*if incontinent or diapered, or to control institutional outbreaks

Droplet Precautions

The goal of droplet precautions is to prevent transmission of infectious organisms spread by droplets (greater than 5 microns) through close respiratory or mucous membrane contact with respiratory secretions via coughing, sneezing, talking, or droplet-inducing procedures.
 
Droplet precautions include:

• Private room or cohort
• Special air flow is not needed, and the door may remain open.
• Wear a mask (surgical or isolation) if working within 3 feet of the patient (some facilities require a mask for all entries into the room).
• Droplet mask on the patient when leaving the room, if tolerated
• Limit transport to essential purposes only.
• Follow respiratory hygiene/cough etiquette.
• Gown and gloves as per standard precautions and facility policy
• Indications include known or suspected infections of the following organisms:
  • Pertussis
  • Influenza virus (seasonal)
  • MRSA (respiratory infection)
  • Neisseria meningitides (suspected or confirmed)
  • Rhinovirus
  • Streptococcus group A
  • Bacterial meningitides (for 24 hours after effective antibiotic therapy)
  • Mumps
  • Rubella
  • Adenovirus (PNA)

Airborne Precautions

Airborne precautions prevent transmission of infectious diseases that are spread by airborne droplets (less than or equal to 5 microns) that remain infectious and suspended in air for long periods of time over long distances and can be widely dispersed by air currents.
 
Airborne precautions include:

• Private room with monitored negative pressure ventilation of 6-12 air exchanges per hour; airborne infection isolation room (AIIR) preferred
• Discharge of air to the outside or HEPA-filtered before recirculation
• Door and windows must be kept closed at all times.
• Respiratory protection (N-95 mask) for susceptible persons must be worn prior to entering the room and removed after leaving the room.
• Droplet mask on patient when leaving the room if tolerated; follow respiratory hygiene/cough etiquette
• Limit transport to essential purposes only.
• If possible, non-immune healthcare workers should not care for patients with vaccine-preventable airborne diseases.
• Indications include known or suspected infections of the following organisms:
  • Measles
  • Smallpox
  • Varicella zoster (chicken pox)
  • Varicella zoster (herpes, disseminated)
  • Suspected or confirmed tuberculosis

Additional recommendations include:

• Airborne and contact precautions for disseminated zoster, immunocompromised patients with localized zoster, severe acute respiratory syndrome, and COVID-19 who are undergoing aerosol-generating procedures.

Guidelines for Precaution Discontinuation (Anderson, 2025)

• Methicillin-resistant Staphylococcus aureus (MRSA): completion of antibiotic therapy, contact precautions may be discontinued after documentation of 1 to 3 negative weekly surveillance cultures. Extension of contact precautions may be warranted for patients with a draining wound, ongoing respiratory secretions associated with MRSA infection, or other evidence implicating risk of ongoing transmission.
• Vancomycin-resistant enterococcus (VRE): completion of antibiotic therapy, contact precautions may be discontinued after documentation of 1 to 3 negative weekly stool or rectal swab surveillance cultures. Extension of contact precautions may be warranted for patients who are highly immunosuppressed, are receiving broad-spectrum antibiotic therapy (without VRE activity), or receiving care in protected environments (such as burn units) or in institutions with high VRE rates.
• Clostridioides difficile: continue contact precautions for at least 48 hours after resolution of diarrhea. Extension of contact precautions beyond resolution of diarrhea (e.g., for remainder of hospitalization) is warranted in some situations, such as for incontinent patients.
• Extended-spectrum beta-lactamase (ESBL) and other multidrug-resistant gram-negative (MDR-GN) pathogens: Continue precautions for the duration of hospitalization. Guidelines recommend assessing discontinuation of precautions on a case-by-case basis related to time since onset of infection, need for ongoing antibiotic use, negative rectal screening samples, and specific pathogen.
• Carbapenem-resistant enterobacteriaceae (CRE) and extremely drug-resistant gram-negative (XDR-GN) pathogens: Maintain as long as patients are hospitalized or in a congregate living setting.
• Influenza: In immunocompetent hosts, the duration of droplet precautions is 7 days after illness onset or until 24 hours after resolution of fever and respiratory symptoms, whichever is longer.
• Varicella zoster virus (VZV) infection: As for localized and disseminated zoster, airborne and contact precautions should be continued until lesions are dry and crusted.
• Herpes Simplex Virus (HSV) infection: Contact precautions should be continued until lesions are dry and crusted.

Healthcare Team Interventions (Douedi, 2023)

• Physicians, nurses, and nursing assistants, should pay close attention to proper PPE use and isolation precautions for the personal safety and safety of the patients.
• It is the responsibility of the healthcare team to enforce isolation precautions on visitors and other members not in compliance with standard protocols to reduce infection transmission within the workplace.