V. Transmission-Based Precautions

In addition to consistent use of Standard Precautions, additional precautions may be warranted in certain situations as described below.

A.  Identifying Potentially Infectious Patients

• Facility staff remain alert for any patient arriving with symptoms of an active infection (e.g., diarrhea, rash, respiratory symptoms, draining wounds or skin lesions)
• If patient calls ahead:
  • Have patients with symptoms of active infection come at a time when the facility is less crowded, if possible
  • Alert registration staff ahead of time to place the patient in a private exam room upon arrival if available and follow the procedures pertinent to the route of transmission as specified below
  • If the purpose of the visit is non-urgent, patients are encouraged to reschedule the appointment until symptoms have resolved

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B.  Contact Precautions

• Apply to patients with any of the following conditions and/or disease:
  • Presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure ulcers, or presence of ostomy tubes and/or bags draining body fluids
  • Presence of generalized rash or exanthems
• Prioritize placement of patients in an exam room if they have stool incontinence, draining wounds and/or skin lesions that cannot be covered, or uncontrolled secretions
• Perform hand hygiene before touching patient and prior to wearing gloves
• PPE use:
  • Wear gloves when touching the patient and the patient’s immediate environment or belongings
  • Wear a gown if substantial contact with the patient or their environment is anticipated
• Perform hand hygiene after removal of PPE; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus)
• Clean/disinfect the exam room accordingly (refer to Section IV.F.4.)
• Instruct patients with known or suspected infectious diarrhea to use a separate bathroom, if available; clean/disinfect the bathroom before it can be used again (refer to Section IV.F.5. for bathroom cleaning/disinfection)

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C.  Droplet Precautions

• Apply to patients known or suspected to be infected with a pathogen that can be transmitted by droplet route; these include, but are not limited to:
  • Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus, respiratory syncytial virus, human metapneumovirus)
  • Bordetella pertusis
  • For first 24 hours of therapy: Neisseria meningitides, group A streptococcus
• Place the patient in an exam room with a closed door as soon as possible (prioritize patients who have excessive cough and sputum production); if an exam room is not available, the patient is provided a facemask and placed in a separate area as far from other patients as possible while awaiting care.
• PPE use:
  • Wear a facemask, such as a procedure or surgical mask, for close contact with the patient; the facemask should be donned upon entering the exam room
  • If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles (or face shield in place of goggles) should be worn
• Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
• Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients, and practice respiratory hygiene and cough etiquette
• Clean and disinfect the exam room accordingly (refer to Section IV.F.4.)

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D.  Airborne Precautions

• Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route; these include, but are not limited to:
  • Tuberculosis
  • Measles
  • Chickenpox (until lesions are crusted over)
  • Localized (in immunocompromised patient) or disseminated herpes zoster (until lesions are crusted over)
• Have patient enter through a separate entrance to the facility (e.g., dedicated isolation entrance), if available, to avoid the reception and registration area
• Place the patient immediately in an airborne infection isolation room (AIIR)
• If an AIIR is not available:
  • Provide a facemask (e.g., procedure or surgical mask) to the patient and place the patient immediately in an exam room with a closed door
  • Instruct the patient to keep the facemask on while in the exam room, if possible, and to change the mask if it becomes wet
  • Initiate protocol to transfer patient to a healthcare facility that has the recommended infection-control capacity to properly manage the patient
• PPE use:
  • Wear a fit-tested N-95 or higher level disposable respirator, if available, when caring for the patient; the respirator should be donned prior to room entry and removed after exiting room
  • If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles or face shield should be worn
• Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and/or body fluids and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
• Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients , and practice respiratory hygiene and cough etiquette
  • Once the patient leaves, the exam room should remain vacant for generally one hour before anyone enters; however, adequate wait time may vary depending on the ventilation rate of the room and should be determined accordingly*
• If staff must enter the room during the wait time, they are required to use respiratory protection

*Francis J. Curry National Tuberculosis Center, FAQ: “How long does it take to clear the air in an isolation or high-risk procedure room?” [PDF - 461 KB]

CDC 2007 Guideline for Isolation Precautions

CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 [PDF - 1.80 MB]

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