guidelines on the prevention and control of tuberculosis

Guidelines on the Prevention and Control of Tuberculosis in Ireland 2010 HSE/HPSC

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List of Appendices Appendix 1: List of Groups who were Consulted

Appendix 2: Notification Pathway for a Case of TB

Appendix 3: Tuberculosis Notification Form

Appendix 4: Ways to Assess and Promote Adherence to LTBI Treatment

Appendix 5: TB Therapy Audit Form

Appendix 6: Questions and Answers about TB

Appendix 7: Contact Details for Clinical and Laboratory TB Advice

Appendix 8: International Standards for TB Care

Appendix 9: DOT Referral form-HSE South (Cork and Kerry)

Appendix 10: Standard and Airborne Precautions

Appendix 11: Discharge Instructions for Patients with Potentially Infectious TB

Appendix 12: List of TB-related Websites and Resources

Appendix 13: Respiratory Hygiene and Cough Etiquette


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Appendix 1: List of groups who were consultedThe following is a list of those to whom a draft of the document was sent for consultation as well as those who made submissions. The document was also posted on the HPSC website. We would like to thank those who made submissions for their invaluable contribution to this document.

Academy of Medical Laboratory Science

Claire Keane, Senior Pharmacist, St. Vincent’s University Hospital, Elm Park, Dublin 4

Consultants in Public Health Medicine

Directors of Public Health

Directors of Public Health Nursing in HSE areas

Dr Eibhlin Connolly, Deputy Chief Medical Officer, Department of Health and Children

Dr Karoline de La Hoz, European Centre for Disease Prevention and Control

Dr Enda Dooley, Medical Director, Department of Justice, Equality and Law Reform

Dr Pat Doorley, National Director of Population Health

Dr Kevin Kelleher, Assistant National Director of Health Protection

Dr Jim Kiely, Chief Medical Officer, Department of Health and Children

Dr Tom O Connell, Chief Medical Officer, Occupational Health Department, Civil Service

Emergency Medicine Association

Faculty of Occupational Medicine, Royal College of Physicians of Ireland

Faculty of Paediatrics, Royal College of Physicians of Ireland

Faculty of Pathology, Royal College of Physicians of Ireland

Faculty of Public Health Medicine, Royal College of Physicians of Ireland

Faculty of Radiology, Royal College of Surgeons of Ireland

Geraldine O Connell Public Health Nurse, South Lee Public Health Nursing Department

Imelda O Connor, Public Health Nurse, HSE-Midwest

Irish College of General Practitioners

Irish Infection Society

Infection Prevention Society

Irish Medicines Board

Irish Society of Clinical Microbiologists

Irish Society of Gastroenterology

Irish Society of Physicians in Geriatric Medicine

Irish Society of Rheumatology

Irish Thoracic Society

Maeve Moran, Senior Pharmacist, St. Vincent’s University Hospital, Elm Park, Dublin 4

Mairead Lane, Occupational Health Department, Mid-Western Regional Hospital, Limerick,

Marie Philbin, Chair of Irish Antimicrobial Pharmacists Group

National Immunisation Advisory Committee, Royal College of Physicians of Ireland

National Immunisation Office

Principal Medical Officers, HSE

Public Health Medicine Communicable Disease Group

Royal College of Physicians of Ireland

School of Pharmacy, Royal College of Surgeons, Ireland

Stella Sheehan, Senior Medical Laboratory Technician, Cork University Hospital

Surveillance Scientists Association

The Federation of Irish Nursing Homes


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Appendix 2: Notification pathway for a case of TB

TB is a notifiable disease. A case of TB should be notified to the department of public health in the relevant HSE area. Currently, the department of public health in turn notifies HPSC through the enhanced TB surveillance system each quarter. Once TB is incorporated onto CIDR, TB cases will be notified to HPSC in “real-time”/weekly basis. HPSC produces quarterly and annual national TB reports.

Case of TB (GP, respiratory/infectious disease

clinician, nursing home, laboratory, etc)

Notify the department of public health (DPH/MOH) in relevant

HSE area

Weekly notifications once TB is incorporated onto CIDR

Currently NTBSS 2000 quarterly returns

Health Protection Surveillance Centre

Quarterly and annual national TB reports


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Appendix 3: Tuberculosis Notification Form

National Tuberculosis Notification Form

TB Case Registration: Year Sequence NumberCCACountyHealth Area

Address

First Name / Initial Surname / Initial

Phone

2 0

A. SOCIODEMOGRAPHIC DETAILS B. DIAGNOSTIC & CLINICAL DETAILS

1. Sex:

4. Most recent occupation

3. Age (years)

2. Date of Birth

10. Date of onset of symptoms

12. Date of notification

11. Date diagnosed

If Extrapulmonary or P+E,please specify site(s)

15. Histology:

Negative

Not done

Positive

Unknown

18. Isolate

M. TB

Other

M. Bovis

Unknown

If OTHER, please specify:

22. BCG Given

23. BCG Scar

25. Immune Code (see explanatory notes)

26. (a) At 2 mths:

If ZN pos at 2 mths then go to (b), otherwise go to (d)

(b) At 3 mths:

(c) At 5 mths:

(d) Rx end:

If ZN pos at 3 mths then go to (c), otherwise go to (d)

Please now go to (d)

Direct Sputum microscopy Not done




If YES, please specify new diagnosis

27. Treatment Outcome

If dead, date of death

Interrupted (>2months)

DiedLost to follow up

Completed

C. OUTCOME DETAILS (**Please note that 26 (a), (b), (c) and (d) apply to SMEAR POSITIVE cases ONLY**)

NoYes Unknown

NoYes Unknown

ZN pos

ZN pos

ZN pos

ZN pos

ZN neg

ZN neg

ZN neg

ZN neg

ZN not done

ZN not done

ZN not done

ZN not done

If dead, was TB the direct cause? NoYes

28. Case Denotified? (i.e. was diagnosis changed?)

NoYes

Pos

Pos

Pos

Pos

Neg

Neg

Neg

Neg

Culture

Culture

Culture

Culture

16. Chest x-ray:

Inactive / Old TB

OtherNormal

Active TB

13. Diagnosis (tick one only)

Pulmonary Extrapulmonary

Pulmonary + extrapulmonary (P+E)

8. Race or ethnic group

Caucasian

Black

Indian subcontinent

Traveller

Chinese

Other


6. Current living status

Home (private / rented)

B&B / Hotel

Homeless

Other

Prison

Institution

Hostel

5. Current employment status

Paid employment

Retired

Housewife / husband

Unemployed

Student

Other


21. Previous history of TB

If YES, please specify:

(b) treated >1month?

(a) year of diagnosis

(c) cured?

NoYes Unknown

NoYes Unknown

NoYes Unknown

24. Risk Factors

If YES, please specify:(e.g. immunosupression, C2H5xs, IVDU)

NoYes Unknown

19. Drug sensitivities (S = sens, R= res, N = not done) (Please fill for each drug used)

20. This case was found by

Presenting as case Contact tracing

Other screeningImmigrant screening

Other (specify)

Isoniazid

Other (specify)

Rifampicin

EthambutolPyrazinamide


9. Refugee / asylum seeker

If YES, date/year of entry into Ireland:

NoYes

If OTHER, please specify country:

7. Country of Birth

OtherIreland

FemaleMale

If done, please specify culture site:

17. Culture Results

Culture neg

Culture not done

Culture pos

Unknown

14. Direct sputum microscopy:

Specimen date

Specimen date

(a) 1st specimen

ZN not done

ZN neg

ZN pos

(b) 2nd specimen

ZN not done

ZN neg

ZN pos


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Thank you for completing this form. Please forward completed forms to your local Department of Public Health

National Tuberculosis Notification Form

(D) CASE LOCATION DETAILS

DED name / code:Hospital name:

Chart Number:

School Address:

Work Address:

(E) CONTACT TRACING DETAILS

Is this case:

Index case or Contact of another case (please tick 1)

If contact of another case, please complete

Address ofindex case:

Name of index case:

REG ID of index case:

Date of notification of index case:

COMPLETING DOCTOR SIGNATURE

Date 1

Date 6

Date 5

Date 4

Date 3

Date 2

Signature 1

Signature 6

Signature 5

Signature 4

Signature 3

Signature 2

Section completed: EDCBA






Tick section(s) completed:


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Appendix 4: Ways to assess and promote adherence to LTBI treatmentWays to assess and promote adherence to LTBI treatment

1. Use directly observed therapy (DOT) for LTBI when available especially for foreign-born persons from countries with an annual TB notification rate ≥ 40 cases per 100,000, homeless persons and intravenous drug users

2. Provide written information about the potential adverse effects of the medications at the start of treatment

3. Send reminder letters or call patients before appointments

4. Follow up promptly on missed appointments to prevent interruption or cessation of treatment

5. Minimise wait time at clinics

6. Ask patients at monthly visits about the number of missed pills in the past week

7. Remind patients to bring in their medication bottle (s) and monitor pill counts (but not in their presence)

8. During each monthly visit, stress the importance of adherence and educate patients about the potential adverse effects of medication.

Adapted with kind permission from Tuberculosis, Clinical Policies and Protocols. New York City Department of Health and Mental Hygiene (2008). Available from www.nyc.gov/html/doh/downloads/pdf/tb/tb-protocol.pdf.


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Appendix 5: Tuberculosis Therapy Audit Form

Tuberculosis Therapy Audit FormPreventive and Curative Therapy Monitor

Month 1 - 6

Bilirubin (total)

Alk Phos (result)

GGTAST / SGOTALT / SGPT

LFTs done? (Y/N)INVESTIGATIONSOther (please specify)ParaesthesiaFatigue (> 3 days)Fever (> 3 days)Dark urineJaundiceRashAbdominal discomfortVomitingNauseaAnorexiaSYMPTOM CHECKAdministration (S or D)*COMPLIANCEOther (please specify)EthambutolStreptomycinPyrazinamideRifampicinIsoniazidTREATMENT

Date

If Resistant, specifyResistance (Y/N)Culture (Pos/Neg)Direct micro (Y/N)Sputum sample (Y/N)Bilirubin (direct)

5321 4 76

Record result once available. Not available =

GOOD = +++, UNCERTAIN = ++, UNSATISFACTORY = +

YES= NO=

* S = Self administered, D = Directly Observed (Preventive) Therapy i.e. DOT

Contact numberIndex case numberIs the patient a: TB case TB contact Date therapy started

Site:NegativePositiveSputum smear:ExtrapulmonaryPulmonaryLaboratory confirmedClinically suspectedTB diagnosis:Index case details -

Surname

Age (years)DOBPhoneAddress

Forename

Hospital/clinicLHOHSE area


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Appendix 6: Questions and Answers about Tuberculosis

What is Tuberculosis? Tuberculosis or “TB” is a disease caused by a bacterium (germ) called Mycobacterium tuberculosis. TB usually affects the lungs but it can also affect other parts of the body, including the glands, the bones and rarely the brain.

Tuberculosis used to be more common in Ireland. There were nearly 7,000 cases a year in the early 1950s. The incidence of TB has declined steadily since then. In 2006, there were 465 cases notified in Ireland. Doctors are obliged to notify each case of TB to the local departments of public health in the Health Service Executive.

TB disease is preventable and curable.

What are the symptoms of TB? Symptoms of TB can include any of the following:

• Fever and night sweats • Cough (generally lasting more than 3 weeks) • Weight loss • Blood in the sputum (phlegm) at any time.

A person with any of these symptoms should visit their family doctor for advice.

How is TB spread? TB is usually spread in the air from another person who has TB of the lungs. It is spread by that person coughing, sneezing or spitting. People with TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. Even then close and prolonged contact with such a person (i.e. family, friends, childminder, co-worker) is needed to become infected. Most cases of infectious TB stop being infectious after a few weeks of treatment. TB in other parts of the body such as the kidney or spine is usually not infectious.

Another type of TB called Mycobacterium bovis can arise from drinking contaminated milk. This form of TB is now rare as pasteurisation of milk removes the risk.

The following people have a greater chance of becoming ill with TB, if exposed to it: • Those in very close contact with infectious people • Children • Elderly people • Diabetics • People on steroids • People on other drugs affecting the body’s defence system • People who are HIV positive • People in overcrowded, poor housing • People dependent on drugs or alcohol • People with chronic poor health.

What happens when a person is found to have infectious TB?• Treatment for TB is started • Public health doctors talk to the infected patient to see if other people need to be checked for TB.

What is the difference between latent tuberculosis infection and active tuberculosis disease? Infection with the TB bacterium may not develop into TB disease. Most people who are exposed to TB are


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able to overcome the bacteria. The bacteria become inactive but they remain dormant in the body and can become active later. This is called latent TB infection (LTBI).

People with LTBI: • Have no symptoms • Don’t feel sick • Can’t spread TB to others • Usually have a positive skin test reaction • Can develop TB disease later in life.

Most people who have LTBI never develop active TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, who have weak immune systems, the bacteria can become active and cause TB disease.

The difference between latent TB infection and active TB disease

A person with Latent TB Infection A person with Active TB Disease

• Has no symptoms

• Does not feel sick

• Usually has a positive skin test or blood test

• Has a normal chest X-ray and sputum test

• Has symptoms which may include:

A bad cough which lasts three weeks or longer

Pain in the chest

Coughing up sputum (phlegm) or blood

Weakness or fatigue

Weight loss

No appetite

Chills

Fever

Night sweats

• May spread TB to others

• Usually has a positive skin test or positive blood test

• May have an abnormal chest X-ray or positive sputum-smear or culture

How is TB diagnosed? There are a number of tests that can be done to check for TB:

• A skin test • A chest X-ray • A test of the sputum (phlegm) • A blood or urine test.

How is TB treated? Yes, today TB is potentially completely curable, if the responsible organism is fully sensitive to the antibiotics being used and the patient takes his or her medication as prescribed.

TB is treated with tablets which must be taken for at least six months. Without treatment, many people used to die from TB. It is essential to take the treatment regularly and to complete the course as prescribed.

The most common medicines used to treat TB are: isoniazid, rifampicin, ethambutol and pyrazinamide. A vitamin B6 tablet called pyridoxine is also prescribed to help prevent some of the side effects that may be caused by isoniazid. Your doctor will decide which TB drugs are best for you.


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If you have infectious TB (TB disease of the lungs or throat), you will need to stay at home from work or school so that you don’t spread the TB bacteria to other people. After taking your medicines for a few weeks, you will feel better and will no longer be infectious to others. Your doctor will tell you when you can return to work or school or visit friends.

What are the side effects of TB medicines?If you are taking medicines for TB, you should take them as directed by your doctor or nurse. The medicines may cause side effects but everyone can react differently and not everyone will have side effects. It is important to report any side effects to your doctor even if they are not listed below. Side effects include:

• No appetite• Nausea (feeling sick in the stomach) and/or vomiting• Abdominal pain (tummy pain)• Yellowish skin or eyes• Dark-coloured urine• Fever for 3 or more days• Skin rash• Itching• Tingling of fingers or toes or around the mouth• Easy bleeding and/or bruising• Blurred or changed vision• Ringing in the ears• Hearing loss• Dizziness• Aching joints.

The following side effects are caused by rifampicin. If you have any of these side effects you can continue your medications (your doctor will advise you of these before starting treatment for TB):

Rifampicin can: • Turn your urine, saliva (spit) or tears orange. The doctor or nurse will advise you not to wear

contact lenses as they may get stained.• Make your skin more sensitive to the sun. This means you should use a good sunscreen and cover

exposed areas so that they don’t burn.• Make birth control pills and implants less effective. Women who take rifampicin should use another

form of birth control.

How important is treatment? Treatment is very important. If you have TB disease or if you have been infected with the TB bacterium but have not yet become unwell i.e. have LTBI, you must take the treatment as directed. It is very important to complete the full course of treatment as it will stop you being infectious (spreading the disease to others) and it will remove the risk of you developing drug-resistant TB. It is important to remember that TB used to kill people before we had modern treatments. Can I drink alcohol with my medication? It is always best to avoid alcohol while you are taking TB medicines. This is because drinking any alcohol can increase the chances of having problems with your liver when taking the medications.

What precautions need to be taken to prevent TB spreading in the home?Some patients who are infectious (with TB) can remain at home in the household that has already been exposed. However, the following precautions should be taken:

• Use tissues when sneezing or coughing and place into a household bin immediately after use• Wash hands after disposing of the tissues• Stay at home and do not go to places where there will be previously unexposed people (e.g. pubs,

clubs, cinemas)• Attend all outpatient visits • No visits by previously unexposed people


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• Children who do not live at home should not visit until your doctor allows• Relatives or friends who have weakened immune systems should not visit until your doctor allows• You can go for a walk outside but you should avoid close contact with previously unexposed

people.

Most people are no longer infectious when they have completed a few weeks of TB tablets and are feeling better and their cough is gone or improving. However your doctor will advise you when the above precautions are no longer necessary. It is also very important that you continue your medications until the doctor tells you to stop.

What should I do if I have been in contact with someone with TB? Discuss this with your family doctor. Only close contacts are at risk of catching TB. You may be asked to attend a chest clinic and to have a skin test and/or a chest X-ray. Sometimes a doctor or nurse will contact you first (they will have a list of close contacts of the person who has TB). This does not necessarily mean that you have TB but is a chance to check for it, so it is very important to attend if you are asked to.

Can TB be prevented? Yes it can, in several ways:

• Treating all people with active TB disease promptly. After two weeks of treatment, most patients are no longer infectious to other people.

• Ensuring that all close contacts of people with TB are seen promptly in the chest clinic. Those found to have LTBI or those at high risk of developing TB after close contact may be offered a course of preventive therapy (chemoprophylaxis) once active TB has been ruled out.

• Vaccination: In Ireland the BCG vaccination (vaccine against TB) is recommended for newborn babies. BCG is also given to adults who are considered to be at risk of developing TB where potential contact with the disease could occur or has occurred. BCG vaccine is very effective, particularly in preventing childhood TB and the more severe forms of TB.

What are multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB)

Multidrug-resistant TB (MDR-TB)MDR-TB is a specific form of TB which is resistant to at least isoniazid and rifampicin, two of the main first line drugs used in the treatment of TB. MDR-TB therefore is much more difficult to treat. It takes longer to treat with second line drugs which are more expensive and have more side-effects.

Extensively drug-resistant TB (XDR-TB)XDR-TB is a rare type of MDR-TB which is also resistant to any of a group of drugs called fluoroquinolones and at least one of three injectable second line anti-TB drugs (capreomycin, kanamycin or amikacin). Because XDR-TB is resistant to first line and second line drugs, treatment options are more limited. Further information on XDR-TB can be found on the WHO website at www.who.int/tb/challenges/xdr/en/index.html

Information on TB in Ireland can be found on the Health Protection Surveillance Centre website at www.hpsc.ie/hpsc/A-Z/VaccinePreventable/TuberculosisTB/.


Appendix 7: Contact details for clinical and laboratory TB adviceRespiratory PhysiciansDr Tim McDonnell, St Vincent’s University Hospital, DublinDr Brendan Keogh, Mater Misericordiae Hospital, DublinDr Terry O Connor, Mercy University Hospital, CorkDr JJ Gilmartin, University College Hospital, Galway

Infectious disease PhysiciansDr C. Fleming, University College Hospital, GalwayDr Karina Butler, Our Lady’s Hospital, Crumlin, Dublin

Consultant Microbiologists Dr Margaret Hannan, Mater Misericordiae Hospital, DublinDr Bartley Cryan, Cork University Hospital

Irish Mycobacteria Reference Laboratory Mr Noel Gibbons, Chief Medical Scientist, (01) 416 2963, [email protected] Prof T Rogers, Clinical Director, (01) 896 2131, [email protected] Dr J Keane, Consultant Respiratory Physician, (01) 410 3920, [email protected]

Webpage: www.stjames.ie/Departments/DepartmentsA-Z/I/IMRL/DepartmentOverview/ or go to www.stjames.ie choose Lab services and then Irish Mycobacteria Reference Laboratory

Antimicrobial Reference Laboratory,

Department of Medical Microbiology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom

The Antimicrobial Reference Laboratory user manual may be found at www.bris.ac.uk/bcare/AssayBooklet.doc

Results and general inquiries: Tel. No: 00-44-117-959-5653

Service Enquiries Prof A. P. MacGowan, Consultant Medical Microbiologist. Contact telephone no: 0044- 117-959-5652Email address: [email protected]

Dr. A. M. Lovering, Consultant Clinical Scientist. Contact telephone no: 0044-117-959 5653Email address: [email protected]

Mr. H. A. Holt, Laboratory Manager. Contact telephone no: 0044-117-959-5658Email address: [email protected]

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Appendix 8: International Standards for Tuberculosis CareIn 2006 the “International Standards for Tuberculosis Care” were published to describe a widely accepted level of care that all practitioners, public and private should seek to achieve in managing patients who have or are suspected of having tuberculosis. The standards are outlined below. The full document is available at www.who.int/tb/publications/2006/istc_report.pdf.

Standards for DiagnosisStandard 1. All persons with otherwise unexplained productive cough lasting two to three weeks or more should be evaluated for tuberculosis.

Standard 2. All patients (adults, adolescents, and children who are capable of producing sputum) suspected of having pulmonary tuberculosis should have at least two and preferably three, sputum specimens obtained for microscopic examination. When possible, at least one early morning specimen should be obtained.

Standard 3. For all patients (adults, adolescents, and children) suspected of having extrapulmonary tuberculosis, appropriate specimens from the suspected sites of involvement should be obtained for microscopy and, where facilities and resources are available, for culture and histopathological examination.

Standard 4. All persons with chest radiographic findings suggestive of tuberculosis should have sputum specimens submitted for microbiological examination.

Standard 5. The diagnosis of sputum smear-negative pulmonary tuberculosis should be based on the following criteria: at least three negative sputum smears (including at least one early morning specimen), chest radiography findings consistent with tuberculosis and lack of response to a trial of broad spectrum antimicrobial agents. (Note: Because the fluoroquinolones are active against M. tuberculosis complex and thus may cause transient improvement in persons with tuberculosis, they should be avoided.) For such patients, if facilities for culture are available, sputum cultures should be obtained. In persons with known or suspected HIV infection, the diagnostic evaluation should be expedited.

Standards for TreatmentStandard 6. The diagnosis of intrathoracic (i.e. pulmonary, pleural, and mediastinal orhilar lymph node) tuberculosis in symptomatic children with negative sputum smears should be based on the finding of chest radiographic abnormalities consistent with tuberculosis and either a history of exposure to an infectious case or evidence of tuberculosis infection (positive TST or interferon gamma release assay). For such patients, if facilities for culture are available, sputum specimens should be obtained (by expectoration, gastric washings, or induced sputum) for culture.

Standard 7. Any practitioner treating a patient for tuberculosis is assuming an importantpublic health responsibility. To fulfill this responsibility the practitioner must not only prescribe an appropriate regimen but, also, be capable of assessing the adherence of the patient to the regimen and addressing poor adherence when it occurs. By so doing, the provider will be able to ensure adherence to the regimen until treatment is completed.

Standard 8. All patients (including those with HIV infection) who have not been treatedpreviously should receive an internationally accepted first-line treatment regimen using drugs of known bioavailability. The initial phase should consist of two months of isoniazid, rifampicin, pyrazinamide, and ethambutol. The preferred continuation phase consists of isoniazid and rifampicin given for four months. Isoniazid and ethambutol given for six months is an alternative continuation phase regimen that may be used when adherence cannot be assessed, but it is associated with a higher rate of failure and

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relapse, especially in patients with HIV infection. The doses of antituberculosis drugs used should conform to international recommendations. Fixed-dose combinations of two (isoniazid and rifampicin), three (isoniazid, rifampicin, and pyrazinamide), and four (isoniazid, rifampicin, pyrazinamide, and ethambutol) drugs are highly recommended, especially when medication ingestion is not observed.Standard 9. To foster and assess adherence, a patient-centered approach to administration of drug treatment, based on the patient’s needs and mutual respect between the patient and the provider, should be developed for all patients. Supervision and support should be gender-sensitive and age-specific and should draw on the full range of recommended interventions and available support services, including patient counselling and education. A central element of the patient-centered strategy is the use of measures to assess and promote adherence to the treatment regimen and to address poor adherence when it occurs. These measures should be tailored to the individual patient’s circumstances and be mutually acceptable to the patient and the provider. Such measures may include direct observation of medication ingestion (directly observed therapy, DOT) by a treatment supporter who is acceptable and accountable to the patient and to the health system.

Standard 10. All patients should be monitored for response to therapy, best judged in patients with pulmonary tuberculosis by follow-up sputum microscopy (two specimens) at least at the time of completion of the initial phase of treatment (two months), at five months, and at the end of treatment. Patients who have positive smears during the fifth month of treatment should be considered as treatment failures and have therapy modified appropriately (see Standards 14 and 15). In patients with extrapulmonary tuberculosis and in children, the response to treatment is best assessed clinically. Follow-up radiographic examinations are usually unnecessary and may be misleading.

Standard 11. A written record of all medications given, bacteriologic response, and adverse reactions should be maintained for all patients.

Standard 12. In areas with a high prevalence of HIV infection in the general population and where tuberculosis and HIV infection are likely to co-exist, HIV counselling and testing is indicated for all tuberculosis patients as part of their routine management. In areas with lower prevalence rates of HIV, HIV counselling and testing is indicated for tuberculosis patients with symptoms and/or signs of HIV-related conditions and in tuberculosis patients having a history suggestive of high risk of HIV exposure.

Standard 13. All patients with tuberculosis and HIV infection should be evaluated to determine if antiretroviral therapy is indicated during the course of treatment for tuberculosis. Appropriate arrangements for access to antiretroviral drugs should be made for patients who meet indications for treatment. Given the complexity of co-administration of antituberculosis treatment and antiretroviral therapy, consultation with a physician who is expert in this area is recommended before initiation of concurrent treatment for tuberculosis and HIV infection, regardless of which disease appeared first.However, initiation of treatment for tuberculosis should not be delayed. Patients with tuberculosis and HIV infection should also receive cotrimoxazole as prophylaxis for other infections.

Standard 14. An assessment of the likelihood of drug resistance, based on history of prior treatment, exposure to a possible source case having drug-resistant organisms, and the community prevalence of drug resistance, should be obtained for all patients. Patients who fail treatment and chronic cases should always be assessed for possible drug resistance. For patients in whom drug resistance is considered to be likely, culture and drug susceptibility testing for isoniazid, rifampicin and ethambutol should be performedpromptly.

Standard 15. Patients with tuberculosis caused by drug-resistant (especially multiple drug-resistant [MDR]) organisms should be treated with specialised regimens containing second-line antituberculosis drugs. At least four drugs to which the organisms are known or presumed to be susceptible should be used and treatment should be given for at least 18 months. Patient centered measures are required to ensure adherence. Consultation with a provider experienced in treatment of patients with MDR-tuberculosisshould be obtained.

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Standards for Public Health ResponsibilitiesStandard 16. All providers of care for patients with tuberculosis should ensure that persons (especially children under 5 years of age and persons with HIV infection) who are in close contact with patients who have infectious tuberculosis are evaluated and managed in line with international recommendations. Children under 5 years of age and persons with HIV infection who have been in contact with an infectious case should be evaluated for both latent infection with M. tuberculosis and for active tuberculosis.

Standard 17. All providers must report both new and retreatment tuberculosis cases andtheir treatment outcomes to local public health authorities, in conformance with applicable legal requirements and policies.

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Appendix 9: DOT referral form-HSE South (Cork and Kerry)

TO/ DIRECTOR OF PUBLIC HEALTH NURSING

REFERRAL REQUEST FOR DIRECTLY OBSERVED THERAPY (TUBERCULOSIS MEDICATION)

Name ________________________________ D.O.B. __________________ Home Address _________________________ Current Address (if different) ___________________ ______________________________________ __________________________________________ ______________________________________ __________________________________________ ______________________________________ ___________________________________________ Contact Number ________________________ Hospital _______________________________ Treating Consultant ______________________ GP _______________________________ Diagnosis ___________________________________________________________________ Date of commencement of TB therapy _____________________________________________ Most recent sputum: Date __________________ Result _________________________ Case Currently Infectious? Yes □ No □ Mask wearing recommended? Yes □ No □ (If yes, for how long? ___________________ ) Reason/s for DOT Request? Poor/Non compliance Yes □ No □ MDR-TB Yes □ No □ TB Relapse Yes □ No □ Homeless Yes □ No □ Other Yes □ No □ (Specify:_____________________) Date Next OPD Appointment ______________________ Patient informed of DOT Request? Yes □ No □ TB Medication ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

(Prescription faxed) Signed: _______________________________________________ Date ______________ Referring Medical Consultant. □ c.c. Senior Medical Officer, Cork. Fax No. 021 4927370 □ c.c. Senior Medical Officer, Kerry. Fax No. 066 7184542

North Lee □ South Lee □ North Cork □ West Cork □ Kerry □

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fect

ious

cas

eSe

e ch

apte

r 6

for

crit

eria

fo

r d

isco

ntin

uati

on

of

Air

bo

rne

Pre

caut

ions

Stan

dar

d P

reca

utio

ns m

ust

be

cont

inue

d f

or

all p

atie

nts

onc

e A

irb

orn

e P

reca

utio

ns a

re d

isco

ntin

ued

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Occ

upat

iona

l H

ealt

h P

rog

ram

me

All

HC

Ws

sho

uld

be

asse

ssed

by

an o

ccup

atio

nal h

eath

tea

m p

rio

r to

co

mm

enci

ng w

ork

. Thi

s as

sess

men

t sh

oul

d in

clud

e:

Imm

unis

atio

ns (I

rish

gui

del

ines

on

imm

unis

atio

ns r

equi

red

•

for

HC

Ws

are

avai

lab

le a

t w

ww

.hp

sc.ie

/hp

sc/A

-Z/

Vacc

ineP

reve

ntab

le/V

acci

nati

on/

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dan

ce/)

Scre

enin

g H

CW

s w

ho p

erfo

rm e

xpo

sure

pro

ne p

roce

dur

es f

or

•b

loo

d b

orn

e vi

ruse

s. D

oH

C g

uid

elin

es a

vaila

ble

at

ww

w.d

ohc

.ie/

pub

licat

ions

/tra

nsm

issi

on_

of_

blo

od

_bo

rne_

dis

ease

s_20

06.h

tml

Pat

ient

P

lace

men

t

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Pla

ce a

ll p

atie

nts

wit

h su

spec

ted

or

confi

rmed

pul

mo

nary

or

lary

ngea

l TB

in

one

the

fo

llow

ing

air

bo

rne

iso

lati

on

roo

ms.

Ref

er t

o fi

gur

e 6.

1 fo

r ri

sk

asse

ssm

ent

alg

ori

thm

if a

n ai

rbo

rne

iso

lati

on

roo

m is

no

t av

aila

ble

. Ref

er t

o

sect

ion

6.5

for

eng

inee

ring

sta

ndar

ds

Neg

ativ

e p

ress

ure

iso

lati

on

roo

m w

ith

a ha

nd w

ash

sink

, an

ante

ro

om

1.

an

d e

n-su

ite

A n

eutr

al p

ress

ure

des

ign

roo

m, a

s d

etai

led

in H

BN

04

Sup

ple

men

t 1

2.

Pat

ient

s w

ith

kno

wn

or

susp

ecte

d m

ulti

dru

g-r

esis

tant

TB

(M

DR

-TB

) m

ust

be

pla

ced

in a

n ai

rbo

rne

iso

lati

on

roo

m w

hich

may

req

uire

tra

nsfe

r o

f th

e p

atie

nt t

o a

noth

er f

acili

ty

A n

oti

ce s

houl

d b

e p

lace

d o

n th

e d

oo

r o

f th

e is

ola

tio

n ro

om

ad

visi

ng t

hose

en

teri

ng t

o r

epo

rt t

o t

he n

urse

in c

harg

e b

efo

re e

nter

ing

Pat

ient

s sh

oul

d b

e ed

ucat

ed r

egar

din

g t

he r

easo

n/in

dic

atio

n fo

r A

irb

orn

e P

reca

utio

ns a

nd r

eque

sted

no

t to

leav

e th

e ro

om

unl

ess

abso

lute

ly n

eces

sary

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

P

lace

men

t(c

ont

)

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Em

erg

ency

dep

artm

ents

(ED

) wit

hout

an

airb

orn

e is

ola

tio

n ro

om

mus

t ha

ve a

p

roce

ss in

pla

ce t

o p

rio

riti

se t

rans

fer

of

pat

ient

s w

ith

susp

ecte

d o

r co

nfirm

ed

TB t

o a

n ap

pro

pri

ate

roo

m. E

D d

epar

tmen

ts w

itho

ut a

ny a

irb

orn

e is

ola

tio

n ro

om

s sh

oul

d p

lace

a s

urg

ical

mas

k o

n th

e p

atie

nt a

nd p

lace

him

/her

in a

n ex

amin

atio

n ro

om

or

sing

le r

oo

m w

hile

aw

aiti

ng t

rans

fer.

This

ro

om

sho

uld

b

e le

ft v

acan

t fo

r 1

hour

onc

e th

e p

atie

nt is

tra

nsfe

rred

to

allo

w f

or

a fu

ll ex

chan

ge

of

air.

Aer

oso

l-gen

erat

ing

pro

ced

ures

suc

h as

sp

utum

ind

ucti

on

and

the

ad

min

istr

atio

n o

f m

edic

atio

ns b

y ne

bul

iser

mus

t b

e av

oid

ed w

hile

a p

atie

nt

wit

h su

spec

ted

or

confi

rmed

TB

is in

an

op

en b

ay o

r an

unv

enti

late

d a

rea

in

any

war

d

Bro

ncho

sco

py

sho

uld

pre

fera

bly

be

per

form

ed in

an

app

rop

riat

e ne

gat

ive

pre

ssur

e su

ite

wit

h ad

equa

te v

enti

lati

on.

Unn

eces

sary

sta

ff a

nd o

ther

pat

ient

s sh

oul

d b

e ex

clud

ed d

urin

g t

he p

roce

dur

e. If

end

osc

op

y ro

om

s ar

e w

itho

ut a

ir

hand

ling

eq

uip

men

t, t

he p

roce

dur

e sh

oul

d b

e d

one

at

the

end

of

the

list

for

the

day

, or

in t

he p

atie

nt’s

ro

om

. Avo

id p

lace

men

t o

f re

cove

ring

pat

ient

s in

a

mul

ti-b

edd

ed w

ard

po

st p

roce

dur

e.

Pro

ced

ures

on

an e

xtra

pul

mo

nary

TB

op

en a

bsc

ess

or

lesi

on

whe

re

aero

solis

atio

n o

f d

rain

age

fluid

may

occ

ur s

houl

d o

nly

be

und

erta

ken

in a

n ai

rbo

rne

iso

lati

on

roo

m

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Han

dH

ygie

neH

and

hyg

iene

is r

eco

mm

end

ed;

Bef

ore

and

aft

er e

ach

epis

od

e o

f p

atie

nt c

ont

act

•B

etw

een

ind

ivid

ual p

atie

nt c

ont

acts

•A

fter

co

ntac

t w

ith

blo

od

, bo

dy

fluid

s, s

ecre

tio

ns o

r •

excr

etio

ns, w

heth

er o

r no

t g

love

s ar

e w

orn

Aft

er h

and

ling

so

iled

/co

ntam

inat

ed e

qui

pm

ent,

mat

eria

ls o

r •

the

envi

ronm

ent

Imm

edia

tely

bef

ore

glo

ve a

pp

licat

ion

•Im

med

iate

ly a

fter

rem

ovi

ng g

love

s o

r o

ther

pro

tect

ive

•cl

oth

ing

Han

ds

sho

uld

be

dec

ont

amin

ated

usi

ng s

oap

and

wat

er o

r al

coho

l g

el if

phy

sica

lly c

lean

. Ant

isep

tic

soap

sho

uld

be

used

pri

or

to

asep

tic

pro

ced

ures

.

Pat

ient

s sh

oul

d w

ash

thei

r ha

nds

afte

r to

ileti

ng a

nd b

efo

re m

eals

. H

CW

s sh

oul

d a

ssis

t th

ose

pat

ient

s un

able

to

per

form

han

d h

ygie

ne

ind

epen

den

tly.

Vis

ito

rs s

houl

d b

e ed

ucat

ed o

n th

e im

po

rtan

ce o

f ha

nd

dec

ont

amin

atio

n b

efo

re a

nd a

fter

vis

itin

g.

(SA

RI)

Gui

del

ines

on

Han

d H

ygie

ne a

re a

vaila

ble

at

ww

w.h

psc

.ie/

hpsc

/A-Z

/Gas

tro

ente

ric/

Han

dw

ashi

ng/

Ant

isep

tic

soap

or

alco

hol g

el if

han

ds

are

phy

sica

lly c

lean

bef

ore

and

aft

er

pat

ient

car

e

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

M

ove

men

t an

d

Tran

sfer

No

sp

ecia

l pre

caut

ions

rec

om

men

ded

Lim

it m

ove

men

t an

d t

rans

po

rt o

f p

atie

nt t

o e

ssen

tial

pur

po

ses

onl

yP

rio

r to

pat

ient

tra

nsfe

r

Pri

or

to a

ccep

ting

a p

atie

nt w

ith

kno

wn

or

susp

ecte

d in

fect

ious

TB

it is

the

•

resp

ons

ibili

ty o

f th

e re

ceiv

ing

fac

ility

to

ens

ure

com

plia

nce

wit

h is

ola

tio

n ro

om

req

uire

men

ts a

s d

escr

ibed

ab

ove

und

er p

atie

nt p

lace

men

t. It

is

the

resp

ons

ibili

ty o

f th

e fa

cilit

y tr

ansf

erri

ng t

he p

atie

nt t

o p

rovi

de

the

info

rmat

ion.

Info

rm t

rans

po

rt p

erso

nnel

(em

erg

ency

med

ical

tec

hnic

ians

, po

rter

s) a

nd

•th

e re

ceiv

ing

dep

artm

ent

of

the

need

fo

r A

irb

orn

e P

reca

utio

ns

Req

uest

pat

ient

to

wea

r a

surg

ical

mas

k w

hich

sho

uld

be

chan

ged

whe

n •

heav

ily c

ont

amin

ated

wit

h re

spir

ato

ry s

ecre

tio

ns a

nd/o

r w

et o

r if

torn

. In

stru

ct p

atie

nt o

n re

spir

ato

ry h

ygie

ne a

nd c

oug

h et

ique

tte

and

ens

ure

the

pat

ient

has

a s

upp

ly o

f ti

ssue

s.

HC

Ws

sho

uld

rem

ove

co

ntam

inat

ed a

pro

n/g

ow

n/g

love

s (if

wo

rn) a

nd

•m

ask

and

dis

po

se p

rio

r to

tra

nsp

ort

ing

pat

ient

s. S

taff

do

no

t ne

ed t

o

wea

r m

asks

dur

ing

inte

rnal

tra

nsp

ort

atio

n un

less

pat

ient

is u

nab

le t

o w

ear

a su

rgic

al m

ask

(e.g

. co

nfus

ed, r

esp

irat

ory

dis

tres

s).

Am

bul

ance

sta

ff s

houl

d c

ons

ider

the

use

of

FFP

2 o

r FF

P3

mas

ks in

the

•

follo

win

g s

itua

tio

ns: (

a) t

he p

atie

nt is

una

ble

to

wea

r a

surg

ical

mas

k; (b

) it

is a

ntic

ipat

ed t

hat

the

dur

atio

n o

f th

e jo

urne

y w

ill b

e ≥

8 ho

urs

(≥ 4

ho

urs

if H

CW

is im

mun

oco

mp

rom

ised

); (c

) if

the

pat

ient

has

eit

her

MD

R-o

r X

DR

-TB

(co

nsul

t in

fect

ion

pre

vent

ion

and

co

ntro

l tea

m in

thi

s si

tuat

ion)

.

Do

n FF

P2/

3 m

ask

pri

or

to h

and

ling

pat

ient

at

the

tran

spo

rt d

esti

nati

on

•(e

.g. X

-ray

, bro

ncho

sco

py

suit

e)

Tran

spo

rt e

qui

pm

ent

(str

etch

er, b

ed w

heel

chai

r) u

sed

to

tra

nsp

ort

pat

ient

•

mus

t b

e cl

eane

d a

nd d

isin

fect

ed w

ith

a d

eter

gen

t an

d 1

,000

pp

m o

f av

aila

ble

chl

ori

ne b

efo

re u

se o

n an

oth

er p

atie

nt

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Res

pir

ato

ry

Eti

que

tte/

Co

ugh

Eti

que

tte

Ad

min

istr

ativ

eE

duc

ate

HC

Ws

on

the

imp

ort

ance

of

cont

rol m

easu

res

to

•co

ntai

n re

spir

ato

ry s

ecre

tio

ns t

o p

reve

nt d

rop

let

and

co

ntac

t tr

ansm

issi

on

of

resp

irat

ory

pat

hog

ens,

esp

ecia

lly d

urin

g

seas

ona

l out

bre

aks

of

vira

l res

pir

ato

ry t

ract

infe

ctio

ns (e

.g.

influ

enza

, RSV

, etc

) in

the

com

mun

ity

Ens

ure

that

sup

plie

s o

f ti

ssue

s, f

oo

t o

per

atin

g w

aste

bin

s an

d

•ha

nd h

ygie

ne f

acili

ties

are

ava

ilab

le in

all

dep

artm

ents

incl

udin

g

wai

ting

are

as t

hro

ugho

ut t

he f

acili

ty

Info

rmat

ion

for

pat

ient

s/vi

sito

rs/p

ublic

Ed

ucat

e p

atie

nts/

visi

tors

/car

ers

on

resp

irat

ory

eti

que

tte

and

co

ugh

hyg

iene

usi

ng s

om

e o

r al

l of

the

follo

win

g:

Pat

ient

info

rmat

ion

leafl

ets

•W

elco

me

pac

ks•

Po

ster

s in

all

dep

artm

ents

esp

ecia

lly w

aiti

ng a

reas

• A

dd

itio

nal p

reca

utio

ns d

urin

g t

imes

of

incr

ease

d p

reva

lenc

e o

f re

spir

ato

ry in

fect

ions

Dur

ing

per

iod

s o

f in

crea

sed

pre

vale

nce

of

resp

irat

ory

infe

ctio

ns

•in

the

co

mm

unit

y, o

ffer

mas

ks t

o c

oug

hing

pat

ient

s an

d o

ther

sy

mp

tom

atic

per

sons

(e.g

. per

sons

who

acc

om

pan

y ill

pat

ient

s)

upo

n en

try

into

the

fac

ility

and

enc

our

age

them

to

mai

ntai

n sp

ecia

l sep

arat

ion,

idea

lly a

dis

tanc

e o

f at

leas

t 3

feet

, fro

m

oth

ers

in c

om

mo

n w

aiti

ng a

reas

Som

e fa

cilit

ies

may

find

it lo

gis

tica

lly e

asie

r to

inst

itut

e th

is

•re

com

men

dat

ion

year

-ro

und

as

a st

and

ard

of

pra

ctic

e

See

app

end

ix 1

4 fo

r sa

mp

le p

ost

er f

or

resp

irat

ory

eti

que

tte/

coug

h et

ique

tte

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

-172-


-173-

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Occ

upat

iona

l H

ealt

h P

rog

ram

me

All

HC

Ws

sho

uld

be

asse

ssed

by

an o

ccup

atio

nal h

eath

tea

m p

rio

r to

co

mm

enci

ng w

ork

. Thi

s as

sess

men

t sh

oul

d in

clud

e:

Imm

unis

atio

ns (I

rish

gui

del

ines

on

imm

unis

atio

ns r

equi

red

•

for

HC

Ws

are

avai

lab

le a

t w

ww

.hp

sc.ie

/hp

sc/A

-Z/

Vacc

ineP

reve

ntab

le/V

acci

nati

on/

Gui

dan

ce/)

Scre

enin

g H

CW

s w

ho p

erfo

rm e

xpo

sure

pro

ne p

roce

dur

es f

or

•b

loo

d b

orn

e vi

ruse

s. D

oH

C g

uid

elin

es a

vaila

ble

at

ww

w.d

ohc

.ie/

pub

licat

ions

/tra

nsm

issi

on_

of_

blo

od

_bo

rne_

dis

ease

s_20

06.h

tml

Pat

ient

P

lace

men

t

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Pla

ce a

ll p

atie

nts

wit

h su

spec

ted

or

confi

rmed

pul

mo

nary

or

lary

ngea

l TB

in

one

the

fo

llow

ing

air

bo

rne

iso

lati

on

roo

ms.

Ref

er t

o fi

gur

e 6.

1 fo

r ri

sk

asse

ssm

ent

alg

ori

thm

if a

n ai

rbo

rne

iso

lati

on

roo

m is

no

t av

aila

ble

. Ref

er t

o

sect

ion

6.5

for

eng

inee

ring

sta

ndar

ds

Neg

ativ

e p

ress

ure

iso

lati

on

roo

m w

ith

a ha

nd w

ash

sink

, an

ante

ro

om

1.

an

d e

n-su

ite

A n

eutr

al p

ress

ure

des

ign

roo

m, a

s d

etai

led

in H

BN

04

Sup

ple

men

t 1

2.

Pat

ient

s w

ith

kno

wn

or

susp

ecte

d m

ulti

dru

g-r

esis

tant

TB

(M

DR

-TB

) m

ust

be

pla

ced

in a

n ai

rbo

rne

iso

lati

on

roo

m w

hich

may

req

uire

tra

nsfe

r o

f th

e p

atie

nt t

o a

noth

er f

acili

ty

A n

oti

ce s

houl

d b

e p

lace

d o

n th

e d

oo

r o

f th

e is

ola

tio

n ro

om

ad

visi

ng t

hose

en

teri

ng t

o r

epo

rt t

o t

he n

urse

in c

harg

e b

efo

re e

nter

ing

Pat

ient

s sh

oul

d b

e ed

ucat

ed r

egar

din

g t

he r

easo

n/in

dic

atio

n fo

r A

irb

orn

e P

reca

utio

ns a

nd r

eque

sted

no

t to

leav

e th

e ro

om

unl

ess

abso

lute

ly n

eces

sary

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

P

lace

men

t(c

ont

)

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Em

erg

ency

dep

artm

ents

(ED

) wit

hout

an

airb

orn

e is

ola

tio

n ro

om

mus

t ha

ve a

p

roce

ss in

pla

ce t

o p

rio

riti

se t

rans

fer

of

pat

ient

s w

ith

susp

ecte

d o

r co

nfirm

ed

TB t

o a

n ap

pro

pri

ate

roo

m. E

D d

epar

tmen

ts w

itho

ut a

ny a

irb

orn

e is

ola

tio

n ro

om

s sh

oul

d p

lace

a s

urg

ical

mas

k o

n th

e p

atie

nt a

nd p

lace

him

/her

in a

n ex

amin

atio

n ro

om

or

sing

le r

oo

m w

hile

aw

aiti

ng t

rans

fer.

This

ro

om

sho

uld

b

e le

ft v

acan

t fo

r 1

hour

onc

e th

e p

atie

nt is

tra

nsfe

rred

to

allo

w f

or

a fu

ll ex

chan

ge

of

air.

Aer

oso

l-gen

erat

ing

pro

ced

ures

suc

h as

sp

utum

ind

ucti

on

and

the

ad

min

istr

atio

n o

f m

edic

atio

ns b

y ne

bul

iser

mus

t b

e av

oid

ed w

hile

a p

atie

nt

wit

h su

spec

ted

or

confi

rmed

TB

is in

an

op

en b

ay o

r an

unv

enti

late

d a

rea

in

any

war

d

Bro

ncho

sco

py

sho

uld

pre

fera

bly

be

per

form

ed in

an

app

rop

riat

e ne

gat

ive

pre

ssur

e su

ite

wit

h ad

equa

te v

enti

lati

on.

Unn

eces

sary

sta

ff a

nd o

ther

pat

ient

s sh

oul

d b

e ex

clud

ed d

urin

g t

he p

roce

dur

e. If

end

osc

op

y ro

om

s ar

e w

itho

ut a

ir

hand

ling

eq

uip

men

t, t

he p

roce

dur

e sh

oul

d b

e d

one

at

the

end

of

the

list

for

the

day

, or

in t

he p

atie

nt’s

ro

om

. Avo

id p

lace

men

t o

f re

cove

ring

pat

ient

s in

a

mul

ti-b

edd

ed w

ard

po

st p

roce

dur

e.

Pro

ced

ures

on

an e

xtra

pul

mo

nary

TB

op

en a

bsc

ess

or

lesi

on

whe

re

aero

solis

atio

n o

f d

rain

age

fluid

may

occ

ur s

houl

d o

nly

be

und

erta

ken

in a

n ai

rbo

rne

iso

lati

on

roo

m

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Han

dH

ygie

neH

and

hyg

iene

is r

eco

mm

end

ed;

Bef

ore

and

aft

er e

ach

epis

od

e o

f p

atie

nt c

ont

act

•B

etw

een

ind

ivid

ual p

atie

nt c

ont

acts

•A

fter

co

ntac

t w

ith

blo

od

, bo

dy

fluid

s, s

ecre

tio

ns o

r •

excr

etio

ns, w

heth

er o

r no

t g

love

s ar

e w

orn

Aft

er h

and

ling

so

iled

/co

ntam

inat

ed e

qui

pm

ent,

mat

eria

ls o

r •

the

envi

ronm

ent

Imm

edia

tely

bef

ore

glo

ve a

pp

licat

ion

•Im

med

iate

ly a

fter

rem

ovi

ng g

love

s o

r o

ther

pro

tect

ive

•cl

oth

ing

Han

ds

sho

uld

be

dec

ont

amin

ated

usi

ng s

oap

and

wat

er o

r al

coho

l g

el if

phy

sica

lly c

lean

. Ant

isep

tic

soap

sho

uld

be

used

pri

or

to

asep

tic

pro

ced

ures

.

Pat

ient

s sh

oul

d w

ash

thei

r ha

nds

afte

r to

ileti

ng a

nd b

efo

re m

eals

. H

CW

s sh

oul

d a

ssis

t th

ose

pat

ient

s un

able

to

per

form

han

d h

ygie

ne

ind

epen

den

tly.

Vis

ito

rs s

houl

d b

e ed

ucat

ed o

n th

e im

po

rtan

ce o

f ha

nd

dec

ont

amin

atio

n b

efo

re a

nd a

fter

vis

itin

g.

(SA

RI)

Gui

del

ines

on

Han

d H

ygie

ne a

re a

vaila

ble

at

ww

w.h

psc

.ie/

hpsc

/A-Z

/Gas

tro

ente

ric/

Han

dw

ashi

ng/

Ant

isep

tic

soap

or

alco

hol g

el if

han

ds

are

phy

sica

lly c

lean

bef

ore

and

aft

er

pat

ient

car

e

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

M

ove

men

t an

d

Tran

sfer

No

sp

ecia

l pre

caut

ions

rec

om

men

ded

Lim

it m

ove

men

t an

d t

rans

po

rt o

f p

atie

nt t

o e

ssen

tial

pur

po

ses

onl

yP

rio

r to

pat

ient

tra

nsfe

r

Pri

or

to a

ccep

ting

a p

atie

nt w

ith

kno

wn

or

susp

ecte

d in

fect

ious

TB

it is

the

•

resp

ons

ibili

ty o

f th

e re

ceiv

ing

fac

ility

to

ens

ure

com

plia

nce

wit

h is

ola

tio

n ro

om

req

uire

men

ts a

s d

escr

ibed

ab

ove

und

er p

atie

nt p

lace

men

t. It

is

the

resp

ons

ibili

ty o

f th

e fa

cilit

y tr

ansf

erri

ng t

he p

atie

nt t

o p

rovi

de

the

info

rmat

ion.

Info

rm t

rans

po

rt p

erso

nnel

(em

erg

ency

med

ical

tec

hnic

ians

, po

rter

s) a

nd

•th

e re

ceiv

ing

dep

artm

ent

of

the

need

fo

r A

irb

orn

e P

reca

utio

ns

Req

uest

pat

ient

to

wea

r a

surg

ical

mas

k w

hich

sho

uld

be

chan

ged

whe

n •

heav

ily c

ont

amin

ated

wit

h re

spir

ato

ry s

ecre

tio

ns a

nd/o

r w

et o

r if

torn

. In

stru

ct p

atie

nt o

n re

spir

ato

ry h

ygie

ne a

nd c

oug

h et

ique

tte

and

ens

ure

the

pat

ient

has

a s

upp

ly o

f ti

ssue

s.

HC

Ws

sho

uld

rem

ove

co

ntam

inat

ed a

pro

n/g

ow

n/g

love

s (if

wo

rn) a

nd

•m

ask

and

dis

po

se p

rio

r to

tra

nsp

ort

ing

pat

ient

s. S

taff

do

no

t ne

ed t

o

wea

r m

asks

dur

ing

inte

rnal

tra

nsp

ort

atio

n un

less

pat

ient

is u

nab

le t

o w

ear

a su

rgic

al m

ask

(e.g

. co

nfus

ed, r

esp

irat

ory

dis

tres

s).

Am

bul

ance

sta

ff s

houl

d c

ons

ider

the

use

of

FFP

2 o

r FF

P3

mas

ks in

the

•

follo

win

g s

itua

tio

ns: (

a) t

he p

atie

nt is

una

ble

to

wea

r a

surg

ical

mas

k; (b

) it

is a

ntic

ipat

ed t

hat

the

dur

atio

n o

f th

e jo

urne

y w

ill b

e ≥

8 ho

urs

(≥ 4

ho

urs

if H

CW

is im

mun

oco

mp

rom

ised

); (c

) if

the

pat

ient

has

eit

her

MD

R-o

r X

DR

-TB

(co

nsul

t in

fect

ion

pre

vent

ion

and

co

ntro

l tea

m in

thi

s si

tuat

ion)

.

Do

n FF

P2/

3 m

ask

pri

or

to h

and

ling

pat

ient

at

the

tran

spo

rt d

esti

nati

on

•(e

.g. X

-ray

, bro

ncho

sco

py

suit

e)

Tran

spo

rt e

qui

pm

ent

(str

etch

er, b

ed w

heel

chai

r) u

sed

to

tra

nsp

ort

pat

ient

•

mus

t b

e cl

eane

d a

nd d

isin

fect

ed w

ith

a d

eter

gen

t an

d 1

,000

pp

m o

f av

aila

ble

chl

ori

ne b

efo

re u

se o

n an

oth

er p

atie

nt

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Res

pir

ato

ry

Eti

que

tte/

Co

ugh

Eti

que

tte

Ad

min

istr

ativ

eE

duc

ate

HC

Ws

on

the

imp

ort

ance

of

cont

rol m

easu

res

to

•co

ntai

n re

spir

ato

ry s

ecre

tio

ns t

o p

reve

nt d

rop

let

and

co

ntac

t tr

ansm

issi

on

of

resp

irat

ory

pat

hog

ens,

esp

ecia

lly d

urin

g

seas

ona

l out

bre

aks

of

vira

l res

pir

ato

ry t

ract

infe

ctio

ns (e

.g.

influ

enza

, RSV

, etc

) in

the

com

mun

ity

Ens

ure

that

sup

plie

s o

f ti

ssue

s, f

oo

t o

per

atin

g w

aste

bin

s an

d

•ha

nd h

ygie

ne f

acili

ties

are

ava

ilab

le in

all

dep

artm

ents

incl

udin

g

wai

ting

are

as t

hro

ugho

ut t

he f

acili

ty

Info

rmat

ion

for

pat

ient

s/vi

sito

rs/p

ublic

Ed

ucat

e p

atie

nts/

visi

tors

/car

ers

on

resp

irat

ory

eti

que

tte

and

co

ugh

hyg

iene

usi

ng s

om

e o

r al

l of

the

follo

win

g:

Pat

ient

info

rmat

ion

leafl

ets

•W

elco

me

pac

ks•

Po

ster

s in

all

dep

artm

ents

esp

ecia

lly w

aiti

ng a

reas

• A

dd

itio

nal p

reca

utio

ns d

urin

g t

imes

of

incr

ease

d p

reva

lenc

e o

f re

spir

ato

ry in

fect

ions

Dur

ing

per

iod

s o

f in

crea

sed

pre

vale

nce

of

resp

irat

ory

infe

ctio

ns

•in

the

co

mm

unit

y, o

ffer

mas

ks t

o c

oug

hing

pat

ient

s an

d o

ther

sy

mp

tom

atic

per

sons

(e.g

. per

sons

who

acc

om

pan

y ill

pat

ient

s)

upo

n en

try

into

the

fac

ility

and

enc

our

age

them

to

mai

ntai

n sp

ecia

l sep

arat

ion,

idea

lly a

dis

tanc

e o

f at

leas

t 3

feet

, fro

m

oth

ers

in c

om

mo

n w

aiti

ng a

reas

Som

e fa

cilit

ies

may

find

it lo

gis

tica

lly e

asie

r to

inst

itut

e th

is

•re

com

men

dat

ion

year

-ro

und

as

a st

and

ard

of

pra

ctic

e

See

app

end

ix 1

4 fo

r sa

mp

le p

ost

er f

or

resp

irat

ory

eti

que

tte/

coug

h et

ique

tte

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed


Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Occ

upat

iona

l H

ealt

h P

rog

ram

me

All

HC

Ws

sho

uld

be

asse

ssed

by

an o

ccup

atio

nal h

eath

tea

m p

rio

r to

co

mm

enci

ng w

ork

. Thi

s as

sess

men

t sh

oul

d in

clud

e:

Imm

unis

atio

ns (I

rish

gui

del

ines

on

imm

unis

atio

ns r

equi

red

•

for

HC

Ws

are

avai

lab

le a

t w

ww

.hp

sc.ie

/hp

sc/A

-Z/

Vacc

ineP

reve

ntab

le/V

acci

nati

on/

Gui

dan

ce/)

Scre

enin

g H

CW

s w

ho p

erfo

rm e

xpo

sure

pro

ne p

roce

dur

es f

or

•b

loo

d b

orn

e vi

ruse

s. D

oH

C g

uid

elin

es a

vaila

ble

at

ww

w.d

ohc

.ie/

pub

licat

ions

/tra

nsm

issi

on_

of_

blo

od

_bo

rne_

dis

ease

s_20

06.h

tml

Pat

ient

P

lace

men

t

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Pla

ce a

ll p

atie

nts

wit

h su

spec

ted

or

confi

rmed

pul

mo

nary

or

lary

ngea

l TB

in

one

the

fo

llow

ing

air

bo

rne

iso

lati

on

roo

ms.

Ref

er t

o fi

gur

e 6.

1 fo

r ri

sk

asse

ssm

ent

alg

ori

thm

if a

n ai

rbo

rne

iso

lati

on

roo

m is

no

t av

aila

ble

. Ref

er t

o

sect

ion

6.5

for

eng

inee

ring

sta

ndar

ds

Neg

ativ

e p

ress

ure

iso

lati

on

roo

m w

ith

a ha

nd w

ash

sink

, an

ante

ro

om

1.

an

d e

n-su

ite

A n

eutr

al p

ress

ure

des

ign

roo

m, a

s d

etai

led

in H

BN

04

Sup

ple

men

t 1

2.

Pat

ient

s w

ith

kno

wn

or

susp

ecte

d m

ulti

dru

g-r

esis

tant

TB

(M

DR

-TB

) m

ust

be

pla

ced

in a

n ai

rbo

rne

iso

lati

on

roo

m w

hich

may

req

uire

tra

nsfe

r o

f th

e p

atie

nt t

o a

noth

er f

acili

ty

A n

oti

ce s

houl

d b

e p

lace

d o

n th

e d

oo

r o

f th

e is

ola

tio

n ro

om

ad

visi

ng t

hose

en

teri

ng t

o r

epo

rt t

o t

he n

urse

in c

harg

e b

efo

re e

nter

ing

Pat

ient

s sh

oul

d b

e ed

ucat

ed r

egar

din

g t

he r

easo

n/in

dic

atio

n fo

r A

irb

orn

e P

reca

utio

ns a

nd r

eque

sted

no

t to

leav

e th

e ro

om

unl

ess

abso

lute

ly n

eces

sary

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

P

lace

men

t(c

ont

)

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Em

erg

ency

dep

artm

ents

(ED

) wit

hout

an

airb

orn

e is

ola

tio

n ro

om

mus

t ha

ve a

p

roce

ss in

pla

ce t

o p

rio

riti

se t

rans

fer

of

pat

ient

s w

ith

susp

ecte

d o

r co

nfirm

ed

TB t

o a

n ap

pro

pri

ate

roo

m. E

D d

epar

tmen

ts w

itho

ut a

ny a

irb

orn

e is

ola

tio

n ro

om

s sh

oul

d p

lace

a s

urg

ical

mas

k o

n th

e p

atie

nt a

nd p

lace

him

/her

in a

n ex

amin

atio

n ro

om

or

sing

le r

oo

m w

hile

aw

aiti

ng t

rans

fer.

This

ro

om

sho

uld

b

e le

ft v

acan

t fo

r 1

hour

onc

e th

e p

atie

nt is

tra

nsfe

rred

to

allo

w f

or

a fu

ll ex

chan

ge

of

air.

Aer

oso

l-gen

erat

ing

pro

ced

ures

suc

h as

sp

utum

ind

ucti

on

and

the

ad

min

istr

atio

n o

f m

edic

atio

ns b

y ne

bul

iser

mus

t b

e av

oid

ed w

hile

a p

atie

nt

wit

h su

spec

ted

or

confi

rmed

TB

is in

an

op

en b

ay o

r an

unv

enti

late

d a

rea

in

any

war

d

Bro

ncho

sco

py

sho

uld

pre

fera

bly

be

per

form

ed in

an

app

rop

riat

e ne

gat

ive

pre

ssur

e su

ite

wit

h ad

equa

te v

enti

lati

on.

Unn

eces

sary

sta

ff a

nd o

ther

pat

ient

s sh

oul

d b

e ex

clud

ed d

urin

g t

he p

roce

dur

e. If

end

osc

op

y ro

om

s ar

e w

itho

ut a

ir

hand

ling

eq

uip

men

t, t

he p

roce

dur

e sh

oul

d b

e d

one

at

the

end

of

the

list

for

the

day

, or

in t

he p

atie

nt’s

ro

om

. Avo

id p

lace

men

t o

f re

cove

ring

pat

ient

s in

a

mul

ti-b

edd

ed w

ard

po

st p

roce

dur

e.

Pro

ced

ures

on

an e

xtra

pul

mo

nary

TB

op

en a

bsc

ess

or

lesi

on

whe

re

aero

solis

atio

n o

f d

rain

age

fluid

may

occ

ur s

houl

d o

nly

be

und

erta

ken

in a

n ai

rbo

rne

iso

lati

on

roo

m

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Han

dH

ygie

neH

and

hyg

iene

is r

eco

mm

end

ed;

Bef

ore

and

aft

er e

ach

epis

od

e o

f p

atie

nt c

ont

act

•B

etw

een

ind

ivid

ual p

atie

nt c

ont

acts

•A

fter

co

ntac

t w

ith

blo

od

, bo

dy

fluid

s, s

ecre

tio

ns o

r •

excr

etio

ns, w

heth

er o

r no

t g

love

s ar

e w

orn

Aft

er h

and

ling

so

iled

/co

ntam

inat

ed e

qui

pm

ent,

mat

eria

ls o

r •

the

envi

ronm

ent

Imm

edia

tely

bef

ore

glo

ve a

pp

licat

ion

•Im

med

iate

ly a

fter

rem

ovi

ng g

love

s o

r o

ther

pro

tect

ive

•cl

oth

ing

Han

ds

sho

uld

be

dec

ont

amin

ated

usi

ng s

oap

and

wat

er o

r al

coho

l g

el if

phy

sica

lly c

lean

. Ant

isep

tic

soap

sho

uld

be

used

pri

or

to

asep

tic

pro

ced

ures

.

Pat

ient

s sh

oul

d w

ash

thei

r ha

nds

afte

r to

ileti

ng a

nd b

efo

re m

eals

. H

CW

s sh

oul

d a

ssis

t th

ose

pat

ient

s un

able

to

per

form

han

d h

ygie

ne

ind

epen

den

tly.

Vis

ito

rs s

houl

d b

e ed

ucat

ed o

n th

e im

po

rtan

ce o

f ha

nd

dec

ont

amin

atio

n b

efo

re a

nd a

fter

vis

itin

g.

(SA

RI)

Gui

del

ines

on

Han

d H

ygie

ne a

re a

vaila

ble

at

ww

w.h

psc

.ie/

hpsc

/A-Z

/Gas

tro

ente

ric/

Han

dw

ashi

ng/

Ant

isep

tic

soap

or

alco

hol g

el if

han

ds

are

phy

sica

lly c

lean

bef

ore

and

aft

er

pat

ient

car

e

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

M

ove

men

t an

d

Tran

sfer

No

sp

ecia

l pre

caut

ions

rec

om

men

ded

Lim

it m

ove

men

t an

d t

rans

po

rt o

f p

atie

nt t

o e

ssen

tial

pur

po

ses

onl

yP

rio

r to

pat

ient

tra

nsfe

r

Pri

or

to a

ccep

ting

a p

atie

nt w

ith

kno

wn

or

susp

ecte

d in

fect

ious

TB

it is

the

•

resp

ons

ibili

ty o

f th

e re

ceiv

ing

fac

ility

to

ens

ure

com

plia

nce

wit

h is

ola

tio

n ro

om

req

uire

men

ts a

s d

escr

ibed

ab

ove

und

er p

atie

nt p

lace

men

t. It

is

the

resp

ons

ibili

ty o

f th

e fa

cilit

y tr

ansf

erri

ng t

he p

atie

nt t

o p

rovi

de

the

info

rmat

ion.

Info

rm t

rans

po

rt p

erso

nnel

(em

erg

ency

med

ical

tec

hnic

ians

, po

rter

s) a

nd

•th

e re

ceiv

ing

dep

artm

ent

of

the

need

fo

r A

irb

orn

e P

reca

utio

ns

Req

uest

pat

ient

to

wea

r a

surg

ical

mas

k w

hich

sho

uld

be

chan

ged

whe

n •

heav

ily c

ont

amin

ated

wit

h re

spir

ato

ry s

ecre

tio

ns a

nd/o

r w

et o

r if

torn

. In

stru

ct p

atie

nt o

n re

spir

ato

ry h

ygie

ne a

nd c

oug

h et

ique

tte

and

ens

ure

the

pat

ient

has

a s

upp

ly o

f ti

ssue

s.

HC

Ws

sho

uld

rem

ove

co

ntam

inat

ed a

pro

n/g

ow

n/g

love

s (if

wo

rn) a

nd

•m

ask

and

dis

po

se p

rio

r to

tra

nsp

ort

ing

pat

ient

s. S

taff

do

no

t ne

ed t

o

wea

r m

asks

dur

ing

inte

rnal

tra

nsp

ort

atio

n un

less

pat

ient

is u

nab

le t

o w

ear

a su

rgic

al m

ask

(e.g

. co

nfus

ed, r

esp

irat

ory

dis

tres

s).

Am

bul

ance

sta

ff s

houl

d c

ons

ider

the

use

of

FFP

2 o

r FF

P3

mas

ks in

the

•

follo

win

g s

itua

tio

ns: (

a) t

he p

atie

nt is

una

ble

to

wea

r a

surg

ical

mas

k; (b

) it

is a

ntic

ipat

ed t

hat

the

dur

atio

n o

f th

e jo

urne

y w

ill b

e ≥

8 ho

urs

(≥ 4

ho

urs

if H

CW

is im

mun

oco

mp

rom

ised

); (c

) if

the

pat

ient

has

eit

her

MD

R-o

r X

DR

-TB

(co

nsul

t in

fect

ion

pre

vent

ion

and

co

ntro

l tea

m in

thi

s si

tuat

ion)

.

Do

n FF

P2/

3 m

ask

pri

or

to h

and

ling

pat

ient

at

the

tran

spo

rt d

esti

nati

on

•(e

.g. X

-ray

, bro

ncho

sco

py

suit

e)

Tran

spo

rt e

qui

pm

ent

(str

etch

er, b

ed w

heel

chai

r) u

sed

to

tra

nsp

ort

pat

ient

•

mus

t b

e cl

eane

d a

nd d

isin

fect

ed w

ith

a d

eter

gen

t an

d 1

,000

pp

m o

f av

aila

ble

chl

ori

ne b

efo

re u

se o

n an

oth

er p

atie

nt

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Res

pir

ato

ry

Eti

que

tte/

Co

ugh

Eti

que

tte

Ad

min

istr

ativ

eE

duc

ate

HC

Ws

on

the

imp

ort

ance

of

cont

rol m

easu

res

to

•co

ntai

n re

spir

ato

ry s

ecre

tio

ns t

o p

reve

nt d

rop

let

and

co

ntac

t tr

ansm

issi

on

of

resp

irat

ory

pat

hog

ens,

esp

ecia

lly d

urin

g

seas

ona

l out

bre

aks

of

vira

l res

pir

ato

ry t

ract

infe

ctio

ns (e

.g.

influ

enza

, RSV

, etc

) in

the

com

mun

ity

Ens

ure

that

sup

plie

s o

f ti

ssue

s, f

oo

t o

per

atin

g w

aste

bin

s an

d

•ha

nd h

ygie

ne f

acili

ties

are

ava

ilab

le in

all

dep

artm

ents

incl

udin

g

wai

ting

are

as t

hro

ugho

ut t

he f

acili

ty

Info

rmat

ion

for

pat

ient

s/vi

sito

rs/p

ublic

Ed

ucat

e p

atie

nts/

visi

tors

/car

ers

on

resp

irat

ory

eti

que

tte

and

co

ugh

hyg

iene

usi

ng s

om

e o

r al

l of

the

follo

win

g:

Pat

ient

info

rmat

ion

leafl

ets

•W

elco

me

pac

ks•

Po

ster

s in

all

dep

artm

ents

esp

ecia

lly w

aiti

ng a

reas

• A

dd

itio

nal p

reca

utio

ns d

urin

g t

imes

of

incr

ease

d p

reva

lenc

e o

f re

spir

ato

ry in

fect

ions

Dur

ing

per

iod

s o

f in

crea

sed

pre

vale

nce

of

resp

irat

ory

infe

ctio

ns

•in

the

co

mm

unit

y, o

ffer

mas

ks t

o c

oug

hing

pat

ient

s an

d o

ther

sy

mp

tom

atic

per

sons

(e.g

. per

sons

who

acc

om

pan

y ill

pat

ient

s)

upo

n en

try

into

the

fac

ility

and

enc

our

age

them

to

mai

ntai

n sp

ecia

l sep

arat

ion,

idea

lly a

dis

tanc

e o

f at

leas

t 3

feet

, fro

m

oth

ers

in c

om

mo

n w

aiti

ng a

reas

Som

e fa

cilit

ies

may

find

it lo

gis

tica

lly e

asie

r to

inst

itut

e th

is

•re

com

men

dat

ion

year

-ro

und

as

a st

and

ard

of

pra

ctic

e

See

app

end

ix 1

4 fo

r sa

mp

le p

ost

er f

or

resp

irat

ory

eti

que

tte/

coug

h et

ique

tte

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed-174-


-175-

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Occ

upat

iona

l H

ealt

h P

rog

ram

me

All

HC

Ws

sho

uld

be

asse

ssed

by

an o

ccup

atio

nal h

eath

tea

m p

rio

r to

co

mm

enci

ng w

ork

. Thi

s as

sess

men

t sh

oul

d in

clud

e:

Imm

unis

atio

ns (I

rish

gui

del

ines

on

imm

unis

atio

ns r

equi

red

•

for

HC

Ws

are

avai

lab

le a

t w

ww

.hp

sc.ie

/hp

sc/A

-Z/

Vacc

ineP

reve

ntab

le/V

acci

nati

on/

Gui

dan

ce/)

Scre

enin

g H

CW

s w

ho p

erfo

rm e

xpo

sure

pro

ne p

roce

dur

es f

or

•b

loo

d b

orn

e vi

ruse

s. D

oH

C g

uid

elin

es a

vaila

ble

at

ww

w.d

ohc

.ie/

pub

licat

ions

/tra

nsm

issi

on_

of_

blo

od

_bo

rne_

dis

ease

s_20

06.h

tml

Pat

ient

P

lace

men

t

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Pla

ce a

ll p

atie

nts

wit

h su

spec

ted

or

confi

rmed

pul

mo

nary

or

lary

ngea

l TB

in

one

the

fo

llow

ing

air

bo

rne

iso

lati

on

roo

ms.

Ref

er t

o fi

gur

e 6.

1 fo

r ri

sk

asse

ssm

ent

alg

ori

thm

if a

n ai

rbo

rne

iso

lati

on

roo

m is

no

t av

aila

ble

. Ref

er t

o

sect

ion

6.5

for

eng

inee

ring

sta

ndar

ds

Neg

ativ

e p

ress

ure

iso

lati

on

roo

m w

ith

a ha

nd w

ash

sink

, an

ante

ro

om

1.

an

d e

n-su

ite

A n

eutr

al p

ress

ure

des

ign

roo

m, a

s d

etai

led

in H

BN

04

Sup

ple

men

t 1

2.

Pat

ient

s w

ith

kno

wn

or

susp

ecte

d m

ulti

dru

g-r

esis

tant

TB

(M

DR

-TB

) m

ust

be

pla

ced

in a

n ai

rbo

rne

iso

lati

on

roo

m w

hich

may

req

uire

tra

nsfe

r o

f th

e p

atie

nt t

o a

noth

er f

acili

ty

A n

oti

ce s

houl

d b

e p

lace

d o

n th

e d

oo

r o

f th

e is

ola

tio

n ro

om

ad

visi

ng t

hose

en

teri

ng t

o r

epo

rt t

o t

he n

urse

in c

harg

e b

efo

re e

nter

ing

Pat

ient

s sh

oul

d b

e ed

ucat

ed r

egar

din

g t

he r

easo

n/in

dic

atio

n fo

r A

irb

orn

e P

reca

utio

ns a

nd r

eque

sted

no

t to

leav

e th

e ro

om

unl

ess

abso

lute

ly n

eces

sary

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

P

lace

men

t(c

ont

)

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Em

erg

ency

dep

artm

ents

(ED

) wit

hout

an

airb

orn

e is

ola

tio

n ro

om

mus

t ha

ve a

p

roce

ss in

pla

ce t

o p

rio

riti

se t

rans

fer

of

pat

ient

s w

ith

susp

ecte

d o

r co

nfirm

ed

TB t

o a

n ap

pro

pri

ate

roo

m. E

D d

epar

tmen

ts w

itho

ut a

ny a

irb

orn

e is

ola

tio

n ro

om

s sh

oul

d p

lace

a s

urg

ical

mas

k o

n th

e p

atie

nt a

nd p

lace

him

/her

in a

n ex

amin

atio

n ro

om

or

sing

le r

oo

m w

hile

aw

aiti

ng t

rans

fer.

This

ro

om

sho

uld

b

e le

ft v

acan

t fo

r 1

hour

onc

e th

e p

atie

nt is

tra

nsfe

rred

to

allo

w f

or

a fu

ll ex

chan

ge

of

air.

Aer

oso

l-gen

erat

ing

pro

ced

ures

suc

h as

sp

utum

ind

ucti

on

and

the

ad

min

istr

atio

n o

f m

edic

atio

ns b

y ne

bul

iser

mus

t b

e av

oid

ed w

hile

a p

atie

nt

wit

h su

spec

ted

or

confi

rmed

TB

is in

an

op

en b

ay o

r an

unv

enti

late

d a

rea

in

any

war

d

Bro

ncho

sco

py

sho

uld

pre

fera

bly

be

per

form

ed in

an

app

rop

riat

e ne

gat

ive

pre

ssur

e su

ite

wit

h ad

equa

te v

enti

lati

on.

Unn

eces

sary

sta

ff a

nd o

ther

pat

ient

s sh

oul

d b

e ex

clud

ed d

urin

g t

he p

roce

dur

e. If

end

osc

op

y ro

om

s ar

e w

itho

ut a

ir

hand

ling

eq

uip

men

t, t

he p

roce

dur

e sh

oul

d b

e d

one

at

the

end

of

the

list

for

the

day

, or

in t

he p

atie

nt’s

ro

om

. Avo

id p

lace

men

t o

f re

cove

ring

pat

ient

s in

a

mul

ti-b

edd

ed w

ard

po

st p

roce

dur

e.

Pro

ced

ures

on

an e

xtra

pul

mo

nary

TB

op

en a

bsc

ess

or

lesi

on

whe

re

aero

solis

atio

n o

f d

rain

age

fluid

may

occ

ur s

houl

d o

nly

be

und

erta

ken

in a

n ai

rbo

rne

iso

lati

on

roo

m

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Han

dH

ygie

neH

and

hyg

iene

is r

eco

mm

end

ed;

Bef

ore

and

aft

er e

ach

epis

od

e o

f p

atie

nt c

ont

act

•B

etw

een

ind

ivid

ual p

atie

nt c

ont

acts

•A

fter

co

ntac

t w

ith

blo

od

, bo

dy

fluid

s, s

ecre

tio

ns o

r •

excr

etio

ns, w

heth

er o

r no

t g

love

s ar

e w

orn

Aft

er h

and

ling

so

iled

/co

ntam

inat

ed e

qui

pm

ent,

mat

eria

ls o

r •

the

envi

ronm

ent

Imm

edia

tely

bef

ore

glo

ve a

pp

licat

ion

•Im

med

iate

ly a

fter

rem

ovi

ng g

love

s o

r o

ther

pro

tect

ive

•cl

oth

ing

Han

ds

sho

uld

be

dec

ont

amin

ated

usi

ng s

oap

and

wat

er o

r al

coho

l g

el if

phy

sica

lly c

lean

. Ant

isep

tic

soap

sho

uld

be

used

pri

or

to

asep

tic

pro

ced

ures

.

Pat

ient

s sh

oul

d w

ash

thei

r ha

nds

afte

r to

ileti

ng a

nd b

efo

re m

eals

. H

CW

s sh

oul

d a

ssis

t th

ose

pat

ient

s un

able

to

per

form

han

d h

ygie

ne

ind

epen

den

tly.

Vis

ito

rs s

houl

d b

e ed

ucat

ed o

n th

e im

po

rtan

ce o

f ha

nd

dec

ont

amin

atio

n b

efo

re a

nd a

fter

vis

itin

g.

(SA

RI)

Gui

del

ines

on

Han

d H

ygie

ne a

re a

vaila

ble

at

ww

w.h

psc

.ie/

hpsc

/A-Z

/Gas

tro

ente

ric/

Han

dw

ashi

ng/

Ant

isep

tic

soap

or

alco

hol g

el if

han

ds

are

phy

sica

lly c

lean

bef

ore

and

aft

er

pat

ient

car

e

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

M

ove

men

t an

d

Tran

sfer

No

sp

ecia

l pre

caut

ions

rec

om

men

ded

Lim

it m

ove

men

t an

d t

rans

po

rt o

f p

atie

nt t

o e

ssen

tial

pur

po

ses

onl

yP

rio

r to

pat

ient

tra

nsfe

r

Pri

or

to a

ccep

ting

a p

atie

nt w

ith

kno

wn

or

susp

ecte

d in

fect

ious

TB

it is

the

•

resp

ons

ibili

ty o

f th

e re

ceiv

ing

fac

ility

to

ens

ure

com

plia

nce

wit

h is

ola

tio

n ro

om

req

uire

men

ts a

s d

escr

ibed

ab

ove

und

er p

atie

nt p

lace

men

t. It

is

the

resp

ons

ibili

ty o

f th

e fa

cilit

y tr

ansf

erri

ng t

he p

atie

nt t

o p

rovi

de

the

info

rmat

ion.

Info

rm t

rans

po

rt p

erso

nnel

(em

erg

ency

med

ical

tec

hnic

ians

, po

rter

s) a

nd

•th

e re

ceiv

ing

dep

artm

ent

of

the

need

fo

r A

irb

orn

e P

reca

utio

ns

Req

uest

pat

ient

to

wea

r a

surg

ical

mas

k w

hich

sho

uld

be

chan

ged

whe

n •

heav

ily c

ont

amin

ated

wit

h re

spir

ato

ry s

ecre

tio

ns a

nd/o

r w

et o

r if

torn

. In

stru

ct p

atie

nt o

n re

spir

ato

ry h

ygie

ne a

nd c

oug

h et

ique

tte

and

ens

ure

the

pat

ient

has

a s

upp

ly o

f ti

ssue

s.

HC

Ws

sho

uld

rem

ove

co

ntam

inat

ed a

pro

n/g

ow

n/g

love

s (if

wo

rn) a

nd

•m

ask

and

dis

po

se p

rio

r to

tra

nsp

ort

ing

pat

ient

s. S

taff

do

no

t ne

ed t

o

wea

r m

asks

dur

ing

inte

rnal

tra

nsp

ort

atio

n un

less

pat

ient

is u

nab

le t

o w

ear

a su

rgic

al m

ask

(e.g

. co

nfus

ed, r

esp

irat

ory

dis

tres

s).

Am

bul

ance

sta

ff s

houl

d c

ons

ider

the

use

of

FFP

2 o

r FF

P3

mas

ks in

the

•

follo

win

g s

itua

tio

ns: (

a) t

he p

atie

nt is

una

ble

to

wea

r a

surg

ical

mas

k; (b

) it

is a

ntic

ipat

ed t

hat

the

dur

atio

n o

f th

e jo

urne

y w

ill b

e ≥

8 ho

urs

(≥ 4

ho

urs

if H

CW

is im

mun

oco

mp

rom

ised

); (c

) if

the

pat

ient

has

eit

her

MD

R-o

r X

DR

-TB

(co

nsul

t in

fect

ion

pre

vent

ion

and

co

ntro

l tea

m in

thi

s si

tuat

ion)

.

Do

n FF

P2/

3 m

ask

pri

or

to h

and

ling

pat

ient

at

the

tran

spo

rt d

esti

nati

on

•(e

.g. X

-ray

, bro

ncho

sco

py

suit

e)

Tran

spo

rt e

qui

pm

ent

(str

etch

er, b

ed w

heel

chai

r) u

sed

to

tra

nsp

ort

pat

ient

•

mus

t b

e cl

eane

d a

nd d

isin

fect

ed w

ith

a d

eter

gen

t an

d 1

,000

pp

m o

f av

aila

ble

chl

ori

ne b

efo

re u

se o

n an

oth

er p

atie

nt

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Res

pir

ato

ry

Eti

que

tte/

Co

ugh

Eti

que

tte

Ad

min

istr

ativ

eE

duc

ate

HC

Ws

on

the

imp

ort

ance

of

cont

rol m

easu

res

to

•co

ntai

n re

spir

ato

ry s

ecre

tio

ns t

o p

reve

nt d

rop

let

and

co

ntac

t tr

ansm

issi

on

of

resp

irat

ory

pat

hog

ens,

esp

ecia

lly d

urin

g

seas

ona

l out

bre

aks

of

vira

l res

pir

ato

ry t

ract

infe

ctio

ns (e

.g.

influ

enza

, RSV

, etc

) in

the

com

mun

ity

Ens

ure

that

sup

plie

s o

f ti

ssue

s, f

oo

t o

per

atin

g w

aste

bin

s an

d

•ha

nd h

ygie

ne f

acili

ties

are

ava

ilab

le in

all

dep

artm

ents

incl

udin

g

wai

ting

are

as t

hro

ugho

ut t

he f

acili

ty

Info

rmat

ion

for

pat

ient

s/vi

sito

rs/p

ublic

Ed

ucat

e p

atie

nts/

visi

tors

/car

ers

on

resp

irat

ory

eti

que

tte

and

co

ugh

hyg

iene

usi

ng s

om

e o

r al

l of

the

follo

win

g:

Pat

ient

info

rmat

ion

leafl

ets

•W

elco

me

pac

ks•

Po

ster

s in

all

dep

artm

ents

esp

ecia

lly w

aiti

ng a

reas

• A

dd

itio

nal p

reca

utio

ns d

urin

g t

imes

of

incr

ease

d p

reva

lenc

e o

f re

spir

ato

ry in

fect

ions

Dur

ing

per

iod

s o

f in

crea

sed

pre

vale

nce

of

resp

irat

ory

infe

ctio

ns

•in

the

co

mm

unit

y, o

ffer

mas

ks t

o c

oug

hing

pat

ient

s an

d o

ther

sy

mp

tom

atic

per

sons

(e.g

. per

sons

who

acc

om

pan

y ill

pat

ient

s)

upo

n en

try

into

the

fac

ility

and

enc

our

age

them

to

mai

ntai

n sp

ecia

l sep

arat

ion,

idea

lly a

dis

tanc

e o

f at

leas

t 3

feet

, fro

m

oth

ers

in c

om

mo

n w

aiti

ng a

reas

Som

e fa

cilit

ies

may

find

it lo

gis

tica

lly e

asie

r to

inst

itut

e th

is

•re

com

men

dat

ion

year

-ro

und

as

a st

and

ard

of

pra

ctic

e

See

app

end

ix 1

4 fo

r sa

mp

le p

ost

er f

or

resp

irat

ory

eti

que

tte/

coug

h et

ique

tte

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed


Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Occ

upat

iona

l H

ealt

h P

rog

ram

me

All

HC

Ws

sho

uld

be

asse

ssed

by

an o

ccup

atio

nal h

eath

tea

m p

rio

r to

co

mm

enci

ng w

ork

. Thi

s as

sess

men

t sh

oul

d in

clud

e:

Imm

unis

atio

ns (I

rish

gui

del

ines

on

imm

unis

atio

ns r

equi

red

•

for

HC

Ws

are

avai

lab

le a

t w

ww

.hp

sc.ie

/hp

sc/A

-Z/

Vacc

ineP

reve

ntab

le/V

acci

nati

on/

Gui

dan

ce/)

Scre

enin

g H

CW

s w

ho p

erfo

rm e

xpo

sure

pro

ne p

roce

dur

es f

or

•b

loo

d b

orn

e vi

ruse

s. D

oH

C g

uid

elin

es a

vaila

ble

at

ww

w.d

ohc

.ie/

pub

licat

ions

/tra

nsm

issi

on_

of_

blo

od

_bo

rne_

dis

ease

s_20

06.h

tml

Pat

ient

P

lace

men

t

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Pla

ce a

ll p

atie

nts

wit

h su

spec

ted

or

confi

rmed

pul

mo

nary

or

lary

ngea

l TB

in

one

the

fo

llow

ing

air

bo

rne

iso

lati

on

roo

ms.

Ref

er t

o fi

gur

e 6.

1 fo

r ri

sk

asse

ssm

ent

alg

ori

thm

if a

n ai

rbo

rne

iso

lati

on

roo

m is

no

t av

aila

ble

. Ref

er t

o

sect

ion

6.5

for

eng

inee

ring

sta

ndar

ds

Neg

ativ

e p

ress

ure

iso

lati

on

roo

m w

ith

a ha

nd w

ash

sink

, an

ante

ro

om

1.

an

d e

n-su

ite

A n

eutr

al p

ress

ure

des

ign

roo

m, a

s d

etai

led

in H

BN

04

Sup

ple

men

t 1

2.

Pat

ient

s w

ith

kno

wn

or

susp

ecte

d m

ulti

dru

g-r

esis

tant

TB

(M

DR

-TB

) m

ust

be

pla

ced

in a

n ai

rbo

rne

iso

lati

on

roo

m w

hich

may

req

uire

tra

nsfe

r o

f th

e p

atie

nt t

o a

noth

er f

acili

ty

A n

oti

ce s

houl

d b

e p

lace

d o

n th

e d

oo

r o

f th

e is

ola

tio

n ro

om

ad

visi

ng t

hose

en

teri

ng t

o r

epo

rt t

o t

he n

urse

in c

harg

e b

efo

re e

nter

ing

Pat

ient

s sh

oul

d b

e ed

ucat

ed r

egar

din

g t

he r

easo

n/in

dic

atio

n fo

r A

irb

orn

e P

reca

utio

ns a

nd r

eque

sted

no

t to

leav

e th

e ro

om

unl

ess

abso

lute

ly n

eces

sary

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

P

lace

men

t(c

ont

)

HC

Ws

sho

uld

incl

ude

the

po

tent

ial f

or

tran

smis

sio

n o

f in

fect

ious

ag

ents

in p

atie

nt p

lace

men

t d

ecis

ions

Whe

re p

oss

ible

, pla

ce p

atie

nts

who

co

ntam

inat

e th

e en

viro

nmen

t o

r ca

nno

t m

aint

ain

app

rop

riat

e hy

gie

ne in

iso

lati

on

roo

ms

wit

h en

sui

te

toile

t fa

cilit

ies

and

ant

e ro

om

Em

erg

ency

dep

artm

ents

(ED

) wit

hout

an

airb

orn

e is

ola

tio

n ro

om

mus

t ha

ve a

p

roce

ss in

pla

ce t

o p

rio

riti

se t

rans

fer

of

pat

ient

s w

ith

susp

ecte

d o

r co

nfirm

ed

TB t

o a

n ap

pro

pri

ate

roo

m. E

D d

epar

tmen

ts w

itho

ut a

ny a

irb

orn

e is

ola

tio

n ro

om

s sh

oul

d p

lace

a s

urg

ical

mas

k o

n th

e p

atie

nt a

nd p

lace

him

/her

in a

n ex

amin

atio

n ro

om

or

sing

le r

oo

m w

hile

aw

aiti

ng t

rans

fer.

This

ro

om

sho

uld

b

e le

ft v

acan

t fo

r 1

hour

onc

e th

e p

atie

nt is

tra

nsfe

rred

to

allo

w f

or

a fu

ll ex

chan

ge

of

air.

Aer

oso

l-gen

erat

ing

pro

ced

ures

suc

h as

sp

utum

ind

ucti

on

and

the

ad

min

istr

atio

n o

f m

edic

atio

ns b

y ne

bul

iser

mus

t b

e av

oid

ed w

hile

a p

atie

nt

wit

h su

spec

ted

or

confi

rmed

TB

is in

an

op

en b

ay o

r an

unv

enti

late

d a

rea

in

any

war

d

Bro

ncho

sco

py

sho

uld

pre

fera

bly

be

per

form

ed in

an

app

rop

riat

e ne

gat

ive

pre

ssur

e su

ite

wit

h ad

equa

te v

enti

lati

on.

Unn

eces

sary

sta

ff a

nd o

ther

pat

ient

s sh

oul

d b

e ex

clud

ed d

urin

g t

he p

roce

dur

e. If

end

osc

op

y ro

om

s ar

e w

itho

ut a

ir

hand

ling

eq

uip

men

t, t

he p

roce

dur

e sh

oul

d b

e d

one

at

the

end

of

the

list

for

the

day

, or

in t

he p

atie

nt’s

ro

om

. Avo

id p

lace

men

t o

f re

cove

ring

pat

ient

s in

a

mul

ti-b

edd

ed w

ard

po

st p

roce

dur

e.

Pro

ced

ures

on

an e

xtra

pul

mo

nary

TB

op

en a

bsc

ess

or

lesi

on

whe

re

aero

solis

atio

n o

f d

rain

age

fluid

may

occ

ur s

houl

d o

nly

be

und

erta

ken

in a

n ai

rbo

rne

iso

lati

on

roo

m

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Han

dH

ygie

neH

and

hyg

iene

is r

eco

mm

end

ed;

Bef

ore

and

aft

er e

ach

epis

od

e o

f p

atie

nt c

ont

act

•B

etw

een

ind

ivid

ual p

atie

nt c

ont

acts

•A

fter

co

ntac

t w

ith

blo

od

, bo

dy

fluid

s, s

ecre

tio

ns o

r •

excr

etio

ns, w

heth

er o

r no

t g

love

s ar

e w

orn

Aft

er h

and

ling

so

iled

/co

ntam

inat

ed e

qui

pm

ent,

mat

eria

ls o

r •

the

envi

ronm

ent

Imm

edia

tely

bef

ore

glo

ve a

pp

licat

ion

•Im

med

iate

ly a

fter

rem

ovi

ng g

love

s o

r o

ther

pro

tect

ive

•cl

oth

ing

Han

ds

sho

uld

be

dec

ont

amin

ated

usi

ng s

oap

and

wat

er o

r al

coho

l g

el if

phy

sica

lly c

lean

. Ant

isep

tic

soap

sho

uld

be

used

pri

or

to

asep

tic

pro

ced

ures

.

Pat

ient

s sh

oul

d w

ash

thei

r ha

nds

afte

r to

ileti

ng a

nd b

efo

re m

eals

. H

CW

s sh

oul

d a

ssis

t th

ose

pat

ient

s un

able

to

per

form

han

d h

ygie

ne

ind

epen

den

tly.

Vis

ito

rs s

houl

d b

e ed

ucat

ed o

n th

e im

po

rtan

ce o

f ha

nd

dec

ont

amin

atio

n b

efo

re a

nd a

fter

vis

itin

g.

(SA

RI)

Gui

del

ines

on

Han

d H

ygie

ne a

re a

vaila

ble

at

ww

w.h

psc

.ie/

hpsc

/A-Z

/Gas

tro

ente

ric/

Han

dw

ashi

ng/

Ant

isep

tic

soap

or

alco

hol g

el if

han

ds

are

phy

sica

lly c

lean

bef

ore

and

aft

er

pat

ient

car

e

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Pat

ient

M

ove

men

t an

d

Tran

sfer

No

sp

ecia

l pre

caut

ions

rec

om

men

ded

Lim

it m

ove

men

t an

d t

rans

po

rt o

f p

atie

nt t

o e

ssen

tial

pur

po

ses

onl

yP

rio

r to

pat

ient

tra

nsfe

r

Pri

or

to a

ccep

ting

a p

atie

nt w

ith

kno

wn

or

susp

ecte

d in

fect

ious

TB

it is

the

•

resp

ons

ibili

ty o

f th

e re

ceiv

ing

fac

ility

to

ens

ure

com

plia

nce

wit

h is

ola

tio

n ro

om

req

uire

men

ts a

s d

escr

ibed

ab

ove

und

er p

atie

nt p

lace

men

t. It

is

the

resp

ons

ibili

ty o

f th

e fa

cilit

y tr

ansf

erri

ng t

he p

atie

nt t

o p

rovi

de

the

info

rmat

ion.

Info

rm t

rans

po

rt p

erso

nnel

(em

erg

ency

med

ical

tec

hnic

ians

, po

rter

s) a

nd

•th

e re

ceiv

ing

dep

artm

ent

of

the

need

fo

r A

irb

orn

e P

reca

utio

ns

Req

uest

pat

ient

to

wea

r a

surg

ical

mas

k w

hich

sho

uld

be

chan

ged

whe

n •

heav

ily c

ont

amin

ated

wit

h re

spir

ato

ry s

ecre

tio

ns a

nd/o

r w

et o

r if

torn

. In

stru

ct p

atie

nt o

n re

spir

ato

ry h

ygie

ne a

nd c

oug

h et

ique

tte

and

ens

ure

the

pat

ient

has

a s

upp

ly o

f ti

ssue

s.

HC

Ws

sho

uld

rem

ove

co

ntam

inat

ed a

pro

n/g

ow

n/g

love

s (if

wo

rn) a

nd

•m

ask

and

dis

po

se p

rio

r to

tra

nsp

ort

ing

pat

ient

s. S

taff

do

no

t ne

ed t

o

wea

r m

asks

dur

ing

inte

rnal

tra

nsp

ort

atio

n un

less

pat

ient

is u

nab

le t

o w

ear

a su

rgic

al m

ask

(e.g

. co

nfus

ed, r

esp

irat

ory

dis

tres

s).

Am

bul

ance

sta

ff s

houl

d c

ons

ider

the

use

of

FFP

2 o

r FF

P3

mas

ks in

the

•

follo

win

g s

itua

tio

ns: (

a) t

he p

atie

nt is

una

ble

to

wea

r a

surg

ical

mas

k; (b

) it

is a

ntic

ipat

ed t

hat

the

dur

atio

n o

f th

e jo

urne

y w

ill b

e ≥

8 ho

urs

(≥ 4

ho

urs

if H

CW

is im

mun

oco

mp

rom

ised

); (c

) if

the

pat

ient

has

eit

her

MD

R-o

r X

DR

-TB

(co

nsul

t in

fect

ion

pre

vent

ion

and

co

ntro

l tea

m in

thi

s si

tuat

ion)

.

Do

n FF

P2/

3 m

ask

pri

or

to h

and

ling

pat

ient

at

the

tran

spo

rt d

esti

nati

on

•(e

.g. X

-ray

, bro

ncho

sco

py

suit

e)

Tran

spo

rt e

qui

pm

ent

(str

etch

er, b

ed w

heel

chai

r) u

sed

to

tra

nsp

ort

pat

ient

•

mus

t b

e cl

eane

d a

nd d

isin

fect

ed w

ith

a d

eter

gen

t an

d 1

,000

pp

m o

f av

aila

ble

chl

ori

ne b

efo

re u

se o

n an

oth

er p

atie

nt

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Res

pir

ato

ry

Eti

que

tte/

Co

ugh

Eti

que

tte

Ad

min

istr

ativ

eE

duc

ate

HC

Ws

on

the

imp

ort

ance

of

cont

rol m

easu

res

to

•co

ntai

n re

spir

ato

ry s

ecre

tio

ns t

o p

reve

nt d

rop

let

and

co

ntac

t tr

ansm

issi

on

of

resp

irat

ory

pat

hog

ens,

esp

ecia

lly d

urin

g

seas

ona

l out

bre

aks

of

vira

l res

pir

ato

ry t

ract

infe

ctio

ns (e

.g.

influ

enza

, RSV

, etc

) in

the

com

mun

ity

Ens

ure

that

sup

plie

s o

f ti

ssue

s, f

oo

t o

per

atin

g w

aste

bin

s an

d

•ha

nd h

ygie

ne f

acili

ties

are

ava

ilab

le in

all

dep

artm

ents

incl

udin

g

wai

ting

are

as t

hro

ugho

ut t

he f

acili

ty

Info

rmat

ion

for

pat

ient

s/vi

sito

rs/p

ublic

Ed

ucat

e p

atie

nts/

visi

tors

/car

ers

on

resp

irat

ory

eti

que

tte

and

co

ugh

hyg

iene

usi

ng s

om

e o

r al

l of

the

follo

win

g:

Pat

ient

info

rmat

ion

leafl

ets

•W

elco

me

pac

ks•

Po

ster

s in

all

dep

artm

ents

esp

ecia

lly w

aiti

ng a

reas

• A

dd

itio

nal p

reca

utio

ns d

urin

g t

imes

of

incr

ease

d p

reva

lenc

e o

f re

spir

ato

ry in

fect

ions

Dur

ing

per

iod

s o

f in

crea

sed

pre

vale

nce

of

resp

irat

ory

infe

ctio

ns

•in

the

co

mm

unit

y, o

ffer

mas

ks t

o c

oug

hing

pat

ient

s an

d o

ther

sy

mp

tom

atic

per

sons

(e.g

. per

sons

who

acc

om

pan

y ill

pat

ient

s)

upo

n en

try

into

the

fac

ility

and

enc

our

age

them

to

mai

ntai

n sp

ecia

l sep

arat

ion,

idea

lly a

dis

tanc

e o

f at

leas

t 3

feet

, fro

m

oth

ers

in c

om

mo

n w

aiti

ng a

reas

Som

e fa

cilit

ies

may

find

it lo

gis

tica

lly e

asie

r to

inst

itut

e th

is

•re

com

men

dat

ion

year

-ro

und

as

a st

and

ard

of

pra

ctic

e

See

app

end

ix 1

4 fo

r sa

mp

le p

ost

er f

or

resp

irat

ory

eti

que

tte/

coug

h et

ique

tte

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

-176-


-177-

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Typ

e an

d s

elec

tio

n o

f P

PE

PP

E c

ons

ists

of:

G

love

s,•

Ap

rons

/go

wns

•E

ye, n

asal

and

mo

uth

pro

tect

ion

• Eac

h H

CW

sho

uld

mak

e an

ris

k as

sess

men

t o

f th

e p

lann

ed p

roce

dur

e an

d s

elec

t P

PE

dep

end

ing

on;

The

natu

re o

f th

e p

roce

dur

e•

The

risk

of

exp

osu

re t

o b

loo

d a

nd b

od

y flu

ids

•Th

e ri

sk o

f co

ntam

inat

ion

•

Ad

dit

iona

l res

pir

ato

ry p

rote

ctio

n re

qui

red

(s

ee f

acia

l pro

tect

ion

sect

ion)

Glo

ves

Glo

ves

sho

uld

be

sing

le u

se it

ems

and

sho

uld

co

nfo

rm t

o E

uro

pea

n C

om

mun

ity

Stan

dar

ds

Glo

ves

are

reco

mm

end

ed;

For

all a

ctiv

itie

s th

at c

arry

a r

isk

of

exp

osu

re t

o b

loo

d, b

od

y flu

ids,

•

secr

etio

ns o

r ex

cret

ions

, sha

rps

or

cont

amin

ated

inst

rum

ents

Whe

n to

uchi

ng m

uco

us m

emb

rane

s an

d n

on-

inta

ct s

kin

•W

hen

hand

ling

co

ntam

inat

ed e

qui

pm

ent

• Glo

ves

sho

uld

be;

Sing

le u

se o

nly

•St

erile

if c

ont

act

anti

cip

ated

wit

h st

erile

bo

dy

site

•

Put

on

imm

edia

tely

bef

ore

an

epis

od

e o

f p

atie

nt c

ont

act

and

•

rem

ove

as

soo

n as

the

act

ivit

y is

co

mp

lete

dC

hang

ed w

hen

cari

ng f

or

diff

eren

t p

atie

nts

and

bet

wee

n d

iffer

ent

•ca

re a

ctiv

itie

s o

n th

e sa

me

pat

ient

Dis

po

sed

of

as h

ealt

h ca

re r

isk

was

te if

co

ntam

inat

ed w

ith

blo

od

or

•b

od

y flu

ids

fro

m p

atie

nts

wit

h su

spec

ted

or

kno

wn

infe

ctio

n.

Han

d h

ygie

ne s

houl

d b

e p

erfo

rmed

bef

ore

do

nnin

g a

nd im

med

iate

ly

follo

win

g r

emo

val o

f g

love

s

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Face

pro

tect

ion

Face

pro

tect

ion

sho

uld

be

wo

rn w

here

:

Ther

e is

a r

isk

of

blo

od

, bo

dy

fluid

s,

•se

cret

ions

or

excr

etio

ns s

pla

shin

g in

to t

he

face

or

eyes

Whe

n p

laci

ng a

cat

hete

r o

r in

ject

ing

into

•

the

spin

al o

r ep

idur

al s

pac

e.

Face

pro

tect

ion

cons

ists

of

one

of

the

follo

win

g:

Flui

d r

epel

lent

mas

k w

ith

sep

arat

e •

go

gg

les

Res

pir

ato

ry m

ask

(FFP

2/3)

•Fa

ce s

hiel

d•

Flui

d r

epel

lent

mas

k w

ith

eye

shie

ld.

• Face

pro

tect

ion

sho

uld

be:

Sing

le u

se o

r si

ngle

per

son

use

(fac

e •

shie

lds

and

go

gg

les

can

be

reus

ed

by

the

sam

e H

CW

but

the

y m

ust

be

adeq

uate

ly c

lean

ed a

nd d

isin

fect

ed a

s p

er m

anuf

actu

rer’s

inst

ruct

ions

aft

er e

ach

use.

In a

dd

itio

n to

eye

pro

tect

ion

as r

equi

red

fo

r St

and

ard

Pre

caut

ions

HC

Ws

and

vis

ito

rs s

houl

d d

on

corr

ectl

y fit

ted

: FF

P2

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r co

nfirm

ed

•in

fect

ious

TB

cas

e w

here

MD

R-T

B n

ot

susp

ecte

dFF

P3

mas

k d

urin

g h

igh

risk

pro

ced

ures

fo

r al

l pat

ient

s w

here

TB

is s

usp

ecte

d

•o

r co

nfirm

ed (s

usce

pti

ble

or

MD

R) s

uch

as:

Sput

um in

duc

tio

no

C

oug

h p

rod

ucin

g p

roce

dur

es (e

.g. a

dm

inis

teri

ng a

ero

solis

ed

o

med

icat

ions

, bro

ncho

sco

py,

air

way

suc

tio

ning

, end

otr

ache

al in

tub

atio

n)P

roce

dur

es w

here

aer

oso

lisat

ion

of

dra

inag

e flu

id f

rom

an

absc

ess/

o

lesi

ons

may

occ

urFF

P3

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r kn

ow

n ca

se

•o

f M

DR

-TB

or

XD

R-T

B

To p

rese

rve

pri

vacy

and

co

nfid

enti

alit

y re

stri

ctin

g v

isit

ing

to

imm

edia

te f

amily

sh

oul

d b

e d

iscu

ssed

wit

h th

e p

atie

nt

All

HC

Ws

who

may

be

req

uire

d t

o u

se r

esp

irat

ory

mas

ks (F

FP2

& F

FP3)

dur

ing

th

e co

urse

of

thei

r w

ork

sho

uld

be

fit t

este

d b

y a

trai

ned

pro

fess

iona

l wit

hin

each

o

rgan

isat

ion

HC

Ws

sho

uld

fit

chec

k th

e m

ask

each

tim

e it

is w

orn

to

che

ck t

he s

eal

HC

Ws

visi

ting

a p

atie

nt in

the

ir o

wn

hom

e sh

oul

d w

ear

a FF

P2

or

FFP

3 m

ask

whi

le

the

pat

ient

is in

fect

ious

(see

cha

pte

r 6

on

Infe

ctio

n P

reve

ntio

n an

d C

ont

rol f

or

dis

cont

inua

tio

n o

f A

irb

orn

e P

reca

utio

ns).

Pat

ient

pri

vacy

mus

t b

e m

aint

aine

d if

m

ask

is w

orn

in t

he h

om

e.

All

mas

ks s

houl

d b

e re

mo

ved

in t

he a

nte

roo

m o

r im

med

iate

ly o

utsi

de

the

sing

le

roo

m if

the

re is

no

ant

e ro

om

Dis

card

mas

k in

to h

ealt

hcar

e ri

sk w

aste

Dec

ont

amin

ate

hand

s im

med

iate

ly a

fter

rem

ovi

ng m

ask

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Ap

rons

or

go

wns

Dis

po

sab

le a

pro

ns s

houl

d b

e w

orn

whe

re t

here

is a

ris

k th

at t

he f

ront

of

unifo

rm/c

loth

ing

may

bec

om

e ex

po

sed

to

blo

od

, bo

dy

fluid

s, e

xcre

tio

ns

or

secr

etio

ns

Long

sle

eved

flui

d r

epel

lent

go

wns

may

be

req

uire

d if

the

re is

a r

isk

that

uni

form

/clo

thin

g a

nd s

kin

may

be

exp

ose

d t

o b

loo

d, b

od

y flu

ids,

ex

cret

ions

or

secr

etio

ns

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Rem

ova

l of

PP

ER

emo

ve P

PE

whe

n p

roce

dur

e is

co

mp

lete

. PP

E s

houl

d b

e re

mo

ved

in

the

fo

llow

ing

ord

er a

nd d

isp

ose

d o

f in

to h

ealt

hcar

e ri

sk w

aste

if

cont

amin

ated

wit

h b

loo

d a

nd/o

r b

od

y flu

ids

Glo

ves

•A

pro

n/g

ow

n•

Dec

ont

amin

ate

hand

s •

Eye

wea

r•

Mas

k (h

and

le b

y th

e m

ask

stra

ps

to a

void

to

uchi

ng t

he f

ront

)•

Dec

ont

amin

ate

hand

s•

All

mas

ks s

houl

d b

e d

isca

rded

into

hea

lthc

are

risk

was

te

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Env

iro

nmen

tal

Dec

ont

amin

atio

nR

out

ine

envi

ronm

enta

l cle

anin

g is

req

uire

d t

o m

inim

ise

the

num

ber

of

mic

ro-o

rgan

ism

s in

the

en

viro

nmen

t.

Par

ticu

lar

atte

ntio

n sh

oul

d b

e g

iven

to

fre

que

ntly

to

uche

d s

urfa

ces

and

tho

se m

ost

like

ly

to b

e co

ntam

inat

ed w

ith

blo

od

or

bo

dy

fluid

s e.

g. b

edra

ils, m

attr

ess,

bed

sid

e ta

ble

s,

com

mo

des

, do

ork

nob

s, s

inks

, sur

face

s an

d e

qui

pm

ent

clo

se t

o t

he p

atie

nt

Che

mic

al d

isin

fect

ants

are

no

t re

com

men

ded

fo

r ro

utin

e en

viro

nmen

tal c

lean

ing

Whe

n us

ing

dis

infe

ctan

ts, s

taff

sho

uld

fo

llow

the

man

ufac

ture

r’s in

stru

ctio

ns f

or

dilu

tio

n an

d

cont

act

tim

es

Ref

er t

o N

atio

nal H

osp

ital

Offi

ce C

lean

ing

Man

ual 2

00

6

Pat

ient

car

e en

viro

nmen

t b

e cl

eane

d a

nd

dis

infe

cted

wit

h a

det

erg

ent

and

100

0pp

m

of

avai

lab

le c

hlo

rine

dai

ly b

efo

re u

se o

n an

oth

er p

atie

nt if

co

ntam

inat

ed w

ith

resp

irat

ory

sec

reti

ons

. P

PE

sho

uld

be

wo

rn

for

all c

lean

ing

pro

ced

ures

as

per

pag

e 18

0-18

2.

Ro

om

sho

uld

rem

ain

vaca

nt f

or

one

ho

ur

wit

h w

ind

ow

s o

pen

bef

ore

re-

use

Pat

ient

Car

e E

qui

pm

ent

&D

eco

ntam

inat

ion

of

Med

ical

Dev

ices

Med

ical

dev

ices

des

igna

ted

as

“Sin

gle

Use

Onl

y” m

ust

not

be

rep

roce

ssed

or

reus

ed u

nder

an

y ci

rcum

stan

ces

(MD

A D

B 2

000)

, (M

DD

) 93/

42/E

EC

No

n-cr

itic

al e

qui

pm

ent

No

n-cr

itic

al e

qui

pm

ent

refe

rs t

o e

qui

pm

ent

that

is e

ithe

r no

t in

co

ntac

t w

ith

a p

atie

nt o

r in

co

ntac

t w

ith

heal

thy

skin

. Suc

h eq

uip

men

t sh

oul

d b

e:In

a s

tate

of

go

od

rep

air

in o

rder

to

fac

ilita

te e

ffec

tive

cle

anin

g•

Mus

t b

e th

oro

ughl

y cl

eane

d p

rio

r to

use

on

ano

ther

pat

ient

/res

iden

t. If

so

iled

wit

h •

blo

od

or

bo

dy

fluid

s, d

isin

fect

usi

ng a

chl

ori

ne-r

elea

sing

so

luti

on

of

1000

pp

m, o

r eq

uiva

lent

acc

ord

ing

to

man

ufac

ture

r’s in

stru

ctio

ns, r

inse

and

dry

.

Reu

sab

le in

vasi

ve m

edic

al d

evic

es (

RIM

D)

RIM

D r

efer

s to

eq

uip

men

t th

at is

cla

ssifi

ed a

s se

mi-c

riti

cal o

r cr

itic

al. R

IMD

s ar

e in

co

ntac

t w

ith

ster

ile b

od

y si

tes,

muc

ous

mem

bra

nes

and

bre

aks

in t

he s

kin.

HC

Ws

mus

t en

sure

tha

t R

IMD

s ar

e no

t us

ed f

or

ano

ther

pat

ient

unt

il th

ey h

ave

bee

n cl

eane

d a

nd r

epro

cess

ed

app

rop

riat

ely.

(HSE

Co

de

of

Pra

ctic

e fo

r D

eco

ntam

inat

ion

of

Reu

sab

le In

vasi

ve M

edic

al D

evic

es 2

007)

ww

w.h

se.ie

/eng

/Pub

licat

ions

/Ho

spit

als/

Co

de_

of_

Pra

ctic

e_fo

r_D

eco

ntam

inat

ion_

of_

Reu

sab

le_I

nvas

ive_

Med

ical

_Dev

ices

_.ht

ml

ww

w.h

psc

.ie/h

psc

/A-Z

/Mic

rob

iolo

gyA

ntim

icro

bia

lRes

ista

nce/

CJD

/Gui

dan

ce/

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Man

agem

ent

of

Hea

lth

Car

e R

isk

Was

te

Dis

po

se o

f he

alth

care

ris

k w

aste

in a

cco

rdan

ce w

ith

the

Dep

artm

ent

of

Hea

lth

& C

hild

ren’

s (D

oH

C) G

uid

elin

es f

or

Was

te D

isp

osa

l, w

hich

out

lines

the

cat

ego

risa

tio

n an

d s

egre

gat

ion

of

heal

thca

re w

aste

.

Dis

po

sal o

f sh

arp

s;Sy

ring

es a

nd n

eed

les

sho

uld

be

dis

po

sed

of

as a

sin

gle

uni

t•

Use

d s

harp

s sh

oul

d b

e ca

refu

lly d

isca

rded

into

des

igna

ted

sha

rps

bin

at

the

po

int

of

use

•Sh

arp

s b

in s

houl

d b

e se

cure

ly s

tore

d o

ut o

f re

ach

of

clie

nts,

vis

ito

rs a

nd c

hild

ren

•N

eed

les

sho

uld

no

t b

e re

-cap

ped

, ben

t, b

roke

n o

r d

isas

sem

ble

d•

Shar

ps

sho

uld

no

t b

e p

asse

d f

rom

per

son-

to-p

erso

n b

y ha

nd•

Do

HC

Gui

del

ines

on

Dis

po

sal o

f H

ealt

hcar

e R

isk

Was

te a

re a

vaila

ble

at

ww

w.d

ohc

.ie/p

ublic

atio

ns/s

egre

gat

ion_

pac

kag

ing

.htm

l

Was

te c

ont

amin

ated

wit

h sp

utum

fro

m a

su

spec

ted

or

kno

wn

TB p

atie

nt s

houl

d b

e d

isp

ose

d o

f as

hea

lthc

are

risk

was

te w

ithi

n a

heal

thca

re f

acili

ty

Res

pir

ato

ry m

asks

sho

uld

be

dis

po

sed

of

into

Hea

lthc

are

risk

was

te

Man

agem

ent

of

need

le s

tick

in

juri

es (

NSI

) an

d

blo

od

and

bo

dy

flui

d e

xpo

sure

All

faci

litie

s m

ust

have

a lo

cal g

uid

elin

e o

n th

e m

anag

emen

t o

f ne

edle

sti

ck in

juri

es a

nd b

loo

d

and

bo

dy

fluid

exp

osu

re. T

his

gui

del

ine

sho

uld

incl

ude;

Firs

t ai

d•

Ris

k as

sess

men

t an

d s

cree

ning

of

sour

ce p

atie

nt (i

f kn

ow

n)•

Ris

k as

sess

men

t f

or

chem

op

rop

hyla

xis

•C

oun

selli

ng a

nd f

ollo

w u

p t

esti

ng

•

Furt

her

info

rmat

ion

fro

m

ww

w.d

ohc

.ie/p

ublic

atio

ns/t

rans

mis

sio

n_o

f_b

loo

d_b

orn

e_d

isea

ses_

2006

.htm

l

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS


Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Typ

e an

d s

elec

tio

n o

f P

PE

PP

E c

ons

ists

of:

G

love

s,•

Ap

rons

/go

wns

•E

ye, n

asal

and

mo

uth

pro

tect

ion

• Eac

h H

CW

sho

uld

mak

e an

ris

k as

sess

men

t o

f th

e p

lann

ed p

roce

dur

e an

d s

elec

t P

PE

dep

end

ing

on;

The

natu

re o

f th

e p

roce

dur

e•

The

risk

of

exp

osu

re t

o b

loo

d a

nd b

od

y flu

ids

•Th

e ri

sk o

f co

ntam

inat

ion

•

Ad

dit

iona

l res

pir

ato

ry p

rote

ctio

n re

qui

red

(s

ee f

acia

l pro

tect

ion

sect

ion)

Glo

ves

Glo

ves

sho

uld

be

sing

le u

se it

ems

and

sho

uld

co

nfo

rm t

o E

uro

pea

n C

om

mun

ity

Stan

dar

ds

Glo

ves

are

reco

mm

end

ed;

For

all a

ctiv

itie

s th

at c

arry

a r

isk

of

exp

osu

re t

o b

loo

d, b

od

y flu

ids,

•

secr

etio

ns o

r ex

cret

ions

, sha

rps

or

cont

amin

ated

inst

rum

ents

Whe

n to

uchi

ng m

uco

us m

emb

rane

s an

d n

on-

inta

ct s

kin

•W

hen

hand

ling

co

ntam

inat

ed e

qui

pm

ent

• Glo

ves

sho

uld

be;

Sing

le u

se o

nly

•St

erile

if c

ont

act

anti

cip

ated

wit

h st

erile

bo

dy

site

•

Put

on

imm

edia

tely

bef

ore

an

epis

od

e o

f p

atie

nt c

ont

act

and

•

rem

ove

as

soo

n as

the

act

ivit

y is

co

mp

lete

dC

hang

ed w

hen

cari

ng f

or

diff

eren

t p

atie

nts

and

bet

wee

n d

iffer

ent

•ca

re a

ctiv

itie

s o

n th

e sa

me

pat

ient

Dis

po

sed

of

as h

ealt

h ca

re r

isk

was

te if

co

ntam

inat

ed w

ith

blo

od

or

•b

od

y flu

ids

fro

m p

atie

nts

wit

h su

spec

ted

or

kno

wn

infe

ctio

n.

Han

d h

ygie

ne s

houl

d b

e p

erfo

rmed

bef

ore

do

nnin

g a

nd im

med

iate

ly

follo

win

g r

emo

val o

f g

love

s

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Face

pro

tect

ion

Face

pro

tect

ion

sho

uld

be

wo

rn w

here

:

Ther

e is

a r

isk

of

blo

od

, bo

dy

fluid

s,

•se

cret

ions

or

excr

etio

ns s

pla

shin

g in

to t

he

face

or

eyes

Whe

n p

laci

ng a

cat

hete

r o

r in

ject

ing

into

•

the

spin

al o

r ep

idur

al s

pac

e.

Face

pro

tect

ion

cons

ists

of

one

of

the

follo

win

g:

Flui

d r

epel

lent

mas

k w

ith

sep

arat

e •

go

gg

les

Res

pir

ato

ry m

ask

(FFP

2/3)

•Fa

ce s

hiel

d•

Flui

d r

epel

lent

mas

k w

ith

eye

shie

ld.

• Face

pro

tect

ion

sho

uld

be:

Sing

le u

se o

r si

ngle

per

son

use

(fac

e •

shie

lds

and

go

gg

les

can

be

reus

ed

by

the

sam

e H

CW

but

the

y m

ust

be

adeq

uate

ly c

lean

ed a

nd d

isin

fect

ed a

s p

er m

anuf

actu

rer’s

inst

ruct

ions

aft

er e

ach

use.

In a

dd

itio

n to

eye

pro

tect

ion

as r

equi

red

fo

r St

and

ard

Pre

caut

ions

HC

Ws

and

vis

ito

rs s

houl

d d

on

corr

ectl

y fit

ted

: FF

P2

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r co

nfirm

ed

•in

fect

ious

TB

cas

e w

here

MD

R-T

B n

ot

susp

ecte

dFF

P3

mas

k d

urin

g h

igh

risk

pro

ced

ures

fo

r al

l pat

ient

s w

here

TB

is s

usp

ecte

d

•o

r co

nfirm

ed (s

usce

pti

ble

or

MD

R) s

uch

as:

Sput

um in

duc

tio

no

C

oug

h p

rod

ucin

g p

roce

dur

es (e

.g. a

dm

inis

teri

ng a

ero

solis

ed

o

med

icat

ions

, bro

ncho

sco

py,

air

way

suc

tio

ning

, end

otr

ache

al in

tub

atio

n)P

roce

dur

es w

here

aer

oso

lisat

ion

of

dra

inag

e flu

id f

rom

an

absc

ess/

o

lesi

ons

may

occ

urFF

P3

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r kn

ow

n ca

se

•o

f M

DR

-TB

or

XD

R-T

B

To p

rese

rve

pri

vacy

and

co

nfid

enti

alit

y re

stri

ctin

g v

isit

ing

to

imm

edia

te f

amily

sh

oul

d b

e d

iscu

ssed

wit

h th

e p

atie

nt

All

HC

Ws

who

may

be

req

uire

d t

o u

se r

esp

irat

ory

mas

ks (F

FP2

& F

FP3)

dur

ing

th

e co

urse

of

thei

r w

ork

sho

uld

be

fit t

este

d b

y a

trai

ned

pro

fess

iona

l wit

hin

each

o

rgan

isat

ion

HC

Ws

sho

uld

fit

chec

k th

e m

ask

each

tim

e it

is w

orn

to

che

ck t

he s

eal

HC

Ws

visi

ting

a p

atie

nt in

the

ir o

wn

hom

e sh

oul

d w

ear

a FF

P2

or

FFP

3 m

ask

whi

le

the

pat

ient

is in

fect

ious

(see

cha

pte

r 6

on

Infe

ctio

n P

reve

ntio

n an

d C

ont

rol f

or

dis

cont

inua

tio

n o

f A

irb

orn

e P

reca

utio

ns).

Pat

ient

pri

vacy

mus

t b

e m

aint

aine

d if

m

ask

is w

orn

in t

he h

om

e.

All

mas

ks s

houl

d b

e re

mo

ved

in t

he a

nte

roo

m o

r im

med

iate

ly o

utsi

de

the

sing

le

roo

m if

the

re is

no

ant

e ro

om

Dis

card

mas

k in

to h

ealt

hcar

e ri

sk w

aste

Dec

ont

amin

ate

hand

s im

med

iate

ly a

fter

rem

ovi

ng m

ask

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Ap

rons

or

go

wns

Dis

po

sab

le a

pro

ns s

houl

d b

e w

orn

whe

re t

here

is a

ris

k th

at t

he f

ront

of

unifo

rm/c

loth

ing

may

bec

om

e ex

po

sed

to

blo

od

, bo

dy

fluid

s, e

xcre

tio

ns

or

secr

etio

ns

Long

sle

eved

flui

d r

epel

lent

go

wns

may

be

req

uire

d if

the

re is

a r

isk

that

uni

form

/clo

thin

g a

nd s

kin

may

be

exp

ose

d t

o b

loo

d, b

od

y flu

ids,

ex

cret

ions

or

secr

etio

ns

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Rem

ova

l of

PP

ER

emo

ve P

PE

whe

n p

roce

dur

e is

co

mp

lete

. PP

E s

houl

d b

e re

mo

ved

in

the

fo

llow

ing

ord

er a

nd d

isp

ose

d o

f in

to h

ealt

hcar

e ri

sk w

aste

if

cont

amin

ated

wit

h b

loo

d a

nd/o

r b

od

y flu

ids

Glo

ves

•A

pro

n/g

ow

n•

Dec

ont

amin

ate

hand

s •

Eye

wea

r•

Mas

k (h

and

le b

y th

e m

ask

stra

ps

to a

void

to

uchi

ng t

he f

ront

)•

Dec

ont

amin

ate

hand

s•

All

mas

ks s

houl

d b

e d

isca

rded

into

hea

lthc

are

risk

was

te

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Env

iro

nmen

tal

Dec

ont

amin

atio

nR

out

ine

envi

ronm

enta

l cle

anin

g is

req

uire

d t

o m

inim

ise

the

num

ber

of

mic

ro-o

rgan

ism

s in

the

en

viro

nmen

t.

Par

ticu

lar

atte

ntio

n sh

oul

d b

e g

iven

to

fre

que

ntly

to

uche

d s

urfa

ces

and

tho

se m

ost

like

ly

to b

e co

ntam

inat

ed w

ith

blo

od

or

bo

dy

fluid

s e.

g. b

edra

ils, m

attr

ess,

bed

sid

e ta

ble

s,

com

mo

des

, do

ork

nob

s, s

inks

, sur

face

s an

d e

qui

pm

ent

clo

se t

o t

he p

atie

nt

Che

mic

al d

isin

fect

ants

are

no

t re

com

men

ded

fo

r ro

utin

e en

viro

nmen

tal c

lean

ing

Whe

n us

ing

dis

infe

ctan

ts, s

taff

sho

uld

fo

llow

the

man

ufac

ture

r’s in

stru

ctio

ns f

or

dilu

tio

n an

d

cont

act

tim

es

Ref

er t

o N

atio

nal H

osp

ital

Offi

ce C

lean

ing

Man

ual 2

00

6

Pat

ient

car

e en

viro

nmen

t b

e cl

eane

d a

nd

dis

infe

cted

wit

h a

det

erg

ent

and

100

0pp

m

of

avai

lab

le c

hlo

rine

dai

ly b

efo

re u

se o

n an

oth

er p

atie

nt if

co

ntam

inat

ed w

ith

resp

irat

ory

sec

reti

ons

. P

PE

sho

uld

be

wo

rn

for

all c

lean

ing

pro

ced

ures

as

per

pag

e 18

0-18

2.

Ro

om

sho

uld

rem

ain

vaca

nt f

or

one

ho

ur

wit

h w

ind

ow

s o

pen

bef

ore

re-

use

Pat

ient

Car

e E

qui

pm

ent

&D

eco

ntam

inat

ion

of

Med

ical

Dev

ices

Med

ical

dev

ices

des

igna

ted

as

“Sin

gle

Use

Onl

y” m

ust

not

be

rep

roce

ssed

or

reus

ed u

nder

an

y ci

rcum

stan

ces

(MD

A D

B 2

000)

, (M

DD

) 93/

42/E

EC

No

n-cr

itic

al e

qui

pm

ent

No

n-cr

itic

al e

qui

pm

ent

refe

rs t

o e

qui

pm

ent

that

is e

ithe

r no

t in

co

ntac

t w

ith

a p

atie

nt o

r in

co

ntac

t w

ith

heal

thy

skin

. Suc

h eq

uip

men

t sh

oul

d b

e:In

a s

tate

of

go

od

rep

air

in o

rder

to

fac

ilita

te e

ffec

tive

cle

anin

g•

Mus

t b

e th

oro

ughl

y cl

eane

d p

rio

r to

use

on

ano

ther

pat

ient

/res

iden

t. If

so

iled

wit

h •

blo

od

or

bo

dy

fluid

s, d

isin

fect

usi

ng a

chl

ori

ne-r

elea

sing

so

luti

on

of

1000

pp

m, o

r eq

uiva

lent

acc

ord

ing

to

man

ufac

ture

r’s in

stru

ctio

ns, r

inse

and

dry

.

Reu

sab

le in

vasi

ve m

edic

al d

evic

es (

RIM

D)

RIM

D r

efer

s to

eq

uip

men

t th

at is

cla

ssifi

ed a

s se

mi-c

riti

cal o

r cr

itic

al. R

IMD

s ar

e in

co

ntac

t w

ith

ster

ile b

od

y si

tes,

muc

ous

mem

bra

nes

and

bre

aks

in t

he s

kin.

HC

Ws

mus

t en

sure

tha

t R

IMD

s ar

e no

t us

ed f

or

ano

ther

pat

ient

unt

il th

ey h

ave

bee

n cl

eane

d a

nd r

epro

cess

ed

app

rop

riat

ely.

(HSE

Co

de

of

Pra

ctic

e fo

r D

eco

ntam

inat

ion

of

Reu

sab

le In

vasi

ve M

edic

al D

evic

es 2

007)

ww

w.h

se.ie

/eng

/Pub

licat

ions

/Ho

spit

als/

Co

de_

of_

Pra

ctic

e_fo

r_D

eco

ntam

inat

ion_

of_

Reu

sab

le_I

nvas

ive_

Med

ical

_Dev

ices

_.ht

ml

ww

w.h

psc

.ie/h

psc

/A-Z

/Mic

rob

iolo

gyA

ntim

icro

bia

lRes

ista

nce/

CJD

/Gui

dan

ce/

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Man

agem

ent

of

Hea

lth

Car

e R

isk

Was

te

Dis

po

se o

f he

alth

care

ris

k w

aste

in a

cco

rdan

ce w

ith

the

Dep

artm

ent

of

Hea

lth

& C

hild

ren’

s (D

oH

C) G

uid

elin

es f

or

Was

te D

isp

osa

l, w

hich

out

lines

the

cat

ego

risa

tio

n an

d s

egre

gat

ion

of

heal

thca

re w

aste

.

Dis

po

sal o

f sh

arp

s;Sy

ring

es a

nd n

eed

les

sho

uld

be

dis

po

sed

of

as a

sin

gle

uni

t•

Use

d s

harp

s sh

oul

d b

e ca

refu

lly d

isca

rded

into

des

igna

ted

sha

rps

bin

at

the

po

int

of

use

•Sh

arp

s b

in s

houl

d b

e se

cure

ly s

tore

d o

ut o

f re

ach

of

clie

nts,

vis

ito

rs a

nd c

hild

ren

•N

eed

les

sho

uld

no

t b

e re

-cap

ped

, ben

t, b

roke

n o

r d

isas

sem

ble

d•

Shar

ps

sho

uld

no

t b

e p

asse

d f

rom

per

son-

to-p

erso

n b

y ha

nd•

Do

HC

Gui

del

ines

on

Dis

po

sal o

f H

ealt

hcar

e R

isk

Was

te a

re a

vaila

ble

at

ww

w.d

ohc

.ie/p

ublic

atio

ns/s

egre

gat

ion_

pac

kag

ing

.htm

l

Was

te c

ont

amin

ated

wit

h sp

utum

fro

m a

su

spec

ted

or

kno

wn

TB p

atie

nt s

houl

d b

e d

isp

ose

d o

f as

hea

lthc

are

risk

was

te w

ithi

n a

heal

thca

re f

acili

ty

Res

pir

ato

ry m

asks

sho

uld

be

dis

po

sed

of

into

Hea

lthc

are

risk

was

te

Man

agem

ent

of

need

le s

tick

in

juri

es (

NSI

) an

d

blo

od

and

bo

dy

flui

d e

xpo

sure

All

faci

litie

s m

ust

have

a lo

cal g

uid

elin

e o

n th

e m

anag

emen

t o

f ne

edle

sti

ck in

juri

es a

nd b

loo

d

and

bo

dy

fluid

exp

osu

re. T

his

gui

del

ine

sho

uld

incl

ude;

Firs

t ai

d•

Ris

k as

sess

men

t an

d s

cree

ning

of

sour

ce p

atie

nt (i

f kn

ow

n)•

Ris

k as

sess

men

t f

or

chem

op

rop

hyla

xis

•C

oun

selli

ng a

nd f

ollo

w u

p t

esti

ng

•

Furt

her

info

rmat

ion

fro

m

ww

w.d

ohc

.ie/p

ublic

atio

ns/t

rans

mis

sio

n_o

f_b

loo

d_b

orn

e_d

isea

ses_

2006

.htm

l

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

-178-


-179-

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Typ

e an

d s

elec

tio

n o

f P

PE

PP

E c

ons

ists

of:

G

love

s,•

Ap

rons

/go

wns

•E

ye, n

asal

and

mo

uth

pro

tect

ion

• Eac

h H

CW

sho

uld

mak

e an

ris

k as

sess

men

t o

f th

e p

lann

ed p

roce

dur

e an

d s

elec

t P

PE

dep

end

ing

on;

The

natu

re o

f th

e p

roce

dur

e•

The

risk

of

exp

osu

re t

o b

loo

d a

nd b

od

y flu

ids

•Th

e ri

sk o

f co

ntam

inat

ion

•

Ad

dit

iona

l res

pir

ato

ry p

rote

ctio

n re

qui

red

(s

ee f

acia

l pro

tect

ion

sect

ion)

Glo

ves

Glo

ves

sho

uld

be

sing

le u

se it

ems

and

sho

uld

co

nfo

rm t

o E

uro

pea

n C

om

mun

ity

Stan

dar

ds

Glo

ves

are

reco

mm

end

ed;

For

all a

ctiv

itie

s th

at c

arry

a r

isk

of

exp

osu

re t

o b

loo

d, b

od

y flu

ids,

•

secr

etio

ns o

r ex

cret

ions

, sha

rps

or

cont

amin

ated

inst

rum

ents

Whe

n to

uchi

ng m

uco

us m

emb

rane

s an

d n

on-

inta

ct s

kin

•W

hen

hand

ling

co

ntam

inat

ed e

qui

pm

ent

• Glo

ves

sho

uld

be;

Sing

le u

se o

nly

•St

erile

if c

ont

act

anti

cip

ated

wit

h st

erile

bo

dy

site

•

Put

on

imm

edia

tely

bef

ore

an

epis

od

e o

f p

atie

nt c

ont

act

and

•

rem

ove

as

soo

n as

the

act

ivit

y is

co

mp

lete

dC

hang

ed w

hen

cari

ng f

or

diff

eren

t p

atie

nts

and

bet

wee

n d

iffer

ent

•ca

re a

ctiv

itie

s o

n th

e sa

me

pat

ient

Dis

po

sed

of

as h

ealt

h ca

re r

isk

was

te if

co

ntam

inat

ed w

ith

blo

od

or

•b

od

y flu

ids

fro

m p

atie

nts

wit

h su

spec

ted

or

kno

wn

infe

ctio

n.

Han

d h

ygie

ne s

houl

d b

e p

erfo

rmed

bef

ore

do

nnin

g a

nd im

med

iate

ly

follo

win

g r

emo

val o

f g

love

s

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Face

pro

tect

ion

Face

pro

tect

ion

sho

uld

be

wo

rn w

here

:

Ther

e is

a r

isk

of

blo

od

, bo

dy

fluid

s,

•se

cret

ions

or

excr

etio

ns s

pla

shin

g in

to t

he

face

or

eyes

Whe

n p

laci

ng a

cat

hete

r o

r in

ject

ing

into

•

the

spin

al o

r ep

idur

al s

pac

e.

Face

pro

tect

ion

cons

ists

of

one

of

the

follo

win

g:

Flui

d r

epel

lent

mas

k w

ith

sep

arat

e •

go

gg

les

Res

pir

ato

ry m

ask

(FFP

2/3)

•Fa

ce s

hiel

d•

Flui

d r

epel

lent

mas

k w

ith

eye

shie

ld.

• Face

pro

tect

ion

sho

uld

be:

Sing

le u

se o

r si

ngle

per

son

use

(fac

e •

shie

lds

and

go

gg

les

can

be

reus

ed

by

the

sam

e H

CW

but

the

y m

ust

be

adeq

uate

ly c

lean

ed a

nd d

isin

fect

ed a

s p

er m

anuf

actu

rer’s

inst

ruct

ions

aft

er e

ach

use.

In a

dd

itio

n to

eye

pro

tect

ion

as r

equi

red

fo

r St

and

ard

Pre

caut

ions

HC

Ws

and

vis

ito

rs s

houl

d d

on

corr

ectl

y fit

ted

: FF

P2

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r co

nfirm

ed

•in

fect

ious

TB

cas

e w

here

MD

R-T

B n

ot

susp

ecte

dFF

P3

mas

k d

urin

g h

igh

risk

pro

ced

ures

fo

r al

l pat

ient

s w

here

TB

is s

usp

ecte

d

•o

r co

nfirm

ed (s

usce

pti

ble

or

MD

R) s

uch

as:

Sput

um in

duc

tio

no

C

oug

h p

rod

ucin

g p

roce

dur

es (e

.g. a

dm

inis

teri

ng a

ero

solis

ed

o

med

icat

ions

, bro

ncho

sco

py,

air

way

suc

tio

ning

, end

otr

ache

al in

tub

atio

n)P

roce

dur

es w

here

aer

oso

lisat

ion

of

dra

inag

e flu

id f

rom

an

absc

ess/

o

lesi

ons

may

occ

urFF

P3

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r kn

ow

n ca

se

•o

f M

DR

-TB

or

XD

R-T

B

To p

rese

rve

pri

vacy

and

co

nfid

enti

alit

y re

stri

ctin

g v

isit

ing

to

imm

edia

te f

amily

sh

oul

d b

e d

iscu

ssed

wit

h th

e p

atie

nt

All

HC

Ws

who

may

be

req

uire

d t

o u

se r

esp

irat

ory

mas

ks (F

FP2

& F

FP3)

dur

ing

th

e co

urse

of

thei

r w

ork

sho

uld

be

fit t

este

d b

y a

trai

ned

pro

fess

iona

l wit

hin

each

o

rgan

isat

ion

HC

Ws

sho

uld

fit

chec

k th

e m

ask

each

tim

e it

is w

orn

to

che

ck t

he s

eal

HC

Ws

visi

ting

a p

atie

nt in

the

ir o

wn

hom

e sh

oul

d w

ear

a FF

P2

or

FFP

3 m

ask

whi

le

the

pat

ient

is in

fect

ious

(see

cha

pte

r 6

on

Infe

ctio

n P

reve

ntio

n an

d C

ont

rol f

or

dis

cont

inua

tio

n o

f A

irb

orn

e P

reca

utio

ns).

Pat

ient

pri

vacy

mus

t b

e m

aint

aine

d if

m

ask

is w

orn

in t

he h

om

e.

All

mas

ks s

houl

d b

e re

mo

ved

in t

he a

nte

roo

m o

r im

med

iate

ly o

utsi

de

the

sing

le

roo

m if

the

re is

no

ant

e ro

om

Dis

card

mas

k in

to h

ealt

hcar

e ri

sk w

aste

Dec

ont

amin

ate

hand

s im

med

iate

ly a

fter

rem

ovi

ng m

ask

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Ap

rons

or

go

wns

Dis

po

sab

le a

pro

ns s

houl

d b

e w

orn

whe

re t

here

is a

ris

k th

at t

he f

ront

of

unifo

rm/c

loth

ing

may

bec

om

e ex

po

sed

to

blo

od

, bo

dy

fluid

s, e

xcre

tio

ns

or

secr

etio

ns

Long

sle

eved

flui

d r

epel

lent

go

wns

may

be

req

uire

d if

the

re is

a r

isk

that

uni

form

/clo

thin

g a

nd s

kin

may

be

exp

ose

d t

o b

loo

d, b

od

y flu

ids,

ex

cret

ions

or

secr

etio

ns

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Rem

ova

l of

PP

ER

emo

ve P

PE

whe

n p

roce

dur

e is

co

mp

lete

. PP

E s

houl

d b

e re

mo

ved

in

the

fo

llow

ing

ord

er a

nd d

isp

ose

d o

f in

to h

ealt

hcar

e ri

sk w

aste

if

cont

amin

ated

wit

h b

loo

d a

nd/o

r b

od

y flu

ids

Glo

ves

•A

pro

n/g

ow

n•

Dec

ont

amin

ate

hand

s •

Eye

wea

r•

Mas

k (h

and

le b

y th

e m

ask

stra

ps

to a

void

to

uchi

ng t

he f

ront

)•

Dec

ont

amin

ate

hand

s•

All

mas

ks s

houl

d b

e d

isca

rded

into

hea

lthc

are

risk

was

te

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Env

iro

nmen

tal

Dec

ont

amin

atio

nR

out

ine

envi

ronm

enta

l cle

anin

g is

req

uire

d t

o m

inim

ise

the

num

ber

of

mic

ro-o

rgan

ism

s in

the

en

viro

nmen

t.

Par

ticu

lar

atte

ntio

n sh

oul

d b

e g

iven

to

fre

que

ntly

to

uche

d s

urfa

ces

and

tho

se m

ost

like

ly

to b

e co

ntam

inat

ed w

ith

blo

od

or

bo

dy

fluid

s e.

g. b

edra

ils, m

attr

ess,

bed

sid

e ta

ble

s,

com

mo

des

, do

ork

nob

s, s

inks

, sur

face

s an

d e

qui

pm

ent

clo

se t

o t

he p

atie

nt

Che

mic

al d

isin

fect

ants

are

no

t re

com

men

ded

fo

r ro

utin

e en

viro

nmen

tal c

lean

ing

Whe

n us

ing

dis

infe

ctan

ts, s

taff

sho

uld

fo

llow

the

man

ufac

ture

r’s in

stru

ctio

ns f

or

dilu

tio

n an

d

cont

act

tim

es

Ref

er t

o N

atio

nal H

osp

ital

Offi

ce C

lean

ing

Man

ual 2

00

6

Pat

ient

car

e en

viro

nmen

t b

e cl

eane

d a

nd

dis

infe

cted

wit

h a

det

erg

ent

and

100

0pp

m

of

avai

lab

le c

hlo

rine

dai

ly b

efo

re u

se o

n an

oth

er p

atie

nt if

co

ntam

inat

ed w

ith

resp

irat

ory

sec

reti

ons

. P

PE

sho

uld

be

wo

rn

for

all c

lean

ing

pro

ced

ures

as

per

pag

e 18

0-18

2.

Ro

om

sho

uld

rem

ain

vaca

nt f

or

one

ho

ur

wit

h w

ind

ow

s o

pen

bef

ore

re-

use

Pat

ient

Car

e E

qui

pm

ent

&D

eco

ntam

inat

ion

of

Med

ical

Dev

ices

Med

ical

dev

ices

des

igna

ted

as

“Sin

gle

Use

Onl

y” m

ust

not

be

rep

roce

ssed

or

reus

ed u

nder

an

y ci

rcum

stan

ces

(MD

A D

B 2

000)

, (M

DD

) 93/

42/E

EC

No

n-cr

itic

al e

qui

pm

ent

No

n-cr

itic

al e

qui

pm

ent

refe

rs t

o e

qui

pm

ent

that

is e

ithe

r no

t in

co

ntac

t w

ith

a p

atie

nt o

r in

co

ntac

t w

ith

heal

thy

skin

. Suc

h eq

uip

men

t sh

oul

d b

e:In

a s

tate

of

go

od

rep

air

in o

rder

to

fac

ilita

te e

ffec

tive

cle

anin

g•

Mus

t b

e th

oro

ughl

y cl

eane

d p

rio

r to

use

on

ano

ther

pat

ient

/res

iden

t. If

so

iled

wit

h •

blo

od

or

bo

dy

fluid

s, d

isin

fect

usi

ng a

chl

ori

ne-r

elea

sing

so

luti

on

of

1000

pp

m, o

r eq

uiva

lent

acc

ord

ing

to

man

ufac

ture

r’s in

stru

ctio

ns, r

inse

and

dry

.

Reu

sab

le in

vasi

ve m

edic

al d

evic

es (

RIM

D)

RIM

D r

efer

s to

eq

uip

men

t th

at is

cla

ssifi

ed a

s se

mi-c

riti

cal o

r cr

itic

al. R

IMD

s ar

e in

co

ntac

t w

ith

ster

ile b

od

y si

tes,

muc

ous

mem

bra

nes

and

bre

aks

in t

he s

kin.

HC

Ws

mus

t en

sure

tha

t R

IMD

s ar

e no

t us

ed f

or

ano

ther

pat

ient

unt

il th

ey h

ave

bee

n cl

eane

d a

nd r

epro

cess

ed

app

rop

riat

ely.

(HSE

Co

de

of

Pra

ctic

e fo

r D

eco

ntam

inat

ion

of

Reu

sab

le In

vasi

ve M

edic

al D

evic

es 2

007)

ww

w.h

se.ie

/eng

/Pub

licat

ions

/Ho

spit

als/

Co

de_

of_

Pra

ctic

e_fo

r_D

eco

ntam

inat

ion_

of_

Reu

sab

le_I

nvas

ive_

Med

ical

_Dev

ices

_.ht

ml

ww

w.h

psc

.ie/h

psc

/A-Z

/Mic

rob

iolo

gyA

ntim

icro

bia

lRes

ista

nce/

CJD

/Gui

dan

ce/

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Man

agem

ent

of

Hea

lth

Car

e R

isk

Was

te

Dis

po

se o

f he

alth

care

ris

k w

aste

in a

cco

rdan

ce w

ith

the

Dep

artm

ent

of

Hea

lth

& C

hild

ren’

s (D

oH

C) G

uid

elin

es f

or

Was

te D

isp

osa

l, w

hich

out

lines

the

cat

ego

risa

tio

n an

d s

egre

gat

ion

of

heal

thca

re w

aste

.

Dis

po

sal o

f sh

arp

s;Sy

ring

es a

nd n

eed

les

sho

uld

be

dis

po

sed

of

as a

sin

gle

uni

t•

Use

d s

harp

s sh

oul

d b

e ca

refu

lly d

isca

rded

into

des

igna

ted

sha

rps

bin

at

the

po

int

of

use

•Sh

arp

s b

in s

houl

d b

e se

cure

ly s

tore

d o

ut o

f re

ach

of

clie

nts,

vis

ito

rs a

nd c

hild

ren

•N

eed

les

sho

uld

no

t b

e re

-cap

ped

, ben

t, b

roke

n o

r d

isas

sem

ble

d•

Shar

ps

sho

uld

no

t b

e p

asse

d f

rom

per

son-

to-p

erso

n b

y ha

nd•

Do

HC

Gui

del

ines

on

Dis

po

sal o

f H

ealt

hcar

e R

isk

Was

te a

re a

vaila

ble

at

ww

w.d

ohc

.ie/p

ublic

atio

ns/s

egre

gat

ion_

pac

kag

ing

.htm

l

Was

te c

ont

amin

ated

wit

h sp

utum

fro

m a

su

spec

ted

or

kno

wn

TB p

atie

nt s

houl

d b

e d

isp

ose

d o

f as

hea

lthc

are

risk

was

te w

ithi

n a

heal

thca

re f

acili

ty

Res

pir

ato

ry m

asks

sho

uld

be

dis

po

sed

of

into

Hea

lthc

are

risk

was

te

Man

agem

ent

of

need

le s

tick

in

juri

es (

NSI

) an

d

blo

od

and

bo

dy

flui

d e

xpo

sure

All

faci

litie

s m

ust

have

a lo

cal g

uid

elin

e o

n th

e m

anag

emen

t o

f ne

edle

sti

ck in

juri

es a

nd b

loo

d

and

bo

dy

fluid

exp

osu

re. T

his

gui

del

ine

sho

uld

incl

ude;

Firs

t ai

d•

Ris

k as

sess

men

t an

d s

cree

ning

of

sour

ce p

atie

nt (i

f kn

ow

n)•

Ris

k as

sess

men

t f

or

chem

op

rop

hyla

xis

•C

oun

selli

ng a

nd f

ollo

w u

p t

esti

ng

•

Furt

her

info

rmat

ion

fro

m

ww

w.d

ohc

.ie/p

ublic

atio

ns/t

rans

mis

sio

n_o

f_b

loo

d_b

orn

e_d

isea

ses_

2006

.htm

l

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS


Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Typ

e an

d s

elec

tio

n o

f P

PE

PP

E c

ons

ists

of:

G

love

s,•

Ap

rons

/go

wns

•E

ye, n

asal

and

mo

uth

pro

tect

ion

• Eac

h H

CW

sho

uld

mak

e an

ris

k as

sess

men

t o

f th

e p

lann

ed p

roce

dur

e an

d s

elec

t P

PE

dep

end

ing

on;

The

natu

re o

f th

e p

roce

dur

e•

The

risk

of

exp

osu

re t

o b

loo

d a

nd b

od

y flu

ids

•Th

e ri

sk o

f co

ntam

inat

ion

•

Ad

dit

iona

l res

pir

ato

ry p

rote

ctio

n re

qui

red

(s

ee f

acia

l pro

tect

ion

sect

ion)

Glo

ves

Glo

ves

sho

uld

be

sing

le u

se it

ems

and

sho

uld

co

nfo

rm t

o E

uro

pea

n C

om

mun

ity

Stan

dar

ds

Glo

ves

are

reco

mm

end

ed;

For

all a

ctiv

itie

s th

at c

arry

a r

isk

of

exp

osu

re t

o b

loo

d, b

od

y flu

ids,

•

secr

etio

ns o

r ex

cret

ions

, sha

rps

or

cont

amin

ated

inst

rum

ents

Whe

n to

uchi

ng m

uco

us m

emb

rane

s an

d n

on-

inta

ct s

kin

•W

hen

hand

ling

co

ntam

inat

ed e

qui

pm

ent

• Glo

ves

sho

uld

be;

Sing

le u

se o

nly

•St

erile

if c

ont

act

anti

cip

ated

wit

h st

erile

bo

dy

site

•

Put

on

imm

edia

tely

bef

ore

an

epis

od

e o

f p

atie

nt c

ont

act

and

•

rem

ove

as

soo

n as

the

act

ivit

y is

co

mp

lete

dC

hang

ed w

hen

cari

ng f

or

diff

eren

t p

atie

nts

and

bet

wee

n d

iffer

ent

•ca

re a

ctiv

itie

s o

n th

e sa

me

pat

ient

Dis

po

sed

of

as h

ealt

h ca

re r

isk

was

te if

co

ntam

inat

ed w

ith

blo

od

or

•b

od

y flu

ids

fro

m p

atie

nts

wit

h su

spec

ted

or

kno

wn

infe

ctio

n.

Han

d h

ygie

ne s

houl

d b

e p

erfo

rmed

bef

ore

do

nnin

g a

nd im

med

iate

ly

follo

win

g r

emo

val o

f g

love

s

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Face

pro

tect

ion

Face

pro

tect

ion

sho

uld

be

wo

rn w

here

:

Ther

e is

a r

isk

of

blo

od

, bo

dy

fluid

s,

•se

cret

ions

or

excr

etio

ns s

pla

shin

g in

to t

he

face

or

eyes

Whe

n p

laci

ng a

cat

hete

r o

r in

ject

ing

into

•

the

spin

al o

r ep

idur

al s

pac

e.

Face

pro

tect

ion

cons

ists

of

one

of

the

follo

win

g:

Flui

d r

epel

lent

mas

k w

ith

sep

arat

e •

go

gg

les

Res

pir

ato

ry m

ask

(FFP

2/3)

•Fa

ce s

hiel

d•

Flui

d r

epel

lent

mas

k w

ith

eye

shie

ld.

• Face

pro

tect

ion

sho

uld

be:

Sing

le u

se o

r si

ngle

per

son

use

(fac

e •

shie

lds

and

go

gg

les

can

be

reus

ed

by

the

sam

e H

CW

but

the

y m

ust

be

adeq

uate

ly c

lean

ed a

nd d

isin

fect

ed a

s p

er m

anuf

actu

rer’s

inst

ruct

ions

aft

er e

ach

use.

In a

dd

itio

n to

eye

pro

tect

ion

as r

equi

red

fo

r St

and

ard

Pre

caut

ions

HC

Ws

and

vis

ito

rs s

houl

d d

on

corr

ectl

y fit

ted

: FF

P2

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r co

nfirm

ed

•in

fect

ious

TB

cas

e w

here

MD

R-T

B n

ot

susp

ecte

dFF

P3

mas

k d

urin

g h

igh

risk

pro

ced

ures

fo

r al

l pat

ient

s w

here

TB

is s

usp

ecte

d

•o

r co

nfirm

ed (s

usce

pti

ble

or

MD

R) s

uch

as:

Sput

um in

duc

tio

no

C

oug

h p

rod

ucin

g p

roce

dur

es (e

.g. a

dm

inis

teri

ng a

ero

solis

ed

o

med

icat

ions

, bro

ncho

sco

py,

air

way

suc

tio

ning

, end

otr

ache

al in

tub

atio

n)P

roce

dur

es w

here

aer

oso

lisat

ion

of

dra

inag

e flu

id f

rom

an

absc

ess/

o

lesi

ons

may

occ

urFF

P3

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r kn

ow

n ca

se

•o

f M

DR

-TB

or

XD

R-T

B

To p

rese

rve

pri

vacy

and

co

nfid

enti

alit

y re

stri

ctin

g v

isit

ing

to

imm

edia

te f

amily

sh

oul

d b

e d

iscu

ssed

wit

h th

e p

atie

nt

All

HC

Ws

who

may

be

req

uire

d t

o u

se r

esp

irat

ory

mas

ks (F

FP2

& F

FP3)

dur

ing

th

e co

urse

of

thei

r w

ork

sho

uld

be

fit t

este

d b

y a

trai

ned

pro

fess

iona

l wit

hin

each

o

rgan

isat

ion

HC

Ws

sho

uld

fit

chec

k th

e m

ask

each

tim

e it

is w

orn

to

che

ck t

he s

eal

HC

Ws

visi

ting

a p

atie

nt in

the

ir o

wn

hom

e sh

oul

d w

ear

a FF

P2

or

FFP

3 m

ask

whi

le

the

pat

ient

is in

fect

ious

(see

cha

pte

r 6

on

Infe

ctio

n P

reve

ntio

n an

d C

ont

rol f

or

dis

cont

inua

tio

n o

f A

irb

orn

e P

reca

utio

ns).

Pat

ient

pri

vacy

mus

t b

e m

aint

aine

d if

m

ask

is w

orn

in t

he h

om

e.

All

mas

ks s

houl

d b

e re

mo

ved

in t

he a

nte

roo

m o

r im

med

iate

ly o

utsi

de

the

sing

le

roo

m if

the

re is

no

ant

e ro

om

Dis

card

mas

k in

to h

ealt

hcar

e ri

sk w

aste

Dec

ont

amin

ate

hand

s im

med

iate

ly a

fter

rem

ovi

ng m

ask

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Ap

rons

or

go

wns

Dis

po

sab

le a

pro

ns s

houl

d b

e w

orn

whe

re t

here

is a

ris

k th

at t

he f

ront

of

unifo

rm/c

loth

ing

may

bec

om

e ex

po

sed

to

blo

od

, bo

dy

fluid

s, e

xcre

tio

ns

or

secr

etio

ns

Long

sle

eved

flui

d r

epel

lent

go

wns

may

be

req

uire

d if

the

re is

a r

isk

that

uni

form

/clo

thin

g a

nd s

kin

may

be

exp

ose

d t

o b

loo

d, b

od

y flu

ids,

ex

cret

ions

or

secr

etio

ns

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Rem

ova

l of

PP

ER

emo

ve P

PE

whe

n p

roce

dur

e is

co

mp

lete

. PP

E s

houl

d b

e re

mo

ved

in

the

fo

llow

ing

ord

er a

nd d

isp

ose

d o

f in

to h

ealt

hcar

e ri

sk w

aste

if

cont

amin

ated

wit

h b

loo

d a

nd/o

r b

od

y flu

ids

Glo

ves

•A

pro

n/g

ow

n•

Dec

ont

amin

ate

hand

s •

Eye

wea

r•

Mas

k (h

and

le b

y th

e m

ask

stra

ps

to a

void

to

uchi

ng t

he f

ront

)•

Dec

ont

amin

ate

hand

s•

All

mas

ks s

houl

d b

e d

isca

rded

into

hea

lthc

are

risk

was

te

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Env

iro

nmen

tal

Dec

ont

amin

atio

nR

out

ine

envi

ronm

enta

l cle

anin

g is

req

uire

d t

o m

inim

ise

the

num

ber

of

mic

ro-o

rgan

ism

s in

the

en

viro

nmen

t.

Par

ticu

lar

atte

ntio

n sh

oul

d b

e g

iven

to

fre

que

ntly

to

uche

d s

urfa

ces

and

tho

se m

ost

like

ly

to b

e co

ntam

inat

ed w

ith

blo

od

or

bo

dy

fluid

s e.

g. b

edra

ils, m

attr

ess,

bed

sid

e ta

ble

s,

com

mo

des

, do

ork

nob

s, s

inks

, sur

face

s an

d e

qui

pm

ent

clo

se t

o t

he p

atie

nt

Che

mic

al d

isin

fect

ants

are

no

t re

com

men

ded

fo

r ro

utin

e en

viro

nmen

tal c

lean

ing

Whe

n us

ing

dis

infe

ctan

ts, s

taff

sho

uld

fo

llow

the

man

ufac

ture

r’s in

stru

ctio

ns f

or

dilu

tio

n an

d

cont

act

tim

es

Ref

er t

o N

atio

nal H

osp

ital

Offi

ce C

lean

ing

Man

ual 2

00

6

Pat

ient

car

e en

viro

nmen

t b

e cl

eane

d a

nd

dis

infe

cted

wit

h a

det

erg

ent

and

100

0pp

m

of

avai

lab

le c

hlo

rine

dai

ly b

efo

re u

se o

n an

oth

er p

atie

nt if

co

ntam

inat

ed w

ith

resp

irat

ory

sec

reti

ons

. P

PE

sho

uld

be

wo

rn

for

all c

lean

ing

pro

ced

ures

as

per

pag

e 18

0-18

2.

Ro

om

sho

uld

rem

ain

vaca

nt f

or

one

ho

ur

wit

h w

ind

ow

s o

pen

bef

ore

re-

use

Pat

ient

Car

e E

qui

pm

ent

&D

eco

ntam

inat

ion

of

Med

ical

Dev

ices

Med

ical

dev

ices

des

igna

ted

as

“Sin

gle

Use

Onl

y” m

ust

not

be

rep

roce

ssed

or

reus

ed u

nder

an

y ci

rcum

stan

ces

(MD

A D

B 2

000)

, (M

DD

) 93/

42/E

EC

No

n-cr

itic

al e

qui

pm

ent

No

n-cr

itic

al e

qui

pm

ent

refe

rs t

o e

qui

pm

ent

that

is e

ithe

r no

t in

co

ntac

t w

ith

a p

atie

nt o

r in

co

ntac

t w

ith

heal

thy

skin

. Suc

h eq

uip

men

t sh

oul

d b

e:In

a s

tate

of

go

od

rep

air

in o

rder

to

fac

ilita

te e

ffec

tive

cle

anin

g•

Mus

t b

e th

oro

ughl

y cl

eane

d p

rio

r to

use

on

ano

ther

pat

ient

/res

iden

t. If

so

iled

wit

h •

blo

od

or

bo

dy

fluid

s, d

isin

fect

usi

ng a

chl

ori

ne-r

elea

sing

so

luti

on

of

1000

pp

m, o

r eq

uiva

lent

acc

ord

ing

to

man

ufac

ture

r’s in

stru

ctio

ns, r

inse

and

dry

.

Reu

sab

le in

vasi

ve m

edic

al d

evic

es (

RIM

D)

RIM

D r

efer

s to

eq

uip

men

t th

at is

cla

ssifi

ed a

s se

mi-c

riti

cal o

r cr

itic

al. R

IMD

s ar

e in

co

ntac

t w

ith

ster

ile b

od

y si

tes,

muc

ous

mem

bra

nes

and

bre

aks

in t

he s

kin.

HC

Ws

mus

t en

sure

tha

t R

IMD

s ar

e no

t us

ed f

or

ano

ther

pat

ient

unt

il th

ey h

ave

bee

n cl

eane

d a

nd r

epro

cess

ed

app

rop

riat

ely.

(HSE

Co

de

of

Pra

ctic

e fo

r D

eco

ntam

inat

ion

of

Reu

sab

le In

vasi

ve M

edic

al D

evic

es 2

007)

ww

w.h

se.ie

/eng

/Pub

licat

ions

/Ho

spit

als/

Co

de_

of_

Pra

ctic

e_fo

r_D

eco

ntam

inat

ion_

of_

Reu

sab

le_I

nvas

ive_

Med

ical

_Dev

ices

_.ht

ml

ww

w.h

psc

.ie/h

psc

/A-Z

/Mic

rob

iolo

gyA

ntim

icro

bia

lRes

ista

nce/

CJD

/Gui

dan

ce/

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Man

agem

ent

of

Hea

lth

Car

e R

isk

Was

te

Dis

po

se o

f he

alth

care

ris

k w

aste

in a

cco

rdan

ce w

ith

the

Dep

artm

ent

of

Hea

lth

& C

hild

ren’

s (D

oH

C) G

uid

elin

es f

or

Was

te D

isp

osa

l, w

hich

out

lines

the

cat

ego

risa

tio

n an

d s

egre

gat

ion

of

heal

thca

re w

aste

.

Dis

po

sal o

f sh

arp

s;Sy

ring

es a

nd n

eed

les

sho

uld

be

dis

po

sed

of

as a

sin

gle

uni

t•

Use

d s

harp

s sh

oul

d b

e ca

refu

lly d

isca

rded

into

des

igna

ted

sha

rps

bin

at

the

po

int

of

use

•Sh

arp

s b

in s

houl

d b

e se

cure

ly s

tore

d o

ut o

f re

ach

of

clie

nts,

vis

ito

rs a

nd c

hild

ren

•N

eed

les

sho

uld

no

t b

e re

-cap

ped

, ben

t, b

roke

n o

r d

isas

sem

ble

d•

Shar

ps

sho

uld

no

t b

e p

asse

d f

rom

per

son-

to-p

erso

n b

y ha

nd•

Do

HC

Gui

del

ines

on

Dis

po

sal o

f H

ealt

hcar

e R

isk

Was

te a

re a

vaila

ble

at

ww

w.d

ohc

.ie/p

ublic

atio

ns/s

egre

gat

ion_

pac

kag

ing

.htm

l

Was

te c

ont

amin

ated

wit

h sp

utum

fro

m a

su

spec

ted

or

kno

wn

TB p

atie

nt s

houl

d b

e d

isp

ose

d o

f as

hea

lthc

are

risk

was

te w

ithi

n a

heal

thca

re f

acili

ty

Res

pir

ato

ry m

asks

sho

uld

be

dis

po

sed

of

into

Hea

lthc

are

risk

was

te

Man

agem

ent

of

need

le s

tick

in

juri

es (

NSI

) an

d

blo

od

and

bo

dy

flui

d e

xpo

sure

All

faci

litie

s m

ust

have

a lo

cal g

uid

elin

e o

n th

e m

anag

emen

t o

f ne

edle

sti

ck in

juri

es a

nd b

loo

d

and

bo

dy

fluid

exp

osu

re. T

his

gui

del

ine

sho

uld

incl

ude;

Firs

t ai

d•

Ris

k as

sess

men

t an

d s

cree

ning

of

sour

ce p

atie

nt (i

f kn

ow

n)•

Ris

k as

sess

men

t f

or

chem

op

rop

hyla

xis

•C

oun

selli

ng a

nd f

ollo

w u

p t

esti

ng

•

Furt

her

info

rmat

ion

fro

m

ww

w.d

ohc

.ie/p

ublic

atio

ns/t

rans

mis

sio

n_o

f_b

loo

d_b

orn

e_d

isea

ses_

2006

.htm

l

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

-180-


-181-

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Typ

e an

d s

elec

tio

n o

f P

PE

PP

E c

ons

ists

of:

G

love

s,•

Ap

rons

/go

wns

•E

ye, n

asal

and

mo

uth

pro

tect

ion

• Eac

h H

CW

sho

uld

mak

e an

ris

k as

sess

men

t o

f th

e p

lann

ed p

roce

dur

e an

d s

elec

t P

PE

dep

end

ing

on;

The

natu

re o

f th

e p

roce

dur

e•

The

risk

of

exp

osu

re t

o b

loo

d a

nd b

od

y flu

ids

•Th

e ri

sk o

f co

ntam

inat

ion

•

Ad

dit

iona

l res

pir

ato

ry p

rote

ctio

n re

qui

red

(s

ee f

acia

l pro

tect

ion

sect

ion)

Glo

ves

Glo

ves

sho

uld

be

sing

le u

se it

ems

and

sho

uld

co

nfo

rm t

o E

uro

pea

n C

om

mun

ity

Stan

dar

ds

Glo

ves

are

reco

mm

end

ed;

For

all a

ctiv

itie

s th

at c

arry

a r

isk

of

exp

osu

re t

o b

loo

d, b

od

y flu

ids,

•

secr

etio

ns o

r ex

cret

ions

, sha

rps

or

cont

amin

ated

inst

rum

ents

Whe

n to

uchi

ng m

uco

us m

emb

rane

s an

d n

on-

inta

ct s

kin

•W

hen

hand

ling

co

ntam

inat

ed e

qui

pm

ent

• Glo

ves

sho

uld

be;

Sing

le u

se o

nly

•St

erile

if c

ont

act

anti

cip

ated

wit

h st

erile

bo

dy

site

•

Put

on

imm

edia

tely

bef

ore

an

epis

od

e o

f p

atie

nt c

ont

act

and

•

rem

ove

as

soo

n as

the

act

ivit

y is

co

mp

lete

dC

hang

ed w

hen

cari

ng f

or

diff

eren

t p

atie

nts

and

bet

wee

n d

iffer

ent

•ca

re a

ctiv

itie

s o

n th

e sa

me

pat

ient

Dis

po

sed

of

as h

ealt

h ca

re r

isk

was

te if

co

ntam

inat

ed w

ith

blo

od

or

•b

od

y flu

ids

fro

m p

atie

nts

wit

h su

spec

ted

or

kno

wn

infe

ctio

n.

Han

d h

ygie

ne s

houl

d b

e p

erfo

rmed

bef

ore

do

nnin

g a

nd im

med

iate

ly

follo

win

g r

emo

val o

f g

love

s

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Face

pro

tect

ion

Face

pro

tect

ion

sho

uld

be

wo

rn w

here

:

Ther

e is

a r

isk

of

blo

od

, bo

dy

fluid

s,

•se

cret

ions

or

excr

etio

ns s

pla

shin

g in

to t

he

face

or

eyes

Whe

n p

laci

ng a

cat

hete

r o

r in

ject

ing

into

•

the

spin

al o

r ep

idur

al s

pac

e.

Face

pro

tect

ion

cons

ists

of

one

of

the

follo

win

g:

Flui

d r

epel

lent

mas

k w

ith

sep

arat

e •

go

gg

les

Res

pir

ato

ry m

ask

(FFP

2/3)

•Fa

ce s

hiel

d•

Flui

d r

epel

lent

mas

k w

ith

eye

shie

ld.

• Face

pro

tect

ion

sho

uld

be:

Sing

le u

se o

r si

ngle

per

son

use

(fac

e •

shie

lds

and

go

gg

les

can

be

reus

ed

by

the

sam

e H

CW

but

the

y m

ust

be

adeq

uate

ly c

lean

ed a

nd d

isin

fect

ed a

s p

er m

anuf

actu

rer’s

inst

ruct

ions

aft

er e

ach

use.

In a

dd

itio

n to

eye

pro

tect

ion

as r

equi

red

fo

r St

and

ard

Pre

caut

ions

HC

Ws

and

vis

ito

rs s

houl

d d

on

corr

ectl

y fit

ted

: FF

P2

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r co

nfirm

ed

•in

fect

ious

TB

cas

e w

here

MD

R-T

B n

ot

susp

ecte

dFF

P3

mas

k d

urin

g h

igh

risk

pro

ced

ures

fo

r al

l pat

ient

s w

here

TB

is s

usp

ecte

d

•o

r co

nfirm

ed (s

usce

pti

ble

or

MD

R) s

uch

as:

Sput

um in

duc

tio

no

C

oug

h p

rod

ucin

g p

roce

dur

es (e

.g. a

dm

inis

teri

ng a

ero

solis

ed

o

med

icat

ions

, bro

ncho

sco

py,

air

way

suc

tio

ning

, end

otr

ache

al in

tub

atio

n)P

roce

dur

es w

here

aer

oso

lisat

ion

of

dra

inag

e flu

id f

rom

an

absc

ess/

o

lesi

ons

may

occ

urFF

P3

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r kn

ow

n ca

se

•o

f M

DR

-TB

or

XD

R-T

B

To p

rese

rve

pri

vacy

and

co

nfid

enti

alit

y re

stri

ctin

g v

isit

ing

to

imm

edia

te f

amily

sh

oul

d b

e d

iscu

ssed

wit

h th

e p

atie

nt

All

HC

Ws

who

may

be

req

uire

d t

o u

se r

esp

irat

ory

mas

ks (F

FP2

& F

FP3)

dur

ing

th

e co

urse

of

thei

r w

ork

sho

uld

be

fit t

este

d b

y a

trai

ned

pro

fess

iona

l wit

hin

each

o

rgan

isat

ion

HC

Ws

sho

uld

fit

chec

k th

e m

ask

each

tim

e it

is w

orn

to

che

ck t

he s

eal

HC

Ws

visi

ting

a p

atie

nt in

the

ir o

wn

hom

e sh

oul

d w

ear

a FF

P2

or

FFP

3 m

ask

whi

le

the

pat

ient

is in

fect

ious

(see

cha

pte

r 6

on

Infe

ctio

n P

reve

ntio

n an

d C

ont

rol f

or

dis

cont

inua

tio

n o

f A

irb

orn

e P

reca

utio

ns).

Pat

ient

pri

vacy

mus

t b

e m

aint

aine

d if

m

ask

is w

orn

in t

he h

om

e.

All

mas

ks s

houl

d b

e re

mo

ved

in t

he a

nte

roo

m o

r im

med

iate

ly o

utsi

de

the

sing

le

roo

m if

the

re is

no

ant

e ro

om

Dis

card

mas

k in

to h

ealt

hcar

e ri

sk w

aste

Dec

ont

amin

ate

hand

s im

med

iate

ly a

fter

rem

ovi

ng m

ask

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Ap

rons

or

go

wns

Dis

po

sab

le a

pro

ns s

houl

d b

e w

orn

whe

re t

here

is a

ris

k th

at t

he f

ront

of

unifo

rm/c

loth

ing

may

bec

om

e ex

po

sed

to

blo

od

, bo

dy

fluid

s, e

xcre

tio

ns

or

secr

etio

ns

Long

sle

eved

flui

d r

epel

lent

go

wns

may

be

req

uire

d if

the

re is

a r

isk

that

uni

form

/clo

thin

g a

nd s

kin

may

be

exp

ose

d t

o b

loo

d, b

od

y flu

ids,

ex

cret

ions

or

secr

etio

ns

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Rem

ova

l of

PP

ER

emo

ve P

PE

whe

n p

roce

dur

e is

co

mp

lete

. PP

E s

houl

d b

e re

mo

ved

in

the

fo

llow

ing

ord

er a

nd d

isp

ose

d o

f in

to h

ealt

hcar

e ri

sk w

aste

if

cont

amin

ated

wit

h b

loo

d a

nd/o

r b

od

y flu

ids

Glo

ves

•A

pro

n/g

ow

n•

Dec

ont

amin

ate

hand

s •

Eye

wea

r•

Mas

k (h

and

le b

y th

e m

ask

stra

ps

to a

void

to

uchi

ng t

he f

ront

)•

Dec

ont

amin

ate

hand

s•

All

mas

ks s

houl

d b

e d

isca

rded

into

hea

lthc

are

risk

was

te

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Env

iro

nmen

tal

Dec

ont

amin

atio

nR

out

ine

envi

ronm

enta

l cle

anin

g is

req

uire

d t

o m

inim

ise

the

num

ber

of

mic

ro-o

rgan

ism

s in

the

en

viro

nmen

t.

Par

ticu

lar

atte

ntio

n sh

oul

d b

e g

iven

to

fre

que

ntly

to

uche

d s

urfa

ces

and

tho

se m

ost

like

ly

to b

e co

ntam

inat

ed w

ith

blo

od

or

bo

dy

fluid

s e.

g. b

edra

ils, m

attr

ess,

bed

sid

e ta

ble

s,

com

mo

des

, do

ork

nob

s, s

inks

, sur

face

s an

d e

qui

pm

ent

clo

se t

o t

he p

atie

nt

Che

mic

al d

isin

fect

ants

are

no

t re

com

men

ded

fo

r ro

utin

e en

viro

nmen

tal c

lean

ing

Whe

n us

ing

dis

infe

ctan

ts, s

taff

sho

uld

fo

llow

the

man

ufac

ture

r’s in

stru

ctio

ns f

or

dilu

tio

n an

d

cont

act

tim

es

Ref

er t

o N

atio

nal H

osp

ital

Offi

ce C

lean

ing

Man

ual 2

00

6

Pat

ient

car

e en

viro

nmen

t b

e cl

eane

d a

nd

dis

infe

cted

wit

h a

det

erg

ent

and

100

0pp

m

of

avai

lab

le c

hlo

rine

dai

ly b

efo

re u

se o

n an

oth

er p

atie

nt if

co

ntam

inat

ed w

ith

resp

irat

ory

sec

reti

ons

. P

PE

sho

uld

be

wo

rn

for

all c

lean

ing

pro

ced

ures

as

per

pag

e 18

0-18

2.

Ro

om

sho

uld

rem

ain

vaca

nt f

or

one

ho

ur

wit

h w

ind

ow

s o

pen

bef

ore

re-

use

Pat

ient

Car

e E

qui

pm

ent

&D

eco

ntam

inat

ion

of

Med

ical

Dev

ices

Med

ical

dev

ices

des

igna

ted

as

“Sin

gle

Use

Onl

y” m

ust

not

be

rep

roce

ssed

or

reus

ed u

nder

an

y ci

rcum

stan

ces

(MD

A D

B 2

000)

, (M

DD

) 93/

42/E

EC

No

n-cr

itic

al e

qui

pm

ent

No

n-cr

itic

al e

qui

pm

ent

refe

rs t

o e

qui

pm

ent

that

is e

ithe

r no

t in

co

ntac

t w

ith

a p

atie

nt o

r in

co

ntac

t w

ith

heal

thy

skin

. Suc

h eq

uip

men

t sh

oul

d b

e:In

a s

tate

of

go

od

rep

air

in o

rder

to

fac

ilita

te e

ffec

tive

cle

anin

g•

Mus

t b

e th

oro

ughl

y cl

eane

d p

rio

r to

use

on

ano

ther

pat

ient

/res

iden

t. If

so

iled

wit

h •

blo

od

or

bo

dy

fluid

s, d

isin

fect

usi

ng a

chl

ori

ne-r

elea

sing

so

luti

on

of

1000

pp

m, o

r eq

uiva

lent

acc

ord

ing

to

man

ufac

ture

r’s in

stru

ctio

ns, r

inse

and

dry

.

Reu

sab

le in

vasi

ve m

edic

al d

evic

es (

RIM

D)

RIM

D r

efer

s to

eq

uip

men

t th

at is

cla

ssifi

ed a

s se

mi-c

riti

cal o

r cr

itic

al. R

IMD

s ar

e in

co

ntac

t w

ith

ster

ile b

od

y si

tes,

muc

ous

mem

bra

nes

and

bre

aks

in t

he s

kin.

HC

Ws

mus

t en

sure

tha

t R

IMD

s ar

e no

t us

ed f

or

ano

ther

pat

ient

unt

il th

ey h

ave

bee

n cl

eane

d a

nd r

epro

cess

ed

app

rop

riat

ely.

(HSE

Co

de

of

Pra

ctic

e fo

r D

eco

ntam

inat

ion

of

Reu

sab

le In

vasi

ve M

edic

al D

evic

es 2

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licat

ions

/Ho

spit

als/

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de_

of_

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ctic

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r_D

eco

ntam

inat

ion_

of_

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nvas

ive_

Med

ical

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ices

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ista

nce/

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dan

ce/

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Man

agem

ent

of

Hea

lth

Car

e R

isk

Was

te

Dis

po

se o

f he

alth

care

ris

k w

aste

in a

cco

rdan

ce w

ith

the

Dep

artm

ent

of

Hea

lth

& C

hild

ren’

s (D

oH

C) G

uid

elin

es f

or

Was

te D

isp

osa

l, w

hich

out

lines

the

cat

ego

risa

tio

n an

d s

egre

gat

ion

of

heal

thca

re w

aste

.

Dis

po

sal o

f sh

arp

s;Sy

ring

es a

nd n

eed

les

sho

uld

be

dis

po

sed

of

as a

sin

gle

uni

t•

Use

d s

harp

s sh

oul

d b

e ca

refu

lly d

isca

rded

into

des

igna

ted

sha

rps

bin

at

the

po

int

of

use

•Sh

arp

s b

in s

houl

d b

e se

cure

ly s

tore

d o

ut o

f re

ach

of

clie

nts,

vis

ito

rs a

nd c

hild

ren

•N

eed

les

sho

uld

no

t b

e re

-cap

ped

, ben

t, b

roke

n o

r d

isas

sem

ble

d•

Shar

ps

sho

uld

no

t b

e p

asse

d f

rom

per

son-

to-p

erso

n b

y ha

nd•

Do

HC

Gui

del

ines

on

Dis

po

sal o

f H

ealt

hcar

e R

isk

Was

te a

re a

vaila

ble

at

ww

w.d

ohc

.ie/p

ublic

atio

ns/s

egre

gat

ion_

pac

kag

ing

.htm

l

Was

te c

ont

amin

ated

wit

h sp

utum

fro

m a

su

spec

ted

or

kno

wn

TB p

atie

nt s

houl

d b

e d

isp

ose

d o

f as

hea

lthc

are

risk

was

te w

ithi

n a

heal

thca

re f

acili

ty

Res

pir

ato

ry m

asks

sho

uld

be

dis

po

sed

of

into

Hea

lthc

are

risk

was

te

Man

agem

ent

of

need

le s

tick

in

juri

es (

NSI

) an

d

blo

od

and

bo

dy

flui

d e

xpo

sure

All

faci

litie

s m

ust

have

a lo

cal g

uid

elin

e o

n th

e m

anag

emen

t o

f ne

edle

sti

ck in

juri

es a

nd b

loo

d

and

bo

dy

fluid

exp

osu

re. T

his

gui

del

ine

sho

uld

incl

ude;

Firs

t ai

d•

Ris

k as

sess

men

t an

d s

cree

ning

of

sour

ce p

atie

nt (i

f kn

ow

n)•

Ris

k as

sess

men

t f

or

chem

op

rop

hyla

xis

•C

oun

selli

ng a

nd f

ollo

w u

p t

esti

ng

•

Furt

her

info

rmat

ion

fro

m

ww

w.d

ohc

.ie/p

ublic

atio

ns/t

rans

mis

sio

n_o

f_b

loo

d_b

orn

e_d

isea

ses_

2006

.htm

l

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS


Laun

dry

car

eLa

und

ry s

houl

d b

e ha

ndle

d a

nd t

rans

po

rted

in a

man

ner

that

pre

vent

s tr

ansm

issi

on

of

mic

ro-o

rgan

ism

s to

o

ther

pat

ient

s, H

CW

s o

r th

e en

viro

nmen

t

Staf

f ha

ndlin

g s

oile

d li

nen

sho

uld

wea

r g

love

s an

d a

dis

po

sab

le p

last

ic a

pro

n

Seg

reg

atio

n an

d t

rans

po

rtat

ion

of

used

laun

dry

sho

uld

be

in a

cco

rdan

ce w

ith

the

gui

del

ines

fro

m t

he

Soci

ety

of

Line

n Se

rvic

es a

nd L

aund

ry M

anag

ers

(200

8)

Staf

f sh

oul

d n

ot

man

ually

slu

ice

or

soak

so

iled

or

infe

cted

line

n/cl

oth

ing

Line

n sh

oul

d b

e he

at d

isin

fect

ed d

urin

g t

he w

ash

pro

cess

by

rais

ing

the

tem

per

atur

e to

eit

her

65°C

fo

r no

t le

ss t

han

10 m

inut

es o

r p

refe

rab

ly 7

1°C

fo

r no

t le

ss t

han

3 m

inut

es. D

isin

fect

ion

of

heat

lab

ile m

ater

ials

(a

cco

rdin

g t

o m

anuf

actu

rer

inst

ruct

ions

) can

be

achi

eved

at

low

tem

per

atur

es b

y in

tro

duc

ing

150

pp

m o

f ch

lori

ne in

to t

he p

enul

tim

ate

rins

e.

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Spill

ages

Spill

ages

of

blo

od

, uri

ne, f

aece

s o

r vo

mit

sho

uld

be

dea

lt w

ith

imm

edia

tely

wea

ring

pro

tect

ive

clo

thin

g

For

spill

ages

of

bo

dy

fluid

(e.g

. uri

ne, f

aece

s o

r vo

mit

);So

ak u

p a

s m

uch

of

the

visi

ble

mat

eria

l as

po

ssib

le w

ith

dis

po

sab

le p

aper

to

wel

s•

Dis

po

se o

f th

e so

iled

pap

er t

ow

els

acco

rdin

g t

o n

atio

nal g

uid

elin

es

•C

lean

the

are

a us

ing

war

m w

ater

and

gen

eral

pur

po

se n

eutr

al d

eter

gen

t•

Dis

infe

ct u

sing

a c

hlo

rine

-rel

easi

ng s

olu

tio

n o

f 1,

000p

pm

, rin

se a

nd d

ry

•D

isca

rd g

love

s an

d a

pro

n ac

cord

ing

to

nat

iona

l gui

del

ines

•

Dec

ont

amin

ate

hand

s

•D

o n

ot

app

ly c

hlo

rine

-bas

ed d

isin

fect

ants

dire

ctly

ont

o s

pill

ages

of

urin

e as

it m

ay r

esul

t in

the

•

rele

ase

of

chlo

rine

vap

our

For

blo

od

sp

illag

es;

Dec

ont

amin

ate

all b

loo

d s

pill

s w

ith

a ch

lori

ne b

ased

dis

infe

ctan

t (e

.g. p

ow

der

, gra

nule

s o

r liq

uid

•

cont

aini

ng 1

0,00

0pp

m a

vaila

ble

chl

ori

ne) o

r su

itab

le a

lter

nati

ve, i

n lin

e w

ith

the

man

ufac

ture

r’s

inst

ruct

ions

and

loca

l po

licy

Wip

e up

the

sp

illag

e w

ith

dis

po

sab

le p

aper

to

wel

s an

d d

isca

rd in

to a

yel

low

hea

lthc

are

risk

bag

•

or

rig

id c

ont

aine

r W

ash

the

area

wit

h a

gen

eral

pur

po

se n

eutr

al d

eter

gen

t an

d w

ater

•D

isca

rd g

love

s an

d a

pro

n in

to h

ealt

hcar

e ri

sk b

ag•

Dec

ont

amin

ate

hand

s •

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Safe

In

ject

ion

Pra

ctic

es

Ad

min

istr

atio

n E

duc

ate

all H

CW

s w

ho a

dm

inis

ter

inje

ctio

ns o

n th

e im

po

rtan

ce o

f sa

fe in

ject

ion

pra

ctic

esA

ll fa

cilit

ies

sho

uld

hav

e a

gui

del

ine

on

the

use

of

mul

ti-d

ose

via

ls.

Pre

par

atio

n o

f In

ject

ions

All

inje

ctio

ns s

houl

d b

e p

rep

ared

in a

cle

an a

rea.

Thi

s ar

ea m

ust

not

be

used

fo

r d

isp

osi

ng o

f us

ed n

eed

les

and

syr

ing

es, h

and

ling

blo

od

sam

ple

s o

r an

y m

ater

ial c

ont

amin

ated

wit

h b

loo

d o

r b

od

y flu

ids

An

asep

tic

tech

niq

ue m

ust

be

used

whe

n d

raw

ing

up

inje

ctio

nsN

eed

les,

syr

ing

es a

nd c

annu

lae

are

ster

ile, s

ing

le u

se it

ems;

the

y m

ust

not

be

reus

ed f

or

ano

ther

pat

ient

no

r to

acc

ess

a m

edic

atio

n o

r so

luti

on

that

mig

ht b

e us

ed f

or

a su

bse

que

nt p

atie

ntU

se s

ing

le d

ose

via

ls w

here

ver

po

ssib

leD

o n

ot

use

sing

le d

ose

via

ls f

or

mul

tip

le p

atie

nts

Do

no

t co

mb

ine

left

ove

rs f

or

late

r us

e

Mul

ti-d

ose

via

lsM

ulti

-do

se v

ials

sho

uld

onl

y b

e us

ed w

hen

abso

lute

ly n

eces

sary

Res

tric

t w

here

ver

po

ssib

le t

he u

se o

f m

ulti

-do

se v

ials

to

a s

ing

le p

atie

ntLa

bel

via

l wit

h p

atie

nt’s

nam

e an

d d

ate

op

ened

Dis

card

if s

teri

lity

is c

om

pro

mis

ed o

r q

uest

iona

ble

Do

no

t le

ave

mul

ti-d

ose

via

ls a

t a

pat

ient

’s b

edsi

de

Use

a s

teri

le s

yrin

ge

and

nee

dle

eve

ry t

ime

a m

edic

atio

n vi

al is

acc

esse

d e

ven

if it

is a

2nd

do

se o

f th

e sa

me

dru

g f

or

the

sam

e p

atie

nt.

Infu

sio

ns a

nd in

trav

eno

us s

ets

Do

no

t us

e b

ags

or

bo

ttle

s o

f in

trav

eno

us fl

uid

s as

a c

om

mo

n so

urce

of

sup

ply

fo

r m

ulti

ple

pat

ient

s

Intr

aven

ous

flui

ds

and

intr

aven

ous

set

s ar

e si

ngle

use

ste

rile

item

s fo

r us

e b

y a

sing

le p

atie

ntC

ons

ider

a s

yrin

ge

or

need

le/c

annu

la c

ont

amin

ated

onc

e it

has

bee

n us

ed t

o e

nter

or

conn

ect

to a

pat

ient

’s

intr

aven

ous

infu

sio

n b

ag o

r ad

min

istr

atio

n se

t.

No

ad

dit

iona

l pre

caut

ions

nec

essa

ry

Pra

ctic

es

for

lum

bar

p

unct

ure

pro

ced

ures

Whe

n in

sert

ing

a c

athe

ter,

inje

ctin

g m

ater

ial/

chem

oth

erap

y in

to t

he s

pin

al c

anal

or

sub

dur

al s

pac

e,

heal

thca

re w

ork

ers

sho

uld

wea

r a

surg

ical

mas

k an

d a

dhe

re t

o a

sep

tic

tech

niq

ue.

No

ad

dit

iona

l pre

caut

ions

nec

essa

ry

-182-

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Typ

e an

d s

elec

tio

n o

f P

PE

PP

E c

ons

ists

of:

G

love

s,•

Ap

rons

/go

wns

•E

ye, n

asal

and

mo

uth

pro

tect

ion

• Eac

h H

CW

sho

uld

mak

e an

ris

k as

sess

men

t o

f th

e p

lann

ed p

roce

dur

e an

d s

elec

t P

PE

dep

end

ing

on;

The

natu

re o

f th

e p

roce

dur

e•

The

risk

of

exp

osu

re t

o b

loo

d a

nd b

od

y flu

ids

•Th

e ri

sk o

f co

ntam

inat

ion

•

Ad

dit

iona

l res

pir

ato

ry p

rote

ctio

n re

qui

red

(s

ee f

acia

l pro

tect

ion

sect

ion)

Glo

ves

Glo

ves

sho

uld

be

sing

le u

se it

ems

and

sho

uld

co

nfo

rm t

o E

uro

pea

n C

om

mun

ity

Stan

dar

ds

Glo

ves

are

reco

mm

end

ed;

For

all a

ctiv

itie

s th

at c

arry

a r

isk

of

exp

osu

re t

o b

loo

d, b

od

y flu

ids,

•

secr

etio

ns o

r ex

cret

ions

, sha

rps

or

cont

amin

ated

inst

rum

ents

Whe

n to

uchi

ng m

uco

us m

emb

rane

s an

d n

on-

inta

ct s

kin

•W

hen

hand

ling

co

ntam

inat

ed e

qui

pm

ent

• Glo

ves

sho

uld

be;

Sing

le u

se o

nly

•St

erile

if c

ont

act

anti

cip

ated

wit

h st

erile

bo

dy

site

•

Put

on

imm

edia

tely

bef

ore

an

epis

od

e o

f p

atie

nt c

ont

act

and

•

rem

ove

as

soo

n as

the

act

ivit

y is

co

mp

lete

dC

hang

ed w

hen

cari

ng f

or

diff

eren

t p

atie

nts

and

bet

wee

n d

iffer

ent

•ca

re a

ctiv

itie

s o

n th

e sa

me

pat

ient

Dis

po

sed

of

as h

ealt

h ca

re r

isk

was

te if

co

ntam

inat

ed w

ith

blo

od

or

•b

od

y flu

ids

fro

m p

atie

nts

wit

h su

spec

ted

or

kno

wn

infe

ctio

n.

Han

d h

ygie

ne s

houl

d b

e p

erfo

rmed

bef

ore

do

nnin

g a

nd im

med

iate

ly

follo

win

g r

emo

val o

f g

love

s

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Face

pro

tect

ion

Face

pro

tect

ion

sho

uld

be

wo

rn w

here

:

Ther

e is

a r

isk

of

blo

od

, bo

dy

fluid

s,

•se

cret

ions

or

excr

etio

ns s

pla

shin

g in

to t

he

face

or

eyes

Whe

n p

laci

ng a

cat

hete

r o

r in

ject

ing

into

•

the

spin

al o

r ep

idur

al s

pac

e.

Face

pro

tect

ion

cons

ists

of

one

of

the

follo

win

g:

Flui

d r

epel

lent

mas

k w

ith

sep

arat

e •

go

gg

les

Res

pir

ato

ry m

ask

(FFP

2/3)

•Fa

ce s

hiel

d•

Flui

d r

epel

lent

mas

k w

ith

eye

shie

ld.

• Face

pro

tect

ion

sho

uld

be:

Sing

le u

se o

r si

ngle

per

son

use

(fac

e •

shie

lds

and

go

gg

les

can

be

reus

ed

by

the

sam

e H

CW

but

the

y m

ust

be

adeq

uate

ly c

lean

ed a

nd d

isin

fect

ed a

s p

er m

anuf

actu

rer’s

inst

ruct

ions

aft

er e

ach

use.

In a

dd

itio

n to

eye

pro

tect

ion

as r

equi

red

fo

r St

and

ard

Pre

caut

ions

HC

Ws

and

vis

ito

rs s

houl

d d

on

corr

ectl

y fit

ted

: FF

P2

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r co

nfirm

ed

•in

fect

ious

TB

cas

e w

here

MD

R-T

B n

ot

susp

ecte

dFF

P3

mas

k d

urin

g h

igh

risk

pro

ced

ures

fo

r al

l pat

ient

s w

here

TB

is s

usp

ecte

d

•o

r co

nfirm

ed (s

usce

pti

ble

or

MD

R) s

uch

as:

Sput

um in

duc

tio

no

C

oug

h p

rod

ucin

g p

roce

dur

es (e

.g. a

dm

inis

teri

ng a

ero

solis

ed

o

med

icat

ions

, bro

ncho

sco

py,

air

way

suc

tio

ning

, end

otr

ache

al in

tub

atio

n)P

roce

dur

es w

here

aer

oso

lisat

ion

of

dra

inag

e flu

id f

rom

an

absc

ess/

o

lesi

ons

may

occ

urFF

P3

mas

ks b

efo

re e

nter

ing

the

iso

lati

on

roo

m o

f a

susp

ecte

d o

r kn

ow

n ca

se

•o

f M

DR

-TB

or

XD

R-T

B

To p

rese

rve

pri

vacy

and

co

nfid

enti

alit

y re

stri

ctin

g v

isit

ing

to

imm

edia

te f

amily

sh

oul

d b

e d

iscu

ssed

wit

h th

e p

atie

nt

All

HC

Ws

who

may

be

req

uire

d t

o u

se r

esp

irat

ory

mas

ks (F

FP2

& F

FP3)

dur

ing

th

e co

urse

of

thei

r w

ork

sho

uld

be

fit t

este

d b

y a

trai

ned

pro

fess

iona

l wit

hin

each

o

rgan

isat

ion

HC

Ws

sho

uld

fit

chec

k th

e m

ask

each

tim

e it

is w

orn

to

che

ck t

he s

eal

HC

Ws

visi

ting

a p

atie

nt in

the

ir o

wn

hom

e sh

oul

d w

ear

a FF

P2

or

FFP

3 m

ask

whi

le

the

pat

ient

is in

fect

ious

(see

cha

pte

r 6

on

Infe

ctio

n P

reve

ntio

n an

d C

ont

rol f

or

dis

cont

inua

tio

n o

f A

irb

orn

e P

reca

utio

ns).

Pat

ient

pri

vacy

mus

t b

e m

aint

aine

d if

m

ask

is w

orn

in t

he h

om

e.

All

mas

ks s

houl

d b

e re

mo

ved

in t

he a

nte

roo

m o

r im

med

iate

ly o

utsi

de

the

sing

le

roo

m if

the

re is

no

ant

e ro

om

Dis

card

mas

k in

to h

ealt

hcar

e ri

sk w

aste

Dec

ont

amin

ate

hand

s im

med

iate

ly a

fter

rem

ovi

ng m

ask

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Use

of

Per

sona

l P

rote

ctiv

e E

qui

pm

ent

(PP

E)

Ap

rons

or

go

wns

Dis

po

sab

le a

pro

ns s

houl

d b

e w

orn

whe

re t

here

is a

ris

k th

at t

he f

ront

of

unifo

rm/c

loth

ing

may

bec

om

e ex

po

sed

to

blo

od

, bo

dy

fluid

s, e

xcre

tio

ns

or

secr

etio

ns

Long

sle

eved

flui

d r

epel

lent

go

wns

may

be

req

uire

d if

the

re is

a r

isk

that

uni

form

/clo

thin

g a

nd s

kin

may

be

exp

ose

d t

o b

loo

d, b

od

y flu

ids,

ex

cret

ions

or

secr

etio

ns

No

ext

ra p

reca

utio

ns r

eco

mm

end

ed

Rem

ova

l of

PP

ER

emo

ve P

PE

whe

n p

roce

dur

e is

co

mp

lete

. PP

E s

houl

d b

e re

mo

ved

in

the

fo

llow

ing

ord

er a

nd d

isp

ose

d o

f in

to h

ealt

hcar

e ri

sk w

aste

if

cont

amin

ated

wit

h b

loo

d a

nd/o

r b

od

y flu

ids

Glo

ves

•A

pro

n/g

ow

n•

Dec

ont

amin

ate

hand

s •

Eye

wea

r•

Mas

k (h

and

le b

y th

e m

ask

stra

ps

to a

void

to

uchi

ng t

he f

ront

)•

Dec

ont

amin

ate

hand

s•

All

mas

ks s

houl

d b

e d

isca

rded

into

hea

lthc

are

risk

was

te

Clin

ical

W

ork

P

ract

ice

STA

ND

AR

D P

RE

CA

UTI

ON

SA

IRB

OR

NE

PR

EC

AU

TIO

NS

Env

iro

nmen

tal

Dec

ont

amin

atio

nR

out

ine

envi

ronm

enta

l cle

anin

g is

req

uire

d t

o m

inim

ise

the

num

ber

of

mic

ro-o

rgan

ism

s in

the

en

viro

nmen

t.

Par

ticu

lar

atte

ntio

n sh

oul

d b

e g

iven

to

fre

que

ntly

to

uche

d s

urfa

ces

and

tho

se m

ost

like

ly

to b

e co

ntam

inat

ed w

ith

blo

od

or

bo

dy

fluid

s e.

g. b

edra

ils, m

attr

ess,

bed

sid

e ta

ble

s,

com

mo

des

, do

ork

nob

s, s

inks

, sur

face

s an

d e

qui

pm

ent

clo

se t

o t

he p

atie

nt

Che

mic

al d

isin

fect

ants

are

no

t re

com

men

ded

fo

r ro

utin

e en

viro

nmen

tal c

lean

ing

Whe

n us

ing

dis

infe

ctan

ts, s

taff

sho

uld

fo

llow

the

man

ufac

ture

r’s in

stru

ctio

ns f

or

dilu

tio

n an

d

cont

act

tim

es

Ref

er t

o N

atio

nal H

osp

ital

Offi

ce C

lean

ing

Man

ual 2

00

6

Pat

ient

car

e en

viro

nmen

t b

e cl

eane

d a

nd

dis

infe

cted

wit

h a

det

erg

ent

and

100

0pp

m

of

avai

lab

le c

hlo

rine

dai

ly b

efo

re u

se o

n an

oth

er p

atie

nt if

co

ntam

inat

ed w

ith

resp

irat

ory

sec

reti

ons

. P

PE

sho

uld

be

wo

rn

for

all c

lean

ing

pro

ced

ures

as

per

pag

e 18

0-18

2.

Ro

om

sho

uld

rem

ain

vaca

nt f

or

one

ho

ur

wit

h w

ind

ow

s o

pen

bef

ore

re-

use

Pat

ient

Car

e E

qui

pm

ent

&D

eco

ntam

inat

ion

of

Med

ical

Dev

ices

Med

ical

dev

ices

des

igna

ted

as

“Sin

gle

Use

Onl

y” m

ust

not

be

rep

roce

ssed

or

reus

ed u

nder

an

y ci

rcum

stan

ces

(MD

A D

B 2

000)

, (M

DD

) 93/

42/E

EC

No

n-cr

itic

al e

qui

pm

ent

No

n-cr

itic

al e

qui

pm

ent

refe

rs t

o e

qui

pm

ent

that

is e

ithe

r no

t in

co

ntac

t w

ith

a p

atie

nt o

r in

co

ntac

t w

ith

heal

thy

skin

. Suc

h eq

uip

men

t sh

oul

d b

e:In

a s

tate

of

go

od

rep

air

in o

rder

to

fac

ilita

te e

ffec

tive

cle

anin

g•

Mus

t b

e th

oro

ughl

y cl

eane

d p

rio

r to

use

on

ano

ther

pat

ient

/res

iden

t. If

so

iled

wit

h •

blo

od

or

bo

dy

fluid

s, d

isin

fect

usi

ng a

chl

ori

ne-r

elea

sing

so

luti

on

of

1000

pp

m, o

r eq

uiva

lent

acc

ord

ing

to

man

ufac

ture

r’s in

stru

ctio

ns, r

inse

and

dry

.

Reu

sab

le in

vasi

ve m

edic

al d

evic

es (

RIM

D)

RIM

D r

efer

s to

eq

uip

men

t th

at is

cla

ssifi

ed a

s se

mi-c

riti

cal o

r cr

itic

al. R

IMD

s ar

e in

co

ntac

t w

ith

ster

ile b

od

y si

tes,

muc

ous

mem

bra

nes

and

bre

aks

in t

he s

kin.

HC

Ws

mus

t en

sure

tha

t R

IMD

s ar

e no

t us

ed f

or

ano

ther

pat

ient

unt

il th

ey h

ave

bee

n cl

eane

d a

nd r

epro

cess

ed

app

rop

riat

ely.

(HSE

Co

de

of

Pra

ctic

e fo

r D

eco

ntam

inat

ion

of

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nec

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-184-

Appendix 11: Discharge instructions for patients with potentially infectious TB You have been placed on medication to treat TB. You are now being discharged home from hospital. However, your TB may remain infectious (contagious) for some time longer. A number of general instructions and temporary restrictions are therefore being advised until it is certain that you are no longer infectious to others. These restrictions will help reduce any possibility of spread of TB germs to other people. You should follow them carefully until you are advised otherwise by the doctor who is treating your TB.

General instructions:• Take your TB medications as instructed by your doctor• You should always cover your nose and mouth with a tissue when coughing or sneezing• Dispose of used tissues in a bin immediately after use and wash your hands• It is ok to share eating utensils (spoons, forks, cups or glasses) and other household items• Keep your doctor’s or clinic appointment so that you complete your treatment.

Temporary restrictions after hospital discharge• Do not go to work or school and you should avoid going to any public areas (e.g. cinema, pubs or

clubs, using public transport) until the doctor who is treating your TB says it is ok for you to do so.

• If there are others living at home you should- limit the time you spend in common household areas (e.g. kitchen or living room) and keep

your bedroom door closed- If advised by your doctor to wear a surgical mask (as a temporary measure) that covers your

nose and mouth (as explained to you in hospital) when you are around other people, follow the instructions given. This will reduce the number of TB germs that you put into the air when you cough or talk.

• You should not be around babies, young children or, to the best of your knowledge, people who have weakened immune systems such as people with HIV/AIDS. (If there are young children at home, you may still be discharged home if the children have been tested for TB infection and are being followed up by the local public health department).

These temporary restrictions will be removed once your doctor decides that you are no longer infectious. However, your TB treatment will continue until the course is completed.

If you have any questions about your treatment, please call ……………………………….……

Adapted with kind permission from Tuberculosis, Clinical Policies and Protocols. New York City Department of Health and Mental Hygiene (2008). Available from www.nyc.gov/html/doh/downloads/pdf/tb/tb-protocol.pdf.


-185-

Appendix 12: List of Tuberculosis-related websites and resourcesNational TB WebsitesHealth Protection Surveillance Centrewww.hpsc.ie/hpsc/A-Z/VaccinePreventable/TuberculosisTB/

Irish Thoracic Societywww.irishthoracicsociety.com/

Immunisation Guidelines of Irelandwww.hpsc.ie/hpsc/A-Z/VaccinePreventable/Vaccination/Guidance/

International TB WebsitesCenters for Disease Control and Prevention, USA, Division of TB Elimination www.cdc.gov/tb/

Health Protection Agency, UKwww.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1191942150134?p=1191942150134

The Public Health Agency of Canadawww.phac-aspc.gc.ca/tbpc-latb/index.html

European Centre for Disease Prevention and Control www.ecdc.europa.eu/Health_topics/Tuberculosis/Tuberculosis.html

EuroTB: Surveillance of TB in Europe www.eurotb.org/

WHO-Geneva Tuberculosis Homepagewww.who.int/tb/en/

WHO-Euro Tuberculosis Sitewww.euro.who.int/tuberculosis

The Global Plan to Stop TB www.stoptb.org/globalplan/

WHO Stop TB Department www.who.int/tb/about/en/index.html

Stop TB Partnershipwww.stoptb.org/

The International Union against TB and Lung Diseasewww.iuatld.org/

NICE: TB information for the Publicwww.nice.org.uk/nicemedia/pdf/CG033publicinfo.pdf

TB Alertwww.tbalert.org/


-186-

Tuberculosis Guidance

UKNICE Tuberculosis Clinical Guidancewww.nice.org.uk/search/guidancesearchresults.jsp?keywords=TUBERCULOSIS&searchType=guidance

Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000. Joint Tuberculosis Committee of the British Thoracic Society. Thorax 2000. Vol. 55, 11: 887-901www.thorax.bmj.com/cgi/reprint/55/11/887

USACenters for Disease Control and Prevention (CDC) TB Guidelines (listed by category or by date)http://www.cdc.gov/tb/pubs/mmwr/maj_guide.htm

CanadaCanadian Tuberculosis Standards 6th Edition, 2007www.phac-aspc.gc.ca/tbpc-latb/pubs/pdf/tbstand07_e.pdf

New ZealandNew Zealand TB Guidelines, 2003www.moh.govt.nz/moh.nsf/0/4760df3580a6f5b5cc256c86006ed394?OpenDocument

World Health OrganizationTuberculosis and Airflight (WHO) www.who.int/docstore/gtb/publications/aircraft/PDF/98_256.pdf

WHO Guidelines for the programmatic management of resistant TBwww.whqlibdoc.who.int/publications/2006/9241546956_eng.pdf

Treatment Guidelines for National Programmes – WHO Global Tuberculosis Programme, Geneva www.who.int/docstore/gtb/publications/ttgnp/

Guidelines for the prevention of tuberculosis in health care facilities in resource limited settings – WHO Global Tuberculosis Programme, Geneva www.who.int/docstore/gtb/publications/healthcare

What is DOTS? - Guide to the WHO recommended TB control strategy www.who.int/docstore/gtb/publications/whatisdots

Scientific ResourcesMEDLINEplus Tuberculosis www.nlm.nih.gov/medlineplus/tuberculosis.html

Francis J. Curry National Tuberculosis Centerwww.nationaltbcenter.edu/

New Jersey Medical School Global Tuberculosis Institute www.umdnj.edu/globaltb/home.htm

Stanford Center for Tuberculosis Research12www.stanford.edu/group/molepi/index.html

Brown University TB/HIV Research Laboratorywww.brown.edu/Research/TB-HIV_Lab/

The Public Health Research Institute (PHRI) Tuberculosis Centerwww.phri.org/programs/program_tbcenter.asp

Aeras Global TB Vaccine Foundation www.aeras.org/


-187-

Appendix 13: Respiratory hygiene and cough etiquette

When coughing or sneezing use a tissue or cover your nose and mouth

These 3 steps will help prevent the spread of respiratory infections

Dispose of the tissues afterwards in a waste bin

Decontaminate your hands after discarding tissue using soap and water or alcohol gel

guidelines on the prevention and control of tuberculosis

Documents