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).