Transmission-Based Precautions
Key Points
- Transmission-based precautions are added when pathogen risk exceeds baseline control with standard-precautions alone.
- Categories are contact, droplet, and airborne precautions.
- PPE selection and workflow are determined by transmission route and expected exposure.
- Signage and pre-entry nursing communication prevent wrong-PPE entry errors.
- Transport should be limited to essential needs and coordinated with receiving teams.
Pathophysiology
transmission-based-precautions are route-specific controls designed to block the pathogen at its dominant mode-of-transmission. They are layered on top of standard-precautions when infection is known or suspected to spread easily in healthcare settings.
The source identifies high-risk organisms and conditions requiring additional controls, including MRSA, VRE, C. difficile, RSV, measles, tuberculosis, and COVID-related risks. The precaution category determines barriers and room practices needed to reduce spread to staff and other patients.
These measures are operational controls, not diagnosis labels. Correct use depends on understanding source site, task risk, and exposure pathway during specific care actions.
Classification
- Contact precautions: Gloves and gown, plus face shield when splash to mucous membranes is possible.
- Droplet precautions: Gloves and mask for pathogens spread by short-range respiratory droplets (about six feet).
- Airborne precautions: Gloves and respirator, with specialized air handling and rapid transfer from long-term care when indicated.
Nursing Assessment
NCLEX Focus
Questions commonly ask which precaution category matches the pathogen route and the planned task.
- Review the care plan and current isolation status before room entry.
- Determine likely source and route of transmission for the suspected or confirmed pathogen.
- Assess the planned task for added splash or aerosol risk that changes PPE needs.
- Confirm required PPE is available and correctly donned before patient contact.
- Verify door signage and clarify uncertainties with the nurse prior to entry.
Nursing Interventions
- Continue standard-precautions for all care, then add route-specific PPE.
- Use contact, droplet, or airborne protocol according to pathogen transmission route.
- Apply barriers during transport and limit movement to essential diagnostics or therapy.
- Notify receiving personnel before transfer so precautions are ready on arrival.
- Maintain clear patient communication despite PPE and reduced contact time.
- Document and report breaches in isolation process immediately.
Airborne Suspected in Long-Term Care
Suspected airborne illness requires urgent escalation and transfer to settings with specialized air-handling capability.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| Not specified in source | None provided in this section | Route-based isolation controls are the primary nursing intervention in this topic |
Clinical Judgment Application
Clinical Scenario
A resident with wound drainage is on contact precautions, then develops cough and frequent sneezing. Staff are preparing for room entry and possible transfer.
Recognize Cues: Existing contact risk plus new respiratory symptom pattern. Analyze Cues: Transmission route may have changed, requiring upgraded barrier strategy. Prioritize Hypotheses: Incorrect precaution category is the highest immediate safety risk. Generate Solutions: Reassess category with nurse, update PPE requirements, and prepare receiving-area notification. Take Action: Apply corrected precautions, reinforce entry controls, and coordinate essential transport only. Evaluate Outcomes: Appropriate PPE compliance, controlled transfer, and no secondary exposure events.
Related Concepts
- standard-precautions - Baseline layer that remains active under all isolation categories.
- contact-precautions - Route-specific controls for touch-mediated transmission.
- droplet-precautions - Controls for short-range respiratory secretion spread.
- airborne-precautions - Controls for small particles that remain suspended in air.
- personal-protective-equipment - PPE mix changes by category and task.
- healthcare-associated-infections - Isolation failures can drive preventable spread.
Self-Check
- What is the difference between contact and droplet precaution workflows?
- Why can the same patient require different PPE for different tasks?
- What pre-transport action is required before moving an isolated patient?