Transmission
The organisms that cause disease can be transmitted in many ways, with some diseases transmitting in multiple ways. The transmission types that a practice needs to consider are:
Standard precautions
Standard precautions must be taken by all staff involved in patient care to achieve a basic level of infection prevention and control. Standard precautions include:
- hand hygiene
- routine use of PPE
- respiratory hygiene and cough etiquette
- safe sharps and clinical waste management
- waste disposal, laundry and cleaning services
- reprocessing of reusable equipment
- environmental cleaning, spills management
- aseptic technique.
Transmission routes
Contact transmission: may occur through direct/ indirect contact with contaminated objects (equipment, shared surfaces) or people (contact with contaminated hands, blood or body substances).
Droplet transmission: may occur when large droplets are produced from coughing, sneezing or clinical procedures such as throat examination/ suction or via nebuliser treatment.
Airborne transmission: may occur where small particles are released from coughing, sneezing, from clinical care or during procedures such as spirometry and are small enough to be dispersed on air currents to remain suspended in the air for extended periods of time.
Droplet and airborne transmission are not distinctly separate modes; transmission through the air is now understood to apply to a continuum of particle sizes, from large droplets to smaller particles that dry and remain airborne for hours. Transmission via aerosols (suspensions of liquid or solid in air) spans droplet and airborne modes.
Transmission based precautions are applied when patients or practice staff are suspected or known to be infected with a highly transmissible infection.
Transmission based precautions are used in conjunction with standard precautions to further reduce transmission opportunities arising from contact, droplet or airborne transmission.
Transmission-based precautions
Contact precautions are used when there is a risk of direct or indirect transmission by contact route. Based on risk assessment for specific staff roles and transmission route, contact precautions may include:
- hand hygiene
- use of gloves for direct contact with infectious patients, patient equipment and contaminated surfaces
- wearing fluid impermeable gowns if there is anticipated risk of clothing being contaminated via contact with the patient or environment
- correct donning and doffing of PPE to avoid inadvertent contamination.
Droplet precautions should be used if there is a risk of infectious disease being transmitted by coughing, sneezing or talking. In addition to the above, droplet precautions include:
- staff vaccination for vaccine-preventable respiratory diseases
- patient use of surgical masks and respiratory etiquette
- use of triage, physical distancing or telehealth to minimise exposure to others
- practice staff use of surgical mask and protective eyewear
- correct donning and doffing of PPE to avoid inadvertent contamination.
Airborne precautions are used when there is a risk of infectious disease transmission by aerosol route. In addition to the above, airborne precautions include use of:
- Particulate Filter Respirator (PFR) (e.g., P2/N95 or high efficiency filtration mask use)
- protective eyewear (e.g., goggles/ face shields).