Part of the ICU Emergencies Hub — browse every related guide in one place.
Standard precautions apply to all patients in all healthcare settings regardless of diagnosis or presumed infection status. They are based on the principle that all blood, body fluids (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents.
Standard precaution elements: Hand hygiene (the single most effective infection prevention measure); gloves when there is potential contact with blood, body fluids, or contaminated surfaces; gown when there is potential for clothing contamination; mask and eye protection when there is potential for splash or spray of body fluids to the face; respiratory hygiene/cough etiquette (encouraging patients and visitors to cover coughs, offer masks in waiting areas); safe injection practices (never reuse needles or syringes; never use medication vials for more than one patient); safe handling of potentially contaminated equipment; environmental controls.
Transmission-based precautions are added on top of standard precautions for patients known or suspected to be infected with pathogens requiring extra measures based on their transmission route.
| Precaution Type | Transmission Route | Room Requirement | Required PPE | Key Diseases |
|---|---|---|---|---|
| Contact Precautions | Direct contact (touching patient or patient's environment) or indirect contact (touching contaminated surfaces/equipment) | Private room preferred; cohorting acceptable if private unavailable; keep door closed | Gown + gloves (don before entering room; doff before leaving and immediately wash hands) | C. difficile (CDI), MRSA, VRE, wound infections with resistant organisms, scabies, impetigo, norovirus, RSV, infectious diarrhea (most causes) |
| Droplet Precautions | Large respiratory droplets (>5 microns) that travel up to 3–6 feet; deposited on mucous membranes of the eyes, nose, or mouth | Private room preferred; door does NOT need to remain closed (droplets travel short distance and don't remain airborne) | Surgical mask (when within 3 feet of patient); eye protection for procedures involving coughing/sneezing | Influenza, COVID-19 (CDC now classifies primarily as droplet/aerosol), pertussis, mumps, rubella, meningococcal meningitis, Streptococcal pharyngitis, pneumonia (many causes) |
| Airborne Precautions | Droplet nuclei (<5 microns) that remain suspended in air for prolonged periods and can travel long distances through air currents | Airborne Infection Isolation Room (AIIR) — negative pressure room, at least 6–12 air changes per hour; door must remain CLOSED at all times; air exhausted directly to outside or HEPA-filtered | N95 respirator (must be fit-tested; worn before entering room and kept on until outside the room with door closed); gown and gloves per standard precautions; eye protection as needed | Tuberculosis (TB) — classic airborne; Measles (rubeola); Varicella (chickenpox); Disseminated herpes zoster (shingles) in immunocompromised patients; COVID-19 high-risk procedures (intubation, bronchoscopy) |
Airborne precautions diseases (MTV): Measles, TB, Varicella (chickenpox) + Disseminated zoster. These three are the classic test-level airborne diseases. Remember: these diseases travel in the air over long distances — the negative pressure room keeps the airborne particles contained.
Droplet precautions diseases (SPIDERMAN): Sepsis (meningococcal), Pertussis (whooping cough), Influenza, Diphtheria, Epiglottitis, Rubella, Adenovirus, Mumps, Neisseria meningitidis (meningococcal).
C. diff is contact precautions. The critical additional point: alcohol-based hand rubs (ABHR — hand sanitizer) do NOT kill C. diff spores. C. diff spores are resistant to alcohol. For patients with confirmed CDI, wash hands with soap and water after contact — not just hand sanitizer. This is a common NCLEX trick question: "Which hand hygiene measure is most appropriate after caring for a C. diff patient?" Answer: soap and water, not alcohol-based hand rub.
Contact precautions. Patients colonized with MRSA or VRE (without active infection) still require contact precautions if they have wounds, drains, or conditions that could allow spread. Active infection adds additional vigilance for wound care and dressing changes.
Current CDC guidance (2026) classifies COVID-19 management with a combination of droplet and airborne precautions, particularly emphasizing N95 for aerosol-generating procedures (intubation, bronchoscopy, high-flow oxygen). Standard institutional practice: surgical mask for routine patient care; N95 for AGPs; private room preferred. Follow your institution's current policy as guidance has evolved.
TB is the prototypical airborne disease. The negative pressure AIIR room is mandatory. The N95 respirator is mandatory for anyone entering the room. The patient wears a surgical mask when leaving the AIIR for transport (the patient doesn't need an N95 — they're the source; the nurse needs the N95 to filter out what the patient exhales).
Protective precautions (also called neutropenic precautions or reverse isolation) are designed to protect severely immunocompromised patients FROM the environment — not to protect the environment from the patient. Used for: severe neutropenia (ANC <500, often during chemotherapy); bone marrow transplant patients; severely immunocompromised patients (advanced AIDS, high-dose immunosuppression).
Elements of protective precautions: private room; staff and visitors with any active infections (cold, flu) should not enter; strict hand hygiene before and after contact; some facilities require masks, gowns, and gloves for all entries; dietary restrictions (no fresh fruits/vegetables that cannot be peeled in some protocols — to prevent ingestion of environmental bacteria/fungi). Protective precautions are not standardized across institutions — follow your facility's protocol.
Patients in isolation sometimes feel stigmatized, isolated, and depressed — they have fewer visitor contacts, care may be perceived as less personalized (providers interact through PPE), and the physical restriction to a single room has psychological impact. Nurses in isolation settings should: explain the reason for precautions without stigmatizing language, ensure call lights are answered promptly, spend adequate interaction time during care, encourage appropriate visitor contact while protecting precaution protocols, and monitor for isolation-related psychological distress.
Related guides: Medication safety | CAUTI prevention | NCLEX strategies | Wound care
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