Precautions for URI/Sinusitis
For upper respiratory infections and sinusitis, implement respiratory hygiene/cough etiquette as standard precautions, including covering coughs/sneezes, hand hygiene after contact with respiratory secretions, and maintaining at least 3 feet of separation from symptomatic patients in waiting areas. 1
Primary Prevention Measures
Hand Hygiene:
- Wash hands with soap or use alcohol-based hand rub, especially when in contact with ill individuals—this is one of the most effective strategies for reducing risk of developing viral respiratory infections that precede bacterial sinusitis 1
- Perform hand hygiene after having contact with respiratory tract secretions and contaminated objects 1
Respiratory Hygiene/Cough Etiquette:
- Cover nose and mouth when coughing or sneezing; cough or sneeze into elbow rather than hand 1
- Use tissues to contain respiratory secretions and dispose in nearest waste receptacle immediately after use 1
- If tolerated and feasible, symptomatic patients should wear a size-appropriate mask to prevent respiratory droplet dispersal while in common waiting areas 1
Environmental Precautions:
- Avoid cigarette smoke exposure, as smoking increases the risk of sinusitis (though secondhand smoke does not appear to be a risk factor) 1
- Avoid relevant allergens, pollution, and barotrauma 1
- Maintain adequate hydration 1
Secondary Prevention for Chronic/Recurrent Disease
Nasal Saline Irrigation:
- Recommended for secondary prevention and after sinus surgery, with benefits including improved mucociliary function, decreased nasal mucosal edema, and mechanical rinsing of infectious debris and allergens 1, 2
- High-volume saline rinsing is more effective than low-volume rinsing for purulent rhinorrhea and post-nasal drip 2
- Critical safety precaution: Do not share nasal delivery devices to minimize infection risk from contaminated water or equipment 2
- Clean irrigation devices thoroughly after each use according to product directions 2
Medical Management:
- Control underlying conditions such as gastroesophageal reflux disease (GERD), as treating GERD may prevent chronic rhinosinusitis 1
- Appropriately treat allergic rhinitis if present 1
- Control blood glucose in patients with diabetes 1
Antibiotic Stewardship:
- Avoid prolonged antibiotic courses (more than 5 days), broad spectrum antibiotics, or unnecessary antibiotics to prevent disruption of normal microbiota 1
- Reserve antibiotics for acute bacterial rhinosinusitis only when symptoms persist >10 days without improvement, are severe (fever >39°C, purulent discharge, facial pain >3 consecutive days), or worsen after initial improvement 1
Healthcare Setting Precautions
Staff Protocols:
- Healthcare personnel should consider wearing a mask when examining ambulatory patients with suspected influenza or respiratory infection 1
- Use surgical-grade mask and face shield or protective eyewear if splashing of body fluids is anticipated 1
- Wash skin surfaces contaminated with blood or body fluids immediately and thoroughly with soap and water 1
Facility Measures:
- Post visual alerts at entrance instructing patients to inform staff of respiratory symptoms when registering 1
- Provide tissues and no-touch receptacles for disposal in reception areas 1
- When space permits, cluster chairs for coughing patients at least 3 feet away from other patients 1
- Have conveniently located alcohol-based hand rub dispensers (out of reach of young children) or sinks with soap and disposable towels 1
Common Pitfalls to Avoid
- Do not use radiographic imaging for routine diagnosis of acute rhinosinusitis unless complications or alternative diagnoses are suspected 1
- Avoid treating viral URI with antibiotics, as most cases of acute rhinosinusitis are viral and resolve without antibiotics 1, 3
- Do not assume purulent nasal discharge indicates bacterial infection—color change of nasal discharge is not a specific sign of bacterial superinfection 1
- Avoid harsh cleansers that disrupt normal vaginal and nasal microbiota 1