Transmission-based precautions

Isolation items are pattern recognition. Name the route of spread, then lock PPE and room. Hand hygiene technique, sterile field rules, and needlestick first aid live in Infection prevention technique. This chapter owns transmission categories and PPE order.

Standard precautions first

Standard precautions stay on for every client; transmission-based layers stack on top and never replace them. Hand hygiene, sterile-field, and needlestick sequencing live in Infection prevention technique.

The three add-ons

Once you know (or reasonably suspect) how the organism leaves one person and reaches the next, you add the matching transmission type on top of standard precautions. Contact covers touch and contaminated surfaces. Droplet covers large respiratory drops that fall within close range. Airborne covers tiny nuclei that stay suspended and travel farther, so the room and respirator change.

The table is a route map, not three separate worlds. Some conditions need more than one type at once - varicella is the classic airborne-plus-contact stack until lesions crust. Start precautions from stem cues (cough plus TB risk, watery diarrhea after antibiotics, vesicular rash) rather than waiting for a culture that arrives after exposure has already happened.

The distractor that looks careful is putting every respiratory infection in an N95 negative-pressure room, or treating a surgical mask as enough for measles or TB. Mask type follows particle behavior: large drops that fall get a surgical mask; lingering nuclei get a fit-tested respirator and an AIIR. Edge case: cohorting same-organism contact clients is allowed when private rooms are scarce - dedicated equipment still matters.

• Some conditions need more than one type (e.g. varicella: airborne + contact).
• Suspect the organism until ruled out - start the right precautions from the stem cues, not after culture returns.

Contact

Spread by direct touch or contaminated surfaces and equipment. The exam wants you in a gown and gloves before you enter, and it wants you not to share blood-pressure cuffs and other gear across rooms when dedicated equipment is available.

C. difficile and norovirus trap

Spores shrug off alcohol-based sanitizer. After care, wash with soap and water. Clean the room with a bleach or other sporicidal product as policy requires. The tempting wrong answer is the alcohol foam.

Droplet

Large respiratory droplets fall within a short distance. A surgical mask protects you in that zone. Private room preferred; negative pressure is not required. Think flu, whooping cough, meningococcal disease, mumps, rubella.

Airborne

Tiny droplet nuclei stay suspended. You need a fit-tested N95 (or higher respirator per policy) and an airborne infection isolation room with negative pressure and the door closed. Keep the list short so you do not invent airborne for every cough. Susceptible staff (not immune to measles or varicella) should not enter when policy offers alternatives.

Protective environment and transport

Protective (neutropenic) precautions flip the usual story: the client is fragile, so you reduce what enters the room. Hand hygiene is strict, fresh flowers and standing water often leave, undercooked foods are restricted as taught, and sick visitors stay home. This is not the same as putting every oncology client in an N95 AIIR - match the stem’s immune status and facility protocol.

When an isolation client must leave the room for a test, contain the source and warn the destination. A droplet or airborne client wears a surgical mask during transport when they can tolerate it; wounds and draining sites are covered; you still wear appropriate PPE for direct care. Elevator rides are planned, not casual hallway tours. Receiving staff need the precaution type before the stretcher arrives so they are not catching PPE mid-procedure.

• Visitors get the same PPE rules you do - teach gown/glove/mask before they hug.
• Dedicated BP cuffs and stethoscopes stay in contact rooms when available.
• Discontinue precautions only when criteria are met (cultures cleared, lesions crusted, TB rule-out done) - not when the client “looks better.”

PPE order

Sequence exists to keep contaminated surfaces off your mucous membranes. Don from clean to dirty so gloves go on last - they will touch the client and the environment. Doff dirtiest first so soiled gloves are gone before your bare hands go near your face. Hand hygiene closes every removal sequence, and any time hands become contaminated mid-stream.

Why the mask or N95 stays until near the end of doffing: it is still protecting your airway while you peel gown and gloves that may fling organisms. For airborne PPE, facility checklists often have you remove the respirator after leaving the room so you are not inhaling room air while bare-faced inside the AIIR. Exact skill-check steps follow your testing checklist; the exam logic is the same - outer contamination off before the respirator comes off.

The distractor that looks decisive is yanking the N95 first while still gloved and gowned inside the room, or reversing donning so gloves go on before the gown and then contaminate every tie. Edge case: if hands become contaminated during doffing, stop and sanitize before the next bare-skin or face step - do not finish the sequence with dirty hands to “get it over with.”

1. Decide the precaution type from the organism or syndrome.
2. Choose PPE and room that match that type.
3. Watch for the soap-and-water exception on spore formers.