What are the standard nasal/sinus precautions for a general patient population, including those undergoing nasal/sinus surgery or with a compromised immune system?

Standard Nasal/Sinus Precautions

Patients with nasal/sinus conditions or those undergoing nasal/sinus surgery should practice meticulous hand hygiene, use saline nasal irrigation regularly, avoid smoking, and minimize exposure to respiratory pathogens through proper hand washing techniques.

Hand Hygiene as Primary Prevention

• Washing hands with soap or using alcohol-based hand rub is one of the most effective strategies for reducing the risk of developing viral rhinosinusitis, which often precedes bacterial sinusitis 1
• Hand hygiene should be performed especially when in contact with ill individuals, as this minimizes exposure to pathogens 1
• Smoking cessation is critical, as smoking increases the risk of sinusitis 1

Saline Nasal Irrigation for Secondary Prevention

• Saline nasal irrigation is specifically recommended for secondary prevention and after sinus surgery 1
• Benefits include improved mucociliary function, decreased nasal mucosal edema, and mechanical rinsing of infectious debris and allergens 1
• Limited evidence suggests that saline nasal irrigations relieve sinonasal symptoms and may reduce reliance on other medications 1
• Recent evidence shows that both gel-based and saline nasal sprays (two sprays per nostril at first sign of infection or after potential exposure, up to 6 times daily) significantly reduce illness duration by approximately 18-19% compared to usual care 2

Postoperative and High-Risk Patient Precautions

• Patients should avoid mechanical obstruction factors including nasal packing when possible, and be aware that nasogastric tubes and mechanical ventilation increase infection risk 1
• For immunocompromised patients or those with impaired ciliary motility (including smokers, cystic fibrosis patients), enhanced precautions are warranted 1
• Patients should be counseled that exposure to secondhand smoke does not appear to be a risk factor, though active smoking significantly increases risk 1

Infection Control in Healthcare Settings

• Healthcare workers should practice contact-isolation precautions when caring for patients with respiratory infections 1
• Wearing gloves and gowns during contact with infected patients or contaminated environments has been associated with decreased incidence of nosocomial respiratory syncytial virus transmission 1
• Gloves must be changed after contact with an infected patient or contaminated fomites, and hands must be washed adequately after glove removal 1

Common Pitfalls to Avoid

• Do not assume all nasal/sinus symptoms require antibiotics—viral rhinosinusitis is greatly over-diagnosed, with up to 60% of patients receiving antibiotics on day 1 when bacterial infection is unlikely 1
• Symptoms must persist for 10-14 days before bacterial sinusitis becomes more likely, or show worsening after initial improvement (double worsening) 1, 3
• Avoid overuse of diagnostic imaging; radiographic imaging is not indicated for patients meeting diagnostic criteria for acute rhinosinusitis unless complications or alternative diagnoses are suspected 3

Additional Preventive Measures

• Patients with chronic or recurrent rhinosinusitis should be evaluated for modifying factors including allergic rhinitis, immunocompromised state, ciliary dyskinesia, and anatomic variations 3
• For patients with recurrent infections, testing for allergy and immune function may be appropriate to identify treatable underlying causes 1, 4
• Antibiotic use should be reserved for confirmed bacterial sinusitis (symptoms ≥10 days or severe symptoms with fever, purulent discharge, and facial pain) 1