Bioterrorism and infection control: How to protect HCWs

Most bioterrorism agents, such as anthrax, are not transmitted from person to person and simply require the use of standard precautions when caring for victims, the Centers for Disease Control and Prevention (CDC) in Atlanta advises. However, some possible agents (notably smallpox and the plague) require a higher level of protection. Here are the recommendations, as published in the Bioterrorism Readiness Plan: A Template for Healthcare Facilities (www.cdc.gov/ncidod/hip/Bio/bio.htm), which was prepared by CDC and the Association of Professionals in Infection Control and Epidemiology in Washington, DC.

All patients in health care facilities, including symptomatic patients with suspected or confirmed bioterrorism-related illnesses, should be managed using standard precautions. Standard precautions are designed to reduce transmission from both recognized and unrecognized sources of infection in health care facilities, and are recommended for all patients receiving care, regardless of their diagnosis or presumed infection status. Standard precautions prevent direct contact with all body fluids (including blood), secretions, excretions, nonintact skin (including rashes), and mucous membranes. Standard precautions routinely practiced by health care providers include:

Hand washing. Hands are washed after touching blood, body fluids, excretions, secretions, or items contaminated with such body fluids, even when gloves are worn. Hands are washed immediately after gloves are removed, between patient contacts, and as appropriate to avoid transfer of microorganisms to other patients and the environment. Either plain or antimicrobial soaps may be used according to facility policy.

Gloves. Clean, nonsterile gloves are worn when touching blood, body fluids, excretions, secretions, or items contaminated with such body fluids. Clean gloves are put on just before touching mucous membranes and nonintact skin. Gloves are changed between tasks and between procedures on the same patient if contact occurs with contaminated material. Hands are washed promptly after removing gloves and before leaving a patient care area.

Masks/eye protection or face shields. A mask and eye protection (or face shield) are worn to protect mucous membranes of the eyes, nose, and mouth while performing procedures and patient care activities that may cause splashes of blood, body fluids, excretions, or secretions.

Gowns. A gown is worn to protect skin and prevent soiling of clothing during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, excretions, or secretions. Selection of gowns and gown materials should be suitable for the activity and amount of body fluid likely to be encountered. Soiled gowns are removed promptly and hands are washed to avoid transfer of microorganisms to other patients and environments.

For pneumonic plague, droplet precautions should be used in addition to standard precautions.

— Droplet precautions are used for patients known or suspected to be infected with microorganisms transmitted by large particle droplets, generally larger than 5 µ in size, that can be generated by the infected patient during coughing, sneezing, talking, or during respiratory-care procedures.

— Droplet precautions require health care providers and others to wear a surgical-type mask when within 3 feet of the infected patient. Based on local policy, some health care facilities require a mask be worn to enter the room of a patient on droplet precautions.

— Droplet precautions should be maintained until patient has completed 72 hours of antimicrobial therapy.

For patients with suspected or confirmed smallpox, both airborne and contact precautions should be used in addition to standard precautions.

— Airborne precautions are used for patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei (small particle residue, 5 µ or smaller in size) of evaporated droplets containing microorganisms that can remain suspended in air and can be widely dispersed by air currents.

— Airborne precautions require health care providers and others to wear respiratory protection when entering the patient room. (Appropriate respiratory protection is based on facility selection policy; must meet the minimal NIOSH standard for particulate respirators, N95).

— Contact precautions are used for patients known or suspected to be infected or colonized with epidemiologically important organisms that can be transmitted by direct contact with the patient or indirect contact with potentially contaminated surfaces in the patient’s care area.

— Contact precautions require health care providers and others to:

  • Wear clean gloves upon entry into patient room.
  • Wear gown for all patient contact and for all contact with the patient’s environment. Based on local policy, some health care facilities require a gown be worn to enter the room of a patient on contact precautions. Gown must be removed before leaving the patient’s room.
  • Wash hands using an antimicrobial agent.