Enteric precautions are infection control measures implemented in healthcare and community settings to prevent the spread of gastrointestinal pathogens. This protocol supplements standard precautions and is specifically designed to interrupt the transmission of infectious agents shed in feces. The goal is to contain microscopic contaminants and prevent them from reaching a new host, thereby controlling outbreaks of infectious diarrhea.
Understanding Fecal-Oral Transmission
Enteric precautions are necessary because many pathogens spread through the fecal-oral route. This occurs when microscopic amounts of fecal matter from an infected person are ingested by a susceptible host. Transmission can be direct, such as through poor hand hygiene, or indirect, involving intermediate steps.
Contaminated hands are a common vector, transferring pathogens to surfaces, food, or directly to another person. Environmental surfaces, like doorknobs, bed rails, and shared equipment, can become reservoirs for these germs. Food and water can also become contaminated, such as through irrigation with polluted water or improper handling.
The infectious dose for some enteric pathogens is extremely low, meaning only a few particles are needed to cause illness. This high infectivity combined with widespread environmental contamination makes strict control measures essential for breaking the chain of transmission.
Essential Steps for Safety Protocols
The implementation of enteric precautions centers on rigorous personal and environmental hygiene, with specific procedural requirements. Hand hygiene is the most important step, but the technique must be adjusted for certain enteric pathogens. For organisms that form spores, such as Clostridioides difficile, alcohol-based hand sanitizers are ineffective because they cannot destroy the protective casing.
In these cases, scrubbing hands thoroughly with soap and water is required because the mechanical action physically removes the spores from the skin. Healthcare providers and visitors must wash their hands upon entering and leaving the patient’s room. This physical removal process is superior to the germ-killing action of alcohol rubs for spore-forming bacteria.
The use of Personal Protective Equipment (PPE) is required when caring for an individual under enteric precautions. This involves wearing a gown and gloves before entering the contaminated environment to prevent soiling clothes or skin. The procedure for removing this equipment is equally important to avoid self-contamination.
Gowns and gloves should be removed together inside the patient’s room, turning the contaminated outer surfaces inward. This technique bundles the soiled items, minimizing the risk of transferring pathogens to the user. Environmental cleaning requires specialized disinfection agents, often chlorine-based (bleach) solutions, which possess sporicidal properties that overcome the resistance of enteric pathogens.
Specific Infections Requiring Enteric Precautions
A range of specific infections necessitates the use of enteric precautions due to their mode of spread and resistance to standard cleaning methods. The most common example is Clostridioides difficile (C. diff), a spore-forming bacterium that causes severe diarrhea and colitis. Its spores are highly resistant and can survive on surfaces for long periods, making environmental control challenging.
Norovirus and Rotavirus are highly contagious viral agents that spread through the fecal-oral route and commonly cause outbreaks of gastroenteritis. They require specific enteric protocols to limit rapid human-to-human transmission. Other infections include certain types of infectious diarrhea, such as that caused by Shiga toxin-producing Escherichia coli O157:H7. These pathogens are virulent and require immediate implementation of caution to protect the public and healthcare workers.