Transmission-based precautions

Transmission-based precautions are additional infection control precautions in health care, and the latest routine infection prevention and control practices applied for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens. The latter require additional control measures to effectively prevent transmission.

Communicable diseases occur as a result of the interaction between:

The control of communicable diseases may involve changing one or more of these components, the first three of which are influenced by the environment. These diseases can have a wide range of effects, varying from silent infection – with no signs or symptoms – to severe illness and death. According to its nature, a certain infectious agent may demonstrate one or more following modes of transmission:

Transmission-based precautions are used when the route(s) of transmission is (are) not completely interrupted using Standard Precautions alone. Three categories of transmission-based precautions are designed with respect to the modes of transmission:

For some diseases that have multiple routes of transmission (e.g., SARS), more than one transmission-based precautions category may be used. When used either singly or in combination, they are always used in addition to Standard Precautions.

When transmission-based precautions are indicated, efforts must be made to counteract possible adverse effects on patients (i.e., anxiety, depression and other mood disturbances, perceptions of stigma, reduced contact with clinical staff, and increases in preventable adverse events in order to improve acceptance by the patients and adherence by health care workers.

Contact precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient’s environment. The specific agents and circumstance for which contact precautions are indicated are found in Appendix A of the Guidance. The application of contact precautions for patients infected or colonized with MDROs is described in the 2006 HICPAC/CDC MDRO guideline. Contact precautions also apply where the presence of excessive wound drainage, fecal incontinence, or other discharges from the body suggest an increased potential for extensive environmental contamination and risk of transmission. A single-patient room is preferred for patients who require contact precautions. When a single-patient room is not available, consultation with infection control personnel is recommended to assess the various risks associated with other patient placement options (e.g., cohorting, keeping the patient with an existing roommate). In multi-patient rooms, >3 feet spatial separation between beds is advised to reduce the opportunities for inadvertent sharing of items between the infected/colonized patient and other patients. Healthcare personnel caring for patients on contact precautions wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient’s environment. Donning PPE upon room entry and discarding before exiting the patient room is done to contain pathogens, especially those that have been implicated in transmission through environmental contamination (e.g., VRE, C. difficile, noroviruses and other intestinal tract pathogens; RSV)

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