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Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care. Geneva: World Health Organization; 2014.

Cover of Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care

Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care.

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Annex JInfection prevention and control across the continuum of health care

The principles of IPC are the same across the continuum of health care. Areas that require particular attention such as emergency and outpatient care, paediatric acute care and home care for ARI patients, are discussed in this section.

J.1. Emergency and outpatient care

Measures for countries with no reported ARIs of potential concern

In countries with no reported ARIs of potential concern, implement the following measures:

  • Post signage that alerts people with severe acute febrile respiratory illness to notify staff immediately, and to use respiratory hygiene (255).
  • Assess patients with acute febrile respiratory illness as promptly as possible.
  • Consider designating separate areas for patients with acute febrile respiratory illness, and whenever possible keep a distance of 1 m between each patient in the waiting area.
  • Provide tissues in the waiting area so that patients can contain respiratory secretions when coughing or sneezing whenever possible. Provide receptacles for disposal of used tissues (if possible, these should be no-touch receptacles).
  • Give people with acute febrile respiratory illness medical masks on entry, if possible.
  • Encourage hand hygiene after contact with respiratory secretions, and provide hand-hygiene facilities (e.g. sinks equipped with water, soap and single-use towel, alcohol-based hand rub) in waiting areas whenever possible.
  • Clean environmental surfaces in waiting and patient-care areas at least daily and when visibly soiled.
  • Ensure that patient-care equipment is appropriately cleaned and disinfected between patients.
  • Use Standard and Droplet Precautions when providing close contact care to patients with acute febrile respiratory illness.
  • Undertake any aerosol-generating procedures associated with an increased risk of ARI transmission in a well-ventilated separate room, and ensure that health-care workers use appropriate PPE (Chapter 2, Section 2.4).
  • If a patient known or suspected to be infected with an ARI of potential concern is referred to another facility, notify receiving staff of the necessary IPC precautions.

Additional measures for countries with reported ARIs of potential concern

In countries with reported ARIs of potential concern, implement the following additional measures:

  • During pandemics, apply strategies to limit unnecessary office visits by ill patients; for example, divert patients to designated pandemic influenza triage and evaluation sites, and use pre-facility triage to determine which patients need on-site medical evaluation.
  • Educate the public about the clues (i.e. signs or symptoms) of ARIs of potential concern, and ask them to seek medical care promptly for assessment and admission.
  • Establish triage criteria to promptly identify people at risk of infection with an ARI of potential concern.
  • If an ARI of potential concern is suspected, ensure that health-care workers use appropriate PPE (Chapter 2, Table 2.1), as available.
  • After a patient known or suspected to be infected with an ARI of potential concern has left the ambulatory-care setting, clean surfaces in the examination room or other areas where the patient was located, and clean and disinfect any patient-care equipment used for the patient.

J.2. Acute paediatric care

Implementing IPC measures for paediatric patients requires special consideration:

  • Family members are essential for the emotional support of children admitted to hospital (56, 256). The child's right to be accompanied by a parent, relative or legal guardian at all times should be guaranteed (257).
  • Family members can be critical in assisting in the care of hospitalized children, particularly if there is a shortage of health-care workers (117).
  • Children are likely to be infectious with ARIs for longer than adults; this may affect the duration of IPC precautions (105).
  • Paediatric patients may not be able to comply with respiratory hygiene.
  • Some pathogens are more prevalent among children and require additional precautions; for example, Contact Precautions for respiratory syncytial virus or parainfluenza virus; and Contact plus Droplet Precautions for adenovirus or metapneumovirus (244).
  • Contamination of the environment may be more prominent with children than with adult or continent patients.
  • Clean and disinfect toys between different children, and take precautions when gathering patients in the playroom (follow the same principles as for cohorting) (258-261).

J.3. Home care for patients with acute respiratory infection

During a public-health emergency, such as a pandemic, it may not be possible to provide acute or ambulatory-care services for all who might need them. Also, ambulatory-care facilities may be unable to meet the demand for health-care services, and may only be able to provide care for the most severely ill patients (262). In this situation, patients infected with ARIs of potential concern may require care at home, and they may still be infectious to household contacts (263, 264).

Infection prevention and control for the home setting

ARIs can spread easily within a household. Anyone who has not already been infected is at risk of infection if they come into contact with an ARI patient. Thus, household members should observe the following recommendations:

  • If a household member develops symptoms of ARI, including fever, cough, sore throat and difficulty breathing, they should follow public-health recommendations.
  • Limit contact with the ill person as much as possible. Stay in a different room or, if that is not possible, stay as far away from the ill person as possible (e.g. sleep in a separate bed).
  • Ensure that shared spaces (e.g. restrooms, kitchen and bathroom) are well ventilated (e.g. keep windows open).
  • If close contact care must be provided to the ill person, ensure that the ill person covers his or her mouth or nose with hands or other materials (e.g. tissues, handkerchiefs or, if available, a mask);
  • Discard materials used to cover the mouth or nose, or clean them appropriately.
  • Avoid direct contact with body fluids. If contact occurs, perform hand hygiene immediately afterwards.
  • Perform hand hygiene, either by washing with soap and water or using an alcohol-based hand rub. Address safety concerns (e.g. accidental ingestion and fire hazards) before recommending alcohol-based hand rubs for household use.
  • Ensure that anyone who is at increased risk of severe disease does not care for the ill person or come into close contact with the ill person. For seasonal influenza, people at increased risk include those with heart, lung or kidney disease; diabetes; immunosuppression; blood disease (e.g. sickle cell anaemia); pregnancy; and aged over 65 years or under 2 years.
  • Avoid other types of possible exposure to the ill person or contaminated items; for example, avoid sharing toothbrushes, cigarettes, eating utensils, drinks, towels, washcloths or bed linen.

    Ensure that people caring for a family member suffering from an ARI of potential concern limit their contact with each other, and follow national or local policies regarding home quarantine recommendations. where possible, the caregiver also wears a medical mask or the best available protection against respiratory droplets when in close contact with the ill person, and performs hand hygiene (265).

Actions to take if a contact of a patient with an ARI of potential concern becomes ill

  • Notify the health-care provider of the diagnosis and receive instructions on where to seek care, when and where to enter the health-care facility, and the IPC precautions that are to be followed.
  • Avoid public transportation if possible; call an ambulance or transport the ill person with own vehicle and open the windows of the vehicle.
  • Always perform respiratory hygiene.
  • Stand or sit as far away from others as possible (at least 1 m), when in transit and when in the health-care facility.
  • Use hand hygiene whenever appropriate.
Copyright © World Health Organization 2014.

All rights reserved. Publications of the World Health Organization are available on the WHO web site ( or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob).

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Bookshelf ID: NBK214349


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