2. INFECTION CONTROL/EXPANDED PRECAUTIONS

3.  In addition to standard precautions, Ambercare personnel will follow strict specifications when caring for patients with infectious diseases. POLICY

4.  Airborne Precautions as Recommended by the CDC  Designed to prevent transmission of infectious diseases primarily over short distances through airborne droplet nuclei.  Diseases which require airborne precautions are:  Measles  Varicella (including disseminated zoster)  Tuberculosis (active pulmonary or laryngeal)  Smallpox  SARS GUIDELINES

5.  Keep patient in one room of the home as much as possible (unless household members are immune – i.e., chickenpox)  N95 respiratory mask must be worn by all Ambercare personnel that comes into contact with patient with suspected or known ACTIVE pulmonary or laryngeal TB  Patient must wear a surgical mask when he/she comes out of room  Gloves are indicated for contact with respiratory secretions  Standard/contact precautions must be followed as well (hand washing before and after touching the patient or potentially contaminated articles)  Articles, including linen must be thoroughly cleaned, disinfected, or discarded  Do NOT use fans in patient’s room SPECIFICATIONS FOR AIRBORNE PRECAUTIONS

6. Droplet precautions are used for patients with known or suspected serious illnesses transmitted by large particle droplets. Diseases which require droplet precautions are:  Hemophilus Influenza (type B) including meningitis, pneumonia, epiglottitis, and sepsis  Neisseria Meningitidis (including meningitis, pneumonia, and sepsis)  Diphtheria (pharyngeal)  Mycoplasma pneumonia  Pertussis (whooping cough)  Staphylococcal (group A) pharyngitis, pneumonia, or scarlet fever in infants and young children  Pneumonic plague INDICATIONS OF DROPLET PRECAUTIONS

7.  Adenovirus  Influenza  Mumps  Parvovirus B19  Rubella SERIOUS VIRAL INFECTIONS SPREAD BY DROPLET TRANSMISSION

8.  Place patient in a room away from susceptible individuals  Surgical masks may be worn when working within 3 feet of the patient and until sputum smear is negative on culture  Instruct patient to cover his/her mouth and nose when coughing or sneezing  Patient should NOT share personal items such as drinking cups  No fans in patient’s room  Pregnant personnel susceptible to RUBELLA SHOULD NOT TAKE CARE OF PATIENTS WITH RUBELLA! SPECIFICATIONS FOR DROPLET PRECAUTIONS

9. Contact precautions are used for patients with known or suspected serious illnesses easily transmitted by direct patient contact or by contact with items in the patient’s environment; they include diseases such as:  GI, respiratory, skin, or wound infections or colonization with multidrug-resistant bacteria (MRSA for example)  Enteric infections including  C-Diff; E-Coli; Shigella, Hep A or Rotavirus CONTACT PRECAUTIONS

10.  Diptheria (cutaneous)  Herpes simplex virus  Impetigo  Major (noncontained) abscesses, cellulitis, or decubiti  Pediculosis  Scabies  Zoster  Viral hemorrhagic conjunctivitis  Ebola, Lassa, Marburg HIGHLY CONTAGIOUS SKIN INFECTIONS

11.  Minimize number of staff members assigned to patient  Make efforts to schedule patient as the last visit of the day if possible  When feasible, leave nursing bag in car – take in only minimal number of required supplies into home  When feasible, leave stethoscope and blood pressure cuffs in the home until precautions are discontinued. Upon removal staff member must follow decontamination protocol (dirty bin placement at office) for proper disinfection.  Clean and disinfect contaminated patient care items, equipment, and surfaces on a daily basis  Linen and laundry require NO special treatment SPECIFICATIONS FOR CONTACT PRECAUTIONS

12.  Gloving when entering room of patient infected or colonized with multidrug-resistant microorganisms, otherwise use of gloves with patient contact  Gloves must be removed prior to leaving patient room – hands washed immediately after – with antimicrobial soap and water  Gowning is required when:  Substantial contact with patient, environmental surfaces, etc.  Patient is incontinent, has diarrhea, an ileostomy, colostomy or uncontained wound drainage  The gown should NOT be worn outside patient room – and NOT removed until ready to leave the room – must be discarded properly SPECIFICATIONS FOR CONTACT PRECAUTIONS CONTINUED