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Essential Nursing Care of the Critically Ill Patient 119

BOX 6.3 Infection-control guidelines for the TABLE 6.12 Transmission-based precautions and
prevention of transmission of infectious infectious conditions
diseases in the healthcare setting 119
Transmission- Examples of infectious
● Healthcare-associated infections are those acquired in care based precautions conditions
establishments (‘nosocomial’ infections) and infections that Contact MROs : MRSA, MRGN, VRE, ESBL
occur as a result of healthcare interventions (‘iatrogenic’ Gastro-intestinal Pathogens: C. difficile,
infections). The infection may manifest after people leave norovirus
the healthcare establishment. Highly contagious skin infections
● A healthcare establishment is any facility that delivers Droplet Influenza
healthcare services. RSV, Pertussis
● Healthcare workers (HCWs) are all people delivering health- Meningococcal
care services, including students, trainees and mortuary Airborne Pulmonary TB
attendants, who have contact with patients or with blood Chickenpox (varicella), Measles (rubella)
and body substances. SARS
● Standard precautions are standard operating procedures Adapted from NHMRC Guidelines. NB: Standard Precautions apply for all
that apply to the care and treatment of all patients, regard- patients at all times
less of their perceived infection risk. They are work practices
required to achieve a basic level of infection control and are There are three types of Transmission-based Precautions
recommended for the treatment and care of all patients recommended for Australian healthcare to counteract
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(see Table 6.13). the various infectious agents: Contact Precautions,
● Transmission-based precautions are required when stan- Droplet Precautions and Airborne Precautions (see
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dard precautions may not be sufficient to prevent the Table 6.12) These types of precautions are applied with
transmission of infectious agents (e.g. in tuberculosis, refinement to the use of personal protective equipment,
measles, Creutzfeldt–Jakob disease). These precautions are room requirements and recommendations for visitors
tailored to the specific infectious agent concerned and specific to the mode of transmission of the organism.
may include measures to prevent airborne, droplet or Critical care nurses should be knowledgeable of both
contact transmission, and healthcare-associated transmis- local and national guidelines and protocols for Infection
sion agents. Control in order to provide safe care to all their patients.
● Transmission-based precautions are recommended for Breaks to the consistent application of Standard Pre-
patients known or suspected to be infected or colonised cautions and, when implemented, Transmission-based
with disease agents that cause infections in healthcare set- Precautions put patients at risk, especially those who are
tings and that may not be contained by standard precau- critically ill.
tions alone.
While good hand hygiene is the single most effective tool
Copyright Commonwealth of Australia in infection control, 120,121 the key components of effective
infection control are surveillance, prevention and control,
which are described in more detail below.

etiquette, which effectively means covering the mouth
with a tissue when coughing or sneezing and then imme- Practice tip
diately disposing of the tissue into waste bins, followed
by effective hand hygiene. Further Transmission-based Good hand hygiene is vital before and after all interventions
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Precautions (previously referred to as Additional Precau- with your patients. Also there are large numbers of objects in a
tions) are implemented as required in response to suspi- single ward or unit, such as computer keyboards and door
cion (while awaiting confirmation from tests) or diagnosis handles, which are touched by many people within a day. The
of a condition in which Standard Precautions may not be movement of contaminants from inanimate objectives to
sufficient to control the transmission of microorgan- patients and the reverse are possible if adherence to good hand
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isms. Transmission-based Precautions appropriately hygiene is not upheld. Remember the 5 moments of hand
applied to specific microorganisms disrupt their method hygiene.
of transmission to other patients, visitors and healthcare
workers. Transmission-based Precautions include con-
tinuation of Standard Precautions, the use of personal
protective equipment specific to the risk of transmission, SURVEILLANCE
individual patient equipment where possible and specific Around 25% of ICU patients are infected prior to admis-
cleaning protocols for shared equipment, placement of sion, 122 so routine screening should be undertaken to
patients in single rooms (or cohorted if appropriate) and detect the presence of bacteria. Ideally, all critically
specific air filtration or circulation and environmental ill patients will be screened for MRSA and VRE on
cleaning protocols. 119 admission. 123 Regular surveillance to identify rates of