Airborne precautions, used in addition to standard precautions, prevents the spread of infectious diseases transmitted by airborne pathogens that are breathed, sneezed, or coughed into the environment. (See Diseases requiring airborne precautions.) This precaution category includes the former categories of acid-fast bacillus (AFB) isolation and respiratory isolation.
Effective airborne precautions require a negative-pressure room with the door kept closed to maintain the proper air pressure balance between the isolation room and the adjoining hallway or corridor. An anteroom is preferred. The negative air pressure must be monitored, and the air is either vented directly to the outside of the building or filtered through high-efficiency particulate air (HEPA) filtration before recirculation.
Respiratory protection must be worn by all persons who enter the room. Such protection is provided by a disposable respirator (such as an N95 respirator or HEPA respirator) or a reusable respirator (such as a HEPA respirator or a powered air-purifying respirator [PAPR]). Regardless of the type of respirator used, the health care worker must ensure proper fit to the face each time she wears the respirator. If the patient must leave the room for an essential procedure, he should wear a surgical mask covering his nose and mouth while out of the room.
Equipment
Respirators (either disposable N95 or HEPA respirators or reusable HEPA respirators or PAPRs) • surgical masks • isolation door card • other personal protective equipment as needed for standard precautions.
Gather any additional supplies, such as a thermometer, stethoscope, and blood pressure cuff.
Preparation of equipment
Keep all airborne precaution supplies outside the patient's room in a cart or anteroom.
Implementation
  • Situate the patient in a negative-pressure room with the door closed. If possible, the room should have an anteroom. The negative pressure should be monitored. If necessary, two patients with the same infection may share a room. Explain isolation precautions to the patient and his family.
  • Keep the patient's door (and the anteroom door) closed at all times to maintain the negative pressure and contain the airborne pathogens. Put the airborne precautions sign on the door to notify anyone entering the room.
  • Pick up your respirator and put it on according to the manufacturer's directions. Adjust the straps for a firm but comfortable fit. Check the respiratory seal. (See Respirator seal check.)
  • Instruct the patient to cover his nose and mouth with a facial tissue while coughing or sneezing.
  • Tape an impervious bag to the patient's bedside so the patient can dispose of facial tissues correctly.
  • Make sure all visitors wear respiratory protection while in the patient's room.
  • Limit the patient's movement from the room. If he must leave the room for essential procedures, make sure he wears a surgical mask over his nose and mouth. Notify the receiving department or area of the patient's isolation precautions so that the precautions will be maintained and the patient can be returned to the room promptly.
Special considerations
  • Before leaving the room, remove gloves (if worn) and wash your hands. Remove your respirator outside the patient's room after closing the door.
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  • Depending on the type of respirator and recommendations from the manufacturer, follow your facility's policy and either discard your respirator or store it until the next use. If your respirator is to be stored until the next use, store it in a dry, well-ventilated place (not a plastic bag) to prevent microbial growth. Nondisposable respirators must be cleaned according to the manufacturer's recommendations.

Documentation
Record the need for airborne precautions on the nursing care plan and as otherwise indicated by your facility. Document initiation and maintenance of the precautions, the patient's tolerance of the procedure, and any patient or family teaching. Also document the date airborne precautions were discontinued.