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Standard Precautions and Transmission-Based Precautions


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Overview

Isolation precautions are used to reduce transmission of microorganisms in healthcare and residential settings. These measures are designed to protect patients/residents, staff, and visitors from contact with infectious agents. There are two categories of isolation precautions: standard precautions and transmission-based precautions.  In 2007, the Healthcare Infection Control Practices Advisory Committee (HICPAC) published recommendations to for how and when to apply standard and transmission-based precautions in healthcare settings, including a table of selected infections/conditions and the type and duration of precautions that are recommended.


Standard Precautions

Standard precautions are a set of basic infection prevention practices intended to prevent transmission of infectious diseases from one person to another.  Because we do not always know if a person has an infectious disease, standard precautions are applied to every person every time to assure that transmission of disease does not occur. These precautions were formerly known as “universal precautions.”
Standard precautions include:
  • Hand hygiene – cleaning hands with soap and water or an alcohol-based hand rub to prevent transmission of  germs  to others
    • Use soap and water instead of an alcohol-based hand rub in the following situations:
      • When hands are visibly dirty, contaminated, or soiled
      • After using the restroom
      • Before eating or preparing food
    • Perform hand hygiene before and after patient/resident contact; after contact with objects or surfaces in the patient/resident’s immediate vicinity; and after removing gloves (if worn).
    • For more information on how to perform hand hygiene and additional indications for when to perform hand hygiene, please see the Hand Hygiene page.

  • Personal protective equipment – certain types of clothing or equipment that a person wears to protect his/her body from injury and infection
    • Face mask/face shield/eye protection (goggles)
      • Worn if contact with blood or body fluids may occur, especially during suctioning and intubation.
    • Gloves
      • Worn if contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated items in the patient/resident’s environment may occur.
    • Gown
      • Worn if contact with blood or body fluids may occur.
  • Patient/resident care equipment
    • Handle in a manner that prevents transfer of germs to others and to the environment.
    • Wear gloves if equipment is visibly contaminated.
    • Perform hand hygiene.
  • Environmental cleaning/disinfection
    • Develop procedures for routine care, cleaning, and disinfection of environmental surfaces, especially frequently touched surfaces in patient/resident-care areas.
  • Patient/resident placement
    • Prioritize for placement in a single-patient/resident room if the patient/resident is at increased risk of transmission, is likely to contaminate the environment, does not maintain appropriate hand hygiene, or is at increased risk of acquiring infection or developing adverse outcome following infection.
  • Handling of textiles/laundry
    • Handle in a manner that prevents transfer of microorganisms to others and to the environment.
  • Safe injection practices
    • Do not recap, bend, break, or hand-manipulate used needles.
    • Use safety features when available.
    • Place used sharps in a puncture-resistant container.
    • For more information on safe injection practices, please see the Safe Injection Practices page.
  • Patient/resident resuscitation practices
    • Use a mouthpiece, resuscitation bag, or other ventilation devices to prevent contact with mouth and oral secretions.
  • Respiratory hygiene/cough etiquette
    • Maintain spatial separation (at least 3 feet) or wear a surgical mask, if the person is able to tolerate it.
    • Cover mouth/nose when coughing/sneezing.
    • Use tissues and promptly dispose of them in trash.
    • Perform hand hygiene after soiling hands with respiratory secretions.
  • Safe lumbar procedures
    • Use a surgical mask for insertion of catheters or injection of material into spinal or epidural spaces via lumbar puncture procedures (e.g., myelogram, spinal or epidural anesthesia).

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Transmission-Based Precautions

There are three types of transmission-based precautions: contact precautions (for diseases spread by direct or indirect contact), droplet precautions (for diseases spread by large particles in the air), and airborne precautions (for diseases spread by small particles in the air).  Each type of precautions has some unique prevention steps that should be taken, but all have standard precautions as their foundation.

Contact Precautions
  • Used for patients/residents that have an infection that can be spread by contact with the person’s skin, mucous membranes, feces, vomit, urine, wound drainage, or other body fluids, or by contact with equipment or environmental surfaces that may be contaminated by the patient/resident or by his/her secretions and excretions.
  • Examples of infections/conditions that require contact precautions: Salmonella, scabies, Shigella, and pressure ulcers.
  • In addition to standard precautions:
    • Wear a gown and gloves upon room entry of a patient/resident on contact precautions.
    • Use disposable single-use or patient/resident-dedicated noncritical care equipment (such as blood pressure cuffs and stethoscopes).
  • For certain organisms likely to have spores (like Clostridium difficile) and some disease with ongoing transmission (like Norovirus), “special” contact precautions are needed. In addition to the measures above, perform hand hygiene using soap and water and consider use of a hypochlorite solution (e.g., bleach) for environmental cleaning.

Droplet Precautions

  • Used for patients/residents that have an infection that can be spread through close respiratory or mucous membrane contact with respiratory secretions.
  • Examples of infections/conditions that require droplet precautions:  influenza, N. meningitidis (one of the causes of meningitis), pertussis (also known as “whooping cough”), and rhinovirus (also known as the “common cold”).
  •  In addition to standard precautions:
    • Wear a mask upon room entry of a patient/resident on droplet precautions.
  • A single patient/resident room is preferred. If not available, spatial separation of more than 3 feet and drawing the curtain between beds is especially important.
  • Patients/residents on droplet precautions who must be transported outside of the room should wear a mask if tolerated and follow respiratory hygiene/cough etiquette.

Airborne Precautions

  • Used for patients/residents that have an infection that can be spread over long distances when suspended in the air. These disease particles are very small and require special respiratory protection and room ventilation.
  • Examples of infections/conditions that require airborne precautions: chickenpox, measles, and tuberculosis.
  • In addition to standard precautions:
    • Wear a mask or respirator prior to room entry, depending on the disease-specific recommendations. Most diseases will require N95 or higher respiratory protection.
    • Place patient/resident in an airborne infection isolation (AII) room – a single-person room that is equipped with special air handing and ventilation capacity.
      • If the facility does not have an AII room, place the person in a private room with the door closed until the person is transferred to another facility with an AII room.
  • When possible, non-immune healthcare workers should not care for patients/residents with vaccine preventable airborne diseases (like measles and chickenpox).

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Last Updated: 02-10-2012

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