Standard Precautions and Transmission-Based Precautions

OT Dude Academy’s Free NBCOT® Exam Prep Course Process Standard Precautions and Transmission-Based Precautions

Standard Precautions

Standard Precautions are used for all patient care. They’re based on a risk assessment and make use of common sense practices and personal protective equipment use that protect healthcare providers from infection and prevent the spread of infection from patient to patient.

  • Perform hand hygiene
  • Use personal protective equipment (PPE) whenever there is an expectation of possible exposure to infectious material
  • Follow respiratory hygiene/cough etiquette principles
  • Ensure appropriate patient placement (room)
  • Properly handle and properly clean and disinfect patient care equipment and instruments/devices
  • Clean and disinfect the environment appropriately
  • Handle textiles and laundry carefully

Hand Hygiene

Recommendation number, description, and category for standard precautions for hand hygiene
# Recommendation Category
IV.A.1. During the delivery of healthcare, avoid unnecessary touching of surfaces in close proximity to the patient to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces IB/IC
IV.A.2. When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water IA
IV.A.3. If hands are not visibly soiled, or after removing visible material with nonantimicrobial soap and water, decontaminate hands in the clinical situations described in IV.A.4.a-f. The preferred method of hand decontamination is with an alcohol-based hand rub. Alternatively, hands may be washed with an antimicrobial soap and water. Frequent use of alcohol-based hand rub immediately following handwashing with nonantimicrobial soap may increase the frequency of dermatitis. IB
IV.A.3 Perform hand hygiene ~ in the following clinical situations: n/a
IV.A.3.a. Before having direct contact with patients IB
IV.A.3.b. After contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings IA
IV.A.3.c. After contact with a patient’s intact skin (e.g., when taking a pulse or blood pressure or lifting a patient) IB
IV.A.3.d. If hands will be moving from a contaminated-body site to a clean-body site during patient care. II
IV.A.3.e. After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient II
IV.A.3.f. After removing gloves IB
IV.A.4. Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if contact with spores (e.g., C. difficile or Bacillus anthracis) is likely to have occurred. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores II
IV.A.5. Do not wear artificial fingernails or extenders if duties include direct contact with patients at high risk for infection and associated adverse outcomes (e.g., those in ICUs or operating rooms) IA
IV.A.5.a. Develop an organizational policy on the wearing of non-natural nails by healthcare personnel who have direct contact with patients outside of the groups specified above

Personal Protective Equipment (PPE)

Recommendation number, description, and category for standard precautions for personal protective equipment and Ebola for healthcare worker updates.
# Recommendation Category
IV.B.1. Observe the following principles of use: n/a
IV.B.1.a. Wear PPE, as described in IV.B.2-4, when the nature of the anticipated patient interaction indicates that contact with blood or body fluids may occur IB/IC
IV.B.1.b. Prevent contamination of clothing and skin during the process of removing PPE. II
IV.B.1.c. Before leaving the patient’s room or cubicle, remove and discard PPE IB/IC
IV.B.2. Gloves n/a
IV.B.2.a. Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur IB/IC
IV.B.2.b. Wear gloves with fit and durability appropriate to the task

  1. Wear disposable medical examination gloves for providing direct patient care.
  2. Wear disposable medical examination gloves or reusable utility gloves for cleaning the environment or medical equipment.
 IB
IV.B.2.c. Remove gloves after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination (see Figure). Do not wear the same pair of gloves for the care of more than one patient. Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens IB
IV.B.2.d. Change gloves during patient care if the hands will move from a contaminated body-site (e.g., perineal area) to a clean body-site (e.g., face). II
IV.B.3. Gowns n/a
IV.B.3.a. Wear a gown, that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated. IB/IC
IV.B.3.a.i. Wear a gown for direct patient contact if the patient has uncontained secretions or excretions IB/IC
IV.B.3.a.ii. Remove gown and perform hand hygiene before leaving the patient’s environment IB/IC
IV.B.3.b. Do not reuse gowns, even for repeated contacts with the same patient. II
IV.B.3.c. Routine donning of gowns upon entrance into a high-risk unit (e.g., ICU, NICU, HSCT unit) is not indicated IB
IV.B.4. Mouth, nose, eye protection n/a
IV.B.4.a. Use PPE to protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed IB/IC
IV.B.5. During aerosol-generating procedures (e.g., bronchoscopy, suctioning of the respiratory tract [if not using in-line suction catheters], endotracheal intubation) in patients who are not suspected of being infected with an agent for which respiratory protection is otherwise recommended (e.g., M. tuberculosis, SARS or hemorrhagic fever viruses), wear one of the following: a face shield that fully covers the front and sides of the face, a mask with attached shield, or a mask and goggles (in addition to gloves and gown).

Contact Precautions

Transmission-Based Precautions are the second tier of basic infection control and are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection transmission.

Use Contact Precautions for patients with known or suspected infections that represent an increased risk for contact transmission.

  • Ensure appropriate patient placement in a single patient space or room if available in acute care hospitals. In long-term and other residential settings, make room placement decisions balancing risks to other patients. In ambulatory settings, place patients requiring contact precautions in an exam room or cubicle as soon as possible.
  • Use personal protective equipment (PPE) appropriately, including gloves and gown. Wear a gown and gloves for all interactions that may involve contact with the patient or the patient’s environment. Donning PPE upon room entry and properly discarding before exiting the patient room is done to contain pathogens.
  • Limit transport and movement of patients outside of the room for medically-necessary purposes.  When transport or movement is necessary, cover or contain the infected or colonized areas of the patient’s body. Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. Don clean PPE to handle the patient at the transport location.
  • Use disposable or dedicated patient-care equipment (e.g., blood pressure cuffs). If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient.
  • Prioritize cleaning and disinfection of the rooms of patients on contact precautions ensuring rooms are frequently cleaned and disinfected (e.g., at least daily or prior to use by another patient if outpatient setting) focusing on frequently-touched surfaces and equipment in the immediate vicinity of the patient.

Droplet Precautions

Use Droplet Precautions for patients known or suspected to be infected with pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking.

  • Source control: put a mask on the patient.
  • Ensure appropriate patient placement in a single room if possible. In acute care hospitals, if single rooms are not available, utilize the recommendations for alternative patient placement considerations in the Guideline for Isolation Precautions. In long-term care and other residential settings, make decisions regarding patient placement on a case-by-case basis considering infection risks to other patients in the room and available alternatives. In ambulatory settings, place patients who require Droplet Precautions in an exam room or cubicle as soon as possible and instruct patients to follow Respiratory Hygiene/Cough Etiquette recommendations.
  • Use personal protective equipment (PPE) appropriately. Don mask upon entry into the patient room or patient space.
  • Limit transport and movement of patients outside of the room for medically-necessary purposes. If transport or movement outside of the room is necessary, instruct the patient to wear a mask and follow Respiratory Hygiene/Cough Etiquette.

Airborne Precautions

Use Airborne Precautions for patients known or suspected to be infected with pathogens transmitted by the airborne route (e.g., tuberculosis, measles, chickenpox, disseminated herpes zoster).

  • Source control: put a mask on the patient.
  • Ensure appropriate patient placement in an airborne infection isolation room (AIIR) constructed according to the Guideline for Isolation Precautions. In settings where Airborne Precautions cannot be implemented due to limited engineering resources, masking the patient and placing the patient in a private room with the door closed will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned home.
  • Restrict susceptible healthcare personnel from entering the room of patients known or suspected to have measles, chickenpox, disseminated zoster, or smallpox if other immune healthcare personnel are available.
  • Use personal protective equipment (PPE) appropriately, including a fit-tested NIOSH-approved  N95 or higher-level respirator for healthcare personnel.
  • Limit transport and movement of patients outside of the room to medically-necessary purposes. If transport or movement outside an AIIR is necessary, instruct patients to wear a surgical mask, if possible, and observe Respiratory Hygiene/Cough Etiquette.  Healthcare personnel transporting patients who are on Airborne Precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and infectious skin lesions are covered.
  • Immunize susceptible persons as soon as possible following unprotected contact with vaccine-preventable infections (e.g., measles, varicella or smallpox).

References

Centers for Disease Control and Prevention. (n.d.). Infection Control: Transmission-Based Precautions. Retrieved from https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html

Centers for Disease Control and Prevention. (n.d.). Infection Control: Isolation Precautions. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

Previous Topic
Back to Topic
Next Lesson