Because children are frequently infected with organisms such as varicella (chickenpox) that are transmissable and dangerous to others, especially immunocompromised patients, it is essential to implement medical asepsis and appropriate barrier precautions when caring for children in the hospital. The Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) have revised the "CDC Guidelines for Isolation Precautions in Hospitals," last published in 1983.
The revised guidelines contain two levels of precautions. The first and most important are those precautions designed for the care of all patients in hospitals, regardless of their diagnosis or presumed infection status. Implementation of these "Standard Precautions" (previously known as universal precautions) is the primary strategy for successful nosocomial infection control. The second level contains precautions designed only for the care of specified patients. These additional "Transmission-based Precautions" are to be used for patients known or suspected to be infected or colonized with epidemiologically important pathogens that can be transmitted by airborne or droplet transmission or by contact with dry skin or contaminated surfaces.
Standard Precautions apply to blood; all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood; nonintact skin; and mucous membranes. Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources.
Transmission-based Precautions are designed for patients known or suspected to be infected with highly transmissable pathogens for which additional precautions (beyond Standard Precautions) are needed to interrupt transmission in hospitals. The three types of Transmission-based Precautions are as follows: Airborne Precautions, designed to reduce the risk of airborne transmission of infectious agents such as measles, varicella (chickenpox), and tuberculosis; Droplet Precautions, designed to reduce the risk of droplet transmission of infectious agents, such as diphtheria, pertussis, Adenovirus, and parvovirus; and Contact Precautions, designed to reduce the risk of transmission of epidemiologically important microorganisms by direct or indirect contact, during such procedures as bathing a patient or changing a dressing.
Nurses caring for young children, who are often susceptible hosts, are frequently in contact with body substances, especially urine, feces, and vomitus, and need to exercise judgement in those situations when gloves, gowns or masks are necessary. When a child wearing diapers has explosive or loose stools, gloves and possibly a gown may be necessary. Otherwise, the plastic lining of disposable diapers provides a sufficient barrier between the hands and body substances. During feedings, gowns should be worn if the child is likely to vomit or spit up, which often occurs during burping. When gloves are worn, wash hands thoroughly after removing gloves because both latex and vinyl gloves fail to provide complete protection. Handwashing between patients and between dirty and clean procedures remains the single most important factor in infection control practice. The disposal of all needles (uncapped and unbroken) in rigid, unpunctured containers near the site of use is also essential.
See Chapter 27 in Nursing Care of Infants and Children, 5th and 6th editions.
See Chapter 22 in Essentials of Pediatric Nursing, 5th edition.
March 15, 2002