Table 2.1, Infection prevention and control precautions for health-care workers and caregivers providing care for patients with acute respiratory infection and tuberculosis - Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care

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Table 2.1Infection prevention and control precautions for health-care workers and caregivers providing care for patients with acute respiratory infection and tuberculosis

Precaution		No pathogen identified, no risk factor for TB or ARI of potential concern (e.g. influenza-like illness without risk factor for ARI of potential concern)	Pathogen
Precaution			Bacterial ARI^a, including plague	TB	Other ARI viruses (e.g. parainfluenza RSV, adenovirus)	Influenza virus with sustained human-to-human transmission (e.g. seasonal influenza, pandemic influenza)	New influenza virus with no sustained human-to-human transmission (e.g. avian influenza)	SARS	Novel ARI^b
Hand hygiene^c		Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Gloves		Risk assessment^d	Risk assessment^d	Risk assessment^d	Yes	Risk assessment^d	Yes	Yes	Yes
Gown^e		Risk assessment^d	Risk assessment^d	Risk assessment^d	Yes	Risk assessment^d	Yes	Yes	Yes
Eye protection		Risk assessment^f	Risk assessment^f	Risk assessment^f	Risk assessment^f	Risk assessment^f	Yes	Yes	Yes
Medical mask for health-care workers and caregivers		Yes	Risk assessment^f	No	Risk assessment^f/Yes^g	Yes	Yes^h	Yesⁱ	Not routinely^b
Particulate respirator for Health-care workers and caregivers	for room entry	No	No	Yes	No	No	Not routinely^h	Not routinelyⁱ	Yes
	within 1 m of patient	No	No	Yes	No	No	Not routinely^h	Not routinelyⁱ	Yes
	for aerosol-generating procedures^j	Yes^k	Yes^k	Yes	Yes^k	Yes^k	Yes^k	Yes	Yes^b^,^k
Medical mask for patient when outside isolation areas^l		Yes	Yes	Yes	Yes^m	Yes	Yes	Yes	Yes
Adequately ventilated separate room		Yes, if availableⁿ	No	No	Yes, if availableⁿ	Yes, if availableⁿ	Yes	Yes	Not routinely^b
Airborne Precaution room^o		No	No	Yes^p	No	No	Not routinely^p	Not routinely^p	Yes^p
Summary of isolation precautions for routine patient care, excluding aerosol-generating procedures^j (Annex B)		Standard	Standard	Standard	Standard	Standard	Standard	Standard	Standard
		Droplet	--	--	Droplet	Droplet	Droplet	Droplet	--
		--	--	--	Contact	--	Contact	Contact	Contact
		--	--	Airborne	--	--	--	--	Airborne

: ARI, acute respiratory infection; IPC, infection prevention and control; RSV, respiratory syncytial virus; SARS, severe acute respiratory syndrome; TB, tuberculosis
a: Bacterial ARI refers to common bacterial respiratory infections caused by organisms such as Streptococcus pneumoniae, Haemophilus influenzae, Chlamydophila spp. and Mycoplasma pneumoniae.
b: When a novel ARI is newly identified, the mode of transmission is usually unknown. Implement the highest available level of IPC precautions, until the situation and mode of transmission is clarified.
c: Perform hand hygiene in accordance with Standard Precautions (Annex B).
d: Gloves and gowns should be worn in accordance with Standard Precautions (Annex B). If glove demand is likely to exceed supply, glove use should always be prioritized for contact with blood and body fluids (nonsterile gloves), and contact with sterile sites (sterile gloves).
e: If splashing with blood or other body fluids is anticipated and gowns are not fluid resistant, a waterproof apron should be worn over the gown.
f: Facial protection, i.e. a medical mask and eye protection (eye visor, goggles) or a face shield, should be used in accordance with Standard Precautions by health-care workers if activities are likely to generate splashes or sprays of blood, body fluids, secretions and excretions onto mucosa of eyes, nose or mouth; or if in close contact with a patient with respiratory symptoms (e.g. coughing/sneezing) and sprays of secretions may reach the mucosa of eyes, nose or mouth.
g: Adenovirus ARI may require use of medical mask
h: As of the publication of this document, no sustained efficient human-to-human transmission of avian influenza A(H5N1) is known to have occurred, and the available evidence does not suggest airborne transmission from humans to humans. Therefore a medical mask is adequate for routine care.
i: The current evidence suggests that SARS transmission in health-care settings occurs mainly by droplet and contact routes; therefore, a medical mask is adequate for routine care
j: See Table K4, Annex K.
k: Some aerosol-generating procedures have been associated with increased risk of transmission of SARS (Annex A; Annex L, Table L.1). The available evidence suggests performing or being exposed to endotracheal intubation either by itself or combined with other procedures (e.g. cardiopulmonary resuscitation, bronchoscopy) was consistently associated with increased risk of transmission of SARS. The risk of transmission of other ARI when performing the aerosol-generating procedures is currently unknown.
l: If medical masks are not available, use other methods for respiratory hygiene (e.g. covering the mouth and nose with tissues or flexed elbow followed by hand hygiene).
m: These are common pathogens in children, who may not be able to comply with this recommendation.
n: Cohort patients with the same diagnosis. If this is not possible, place patient beds at least 1 m (3 feet) apart.
o: Airborne Precaution rooms can be naturally or mechanically ventilated, with adequate ventilation rate of 160 l/s/patient or at least 12 air changes per hour and controlled direction of airflow.
p: Airborne Precaution rooms, if available, should be prioritized for patients with airborne infections (e.g. pulmonary TB, chickenpox and measles) and for those with novel organisms causing ARI.

From: 2, Infection prevention and control recommendations

Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care.

Geneva: World Health Organization; 2014.

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