PPE, they are put on last. Gloves that fit snugly around the wrist are preferred for use with an isolation gown because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands"

"When removing PPE is the order gloves, eyewear, gown and mask?"

Note: from CDC's 2007 guidelines: (there wasn't anything about the sentence above)

"Isolation gowns should be removed before leaving the patient care area to prevent possible contamination of the environment outside the patient's room." and

"Isolation gowns should be removed in a manner that prevents contamination of clothing or skin (figure). The outer, "Contaminated", side of the gown is turned inward and rolled into a bundle, and then discarded into a designated container for waste or linen to contain contamination"

"Hand hygiene is always the final step after removing and disposing of PPE." CDC

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What room should a patient with Contact precautions be placed in? Does it depend on the Infection? And for example what room should a pt. With C Diff be placed in?

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So someone with ESBL of sputum, should not be on droplet isolation? I told a charge nurse that the other institution's they are on contact isolation. She argued against and stated only droplet ( they dress out with gown, gloves, and mask for droplet). They seem to think esbl of mucus can be spread by pt touching my scrubs after sneezing....

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