The pre-final 2024 guideline states that in the healthcare setting , pathogen transmission pathways can be grouped into two broad categories : Pathogens that spread via the air , and pathogens that spread via touch .
Pathogens generally spread via a major pathway , although multiple pathways might contribute to the spread .” and eye protection are worn by HCP on room entry .
( Expert Opinion ) b . A private room is indicated . ( Expert Opinion ) c . Rooms should be appropriately ventilated , but an AIIR is not routinely needed . ( Expert Opinion ) d . Source control masking is indicated for the patient when they leave their room ( e . g ., for transport to a procedure ). ( Expert Opinion )
➌ Extended Air Precautions : a . A NIOSH-approved ® fit-tested N95 ( or higher-level ) respirator is worn by HCP on room entry , and eye protection is used based on Standard Precautions . ( Standard Practice ) b . A private room is indicated . ( Standard Practice ) c . An AIIR is required . ( Standard Practice ) d . Source control masking is indicated for the patient when they leave their room . ( Standard Practice ) e . Travel outside the room should be limited ( e . g ., for necessary procedures and treatments ). ( Standard Practice )
As the pre-final guideline explains , “ Routine Air Precautions are focused on reducing transmission of common , often endemic , respiratory pathogens that spread predominantly over short distances based on observed patterns of transmission , and for which individuals and their communities are likely to have some degree of immunity . Special Air Precautions are applied to patients with a respiratory pathogen , typically new or emerging , that is not observed or anticipated to spread efficiently over long distances ( such as through ventilation systems ), for which infection generally leads to more than mild illness , and where immunity ( or vaccine ) and effective treatment are not available . Extended Air Precautions are used when providing care to patients with pathogens that are observed to spread efficiently across long distances and over extended times , such that room air needs to be contained ( e . g ., prevented from moving into the hallway where individuals are not appropriately protected ). While not required for Routine Air Precautions , HCP may choose voluntarily to wear a NIOSH-approved ® N95 ( or higher-level ) respirator , per existing federal regulations . For Routine and Extended Air Precautions , eye protection may be added as required PPE based on infection control risk assessment performed by the facility for specific pathogens ( e . g ., implementing eye protection for care of all patients with respiratory viral infections during periods of high incidence in the community or facility ). For Special Air Precautions , although an AIIR is not routinely recommended , an AIIR may be suggested for certain pathogens listed in Appendix A ( 2007 ), and for pathogens with uncertain transmission characteristics .”
• Updating the conceptual framework for respiratory pathogen transmission , including a continuum of pathogen transmission by air , rather than the dichotomy
of “ droplet ” versus “ airborne ” transmission .
The pre-final 2024 guideline states that in the healthcare setting , pathogen transmission pathways can be grouped into two broad categories : Pathogens that spread via the air , and pathogens that spread via touch . Pathogens generally spread via a major pathway , although multiple pathways might contribute to spread .
Regarding transmission via air , the pre-final 2024 guideline explains that “ Pathogens can transmit via air over short distances through direct splash or spray of the pathogen onto a part of the body ( e . g ., spray from a sneeze landing on a person ’ s eyes or mouth ) or variably across ranges of distance and time via suspended infectious particles . Pathogens suspended in the air cause infection via inhalation and deposition along the respiratory tract , anywhere from the nasal or oral passages to the lungs . Historically , the infection prevention community has categorized transmission of respiratory pathogens as ‘ droplet ’ or ‘ airborne .’ While these epidemiologic terms reflect observed patterns of short versus long distance transmission respectively , the terms do not explicitly describe the continuum of respiratory pathogen transmission through in the air . Pathogens that spread via the air preferentially transmit over short distances , due to greater concentrations of infectious particles in the air near an infectious person . However , each pathogen has a signature pattern of observed transmission that extends variably across short-to-long distances and over time , reflecting unique characteristics such as pathogen viability while suspended in the air and the required dose for causing an infection in a susceptible person . Pathogens that remain infectious for a long time while suspended in the air ( e . g ., M . tuberculosis , measles virus , and varicella virus ) can cause infections over long distances , such as across a large part of a building or healthcare facility .”
Months before HICPAC met in November to conduct a final review and revision of the recommendations of the workgroup , reports in the media began documenting outrage on the part of some healthcare professionals , nursing unions , and consumers who asserted that HICPAC was weakening the protections of healthcare personnel by recommending the wearing of surgical masks over N95 respirators when caring for patients with more common viruses considered to be endemic , such as seasonal influenza , though this is the current guidance in the 2007 guideline . HICPAC released its draft recommendations in June , inciting dissatisfaction with its review of studies that identified no difference in infection rates among healthcare professionals who wore N95 masks versus surgical masks in the healthcare facility . As we know , a very large number of studies emerged during the pandemic that found equivalence between these two pieces of PPE , as well as trials that contradicted those findings .
18 december 2023 • www . healthcarehygienemagazine . com