Preventing and Controlling the Transmission of Infectious Agents
What to know
Standard precautions apply to all patients at all times: hand hygiene, gloves, gown, mask/eye protection based on anticipated exposure, safe injection practices, and respiratory hygiene. Transmission-based precautions add to standard precautions:
- Contact: MRSA, VRE, C. difficile, scabies, RSV in infants; gown and gloves; dedicated equipment.
- Droplet: influenza, pertussis, meningococcus, mumps; mask within 3–6 feet; private room if possible.
- Airborne: tuberculosis, measles, varicella, disseminated zoster; N95 or higher, negative-pressure room, door closed.
Know hand hygiene indications (before/after patient contact, after body fluid exposure, before aseptic tasks) and that alcohol-based rub is preferred except for C. difficile and norovirus, where soap and water is preferred. Understand isolation duration and the difference between empiric and pathogen-specific precautions.
Traps
- Applying airborne precautions to influenza (it is droplet).
- Forgetting that standard precautions apply even with transmission-based precautions.
- Using alcohol rub for C. difficile.
- Discontinuing precautions without meeting criteria.
- Confusing a respirator (fit-tested N95) with a surgical mask.
Worked example / rule of thumb
A patient with suspected pulmonary TB is admitted. Place in an airborne infection isolation room, door closed, N95 respirator, and notify public health. Rule of thumb: if it is spread by small particles that stay suspended (TB, measles, varicella), think airborne; if by large droplets that fall within 3–6 feet, think droplet.