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Infection Control at SickKids

Two types of precautions are in place to prevent the transmission/acquisition of infections at SickKids. 

  1. Routine Practices, designed for the care of all patients in the hospital regardless of diagnosis or presumed infection status. 
  2. Additional Precautions, required to interrupt the routes of transmission of infectious agents which are known or suspected to be spread by the airborne, contact or droplet route.

Routine Practices

Routine practices involve the use of barrier techniques to decrease the risk of transmission of microorganisms. Because all human blood, moist body substances and non-intact skin are capable of harbouring infectious pathogens, barrier techniques are to be used for all procedures/actions/situations where there is risk of exposure to blood or body fluids regardless of diagnosis or presumed infection status. This includes blood, body fluids, secretions and excretions (except sweat), breast milk, non-intact skin, mucous membranes and undiagnosed rashes, and to items or environmental surfaces contaminated by any of these. Routine practices emphasize the need for informed decision making in the use of barriers in conjunction with hand hygiene, based upon individual assessment of the degree of exposure personnel expect to have with body substances, mucous membranes, non-intact skin or undiagnosed rashes.

Additional Precautions

Signs are posted on patient room doors or above the bed to remind caregivers of the additional infection control precautions required for the patient they are caring for.  

Contact Precautions 

Contact transmission includes direct and indirect transmission. Direct contact transmission occurs with the transfer of microorganisms by direct physical contact. Indirect contact involves the transfer via an intermediate object such as contaminated hands or equipment.

  • Gastroenteritis (e.g. Rotavirus, Torovirus, Salmonellosis)
  • Enteroviral Infections (e.g. hand-foot-and-mouth disease)
  • Hepatitis A
  • Herpes Simplex (contained)
  • ARO (Antibiotic Resistant Organisms)
  • Head Lice
  • Scabies

Contact Precautions "R"

These precautions should be initiated for Clostridium difficile infection.

Patient room and equipment requires cleaning with sporicidal agent. Avoid sharing equipment with other patients.

Contact Precautions "Mask"

These precautions should be initiated for Methicillin Resistant Staphylococcus Aureus (MRSA).

Droplet/ Contact Precautions 

Droplet transmission accounts for transmission of organisms via large droplets (five microns in diameter). These droplets are released during coughing, sneezing, speaking, crying or during procedures such as suctioning or bronchoscopy. They are propelled short distances (< 2 m) through the air and can contaminate the mucous membranes of the nose, eyes or mouth. As well, organisms can settle on objects in the immediate environment of the patient and can be transmitted by unwashed hands to other individuals (contact transmission). These large droplets do not remain suspended in the air. 

  • Respiratory infections  (Influenza, Parainfluenza, RSV, Adenovirus)
  • Pertussis
  • Mumps
  • Meningitis

Enhanced Droplet/Contact Precautions 

These precautions should be initiated when there is an international, regional or local health alert of an epidemiologically significant respiratory pathogen. Infection Prevention and Control will advise if and when to institute.
Precautions include the use of an N95 mask, gown, gloves, and eye protection.

  • SARS
  • Pandemic Influenza strains
  • Other epidemiologically significant pathogens not yet identified


Airborne Precautions 

Airborne transmission refers to dissemination of microorganisms by aerosolization. Organisms are contained in small airborne particles (< 5 μm in diameter) or in dust particles that remain suspended in the air for long periods of time. These microorganisms are widely dispersed in air currents and inhaled by others who may be some distances away. 

  • Pulmonary tuberculosis 
  • Varicella (Chicken pox) 
  • Disseminated zoster (Shingles);
  •  Measles (Rubeola)

Patients require Single Room with negative pressure airflow. 

Hand Hygiene

Hand hygiene is the single most important process in the prevention of infection transmission. The use of waterless hand rinses is preferred unless hands are wet, grossly soiled or if directed otherwise by Infection Prevention & Control. Indications for hand hygiene include but are not limited to the “4 Moments of Hand Hygiene”


1. Before initial patient/patient environment contact - Before entering the patient room or the patient’s space. To protect the patient/ patient environment from harmful organisms carried on your hands.

2. Before aseptic procedure - Before starting IVs, inserting urine catheters, dressing changes, etc. To protect the patient against harmful organisms, including the patient's own organisms, entering the body.

3. After body fluid exposure risk. - To protect yourself and the health care environment from harmful patient organisms. ALWAYS clean hands after removing gloves

4. After patient/patient environment contact - Before leaving the room. To protect yourself and the health care environment from harmful patient organisms.