What other precautions might you need to apply in addition to the Standard Precautions to prevent the transmission of infection?

Transmission based precautions are additional measures focused on the particular mode of transmission and are always in addition to standard precautions. They are grouped into categories according to the route of transmission of the infectious agent.

Transmission based precautions should be applied when caring for:

• Patients with known infection
• Patients who are colonised with an infectious organism
• Asymptomatic patients who are suspected of/under investigation for colonisation or infection with an infectious microorganism.  

Transmission based precautions are categorised by the route of transmission of the infections agent:

Contact Precautions are required for patients known or suspected to be infected or colonised with microorganisms that can be transmitted by direct contact or through the patients secretions or bodily fluids; i.e. contact which occurs when performing patient-care activities that require touching the patients skin, secretions or bodily fluids; or indirect contact i.e. touching potentially contaminated environmental surfaces or equipment in the patients environment.

Examples include Staphylococcus aureus (MSSA or MRSA), Vancomycin resistant enterococci (VRE), Clostridium difficile infection (CDI) and scabies.
 

Droplet Precautions are required for patients known or suspected to be infected with microorganisms transmitted by droplets. Droplets can be generated by coughing, sneezing, talking or during the performance of procedures (e.g. nebulisation).

Examples include pertussis, influenza, rubella and mumps.
 

Airborne Precautions are required for patients known or suspected to be infected with microorganisms that can be transmitted to other patients/staff via the airborne route e.g. in dust.

Examples include Tuberculosis, chickenpox and measles.

Note: Some diseases have multiple routes of transmission and more than one Transmission-Based Precautions category may be used, for example Multi-drug resistant microorganisms such as Multi-drug resistant tuberculosis (MDR-TB) and Human respiratory syncytial virus (RSV). When used either singularly or in combination, they are always used in addition to Standard Precautions.

Risk Assessment

• Consult with infection control nurses/doctors to ensure that appropriate transmission-based precautions are applied and that they remain in place until the risk of transmission of the infectious agent has passed
• Remember that transmission-based precautions are applied AS WELL as standard precautions
• Ensure that transmission based precautions are maintained when moving patients from one patient-care area to another
• Explain to the patient why transmission based precautions are necessary
• Become familiar with the local policy on appropriate PPE; when it should be used and how it should be put on and taken off
• Make sure you know which type of mask is needed in different situations and how to check that they are properly fitted
• Make sure you are fully immunised against vaccine-preventable diseases as recommended in the Green Book.

Transmission based precaution requirements

In addition to standard precautions and appropriate PPE (insert hyperlink to standard precautions), the following will be required for all patients who require transmission based precautions:

Transmission-based precautions are used in addition to standard precautions when use of standard precautions alone does not fully prevent communicable disease transmission. There are three types of transmission-based precautions--contact, droplet, and airborne - the type used depends on the mode of transmission of a specific disease. Some diseases require more than one type of transmission-based precaution (e.g. SARS, which requires airborne and contact precautions as well as eye protection with all client contact).

Additional resources

Isolation Precautions CDC Guidelines

Contacts

Healthcare-Associated Infection (HAI) Prevention Program
Division of Public Health
Bureau of Communicable Diseases
Phone 608-267-7711
Fax 608-261-4976

• Contact Precautions
  • Use the following measure in addition to standard precautions when in contact with individuals known or suspected of having diseases spread by direct or indirect contact (examples include norovirus, rotavirus, draining abscesses, head lice).
  • Wear gloves and gown when in contact with the individual, surfaces, or objects within his/her environment.
  • All re-usable items taken into an exam room or home should be cleaned and disinfected before removed. Disposable items should be discarded at point of use.
• Droplet Precautions

  In addition to standard precautions, wear a surgical mask when within 3 feet (6 feet for smallpox) of persons known or suspected of having diseases spread by droplets (examples include influenza, pertussis, meningococcal disease).

• Airborne Precautions
  • Use the following measures in addition to standard precautions when in contact with individuals known or suspected to have diseases spread by fine particles dispersed by air currents (examples include tuberculosis, measles, and SARS).
  • Put on a NIOSH-certified fit-tested N-95 respirator just before entry to an area of shared air space and wear at all times while in the area of shared air space. Remove and discard respirator just after exiting area. The respirator may be discarded into the regular trash unless contact precautions must also be followed. In this case, place the respirator in a plastic zip-lock bag, seal and then discard into the trash. A powered air-purifying respirator (PAPR) may also be used (see PPE section).
  • If available, portable high efficiency particulate air (HEPA) filtration units may be operated in the area where the infected individual is located to filter out infectious particles. (Use of such a unit does NOT eliminate the need for employees to wear respiratory protection).
• Eye Protection

  If eye protection is indicated, wear goggles or a face shield during ALL contact with the individual, not just when splashes or sprays are anticipated, as with standard precautions.

  What are additional precautions and when should they be used?

  Additional Precautions are based on the mode of transmission of the causative organism. Additional Precautions are used as an adjunct to Routine Practices when microorganisms are: Highly infectious • Known to create severe disease • Difficult to treat (antibiotic resistant).

  Which action is the best precaution against transmission of infection?

  Good hygiene: the primary way to prevent infections.