Transmission based precautions provide additional infection control measures based on disease specific recommendations and should always be used in addition to standard precautions.
Contact Precautions
Contact precautions prevent transmission of infectious organisms spread by direct or indirect contact with the patient or the patient’s environment.
Contact precautions include:
- Private room or cohort
- Clean, nonsterile gloves when entering the room; remove before exiting
- Clean, nonsterile gown when entering the room if substantial contact with the patient or potentially contaminated areas in the patient’s environment is anticipated; remove before exiting
- Limit transport to essential purposes and ensure precautions are taken to minimize contamination of environmental surfaces and equipment.
- When possible, dedicate the use of noncritical patient care equipment to a single patient and avoid sharing between patients.
- Indications:
- Colonization of any bodily site with multidrug-resistant bacteria such as Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), and drug-resistant gram-negative organisms
- Enteric infections (Norovirus, C. difficile, Escherichia coli)
- Viral infections (Herpes Simplex Virus, Varicella-Zoster Virus, parainfluenza, enterovirus, certain coronaviruses)
- Scabies
- Impetigo
- Noncontained abcesses or decubitus ulcers (especially for Staphylococcus aureus and group A Streptococcus)
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 door may remain open.
- Wear mask (surgical or isolation) if working within 3 feet of the patient. (Note: some facilities require mask for all entries into the room.)
- Droplet mask on patient when leaving 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:
- Neisseria meningitidis
- Haemophilus influenzae type B
- Mycoplasma pneumoniae
- Bordetella pertussis
- Group A Streptococcus
- Diphtheria
- Pneumonic plague
- Influenza
- Rubella
- Mumps
- Adenovirus
- Parvovirus B19
- Rhinovirus (pediatric patients)
- Certain coronaviruses
Airborne Precautions
Airborne precautions prevent transmission of infectious disease 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 (usually an N-95 mask) for susceptible persons must be worn prior to entering room and removed after leaving room.
- Droplet mask on patient when leaving 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:
- Tuberculosis
- Varicella
- Measles
- Smallpox
- Certain coronaviruses
- Ebola