Droplet precautions on intubated patients

[zzyzx]

What is the point of wearing a mask if you have a patient who is intubated and not coughing anyhow? Is it that you could touch something that has their respiratory secretions on it, and then touch your face?

[chare]

And if the ventilator circuit disconnects or there is an unplanned extubationwhile you are caring for the patient?

[heinz57]

With some ventilator patients we advance the droplet to airborne precautions.

Commonsense and your universal precautions should address airways. A ventilator may need to be disconnected for many reasons. That humidifier heated circuit or HME is a petri dish of whatever the patient has. On disconnect it sprays droplets of all sizes at 200 l/m into room which contains secretions and medications. You don't want to inhale any of it.

Not all ventilators have the same filtering systems. Some hospitals invest in better filters for their ventilators and some don't. Some have none like the transport ventilators Paramedics use. BVMs also rarely have filters. We use filtered bags but if in ER, EMS does not. Some keep using the unfiltered bag while patient is in ER or moved through the halls. That is not per our policy but who wants to get into with EMS. They should have had similar infection training.

Protect yourself.

[WestCoastSunRN, MSN, CNS]

My first year in ICU was about 19 years ago. That year I became flu-like ill about 5 or 6 times. I was afraid I was seriously immunocompromised in some way. After taking a look at what I came in contact with every day at work, my doctor was not surprised I was ill so much. There were a lot of bad bugs in that ICU (as with most). And no, I did not protect myself properly all the time. I remember at least ONE time (it may have happened more than once) ventilator tubing came disconnected and blew in my face! Actually I can remember several times the alarms were going off and I'd run in a room to find the tubing disconnected (maybe it was a bad brand of equipment -- it hardly happens now). So I understand the droplet/airborn precautions. And when in doubt, it's better to over-isolate than under-isolate.