Introduction
Transmission based precautions are additional measures focused on the particular mode of transmission and are always in addition to standard precautions. They are grouped into categories according to the route of transmission of the infectious agent.
Transmission based precautions should be applied when caring for:
- Patients with known infection
- Patients who are colonised with an infectious organism
- Asymptomatic patients who are suspected of/under investigation for colonisation or infection with an infectious microorganism.
Transmission based precautions are categorised by the route of transmission of the infections agent:
Contact Precautions are required for patients known or suspected to be infected or colonised with microorganisms that can be transmitted by direct contact or through the patients secretions or bodily fluids; i.e. contact which occurs when performing patient-care activities that require touching the patients skin, secretions or bodily fluids; or indirect contact i.e. touching potentially contaminated environmental surfaces or equipment in the patients environment.
Examples include Staphylococcus aureus (MSSA or MRSA), Vancomycin resistant enterococci (VRE), Clostridium difficile infection (CDI) and scabies.
Droplet Precautions are required for patients known or suspected to be infected with microorganisms transmitted by droplets. Droplets can be generated by coughing, sneezing, talking or during the performance of procedures (e.g. nebulisation).
Examples include pertussis, influenza, rubella and mumps.
Airborne Precautions are required for patients known or suspected to be infected with microorganisms that can be transmitted to other patients/staff via the airborne route e.g. in dust.
Examples include Tuberculosis, chickenpox and measles.
Note: Some diseases have multiple routes of transmission and more than one Transmission-Based Precautions category may be used, for example Multi-drug resistant microorganisms such as Multi-drug resistant tuberculosis (MDR-TB) and Human respiratory syncytial virus (RSV). When used either singularly or in combination, they are always used in addition to Standard Precautions.
Risk Assessment
- Consult with infection control nurses/doctors to ensure that appropriate transmission-based precautions are applied and that they remain in place until the risk of transmission of the infectious agent has passed
- Remember that transmission-based precautions are applied AS WELL as standard precautions
- Ensure that transmission based precautions are maintained when moving patients from one patient-care area to another
- Explain to the patient why transmission based precautions are necessary
- Become familiar with the local policy on appropriate PPE; when it should be used and how it should be put on and taken off
- Make sure you know which type of mask is needed in different situations and how to check that they are properly fitted
- Make sure you are fully immunised against vaccine-preventable diseases as recommended in the Green Book.
Transmission based precaution requirements
In addition to standard precautions and appropriate PPE (insert hyperlink to standard precautions), the following will be required for all patients who require transmission based precautions: