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Infection Prevention, and Control Guidelines for Primary Care Physicians
Contact Precautions
Introduction:
Contact transmission is the most important and frequent mode of transmission of health care associated infections. Transmission occurs when transfer of microorganisms results from direct physical contact between an infected or colonized individual and a susceptible host. Indirect contact involves passive transfer of microorganisms to a susceptible host via an intermediate object, such as contaminated hands that are not washed between patients or contaminated instruments or other inanimate objects in the patient environment.
Consider the following for all patients with infectious diseases that are spread by direct and or indirect contact.
Disease Examples:
- Clostridium Difficile
- Gastroenteritis
- Undiagnosed Diarrhea
- Scabies
- Pediculosis (Head Lice)
- Zoster-limited (Shingles)
- Undiagnosed Rash
- Antibiotic Resistant Organisms
i.e. MRSA, VRE, ESBL
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Best Practices:
As well as universal routine practices, Contact Precautions include the following:
1. If clinical status allows, assess these patients at the end of the office day
2. When patient arrives, instruct to perform hand hygiene
3. Quickly triage patient out of common waiting areas, assure that the patient is separate form other patients
4. Move patient to examination room
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Door may remain open
- Inform care provider of risk via verbal, signage or flagging chart.
5. For direct patient care
Perform hand hygiene
- Wear gloves
- Wear fluid resistant gown if soiling of clothing is likely
6. At the end of office visit
Perform hand hygiene
- Wipe all horizontal surfaces (with low level disinfectant) in the examining room that have been in contact with the patient
- Wipe all equipment (with low level disinfectant) used to examine the patient (blood pressure cuff, stethoscope, etc.)
References:
Health Canada, (1999), Routine practices and additional precautions for preventing the transmission of infection in health care, Vol. 25S4.
Canadian Committee on Antibiotic Resistance (2007) Infection Prevention and Control Best Practices for Long Term Care, Home and Community Care including Health Care Offices and Ambulatory Clinics
Centers for Disease Control, (1996), Guideline for isolation precautions in hospitals, http://www.cdc.gov/ncidod/hip/ISOLAT/contact_prec_excerpt.htm
College of Physicians and Surgeons of Ontario (2004) Infection Control in the Physicians Office
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