Transmission-based precautions are additional measures used in healthcare and community settings to prevent the spread of infectious diseases. They protect patients, healthcare workers, and the public from various pathogens. These measures are implemented when the known or suspected presence of certain infectious agents necessitates additional layers of protection beyond routine practices.
Standard Precautions as a Baseline
Standard precautions represent the foundational level of infection control applied universally to all patients, regardless of their diagnosis or presumed infection status. This approach acknowledges that any patient could potentially carry an infectious agent. Common practices include thorough hand hygiene (washing hands with soap and water or using alcohol-based hand rub).
Healthcare professionals also use personal protective equipment (PPE) like gloves, gowns, masks, and eye protection when anticipating contact with body fluids, non-intact skin, or mucous membranes. Safe injection practices, proper handling and disposal of sharps, and the cleaning and disinfection of contaminated equipment and surfaces are integral components. Respiratory hygiene and cough etiquette, encouraging individuals to cover coughs and sneezes and perform hand hygiene afterward, are also part of standard precautions. Transmission-based precautions are always implemented in addition to these standard measures.
Types of Transmission-Based Precautions
Transmission-based precautions are categorized into three main types, each targeting a specific mode of pathogen transmission. Contact precautions are for infections that spread through direct physical contact or indirect contact with contaminated surfaces. These require the use of gloves and gowns upon entering the patient’s room.
Droplet precautions address infections transmitted by larger respiratory droplets generated during coughing, sneezing, or talking. These droplets travel short distances, usually less than 6 feet, before settling. Personal protective equipment for droplet precautions includes a surgical mask worn by healthcare personnel when in close proximity to the patient.
Airborne precautions are for infections spread by tiny airborne particles that can remain suspended in the air for extended periods and travel over longer distances. Controlling airborne transmission involves specialized ventilation systems, such as negative pressure rooms. Healthcare personnel caring for patients on airborne precautions wear a fit-tested N95 respirator.
When to Use Each Precaution Type
The application of each transmission-based precaution type depends on the specific infectious agent and its mode of spread. Contact precautions are used for conditions like Clostridioides difficile (C. diff) infections, Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), scabies, highly contagious skin infections, diarrheal illnesses, and open wounds.
Droplet precautions are necessary for diseases spread through respiratory droplets, such as influenza, pertussis (whooping cough), mumps, and some forms of bacterial meningitis. Patients with suspected or confirmed infections that spread via droplets are often placed in a single room to limit exposure.
Airborne precautions are for infections like tuberculosis, measles, and varicella (chickenpox). Patients with these conditions are typically cared for in specialized airborne infection isolation rooms (AIIRs). The decision to use a specific precaution is based on the clinical presentation and suspected pathogen, with adjustments made once laboratory confirmation is available.
The Critical Role of Adherence
Consistent and correct application of transmission-based precautions is fundamental to preventing the spread of infectious diseases. Adherence protects patients from healthcare-associated infections (HAIs) and safeguards healthcare workers from exposure. Proper use of personal protective equipment and environmental controls significantly reduces transmission risks.
Education and ongoing training are important to ensure all individuals understand and follow the correct protocols for each precaution type. This commitment reinforces the collective effort to maintain a safe environment and limit the impact of transmissible diseases.