Apr 17, 2018

Understanding Transmission-Based Precautions and recommended practices

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Patients in isolation are among the most infectious, and the most vulnerable. By understanding the different types of isolation precautions and when to apply them, we can help improve patient safety and outcomes.

Standard Precautions prevent the transmission of infection from patient to patient as well as patient to healthcare providers.  Standard Precautions include hand hygiene, use of gloves, gown, mask, eye protection and safe injection practices.1

In addition to Standard Precautions, Transmission-Based Precautions can be implemented when Standard Precautions won’t interrupt the route of transmission.  Usually, a patient is placed in Transmission-Based Precautions when there is a known infection or if the patient is colonized.2

There are three main transmission based precautions: contact, droplet and airborne.2  Each precaution has recommendations for healthcare settings to follow.  It is important to note that more than one Transmission-Based Precaution may be used on one patient and all of these precautions are in addition to Standard Precautions.2

Contact Precautions:

Contact Precautions are implemented when the infectious agent is spread by direct or indirect contact with the patient or the patient’s environment.2  The CDC recommends placing the patient in a single room, and health care providers entering the room should wear a gown and gloves for all interactions.2  Examples of conditions requiring contact precautions are Clostridium Difficile (C diff), Vancomycin-resistant Enterococci (VRE), Respiratory Syncytial Virus (RSV), and Methicillin-Resistant Staphylococcus Aureus (MRSA).  For contact precautions, the CDC strongly recommends using disposable noncritical patient-care equipment or implement patient-dedicated equipment.2  Other organizations including the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) created a summary of strategies to prevent Healthcare associated infections (HAIs) including Clostridium difficile (CDI) and MRSA.  These summaries state that “dedicated equipment should be readily available for healthcare providers (e.g., stethoscopes)” and to use “dedicated patient care equipment and items.” 3,4

Droplet Precautions:

When the infectious agent is spread by contact through close respiratory or mucous membrane contact with respiratory secretions, Droplet Precautions are implemented.2  Placing the patient in a single room and having visitors and healthcare providers wear a mask are recommended practices for Droplet Precautions.2  Common conditions requiring Droplet Precautions include the influenza virus, pertussis, and mumps.

Airborne Precautions

Airborne Precautions are implemented when the infectious agent is small enough to remain suspended in the air.2  Patients should be placed in a single room with negative air flow and healthcare providers should wear respirators when caring for these patients.2  Tuberculosis, measles and chickenpox are examples of conditions requiring airborne precautions.2

It is important to note that the CDC states “In all healthcare settings, providing patients who are on Transmission-Based Precautions with dedicated non-critical medical equipment (e.g., stethoscope, blood pressure cuff, electronic thermometer) has been beneficial for preventing transmission.”2

It is the responsibility of the entire healthcare delivery team to provide appropriate resources to follow these recommended practices to keep patients and healthcare providers safe.

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