Isolation Precautions
Standard, contact, droplet, and airborne precautions with PPE requirements and disease-specific guidelines.
Standard Precautions (Apply to ALL Patients)
- Hand hygiene before and after every patient contact
- Gloves when touching blood, body fluids, mucous membranes, non-intact skin
- Gown if clothing may become soiled
- Mask + eye protection if splash/spray is anticipated
- Safe injection practices (single-use needles, no multi-dose vial contamination)
- Respiratory hygiene/cough etiquette
- Safe handling of contaminated equipment and linens
Transmission-Based Precautions
| Type | Contact | Droplet | Airborne |
|---|---|---|---|
| Transmission | Direct or indirect contact with patient or contaminated surfaces | Large respiratory droplets (> 5 microns) travel ≤ 3 feet | Small airborne particles (≤ 5 microns) remain suspended in air |
| Room | Private room preferred; cohort if same organism | Private room; door may remain open | Airborne Infection Isolation Room (AIIR) — negative pressure, 6–12 air exchanges/hr, door must remain closed |
| PPE Required | Gloves + Gown (upon room entry) | Surgical mask (within 3–6 feet) | N95 respirator or PAPR (must be fit-tested) |
| Patient Transport | Limit transport; cover infected area | Patient wears surgical mask during transport | Patient wears surgical mask during transport; notify receiving department |
| Equipment | Dedicated equipment (stethoscope, BP cuff); disinfect between patients | Routine cleaning | Routine cleaning |
Diseases by Precaution Type
Contact Precautions
Remember: "MRSA Cdiff VRE"
- MRSA (Methicillin-Resistant Staphylococcus aureus)
- C. difficile (use soap and water, not alcohol-based sanitizer)
- VRE (Vancomycin-Resistant Enterococcus)
- Scabies
- Lice (pediculosis)
- Herpes simplex (disseminated or primary severe)
- Impetigo
- Wound infections with heavy drainage
- Rotavirus
- RSV (Respiratory Syncytial Virus) — contact + droplet
Droplet Precautions
Remember: "SPIDERMAN" — Sepsis, Pertussis, Influenza, Diphtheria (pharyngeal), Epiglottitis, Rubella, Meningitis (bacterial), Adenovirus, Norovirus (also contact), Mumps
- Influenza
- Pertussis (whooping cough)
- Bacterial meningitis (Neisseria, H. influenzae)
- Mumps
- Rubella (German measles)
- Diphtheria (pharyngeal)
- Streptococcal pharyngitis
- Pneumonia (Mycoplasma, Group A Strep)
- Epiglottitis
Airborne Precautions
Remember: "MTV" — Measles, Tuberculosis, Varicella (chickenpox/disseminated zoster)
- Measles (rubeola)
- Tuberculosis (pulmonary or laryngeal)
- Varicella (chickenpox)
- Disseminated herpes zoster (shingles)
- SARS / COVID-19 (during aerosol-generating procedures)
- Smallpox
Special Considerations
| Situation | Action |
|---|---|
| C. difficile hand hygiene | Soap and water ONLY (alcohol does not kill spores) |
| TB suspected | Place in AIIR immediately; initiate airborne precautions before confirmation |
| N95 fitting | Annual fit-testing required; facial hair prevents proper seal |
| Chickenpox exposure in non-immune HCW | Furlough days 10–21 post-exposure |
| Pregnant nurse assignments | Avoid caring for patients with CMV, varicella (if non-immune), herpes zoster, rubella |
| Immunocompromised patient | Protective (reverse) isolation: private room, positive pressure, mask for visitors, no fresh flowers/fruits |
PPE Donning and Doffing Order
- Donning (putting on): Gown → Mask/Respirator → Goggles/Face shield → Gloves
- Doffing (removing): Gloves → Goggles/Face shield → Gown → Mask/Respirator
- Perform hand hygiene after each piece is removed and after all PPE is off