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
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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