Isolation and Infection Precautions

Introduction to PPE

There are four levels of isolation precautions.

1. Standard/Universal precautions
2. Contact precautions
3. Droplet precautions
4. Airborne precautions

Standard or Universal Precautions

Clinicians apply standard or universal precautions at all times. To stay safe, clinicians should treat every patient as if they may have a transmittable condition. The Center for Disease Control and Prevention (CDC) describes standard precautions as:

1. Hand hygiene
2. Use of PPE
3. Respiratory hygiene and cough etiquette
4. Sharps safety
5. Safe injection practices
6. Sterile instruments and devices
7. Clean and disinfected environmental surfaces

Clinicians should sanitize their hands before and after patient contact using hand sanitizer. If a clinician’s hand is visibly dirty or contaminated after leaving a patient’s room, or the clinician has been in a room with a patient with C. difficile, they must wash their hands with soap and water.

Contact Precautions

Contact precautions are one form of transmission-based or isolation-based precautions. Contact precautions are used when patients carry infectious agents that may transmit through direct or indirect contact (e.g., when the patient has touched something within the environment).

Contact precautions include:

• Gloves and a gown worn in the patient’s environment.
• Appropriate patient placement. Patients should be placed in a single room rather than shared rooms.
• Clinicians using disposable or dedicated patient-care equipment. If equipment must be shared between patients (i.e. blood pressure cuffs), it must be cleaned and disinfected after each use.
• Frequent room cleaning and disinfection.
• Limiting patient transport and movement.

Clinicians must remember contaminants spread through indirect as well as direct contact. Even if they’re simply changing an IV pump with no chance of patient contact, they still must take all contact precautions. A clinician must have their gloves and gown on to limit pathogen transmission and protect themselves.

Precaution signs should be posted outside patient rooms.

Droplet Precautions

Droplet precautions are isolation precautions applied to illnesses transmitted via droplets when a patient sneezes, coughs, or talks. Large droplets may travel up to three feet before drying out. Luckily, pathogens don’t survive the drying out process.

Droplet precautions are used for pathogens such as:

• Influenza
• Rhinovirus
• Pertussis

Droplet precautions consist of:

• Wearing a surgical mask and gloves upon entry of the room.
• Putting a mask on the patient for source control.
• Ensuring appropriate patient placement. Patients should be placed in a single room rather than shared rooms.
• Limiting transport and movement of the patient.

Physicians must wear a surgical mask and gloves when performing droplet precautions. The surgical mask PPE is unique to droplet precautions. A gown is not required unless the patient is on other precautions, such as contact.

Surgical masks and gloves are required for patients on droplet precautions.

Airborne Precautions

Airborne precautions — transmitted through coughing, sneezing, and talking — differ from droplet precautions because they survive the drying-out process. 

Clinicians must wear an N95 respirator mask, unique to airborne precautions. Physicians are fit-tested for the N95 respirator mask every year. The patient is placed in a negative pressure room or a room continuously changing out the air within. The door must remain shut.

Airborne precautions include such diseases as:

• Covid-19
• Tuberculosis
• Disseminated herpes zoster
• Measles
• Chickenpox

Depending on the infectious disease, the patient may be in both airborne isolation and contact isolation. Eye protection may also be required even if there is no risk of body fluid splashes. For example, If a patient is diagnosed with Covid-19, they’re placed in airborne plus contact precautions and clinicians also wear eye protection at all times

In summary, the airborne precautions include:

• Wearing a fit-tested N95 mask or higher-level respirator and gloves.
• Putting a mask on the patient for source control.
• Placing the patient in an airborne infection isolation room. The door must remain closed.
• Restricting susceptible healthcare personnel from entering the room.
• Limiting transport and movement of patients.
• Immunizing susceptible persons as soon as possible following unprotected contact with vaccine-preventable infections.

An N95 mask is required for patients on airborne precautions.

Related Video – How to Properly Remove Gloves and Wash Your Hands

Order of Donning and Doffing Personal Protective Equipment

Donning refers to putting on PPE. Clinicians put on PPE “from the bottom up,” holding their hands above their head. The donning order is:

Gown 🡪 Mask 🡪 Goggles 🡪 Gloves

Doffing is taking off PPE. Clinicians do this in alphabetical order:

Gloves 🡪 Goggles 🡪 Gown 🡪 Mask

The specific order of donning and doffing personal protective equipment.

Summary

There are different isolation precautions for patients depending on their diagnosis. The different precautions include standard, contact, droplet, and airborne. 

Clinicians have different PPE and sanitary requirements depending on their patient’s precaution level, and they must don and doff the PPE in the correct order.