Transmission-based precautions

Reviewed and revised 11 July 2014

OVERVIEW

Transmission-based precautions are recommended where standard precautions alone may be insufficient to prevent transmission of an infection, such as an outbreak.

• They are tailored to the infectious agent
• they are additional to standard precautions

TYPES

• Contact precautions — when there is known or suspected risk of direct or indirect contact transmission of infectious agents that are not effectively contained by standard precautions alone.
• droplet precautions —  for patients known or suspected to be infected with agents transmitted over short distances by large respiratory droplets
• airborne precautions —  for patients known or suspected to be infected with agents transmitted person-to-person by the airborne route

FEATURES

Transmission-based precautions may include one or any combination of the following:

• allocating a single room with closing door to patient with a suspected or confirmed infection (isolation)
• placing patients colonised or infected with the same infectious agent and antibiogram in a room together (cohorting)
• wearing specific personal protective equipment
• providing patient-dedicated equipment
• using a TGA registered disinfectant with label claims specifying its effectiveness against specific infectious organisms
• using specific air handling techniques
• restricting movement both of patients and healthcare workers.

SYNDROMES AND ORGANSIMS REQUIRING TRANSMISSION-BASED PRECAUTIONS

Contact precautions

• diarrhoea in incontinent or diapered patients with suspected infectious cause (e.g. enterohemorrhagic Escherichia coli O157:H7, Shigella spp, hepatitis A virus, noroviruses, rotavirus, C. difficile)
• abscess or draining wound that can’t be covered (MRSA or group A Strep – also need airborne precautions for 24h if suspected invasive GAS)
• localised Herpes Simplex Virus (HSV)
• enterovirus meningitis

Droplet precautions (in addition to contact precautions)

• suspected viral haemorrhagic fever
• suspected meningococcemia or meningococcal meningitis (first 24h of antibiotic therapy)
• Suspected viral LRTI in children (e.g. Respiratory syncytial virus, parainfluenza virus, adenovirus, influenza virus, Human metapneumovirus)
  • also need contact precautions until adenovirus and influenza are ruled out

Airborne precautions (in addition to contact precautions)

• Respiratory infections
  • suspected LRTI in adults (e.g. fever, cough, lung infiltrates) due to M. tuberculosis, Respiratory viruses, S. pneumoniae, S. aureus (MSSA or MRSA)
  • Cough/fever/pulmonary infiltrate in any lung location in an HIV-infected patient or a patient at high risk for HIV infection
  • eye protection also required if: suspected SARS/ COVID19, avian influenza, Tb or aerosol-generating procedures in an HIV positive patient
• Suspected measles
• Vesicular rash (suspected Varicella-zoster, herpes simplex, variola (smallpox), vaccinia viruses)
• Tb meningitis

REMOVAL OF PRECAUTIONS

• depends on the individual disease and patient
• duration of contact precautions for patients who are colonized or infected with MDROs remains undefined; only MRSA has effective decolonization strategies
• immunocompromised patients may remain infectious for protracted periods
• liaise with ID/ infection control

References and Links

LITFL

• CCC — Standard precautions
• CCC — Handwashing in the ICU
• CCC — Hand Hygiene

FOAM and web resources

• Hand Hygiene Australia