Key Takeaways
- Contact Precautions: gown and gloves for all patient contact; used for MRSA, VRE, C. diff, scabies
- Droplet Precautions: surgical mask within 6 feet; used for influenza, pertussis, bacterial meningitis
- Airborne Precautions: N95 respirator, negative pressure room; used for TB, measles, varicella
- Multiple precaution types may be combined based on the organism's transmission routes
- Patients should be educated about the reason for isolation to reduce anxiety and promote compliance
Transmission-Based Precautions
When standard precautions are not sufficient to prevent transmission, additional transmission-based precautions are implemented based on how the infection spreads.
Three Types of Transmission-Based Precautions
| Type | Transmission Route | Room | PPE |
|---|---|---|---|
| Contact | Touch, fomites | Private or cohort | Gown and gloves |
| Droplet | Large respiratory particles | Private or cohort | Surgical mask (within 6 feet) |
| Airborne | Small airborne particles | Negative pressure, closed door | N95 respirator |
Contact Precautions
Used for infections spread by direct or indirect contact.
Common Conditions:
| Organism | Notes |
|---|---|
| MRSA | Methicillin-resistant Staphylococcus aureus |
| VRE | Vancomycin-resistant Enterococcus |
| C. difficile | Requires soap and water for hand hygiene |
| Scabies | Until 24 hours after treatment |
| Impetigo | Until 24 hours after treatment |
| Wound infections | Large or draining wounds |
Contact Precautions Requirements:
| Element | Requirement |
|---|---|
| Room | Private preferred; cohort with same organism acceptable |
| PPE | Gown and gloves upon entry |
| Equipment | Dedicated or disinfect between patients |
| Transport | Limit; cover wounds |
| Hand hygiene | After removing PPE; soap and water for C. diff |
Droplet Precautions
Used for infections spread by large respiratory droplets (>5 microns).
Common Conditions:
| Organism | Notes |
|---|---|
| Influenza | Seasonal flu |
| Pertussis | Whooping cough |
| Bacterial meningitis | N. meningitidis, H. influenzae |
| Mumps | Until 5 days after onset |
| Rubella | Until 7 days after rash onset |
| COVID-19 | May also require airborne precautions |
Droplet Precautions Requirements:
| Element | Requirement |
|---|---|
| Room | Private preferred; cohort acceptable; maintain 6-foot distance |
| PPE | Surgical mask within 6 feet of patient |
| Transport | Patient wears surgical mask |
| Special ventilation | Not required |
Airborne Precautions
Used for infections spread by small particles that remain suspended in air.
Common Conditions:
| Organism | Notes |
|---|---|
| Tuberculosis (TB) | Pulmonary or laryngeal |
| Measles | Rubeola |
| Varicella | Chickenpox |
| Disseminated zoster | Shingles in immunocompromised |
Airborne Precautions Requirements:
| Element | Requirement |
|---|---|
| Room | Airborne Infection Isolation Room (AIIR), negative pressure |
| PPE | N95 respirator or PAPR |
| Transport | Limit; patient wears surgical mask |
| Door | Keep closed |
| Fit testing | Required for N95 use |
Airborne Infection Isolation Room (AIIR)
Features of negative pressure rooms:
- Air flows into the room, not out
- 6-12 air changes per hour
- Air exhausted outdoors or through HEPA filter
- Door must remain closed
- Monitor pressure indicator
N95 Respirator vs. Surgical Mask
| Feature | N95 Respirator | Surgical Mask |
|---|---|---|
| Filtration | 95% of small particles | Droplets only |
| Fit | Tight seal, fit testing required | Loose fit |
| Use | Airborne precautions | Droplet precautions |
| Examples | TB, measles, varicella | Influenza, pertussis |
Combining Precautions
Some conditions require multiple types:
| Condition | Precautions |
|---|---|
| Varicella (chickenpox) | Airborne + Contact |
| Disseminated shingles | Airborne + Contact |
| SARS-CoV-2 (COVID-19) | Droplet + Contact (some situations Airborne) |
| Pandemic influenza | Droplet + Contact |
Patient Education and Psychosocial Support
Isolation can cause:
- Anxiety and depression
- Feelings of loneliness
- Stigma and embarrassment
- Frustration with restrictions
Nursing interventions:
- Explain the reason for isolation clearly
- Reassure that staff will still provide attentive care
- Encourage family phone/video calls
- Check on patient frequently
- Provide diversional activities
- Address emotional needs
Duration of Precautions
Precautions continue until:
- Negative cultures (when applicable)
- Symptoms resolve
- Specific time period elapses
- Provider discontinues order
Examples:
| Condition | Duration |
|---|---|
| TB | Until 3 negative sputum smears |
| Pertussis | 5 days after antibiotic initiation |
| Influenza | While symptomatic or per policy |
| Varicella | Until all lesions crusted |
On the NCLEX-PN
Expect questions about:
- Which precautions for which conditions
- Appropriate PPE for each precaution type
- Room requirements for each type
- Patient transport procedures
A patient is admitted with suspected pulmonary tuberculosis. Which room assignment is appropriate?
What PPE is required when entering the room of a patient on Droplet Precautions to take vital signs?
A patient with MRSA in a wound needs to go to radiology for an X-ray. What preparation is required?