Transmission-based Precautions
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 are recommended when the presence of excessive wound drainage, fecal incontinence, or other discharge from the body suggests an increased risk for environmental contamination and transmission of infection.
Contact precautions include:
- Private room or cohort, ensuring rooms are frequently cleaned and disinfected at least daily or prior to use by another patient, focusing on frequently-touched surfaces and equipment in the immediate vicinity of the patient
- 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:
- Methicillin-resistant Staphylococcus aureus (MRSA) (mask if respiratory infection)
- Vancomycin-Resistant Enterococci (VRE)
- Adenovirus*
- Diarrhea
- C. difficile
- Rotavirus
- Herpes simplex (until lesions are dried and healed)
- Coxsackie*
- Parainfluenza (mask if coughing)
- Escherichia coli (E. coli)*
- Enterovirus*
- Salmonella*
- Shigella*
- Hepatitis A and E*
- Herpes zoster (shingles, localized)
- Respiratory syncytial virus (RSV) (mask if productive cough)
- Head lice
- Scabies
- Poliomyelitis
- Varicella zoster (chicken pox; symptomatic, until all lesions crusted and dried)
- Norovirus (for a minimum of 48 hours after resolution of symptoms
- Human metapneumovirus
*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.