MASSACHUSETTS NURSE NEWSLETTER :: January/February
2004
Universal
Respiratory Etiquette: A Revolutionary Approach to Reducing Exposure
to Bacteria and Viruses
By
Evelyn I. Bain, M Ed, RN, COHN-S
Associate Director/Coordinator, Occupational Safety and Health
Specialist
Printed in the Jan./Feb. 2004 issue of the Massachusetts Nurse
Newsletter
Universal
Respiratory Etiquette is a rather simplistic term for an extremely important
infection control practice. In occupational health jargon, it is called
controlling the exposure at the source. More importantly, it is a strategy
and practice that—along with traditional hand washing—would
provide a previously unrecognized measure to protect the health of nurses
and others who are continuously caring for patients who are coughing.
CDC states
that, "In Toronto (in 2003) 77 percent of the patients in the first
phase of the SARS outbreak were infected in the hospital setting and
half of all SARS cases in Toronto were in healthcare workers. These
sick health care workers were exposed to respiratory secretions from
patients with SARS." Research has shown that the SARS virus is
transmitted by other modes as well and that strict attention to hand
washing will also reduce transmission of the virus to healthcare workers.
The "2003
DRAFT Guidelines for SARS" indicate that patients who are coughing
should be wearing surgical masks while they await diagnosis—yes,
like the people walking the streets of China in the spring of 2003.
It appears that hospitals as close as Colorado have adopted this procedure.
A recent clip on the "NBC Today Show" on the 2003 flu season
showed a Colorado hospital ER waiting area full of patients wearing
surgical masks.
What
does the CDC say about Universal Respiratory Etiquette?
In a lengthy document, entitled "Supplement C: Preparedness and
Response in Healthcare Facilities," a discussion of infection control
and respiratory etiquette identifies several objectives of increasing
infection control practices:
-
Provide
surgical masks to all patients with symptoms of a respiratory illness.
Provide instructions on the proper use and disposal of masks.
-
For
patients who cannot wear a surgical mask, provide tissues and instructions
on when to use them (i.e., when coughing, sneezing, or controlling
nasal secretions), how and where to dispose of them, and the importance
of hand hygiene after handling this material.
-
Provide
hand-hygiene materials in waiting room areas and encourage patients
with respiratory symptoms to perform hand hygiene.
-
Designate
an area in waiting rooms where patients with respiratory symptoms
can be segregated (ideally by at least three feet) from other patients
who do not have respiratory symptoms.
-
As
soon as possible, place patients with respiratory symptoms in a private
room or cubicle as soon as possible for further evaluation.
-
Implement
use of surgical or procedure masks by health care personnel during
the evaluation of patients with respiratory symptoms.
-
Consider
the installation of Plexiglas barriers at the point of triage or registration
to protect health care personnel from contact with respiratory droplets.
-
If
no barriers are present, instruct registration and triage staff to
remain at least three feet from unmasked patients and to consider
wearing surgical masks during respiratory infection season.
-
Continue
to use droplet precautions in order to manage patients with respiratory
systems until it is determined that the cause of symptoms is not an
infectious agent that requires precautions beyond standard precautions.
The use
of surgical masks to protect health care workers is a diversion from
the use of N95 respirators that are required for TB and diagnosed SARS
cases. The rationale is that surgical masks provide a measure of protection
for healthcare workers exposed to airborne droplets. They are useful
when worn by patients because the masks will capture and contain the
bacteria and viruses in large droplets of sputum that are expelled as
patients cough. N95 respirators, and more protective equipment such
as powered air purifying respirators (PAPRs), are still required when
caring for patients who have been diagnosed with TB or SARS.
This document,
"2003 DRAFT Guidelines for SARS," is available in its entirety
at www.cdc.gov. Universal Respiratory
Etiquette is described on pages nine and 10 of "Supplement C: Preparedness
and Response in Healthcare Facilities."
You do
not have to wait for guidelines or suggested practices to be adopted
by CDC. With the early onset of influenza in the fall of 2003, adopting
Universal Respiratory Etiquette can break the chain of health care worker
exposures that often results in the transmission of flu and other illnesses.
For help
in moving this issue at your hospital, contact your bargaining unit
chairperson or Evie Bain or Chris Pontus
at the MNA.
