Today's POTD is going to be short but sweet.
It's not based on a particular case from The Pitt, but rather emerged from seeing the physical comedy of poor MS4 Whitaker being soaked in various patient fluids at multiple points in the season. As we all know, patient fluids — along with their droplets, aerosolized particles, etc. — can be vectors for the transmission of disease. Recognizing that, today we'll be talking about the primary ways to protect yourself from communicable diseases in the healthcare setting: PPE and isolation precautions!
We're all trained in "standard precautions", a minimal level of common-sense practices that should be used during all patient encounters to reduce risk of infection and transmission.
Hand hygiene
PPE used as needed
Cough etiquette
Clean and disinfect equipment
Clean/replace textiles/laundry
Safe sharps practices
When a patient is suspected to carry certain infectious diseases, "transmission-based precautions" should be added to reduce risk. These include specific recommendations as to what type of PPE one should wear.
Contact precautions are added for pathogens tthat spread through direct contact with the patient or with contaminated materials (blankets, clothing, etc.). This includes suspected C. diff or enterococcus infection, norovirus, uncontrolled diarrhea due to other gastrointestinal infection, MRSA, Candida species, MRSA, lice and scabies, and herpesviruses.
Minimize contact with other patients
Wear gown + gloves for all patient/environmental contact
Cover patient during transport, disinfect rooms/equipment during/after transport
Use dedicated or disposable equipment
Droplet precautions are added for pathogens that spread through respiratory droplets generated by talking, coughing, or sneezing. This includes influenza, Neisseria and HIb meningitis, other meningococcal disease, mumps, pertussis, plague, rhinovirus, rubella, group A streptococcal disease, and COVID in general. For many of these conditions, droplet precautions can be deescalated after 24 hours of appropriately antimicrobial therapy.
Single patient room vs dedicated isolation unit
Source control w/ patient masking, especially during transport
PPE should cover eyes, nose, and mouth, and should be discarded (or sanitized) immediately before room exit
Extra emphasis on "covering the eyes" — see the face shield vs goggles in the CDC graphic below. Regular eyeglasses are inadequate (I am often guilty of this, even though we have masks with integrated face shields readily available in the ED's yellow carts).
Airborne precautions are added for pathogens that can be aerosolized, i.e. carried through the air in small particles that remain airborne for an extended time and are small enough to penetrate many barriers. This includes herpes zoster that is disseminated or in immunocompromised patients, measles, SARS, smallpox, pulmonary or extrapulmonary draining tuberculosis, and COVID with aerosol-generating procedures.
Airborne infection isolation room (if unavailable, patient masking + private room w/ closed room)
Source control w/ patient masking, especially during transport
Use a fit-tested N95+ respirator, which should only be removed after leaving room
Limited contact with susceptible healthcare workers
Often combined with contact precautions (add gown + glove)
Lastly, and most relevantly for Whitaker, procedures should prompt the use of appropriate barrier PPE.
Gloves, always
Mask + eye protection for any procedure that may generate respiratory droplets or fluid splashes
Semipermeable (yellow woven/spun) isolation gown for procedures on patients with contact precautions, light splash risk
Nonpermeable (blue plastic-y) isolation gown for procedures with risk of high volume fluid exposure (bloody traumas, disimpactions)
Sterile gloves, sterile gown, mask, and bouffant cap for all sterile procedures
References:
https://www.cdc.gov/infection-control/hcp/basics/standard-precautions.html
https://www.cdc.gov/infection-control/hcp/basics/transmission-based-precautions.html
https://www.cdc.gov/infection-control/hcp/isolation-precautions/appendix-a-type-duration.html
https://www.fda.gov/medical-devices/general-hospital-devices-and-supplies/personal-protective-equipment-infection-control