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Types of precautions for infection control[1]

Types of precautions for infection control[1]
Type of precaution Selected patients Major specifications
Standard All patients

Perform hand hygiene before and after every patient contact.*

Gloves, gowns, eye protection as required.

Safe disposal or cleaning of instruments and linen.

Cough etiquette: Patients and visitors should cover their nose or mouth when coughing, promptly dispose used tissues, and practice hand hygiene after contact with respiratory secretions.

Contact

Colonization of any bodily site with multidrug-resistant bacteria (MRSA, VRE, drug-resistant gram-negative organisms)

Enteric infections (Norovirus, Clostridioides difficile*Escherichia coli O157:H7)

Viral infections (HSV, VZV, RSVΔ, parainfluenza, enterovirus, rhinovirus, certain coronaviruses [eg, SARS-CoV-2, MERS-CoV])

Scabies

Impetigo

Noncontained abcesses or decubitus ulcers (especially for Staphylococcus aureus and group A Streptococcus)§

In addition to standard precautions:

Private room preferred; cohorting allowed if necessary.

Gloves required upon entering room. Change gloves after contact with contaminated secretions.

Gown required if clothing may come into contact with the patient or environmental surfaces or if the patient has diarrhea.

Minimize risk of environmental contamination during patient transport (eg, patient can be placed in a gown).

Noncritical items should be dedicated to use for a single patient if possible.

Droplet

Known or suspected:

Neisseria meningitidis

Haemophilus influenzae type B

Mycoplasma pneumoniae

Bordetella pertussis

Group A Streptococcus§

Diphtheria

Pneumonic plague

Influenza

Rubella

Mumps

Adenovirus

Parvovirus B19

Rhinovirus

Certain coronaviruses¥

In addition to standard precautions:

Private room preferred; cohorting allowed if necessary.

Wear a mask when within 3 feet of the patient.

Mask the patient during transport.

Cough etiquette: Patients and visitors should cover their nose or mouth when coughing, promptly dispose used tissues, and practice hand hygiene after contact with respiratory secretions.

Airborne

Known or suspected:

Tuberculosis

Varicella

Measles

Smallpox

Certain coronaviruses¥

Ebola

In addition to standard precautions:

Place the patient in an AIIR (a monitored negative pressure room with at least 6 to 12 air exchanges per hour).

Room exhaust must be appropriately discharged outdoors or passed through a HEPA filter before recirculation within the hospital.

A certified respirator must be worn when entering the room of a patient with diagnosed or suspected tuberculosis. Susceptible individuals should not enter the room of patients with confirmed or suspected measles or chickenpox.

Transport of the patient should be minimized; the patient should be masked if transport within the hospital is unavoidable.

Cough etiquette: Patients and visitors should cover their nose or mouth when coughing, promptly dispose used tissues, and practice hand hygiene after contact with respiratory secretions.

This system of isolation precautions is recommended by the United States Healthcare Infection Control Practices Advisory Committee.
MRSA: methicillin-resistant S. aureus; VRE: vancomycin-resistant enterococci; HSV: herpes simplex virus; VZV: varicella-zoster virus; RSV: respiratory syncytial virus; SARS-CoV: severe acute respiratory syndrome coronavirus; MERS-CoV: Middle East Respiratory Syndrome coronavirus; AIIR: airborne infection isolation room; HEPA: high-efficiency particulate aerator.
* Alcohol-based hand disinfectant is an acceptable alternative to soap and water in all situations EXCEPT in the setting of norovirus and C. difficile infection, for which soap and water should be used.
¶ Many hospitals favor simplifying the approach to isolation precautions for viral respiratory pathogens by placing all patients with suspected viral illness on both contact and droplet precautions.
Δ RSV may be transmitted by the droplet route but is primarily spread by direct contact with infectious respiratory secretions. Droplet precautions are not routinely warranted but are appropriate if the infecting agent is not known, if the patient may be coinfected with other pathogens that require droplet precautions, and/or if there is a chance of exposure to aerosols of infectious respiratory secretions.
◊ The most important route of transmission for rhinovirus is via droplets; contact precautions should be added if copious moist secretions and close contact are likely to occur (eg, young infants).
§ Patients with invasive group A streptococcal infection associated with soft tissue involvement warrant both droplet precautions and contact precautions. Droplet precautions alone are warranted for patients with streptococcal toxic shock or streptococcal pneumonia, as well as for infants and young children in the setting of pharyngitis or scarlet fever. Droplet and contact precautions may be discontinued after the first 24 hours of antimicrobial therapy.
¥ Refer to UpToDate topics on coronaviruses, including SARS-CoV, SARS-CoV-2, and MERS-CoV, for specific information on infection control precautions.
‡ Refer to the UpToDate topic on prevention of Ebola virus infection for full discussion of infection control issues.
Reference:
  1. Siegel JD, Rhinehart E, Jackson M, et al. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007; 35:S65.
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