Basic Infection Control and Prevention Plan for Outpatient Oncology Settings
Download the complete Basic Infection Control and Prevention Plan for Outpatient Oncology Settings [PDF - 522 KB]
V. Transmission-Based Precautions
In addition to consistent use of Standard Precautions, additional precautions may be warranted in certain situations as described below.
A. Identifying Potentially Infectious Patients
- Facility staff remain alert for any patient arriving with symptoms of an active infection (e.g., diarrhea, rash, respiratory symptoms, draining wounds or skin lesions)
- If patient calls ahead:
- Have patients with symptoms of active infection come at a time when the facility is less crowded, if possible
- Alert registration staff ahead of time to place the patient in a private exam room upon arrival if available and follow the procedures pertinent to the route of transmission as specified below
- If the purpose of the visit is non-urgent, patients are encouraged to reschedule the appointment until symptoms have resolved
B. Contact Precautions
- Apply to patients with any of the following conditions and/or disease:
- Presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure ulcers, or presence of ostomy tubes and/or bags draining body fluids
- Presence of generalized rash or exanthems
- Prioritize placement of patients in an exam room if they have stool incontinence, draining wounds and/or skin lesions that cannot be covered, or uncontrolled secretions
- Perform hand hygiene before touching patient and prior to wearing gloves
- PPE use:
- Wear gloves when touching the patient and the patient’s immediate environment or belongings
- Wear a gown if substantial contact with the patient or their environment is anticipated
- Perform hand hygiene after removal of PPE; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus)
- Clean/disinfect the exam room accordingly (refer to Section IV.F.4.)
- Instruct patients with known or suspected infectious diarrhea to use a separate bathroom, if available; clean/disinfect the bathroom before it can be used again (refer to Section IV.F.5. for bathroom cleaning/disinfection)
C. Droplet Precautions
- Apply to patients known or suspected to be infected with a pathogen that can be transmitted by droplet route; these include, but are not limited to:
- Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus, respiratory syncytial virus, human metapneumovirus)
- Bordetella pertusis
- For first 24 hours of therapy: Neisseria meningitides, group A streptococcus
- Place the patient in an exam room with a closed door as soon as possible (prioritize patients who have excessive cough and sputum production); if an exam room is not available, the patient is provided a facemask and placed in a separate area as far from other patients as possible while awaiting care.
- PPE use:
- Wear a facemask, such as a procedure or surgical mask, for close contact with the patient; the facemask should be donned upon entering the exam room
- If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles (or face shield in place of goggles) should be worn
- Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
- Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients, and practice respiratory hygiene and cough etiquette
- Clean and disinfect the exam room accordingly (refer to Section IV.F.4.)
D. Airborne Precautions
- Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route; these include, but are not limited to:
- Tuberculosis
- Measles
- Chickenpox (until lesions are crusted over)
- Localized (in immunocompromised patient) or disseminated herpes zoster (until lesions are crusted over)
- Have patient enter through a separate entrance to the facility (e.g., dedicated isolation entrance), if available, to avoid the reception and registration area
- Place the patient immediately in an airborne infection isolation room (AIIR)
- If an AIIR is not available:
- Provide a facemask (e.g., procedure or surgical mask) to the patient and place the patient immediately in an exam room with a closed door
- Instruct the patient to keep the facemask on while in the exam room, if possible, and to change the mask if it becomes wet
- Initiate protocol to transfer patient to a healthcare facility that has the recommended infection-control capacity to properly manage the patient
- PPE use:
- Wear a fit-tested N-95 or higher level disposable respirator, if available, when caring for the patient; the respirator should be donned prior to room entry and removed after exiting room
- If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles or face shield should be worn
- Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and/or body fluids and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
- Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients , and practice respiratory hygiene and cough etiquette
- Once the patient leaves, the exam room should remain vacant for generally one hour before anyone enters; however, adequate wait time may vary depending on the ventilation rate of the room and should be determined accordingly*
- If staff must enter the room during the wait time, they are required to use respiratory protection
*Francis J. Curry National Tuberculosis Center, FAQ: “How long does it take to clear the air in an isolation or high-risk procedure room?” [PDF - 461 KB]
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