Guidelines on the Prevention and Control of Tuberculosis in Ireland

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<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCClinicalWorkPracticePatientPlacement(cont)ClinicalWorkPracticeHandHygieneentering to report to the nurse in charge before enteringPatients should be educated regarding the reason/indication for AirbornePrecautions and requested not to leave the room unless absolutely necessarySTANDARD PRECAUTIONS AIRBORNE PRECAUTIONSHCWs should include the potential for transmission of infectiousagents in patient placement decisionsWhere possible, place patients who contaminate the environment orcannot maintain appropriate hygiene in isolation rooms with en suitetoilet facilities and ante roomEmergency departments (ED) without an airborne isolation room must have aprocess in place to prioritise transfer of patients with suspected or confirmedTB to an appropriate room. ED departments without any airborne isolationrooms should place a surgical mask on the patient and place him/her in anexamination room or single room while awaiting transfer. This room shouldbe left vacant for 1 hour once the patient is transferred to allow for a fullexchange of air.Aerosol-generating procedures such as sputum induction and theadministration of medications by nebuliser must be avoided while a patientwith suspected or confirmed TB is in an open bay or an unventilated area inany wardBronchoscopy should preferably be performed in an appropriate negativepressure suite with adequate ventilation. Unnecessary staff and other patientsshould be excluded during the procedure. If endoscopy rooms are without airhandling equipment, the procedure should be done at the end of the list forthe day, or in the patient’s room. Avoid placement of recovering patients in amulti-bedded ward post procedure.Procedures on an extrapulmonary TB open abscess or lesion whereaerosolisation of drainage fluid may occur should only be undertaken in anairborne isolation roomSTANDARD PRECAUTIONS AIRBORNE PRECAUTIONSHand hygiene is recommended;••••••Before and after each episode of patient contactBetween individual patient contactsAfter contact with blood, body fluids, secretions orexcretions, whether or not gloves are wornAfter handling soiled/contaminated equipment, materials orthe environmentImmediately before glove applicationImmediately after removing gloves or other protectiveclothingAntiseptic soap or alcohol gel if hands are physically clean before and afterpatient careHands should be decontaminated using soap and water or alcoholgel if physically clean. Antiseptic soap should be used prior toaseptic procedures.Patients should wash their hands after toileting and before meals.-173-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCClinicalWorkPracticeHandHygieneClinicalWorkPracticePatientMovement andTransfermulti-bedded ward post procedure.Procedures on an extrapulmonary TB open abscess or lesion whereaerosolisation of drainage fluid may occur should only be undertaken in anairborne isolation roomSTANDARD PRECAUTIONS AIRBORNE PRECAUTIONSHand hygiene is recommended;••••••Before and after each episode of patient contactBetween individual patient contactsAfter contact with blood, body fluids, secretions orexcretions, whether or not gloves are wornAfter handling soiled/contaminated equipment, materials orthe environmentImmediately before glove applicationImmediately after removing gloves or other protectiveclothingAntiseptic soap or alcohol gel if hands are physically clean before and afterpatient careHands should be decontaminated using soap and water or alcoholgel if physically clean. Antiseptic soap should be used prior toaseptic procedures.Patients should wash their hands after toileting and before meals.HCWs should assist those patients unable to perform hand hygieneindependently.Visitors should be educated on the importance of handdecontamination before and after visiting.(SARI) <strong>Guidelines</strong> on Hand Hygiene are available at www.hpsc.ie/hpsc/A-Z/Gastroenteric/Handwashing/STANDARD PRECAUTIONS AIRBORNE PRECAUTIONSNo special precautions recommended Limit movement and transport of patient to essential purposes onlyPrior to patient transfer•••Prior to accepting a patient with known or suspected infectious TB it is theresponsibility of the receiving facility to ensure compliance with isolationroom requirements as described above under patient placement. It isthe responsibility of the facility transferring the patient to provide theinformation.Inform transport personnel (emergency medical technicians, porters) andthe receiving department of the need for Airborne PrecautionsRequest patient to wear a surgical mask which should be changed whenheavily contaminated with respiratory secretions and/or wet or if torn.Instruct patient on respiratory hygiene and cough etiquette and ensurethe patient has a supply of tissues.-174-
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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