Infection prevention and control: Guideline for speech pathologists, Version 1,2020.

6.0 Transmission-Based Precautions

Transmission-based precautions are additional precautions used in situations where standard precautions alone may not sufficiently interrupt the route of transmission. Transmission-based precautions remain in effect for a limited period (i.e. while the risk of transmission persists or for the duration of the illness) and/or according to recommendations from infection control professionals.51 The three transmission routes, as mentioned in Section 4.0, are contact, droplet and airborne (see Table 7). The transmission route of an infectious agent determines the precautions that are required.3 It is crucial to determine the precaution type (including associated PPE) before interacting with a client or others to mitigate and/or minimise risk. It is also important to identify the appropriate precaution type to assist with cleaning and reprocessing of equipment following the delivery of service. In clinical or practice areas, consider removing shared or communal food items. Speech pathology involves many tasks that require close proximity to clients, contact with mucous membranes and potential contact with bodily fluids (e.g., saliva and respiratory droplets). Dealing with an infectious agent (including high community transmission rates) may require additional measures or task modifications to ensure individual and workplace health and safety is maintained. Table 8 provides implementation examples of task modifications for different speech pathology practice settings. The following list is not exhaustive but is designed to provide some examples of common speech pathology tasks that might require consideration: • Cough or gag reflex testing • Aspects of oro-motor function assessment or intervention (e.g., assessing velar movement, tongue strength testing) • Saliva management • Swallowing or communication assessment or intervention (including non-verbal and speech) requiring contact (e.g., Facial-Oral Tract Therapy, Prompts for Restructuring Oral Muscular Phonetic Targets) • Swallowing/feeding/mealtime support assessment or intervention, including food/fluid preparation/handling, and the delivery of mouth care • Voice assessment or therapy involving singing, loud and/or extended voicing tasks (e.g., maximum phonation time, s/z ratio, dynamic and pitch range tasks) • Swallowing/feeding/mealtime support or communication assessment or intervention with clients requiring: non-invasive ventilation (NIV); high-flow nasal oxygen (HFNO); respiratory support via nasal cannulae; face mask • Multi-use of swallowing/feeding/mealtime support or communication assessment or intervention equipment (e.g., stethoscope, torch, Western Aphasia Battery objects, Preschool Language Scales objects, Augmentative and Alternative Communication devices, toys and games used in therapy) • Management of critical care populations and immunosuppressed clients • Speech pathologist-led tracheostomy management for speech and swallowing (+/- ventilation) • Speech pathologist-led laryngectomy care and management (e.g., voice prosthesis changes, stoma inspection) • Endoscopic assessment of vocal function (flexible and/or rigid endoscopes) • Instrumental assessments of swallow function, including flexible endoscopic evaluation of swallowing (FEES), Videofluoroscopic Swallowing Study (VFSS), Manometry • Use of intraoral lingual strengthening devices (e.g., Iowa Oral Performance Instrument (IOPI)), jaw stretching devices (e.g., Therabite), oral tissue stretching devices for minimising contracture formation (e.g., Orastretch)

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Infection Prevention and Control - Guideline for Speech Pathologists | Version 1, 2020