Droplet

Precautions
Implementing Transmission-Based Precaution
NCM 112
DR PLET PRECAUTION
In addition to Standard Precautions
Clients with serious illnesses by particle droplets larger
than

5 Microns
 tionale
Ra
Prevent Spread of infectious
diseases transmitted by contact of
NASAL and ORAL secretions

Infected patient >>> Mucous Membranes

of Susceptible host
 EQUIPMENT
Supplies:
Stethoscope Plastic Bags
Thermometer
Blood Pressure Cuff
Droplet precaution
MASK Gloves Gowns
door card
PREPARATION F EQUIPMENT
Keep all droplet precaution supplies
outside the patient’s room in a cart
or anteroom

Healthjade.net
Planning and
Implementation
ACTION

1. Introduce self and verify

the client’s identify using
agency protocol
Planning and
Implementation
ACTION RATIONALE
It is extremely important that clients
2. Explain to the client what you
and family members understand the
are going to do, why it is rationale for the use of barriers to
necessary, and how he or she infection transmission. They must be
can participate. given the opportunity to ask questions
and express feelings.

Hospitalized clients are already socially

isolated from others and use of
additional barriers can initiate negative
feelings such as depression and
withdrawal.
Planning and
Implementation
ACTION RATIONALE

3. Use standard precautions.

4. Place the patient in a single room with

private toilet facilities and an anteroom if
possible.
• The door does not need to be closed
• If a private room is not available, place the
client with another client who is infected with
the same organism
Planning and
Implementation
ACTION RATIONALE

5. Put a droplet precautions card To notify anyone

on the door. entering the room
Planning and
Implementation
ACTION RATIONALE

6. Wash your hands before

entering and leaving the room
and during care as indicated
Planning and
Implementation
ACTION

7. Wear mask when entering the

room if you will be working within
3 feet of the client.
Planning and
Implementation
ACTION

8. Instruct the patient to cover his

nose and mouth with a facial
tissue while coughing or sneezing.
Planning and
Implementation
ACTION RATIONALE

9. Tape an impervious bag to the So that the patient

patient’s bedside. can dispose facial
tissues correctly.

10. Make sure all visitors wear

masks when in close proximity
with the patient (within 3’) and, if
necessary, gowns and gloves.
Planning and
Implementation
ACTION RATIONALE

11. If he must lave the room for So that the

essential procedures, make sure precautions will be
he wears a surgical mask over his maintained and the
nose and mouth. Notify the patient can be
receiving department or area of returned to the room
the patient’s isolation precautions. promptly.
Special consideration
Before removing the mask,
remove your gloves (if worn)
and wash your hands.

Untie the strings and

dispose of the mask, handling
it by the strings only
Record:
 Need for droplet precautions
on the NCP and as otherwise
indicated by your facility.

 Initiation and maintenance of

the precautions

 Patient’s tolerance of the

procedure

 Any patient or family

teaching.

 Date the droplet precautions

were discontinued.
 Contact
Precautions
Implementing Transmission-Based Precaution
NCM 112
C NTACT PRECAUTION
In addition to Standard Precautions
Clients with serious illnesses transmitted by DIRECT
CLIENT CONTACT or contact with ITEMS IN THE
CLIENT’S ENVIRONMENT
 tionale
Ra
Prevent Spread of infectious
diseases transmitted by contact
with body substances containing
the infectious agent or items
contaminated with the body
substances containing the
infectious agent.
Infected patient >>> patient or patient’s
environment
 EQUIPMENT
Supplies:
Stethoscope Plastic Bags
Thermometer
Blood Pressure Cuff
Isolation precaution
MASK Gloves Gowns
door card
PREPARATION F EQUIPMENT
Keep all CONTACT precaution
supplies outside the patient’s room in
a cart or anteroom

Healthjade.net
Planning and
Implementation
ACTION

1. Introduce self and verify

the client’s identify using
agency protocol
Planning and
Implementation
ACTION RATIONALE
It is extremely important that clients
2. Explain to the client what you
and family members understand the
are going to do, why it is rationale for the use of barriers to
necessary, and how he or she infection transmission. They must be
can participate. given the opportunity to ask questions
and express feelings.

Hospitalized clients are already socially

isolated from others and use of
additional barriers can initiate negative
feelings such as depression and
withdrawal.
Planning and
Implementation
ACTION

3. Use standard precautions.

4. Place the patient in a single room with

private toilet facilities and an anteroom if
possible.
• If a private room is not available, place the
client with another client who is infected with
the same organism
Planning and
Implementation
ACTION

5. Place a contact precaution

card on the door.

RATIONALE
To notify anyone
entering the room
Planning and
Implementation
ACTION RATIONALE

6. Wash your hands before

entering and leaving the room
and after removing gloves.
Planning and
Implementation
ACTION
7. Apply clean gloves. Change
gloves and perform hand hygiene
after contact with infectious
materials.

8. Wear a gown when entering

the patient’s room if there will be
any client contact with potentially
contaminated areas.
Planning and
Implementation
ACTION
9. Bag contaminated articles.
a. Identify and separate items that are disposable from those
that are reusable.
b. Place garbage and disposable items such as dressings or
single-use equipment in the plastic bags that line the waste
basket and tie the bag.
c. Place disposable sharps (Needles, scalpels, syringes_
directly into designated sharps containers. Do not
disassemble or recap sharps.
Rationale: To decrease the chances of sustaining a puncture injury.
Planning and
Implementation
ACTION
9. Bag contaminated articles.
d. Place contaminated reusable items in an impermeable bag
and send to the proper area for decontamination.
e. Place soiled linen directly in the linen hamper. Close the
bag and send to the laundry as specified by policy.
f. Place any laboratory specimens in impervious, labeled
containers, and send them to the laboratory at once. Attach a
requisition slip to the outside of the container.
g. Food dishes and silverware require no special handling.
Planning and
Implementation
ACTION

10. Instruct visitors to wear gloves

and a gown while visiting the
patient and to wash their hands
after removing the gown and
gloves.
Planning and
Implementation
11. Remove PPE at the doorway before leaving the room or in the
anteroom, in the proper sequence and dispose of properly.
a. Remove gloves without touching the hands to the
outside of the gloves.
b. Remove googles or face shield.
c. Remove gown without touching hands to the outside of the
gown.
d. Make sure uniform does not contact possible
contaminated surfaces.
e. Remove mask grasping only the ties or elastic.
f. Cleanse hands immediately.
Planning and
Implementation
12. Limit the patient’s movement from the room. If the patient must
be moved, cover any draining wounds with clean dressings. Notify
the receiving department or area of the patient’s isolation
precautions.

Rationale: So that the precautions will be maintained and the

patient can be returned to the room promptly.
Special consideration
Cleaning and disinfection of
equipment between patients
is essential

Designate certain reusable

equipment (thermometer,
stethoscope, BP cuff) for the
patient in contact precautions
to reduce transmitting
infection to other patients.
Special consideration
Remember to change gloves
during patient care as
indicated by the procedure or
task. Wash hands after
removing gloves and before
putting on new ones.
Record:
 Need for contact precautions
on the NCP and as otherwise
indicated by your facility.

 Initiation and maintenance of

the precautions

 Patient’s tolerance of the

procedure

 Any patient or family

teaching.

 Date the droplet precautions

were discontinued.
THANK YOU
ADMINISTERING
CARE FOR
CLIENTS UNDER
ISOLATION
PROTOCOLS
DEFINITION
When a client has a known
source of infection, he
must be placed in isolation
to prevent the spread of
an infectious process and
health care workers follow
specific infection control
practices and take
preventive actions.
 RATIONALE
To decrease the risk of transmitting infectious disease among
clients or health care workers
EQUIPMENT
EYEWEAR
FACE MASK

DISPOSABLE FACE SHEILD

GLOVES

ISOLATION
SIGN
STANDARD PROTOCOLS
PROPER WAY OF
GOWNING
PROPER WAY TO
REMOVE GOWN
COLLECTION SPECIMEN: URINE SAMPLE
EVALUATION
1. The appropriate type of isolation was instituted.
2. The client and family express understanding of
the client’s condition and the reason isolation.

DOCUMENTATION
1. Date, time, and type of isolation instituted.
2. Document procedures performed and client’s
response to social isolation in nurses’ progress
notes.
3. Document any client education performed and
reinforced
 References:

Manual of Nursing Procedures, A compilation (Revised 2019)

USLS College of Nursing

Personal Protective Equipment Market Size, Share | PPE Market

Research Report by 2025 |. (2020, April 3). Retrieved from
Medgadget website:
https://www.medgadget.com/2020/04/personal-protective-
equipment-market-size-share-ppe-market-research-report-by-
2025.html
When and how to use masks. (n.d.). Retrieved from www.who.int
website: https://www.who.int/emergencies/diseases/novel-
coronavirus-2019/advice-for-public/when-and-how-to-use-masks
CARE OF ISOLATION
EQUIPMENT
Environmental controls: Cleaning and
disinfection

Environmental cleaning and disinfection is intended to remove pathogens or

significantly reduce their numbers on contaminated surfaces and items, thus
breaking the chain of transmission

Disinfection is a physical or chemical means of killing microorganisms (but not

spores), and should be used for non-critical medical equipment used or shared by
patients.
The viruses and bacteria that cause
Acute Respiratory Infections are
inactivated by a range of
disinfectants . However, in some
countries, regulatory agencies will
control the types of disinfectant
available for hospital use.
1. sodium hypochlorite (household bleach)
- is a compound that can be effectively used for water purification. It is used on
a large scale for surface purification, bleaching, odor removal and water
disinfection.
2. ALCOHOL

3. Hydrogen peroxide
 3 Dialdehyde solution-

is a fast and effective way to disinfect and sterilize a wide variety

of medical devices and instruments. Cidex 14 day use, a 2.4%
alkaline glutaraldehyde solution, destroys 99.8% of Mycobacterium
tuberculosis in 45 minutes at 25 degrees Celsius.
 Clean horizontal surfaces in isolation rooms or areas – focusing particularly on
surfaces where the patient has been lying or has frequently touched, and
immediately around the patient's bed – regularly and on discharge.
 To avoid the possible generation of aerosols of ARI pathogens, use damp
cleaning (moistened cloth) rather than dry dusting or sweeping.
 During wet cleaning, cleaning solutions and equipment soon become
contaminated; change cleaning solutions, cleaning cloths and mop heads
frequently, according to health-care facility's policies.
 Ensure that equipment used for cleaning and disinfection is cleaned and dried
after each use.
 Launder mop heads daily and dry them thoroughly before storage or reuse.
 To facilitate daily cleaning, keep areas around the patient free of
unnecessary supplies and equipment.
 Use disinfectant to wipe down surfaces used by patients who are known or
suspected to be infected with an ARI of potential concern.
 Do not spray (i.e. fog) occupied or unoccupied rooms with disinfectant; this is
a potentially dangerous practice that has no proven disease-control benefit.
 To facilitate cleaning, and to reduce the potential for generation of aerosols
caused by use of a vacuum cleaner, accommodate patients in uncarpeted
rooms or areas where possible. If vacuuming is necessary, use a vacuum
cleaner that is equipped with a high-efficiency particulate air (HEPA) filter, if
available.
 If equipment is reused, follow general protocols for disinfection and
sterilization.
 If not visibly soiled, wipe external surfaces of large portable equipment (e.g.
X-ray machines and ultrasound machines) that has been used in the isolation
room or area with an approved hospital disinfectant upon removal from the
patient's room or area.
Equipment and environment

 If possible, use either disposable equipment or dedicated equipment (e.g.

stethoscopes, blood pressure cuffs and thermometers) when dealing with
patients under Contact Precautions. If equipment needs to be shared among
patients, clean and disinfect it between each patient use.
 Ensure that health-care workers refrain from touching their eyes, nose or
mouth with potentially contaminated gloved or ungloved hands.
 Avoid contaminating environmental surfaces that are not directly related to
patient care (e.g. door handles and light switches).
COMPLYING WITH
COMMUNICABLE DISEASE
CONTROL AND PREVENTION
GUIDELINES FOR ISOLATION
PROCEDURES
Definition:

Isolation Precautions – are

guidelines created to prevent transmission
and spread of infections or potentially
infectious microorganisms to health
personnel, clients and visitors
2 Tiers of Isolation Precautions
 First
Tier :
Standard Precaution- designed for the
care of all patients in the hospital regardless
of diagnosis or infection status and is the
primary strategy for preventing hospital
acquired infections.
 SecondTier:
Transmission Based Precaution - Are
used in addition to standard precautions
designed for the care of patients with known
or suspected infectious diseases spread by
Airborne, Droplet, Contact routes.
The Elements of Standard Precautions
includes:

1. Hand Hygiene
2. Use of Personal Protective equipment ( PPE eg, gloves,
gowns, mask )
3. Proper handling of Patient Care Equipment and Linens
4. Environment Control
5. Prevention of Injury from Sharps Devices
6. Patient placement ( i.e.., room assignments) Within
Health Care Facilities
PPE ( Personal Protective Equipment
Sharps Container
Place all laboratory specimens collected from
patients in leak proof container properly labeled
Documentation:

 Record any special

needs for Isolation
precautions on the
nursing care plan and
as otherwise indicated
by facility. Document
patient and family
teaching about
Isolation precautions
Transmission - Based Precautions – are
used in addition to Standard precaution when
those precautions do not completely block
the chain of infection and the infections are
spread in one of the three ways: by airborne
or droplet transmission, or by contact.
Airborne Precaution
Airborne precautions
are used for patients
known or suspected
to have serious
illness transmitted by
airborne droplet
nuclei smaller than 5
microns
Rationale
 To prevent the spread
of infectious diseases
transmitted by
airborne pathogens
that are sneezed or
coughed into the
environment
Equipment
Negative Pressure Room with
airborne precautions sign on the
door.
Store your respirator in a dry and well
ventilated place to prevent microbial growth.
 Record the need for
airborne precautions on
the NCP indicated by the
facility. Document
initiation and
maintenance of the
precaution, patient
tolerance of the
procedure and any patient
and family teaching.
Document the date the
airborne precaution were
discontinued
Hand Hygiene Protocol
Hand washing
Procedure wherein thorough
cleaning of the hand using soap
and or liquid detergent is done by
rubbing briskly in a rotary and
systematic motion.
Rationale
1. To remove transient Microorganism that might be
transmitted to the nurse, clients, visitors or other health
care personnel.
2. To deliver Client with pathogen free
3. To protect clients from cross-contamination
4. To protect nurse from cross contamination

Equipment:
1. Running water
2. Soap or detergent
3. Paper towels
4. Trash basket
1.Remove Jewelries
2.Wet hands with water and apply
liquid/ bar soap
3.Rub hands, palm to palm with fingers
interlaced
4. Rub back hands with interlock fingers
5.Rub hands together with interlaced
fingers.
6.Rub fingertips
7. Rub Around / base of the thumb in rotating
manner
8.Rub Finger nails / Finger tips against
the palm (vice versa)
9.Around the wrist.
10.Rinse the soap from your hands, by letting
the water run from wrists towards the finger
11.Dry hands and wrists with paper towel
Use paper towel to close the faucet
Discard paper towel in appropriate
container.
Dietary Instructions to
Boost your Immune
Response
By: Ms. Marites A. Pasilan RN,MN
• Most people turn straight
to Vitamin C after they’ve caught
a cold. That’s because it helps
build up your immune system.
• Vitamin C is thought to increase
the production of white blood
cells, which are key to fighting
infections.

Popular citrus fruits include:

grapefruit
oranges
clementines
tangerines
lemons
limes
• Red bell peppers contain
almost 3 times as much
vitamin C. They’re also a
rich source of beta
carotene.
• Besides boosting your
immune system, vitamin C
may help you maintain
healthy skin.
• Beta carotene, which your
body converts into vitamin
A, helps keep your eyes
and skin healthy.
Broccoli is
supercharged with
vitamins and minerals.
Packed with vitamins A,
C, and E, as well
as fiber and many
other antioxidants,
broccoli is one of the
healthiest vegetables
you can put on your
plate.
Garlic is found in almost
every cuisine in the world.
It adds a little zing to food
and it’s a must-have for
your health.
Early civilizations
recognized its value in
fighting infections. Garlic
may also slow down
hardening of the arteries.
Garlic’s immune-boosting
properties seem to come
from a heavy
concentration of sulfur-
containing compounds,
Ginger may help decrease
inflammation, which can help
reduce a sore throat and
inflammatory illnesses. Ginger
may help with nausea as well.
While it’s used in many sweet
desserts, ginger packs some
heat in the form of gingerol, a
relative of capsaicin.
Ginger may also decrease
chronic pain and might even
possess cholesterol-lowering
properties.
 Spinach is rich in
vitamin C — it’s also
packed with numerous
antioxidants and beta
carotene, which may
both increase the
infection-fighting ability
of our immune
systems.
Look for yogurts that have the
phrase “live and active cultures”
printed on the label, like Greek
yogurt. These cultures may
stimulate your immune system
to help fight diseases.
Try to get plain yogurts rather
than the kind that are flavored
and loaded with sugar. You can
sweeten plain yogurt yourself
with healthy fruits and a drizzle
of honey instead.
Yogurt can also be a great
source of vitamin D, that helps
regulate the immune system
and boost our body’s natural
defenses against diseases.
 Vitamin E powerful antioxidant
is key to a healthy immune
system.
It’s a fat-soluble vitamin, which
means it requires the presence
of fat to be absorbed properly.
Nuts, such as almonds, are
packed with the vitamin and
also have healthy fats.
Adults only need about 15
mg of vitamin E each day. A
half-cup serving of almonds,
which is about 46 whole,
shelled almonds,
provides around 100
percent of the recommended
daily amount.
Sunflower seeds are full of
nutrients,
including phosphorous, magnesiu
m, and vitamins B-6 and E.
Vitamin E is important in
regulating and maintaining
immune system function. Other
foods with high amounts of
vitamin E include avocados and
dark leafy greens.
Sunflower seeds are also
incredibly high in selenium. Just 1
ounce contains nearly half the
selenium that the average adult
needs daily. A variety of studies,
mostly performed on animals,
have looked at its potential to
combat viral infections such
as swine flu (H1N1).
You may know turmeric as a
key ingredient in many curries.
This bright yellow, bitter spice
has also been used for years as
an anti-inflammatory in treating
both osteoarthritis and rheumat
oid arthritis.
It shows that high
concentrations of curcumin,
which gives turmeric its
distinctive color, can help
decrease exercise-induced
muscle damage. Curcumin
has promise as an immune
booster and an antiviral.
Both green and black
teas are packed with
flavonoids, a type of
antioxidant.
Where green tea really
excels is in its levels of
epigallocatechin gallate
(EGCG), another
powerful antioxidant.
Green tea is also a
good source of the
amino acid L-
theanine. L-theanine
may aid in the
production of germ-
Papaya is another fruit
loaded with vitamin C.
Papayas also have a
digestive enzyme called
papain that has anti-
inflammatory effects.
Papayas have decent
amounts of potassium,
magnesium, and folate, all
of which are beneficial to
your overall health.
Like papayas, kiwis are
naturally full of a ton of
essential nutrients,
including folate,
potassium, vitamin K,
and vitamin C.
Vitamin C boosts the
white blood cells to fight
infection, while kiwi’s
other nutrients keep the
rest of your body
functioning properly.
 Chicken Soup has a
placebo effect that makes
you feel better. The soup
may help lower
inflammation, which could
improve symptoms of a
cold.
It is high in vitamin B-6 that
plays an important player in
formation of new and
healthy red blood cells.
Stock or broth made by
boiling chicken bones
contains gelatin, chondroitin,
and other nutrients helpful
Shellfish are packed
with zinc.
Zinc is needed for the
immune cells to function
as intended.
Varieties of shellfish that are
high in zinc include:
oysters
crab
lobster
mussels
Nursing Management of
Patients with
Immunodeficiencies
Sherlyn Joy B. Bayona RN, MN
Who might be immunocompromised or have weak
immune system?
Examples of persons with weakened immune systems include those
with HIV/AIDS; cancer and transplant patients who are taking certain
immunosuppressive drugs; and those with inherited diseases that
affect the immune system .
The risk of developing severe disease may differ depending on each person’s degree of immune

suppression.
Nursing Management for Patients with
Immunodeficiencies

1. Assessment
2. Patient Teaching
3. Continuing Care
1. Assessment
1.Health history and Physical Exam
• Age
• Nutrition
• Infection and immunization
• Allergy
• Disorders and diseases
• Chronic Illness and Surgery
• Medications and Blood Transfusions
• Lifestyle and Other Factors
Assessment
2. Monitors the patient for signs and symptoms
of infection.

3. Monitor for subtle and unusual signs and

changes in physical status.

4. Monitor laboratory values for changes

indicating infection

5. Monitor nutritional status; stress level and

coping skills.
2. Patient Teaching
The patient and the caregivers are instructed
about the signs and symptoms that indicate
infection. The nurse explains that the
immunosuppressed patient may also have atypical
symptoms secondary to underlying
immunosuppression.
2. Patient Teaching
The patient and caregiver need instruction
about any prophylactic medication regimen
3. Continuing Care

The importance of follow-up appointments is emphasized to the

patient and family. They are urged to notify the primary health care
provider about early signs and symptoms of infection, including any
subtle changes.
Resources
• Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA
30333; (404) 639-3311 or (800) 311-3435; http://www.cdc.gov.
• National Institute of Allergy and Infectious Disease, NIAID Office of
Communications and Public Liaison, NIH, Building #31, Room 7A50, 31 Center
Drive, MSC 2520, Bethesda, MD 20892-2520; (301) 496-5717,
http://www.niaid.nih.gov.
• National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892; (301)
496-4000, http://www.nih.gov.
• National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894; (888)
FIND-NLM, (888) 346-3656, (301) 594-5983; http://www.nlm.nih.gov.