What is the difference between transmission based precautions and standard precautions

Ensure appropriate patient placement in a single patient space or room if available in acute care hospitals. In long-term and other residential settings, make room placement decisions balancing risks to other patients. In ambulatory settings, place patients requiring contact precautions in an exam room or cubicle as soon as possible. Use personal protective equipment PPE appropriately, including gloves and gown. Donning PPE upon room entry and properly discarding before exiting the patient room is done to contain pathogens.

Limit transport and movement of patients outside of the room to medically-necessary purposes. Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. Don clean PPE to handle the patient at the transport location. Use disposable or dedicated patient-care equipment e. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient.

Prioritize cleaning and disinfection of the rooms of patients on contact precautions ensuring rooms are frequently cleaned and disinfected e. Droplet Precautions. Source control: put a mask on the patient. Ensure appropriate patient placement in a single room if possible. In acute care hospitals , if single rooms are not available, utilize the recommendations for alternative patient placement considerations in the Guideline for Isolation Precautions.

In long-term care and other residential settings, make decisions regarding patient placement on a case-by-case basis considering infection risks to other patients in the room and available alternatives. Home Public health Infectious diseases Infection control guidelines Infection control - standard and transmission-based precautions.

Infection control - standard and transmission-based precautions. On this page. Key messages Standard precautions Transmission-based precautions. Standard precautions All people potentially harbour infectious microorganisms. Standard precautions consist of the following practices: hand hygiene before and after all patient contact the use of personal protective equipment, which may include gloves, impermeable gowns, plastic aprons, masks, face shields and eye protection the safe use and disposal of sharps the use of aseptic "non-touch" technique for all invasive procedures, including appropriate use of skin disinfectants reprocessing of reusable instruments and equipment routine environmental cleaning waste management respiratory hygiene and cough etiquette appropriate handling of linen.

Hand hygiene Hand hygiene is considered one of the most important infection control measures for reducing the spread of infection. Gloves The use of gloves should not be considered an alternative to performing hand hygiene. Hand hygiene is required before putting on gloves and immediately after removal. Sterile gloves are only required for certain invasive procedures, otherwise non-sterile gloves may be used if a aseptic non-touch technique is used.

Change gloves between tasks and procedures on the same patient. Gloves should be removed immediately after a procedure and hand hygiene performed so as to avoid contaminating the environment, other patients or other sites on the same patient.

Gloves used for healthcare activities are to be single-use only. ABHR should not be used on gloves to decontaminate them, nor should gloves be washed with soap and water and continued to be used. Gowns and aprons Wear an apron or gown to protect skin and prevent soiling of clothing during procedures and patient care activities that are likely to generate splashing or sprays of blood, body fluids, secretions or excretions, or cause soiling of clothing.

Select a gown or apron i. Remove the used gown as promptly as possible and roll it up carefully and discard appropriately. Perform hand hygiene immediately after removal.

Masks, eye protection, face shields Wear a mask and eye protection, or a face shield to protect mucous membranes of the eyes, nose and mouth during procedures, patient-care activities and cleaning procedures that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions.

Remove the mask by holding the ties only and dispose of the mask into a waste bin. Environmental control Ensure that the health service has adequate procedures for the routine care, cleaning and disinfection of environmental surfaces, beds, bedrails, bedside equipment and other frequently touched surfaces, and that these procedures are being followed. See also Cleaning and waste disposal for further information.

Transmission-based precautions Transmission-based precautions TBPs are used in addition to standard precautions when standard precautions alone may be insufficient to prevent transmission of infection. In this topic. Below, I summarize the recommendations for PPE, patient placement and patient transport for those treating patients in hospitals and for those treating patients in ambulatory care or outpatient settings such as a dental office or a hospital-based outpatient clinic.

I emphasize the differences between recommendations for inpatient hospital and ambulatory care settings. Special or additional procedures for cleaning and disinfecting environmental surfaces or instrument processing, which are available in CDC's infection control guidelines for dental health care settings, 1 are not indicated after treating patients requiring Transmission-Based Precautions.

It is beyond the scope of this article to review specific diseases; however, I mention some briefly as examples. Contact is the most common mode of transmission.

Examples of direct contact in health care settings are touching, contact with oral secretions or contact with body lesions. Infectious microorganisms also can be transferred indirectly via a contaminated intermediate object or person. Contaminated hands frequently are cited as a significant source of indirect contact transmission. Contact Precautions are intended to prevent transmission of infectious agents that are spread by direct or indirect contact with the patient or the patient's environment.

Examples of conditions requiring Contact Precautions include, but are not limited to, herpes simplex mucocutaneous, disseminated, or primary or severe and MRSA. Recurrent oral herpetic lesions only require Standard Precautions. HCP caring for patients requiring Contact Precautions should wear protective clothing and gloves whenever contacting the patient or potentially contaminated areas surrounding the patient.

This is distinctly different from Standard Precautions, for which protective clothing is worn only if contact with blood or body fluid is anticipated. Also, to prevent environmental contamination outside of the treatment room, PPE should be removed in a manner that prevents contamination of underlying clothing and skin and discarded before exiting the room, and hand hygiene should be performed.

In ambulatory care clinics, such as a dental clinic, Contact Precautions are indicated only for patients who have uncontrolled wound drainage or other syndromes representing increased risk of contact transmission. Strict enforcement of Standard Precautions, including wearing gloves and protective clothing when contact with uncontrolled secretions and other potentially infectious body fluids is anticipated, is considered adequate in most situations to prevent the transmission of MRSA and other MDROs.

In acute care hospitals, it is preferred that each inpatient is placed in a single-patient room to limit the opportunities for transmission. In some cases, cohorting grouping patients infected or colonized with the same infectious agent together in one area to limit further transmission may be acceptable after assessing the risks associated with this type of patient placement.

In dental care settings, place patients requiring Contact Precautions in a treatment room or operatory as soon as possible after they arrive at the dental office to limit the number of people exposed in the waiting area. Transporting patients should be limited as much as possible to reduce opportunities for disease transmission to staff members and other patients. If a patient in any health care setting must be transported to another area in the facility or office, all infected or colonized areas of the patient's body should be contained or covered.

Droplet Precautions should be followed to prevent the transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions. Blood and saliva frequently spatter during dental treatment, and disease transmission may occur if these fluids from an infected patient contact unprotected broken skin or mucous membranes. It can cause mild to severe illness, but sometimes it can lead to death. Influenza is spread from person to person primarily when an infected person coughs and sneezes, so it is a good example of a condition requiring Droplet Precautions.

As I previously mentioned, sometimes people become infected by touching something with influenza viruses on it and then touching their mouths or noses. Therefore, frequent hand hygiene is critical in preventing further spread of influenza. Patients with acute respiratory illnesses often visit their dentists, and, as with any patient, the goal of infection control is to prevent transmission of the disease.

Other examples of diseases spread through droplets include pertussis, mumps and rubella. Implementing respiratory hygiene and cough etiquette measures at the first point of contact with a potentially infected person is vital with diseases spread by droplets.

HCP should wear a mask that preferably is donned when entering a room before engaging in close contact with infective patients. CDC's isolation guideline does not make a recommendation for routinely wearing eye protection in addition to a mask for close contact with patients who require Droplet Precautions.

As with Contact Precautions, placing each patient in a single-patient room is preferable so that opportunities for transmission are limited.

In some cases, cohorting may be acceptable after assessing the risks associated with this type of patient placement. Instruct patients receiving treatment in dental ambulatory care settings to follow respiratory hygiene and cough etiquette and place them in an examination room promptly after arriving at the dental office to limit exposure to other people in the waiting area.

Transporting of patients who require Droplet Precautions should be limited. If a patient requires transport to another area of the facility, the patient should wear a mask and follow respiratory hygiene and cough etiquette to reduce opportunities for transmission.

Exposure to aerosols containing microorganisms from a patient's blood or saliva may occur during a use of rotary dental and surgical instruments, including dental handpieces and ultrasonic scalers. Examples of diseases transmitted via the airborne route may include, but are not limited to, rubeola virus measles and Mycobacterium tuberculosis.

Because surgical masks protect the mouth and nose only from splashes, spray and spatter from large-particle droplets and not the smaller aerosol particles, they cannot be used when Airborne Precautions are indicated. When breathing with a surgical mask in place, much of the inhaled air comes in around the sides of the mask, along with airborne organisms.

When HCP use respirators while treating patients with diseases requiring Airborne Precautions, they should use the respirators in the context of a complete respiratory protection program. This program should include training and fit testing to ensure an adequate seal between the edges of the respirator and the wearer's face. Health care settings in which HCP do not treat patients with TB need only written protocols for recognizing the signs and symptoms of TB and for referring patients to a setting in which they can be treated.

A patient requiring Airborne Precautions should be in an airborne infection isolation room AIIR , which is a single-patient room with special air-handling and ventilation capacity. If the facility has an AIIR, a respiratory protection program is required. Elements of a respiratory protection program include education about use of respirators, fit testing and user seal checks with each use of an N95 respirator. In dental offices or other medical settings in which Airborne Precautions cannot be implemented because of limited engineering resources, having the patient wear a mask, placing the patient in a private room for example, an examination room with the door closed and providing N95 or better respirators or masks, if respirators are not available to HCP will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned to the home environment, as deemed medically appropriate.

In hospitals, transport of patients requiring Airborne Precautions should be limited. If a patient must be moved outside of the AIIR, the patient should wear a surgical mask, if possible, and observe respiratory hygiene and cough etiquette.

If the patient is wearing a mask and skin lesions are covered, the HCP transporting the patient is not required to wear a mask. I have presented limited examples of conditions requiring Transmission-Based Precautions. Many conditions for example, SARS, smallpox, varicella zoster, H1N1 influenza can be transmitted via multiple routes and, therefore, require the use of more than one type of Transmission-Based Precaution in addition to Standard Precautions.

Also, as with MDROs, additional precautions may be indicated. A relevant example of this is H1N1 influenza. CDC has published specific H1N1 influenza infection control recommendations for dentistry on its Web site.

Use patient-reminder calls to identify patients reporting influenzalike illness. If the patient reports influenzalike illness, reschedule nonurgent visits for 24 hours after the patient is free of fever without the use of fever-reducing medicine. Identify patients with influenzalike illness at check-in. Offer a face mask or tissues to patients with symptoms, ask them to follow respiratory hygiene and cough etiquette, and reschedule nonurgent care. When evaluating patients for urgent care, separate ill patients from others whenever possible.

Urgent dental treatment can be performed without the use of an AIIR because transmission of H1N1 influenza is thought not to occur across long distances through the air, such as from one patient room to another. Use a treatment room with a closed door, if available. If one is not available, use the one that is the farthest away from other patients and personnel. If N95 respirators, fit testing services or both are not available despite reasonable attempts to obtain them, the dental office should transition to a prioritized use mode that is, nonfit—tested disposable N95 respirators or surgical face masks can be considered a lower level of protection for personnel at lower risk of exposure or lower risk of complications resulting from influenza than personnel at the highest risk of experiencing influenza exposure until fit-tested N95 respirators are available.

The recommendation for using an N95 respirator when treating patients with H1N1 influenza differs from current infection control guidance for seasonal influenza, which recommends that HCP wear surgical masks for patient care. CDC's Web site will have the most current infection control recommendations.

In this article, I reviewed the importance of using Standard Precautions and introduced two new elements of Standard Precautions—safe injection practices and respiratory hygiene and cough etiquette—which DHCP should add to their infection control programs. Using Standard Precautions is the primary infection control strategy; it was designed to use when treating all patients, regardless of diagnosis or presumed infectious status.