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{{See|Isolation (health care)}}
'''Transmission-based precautions''' are
* Hand hygiene principles▼
** Hand hygiene or [[hand washing]] is important in preventing oneself from contracting an illness or disease and preventing the spread of pathogens (e.g. bacteria, viruses, parasites) to other people, thus reducing the potential for transmission. Hand hygiene can be accomplished with different modalities including alcohol-based hand sanitizers, soap and water, or antiseptic hand wash. There are techniques and benefits to using one modality over another. Utilization of alcohol-based hand sanitizer is generally recommended when the hands are not visibly soiled or before and after contact with a person (e.g. patient in a healthcare setting), or object. With proper technique, soap and water is preferred for visibly soiled hands or in situations where hands various pathogens cannot be killed with alcohol-based hand sanitizers (e.g. spore producing organisms like clostridium difficile)<ref>{{Cite web|url=https://www.cdc.gov/handhygiene/providers/index.html|title=Healthcare Providers {{!}} Hand Hygiene {{!}} CDC|date=2020-02-11|website=www.cdc.gov|language=en-us|access-date=2020-04-14}}</ref>.▼
* PPE in cases of infectious material exposure etiquette,▼
* patient isolation controls,▼
* soiled equipment handling,▼
* and injection handling. ▼
==History ==
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==Rationale for use in healthcare setting==
Communicable diseases occur as a result of the interaction between a source (or reservoir) of infectious agents, a mode of transmission for the agent, a susceptible host with a portal of entry receptive to the agent, the environment. 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.▼
===Standard precautions===
The so called "standard precautions" include:<ref name=standard/>
▲
▲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:
▲* personal protective equipment (PPE) in cases of infectious material exposure etiquette,
▲* patient isolation controls,
▲* soiled equipment handling,
▲Transmission-based precautions are used when the route(s) of transmission is (are) not completely interrupted using standard precautions alone.
▲* and injection handling.
Three categories of transmission-based precautions are designed with respect to the modes of transmission:▼
==Definitions==
▲Three categories of transmission-based precautions
* Contact precautions,
* Droplet precautions, and
* Airborne precautions.
For some diseases
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,<ref>Catalano G, Houston SH, Catalano MC, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96(2):141-5.</ref><ref>Tarzi S, Kennedy P, Stone S, Evans M. [[Methicillin-resistant Staphylococcus aureus]]: psychological impact of hospitalization and isolation in an older adult population. J Hosp Infect 2001;49(4):250-4.</ref><ref>Kelly-Rossini L, Perlman DC, Mason DJ. The experience of respiratory isolation for HIV-infected persons with tuberculosis. J Assoc Nurses AIDS Care 1996;Jan-Feb; 7(1):29-36.</ref> perceptions of stigma,<ref>Knowles HE. The experience of infectious patients in isolation. Nurs Times 1993;89(30):53-6.</ref> reduced contact with clinical staff,<ref>Evans HL, Shaffer MM, Hughes MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134(2):180-8.</ref><ref>Kirkland KB, Weinstein JM. Adverse effects of contact isolation. Lancet 1999;354(9185):1177-8.</ref><ref>Saint S, Higgins LA, Nallamothu BK, Chenoweth C. Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control 2003;31(6):354-6.</ref> and increases in preventable adverse events<ref>Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infection control. JAMA 2003;290(14):1899-905.</ref> in order to improve acceptance by the patients and adherence by health care workers).▼
===Contact precautions===
[[File:Contact Precautions poster.pdf|thumb|Contact precautions poster]]
Contact precautions are intended to prevent transmission of infectious agents, including epidemiologically important [[microorganism]]s, 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 2007 CDC Guidance.<ref name="autogenerated2007"/> The application of contact precautions for patients infected or colonized with Multidrug-Resistant Organisms MDROs is described in the 2006 HICPAC/CDC MDRO guideline.<ref name="autogenerated2006">Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006. 2006. www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf</ref> 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)<ref>Donskey CJ. The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 2004;39(2):219-26.</ref><ref>Bhalla A, Pultz NJ, Gries DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25(2):164-7.</ref><ref>Duckro AN, Blom DW, Lyle EA, Weinstein RA, Hayden MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165(3):302-7.</ref><ref>Hall CB, Douglas RG, Jr. Modes of transmission of respiratory syncytial virus. J Pediatr 1981;99(1):100-3.</ref><ref>Evans MR, Meldrum R, Lane W, et al. An outbreak of viral gastroenteritis following environmental contamination at a concert hall. Epidemiol Infect 2002;129(2):355-60.</ref><ref>Wu HM, Fornek M, Kellogg JS, et al. A Norovirus Outbreak at a Long-Term-Care Facility: The Role of Environmental Surface Contamination. Infect Control Hosp Epidemiol 2005;26(10):802-10.</ref><ref name="recommendations1995">CDC. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1995;44 (RR12):1-13.</ref>▼
▲of the Guidance.<ref name="autogenerated2007"/> The application of contact precautions for patients infected or colonized with MDROs is described in the 2006 HICPAC/CDC MDRO guideline.<ref name="autogenerated2006">Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006. 2006. www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf</ref> 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)<ref>Donskey CJ. The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 2004;39(2):219-26.</ref><ref>Bhalla A, Pultz NJ, Gries DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25(2):164-7.</ref><ref>Duckro AN, Blom DW, Lyle EA, Weinstein RA, Hayden MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165(3):302-7.</ref><ref>Hall CB, Douglas RG, Jr. Modes of transmission of respiratory syncytial virus. J Pediatr 1981;99(1):100-3.</ref><ref>Evans MR, Meldrum R, Lane W, et al. An outbreak of viral gastroenteritis following environmental contamination at a concert hall. Epidemiol Infect 2002;129(2):355-60.</ref><ref>Wu HM, Fornek M, Kellogg JS, et al. A Norovirus Outbreak at a Long-Term-Care Facility: The Role of Environmental Surface Contamination. Infect Control Hosp Epidemiol 2005;26(10):802-10.</ref><ref name="recommendations1995">CDC. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1995;44 (RR12):1-13.</ref>
===Droplet precautions===
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Patients placed in long-term care facilities should be placed in single rooms, have access to their own items or use disposable items, and should have limited contact with other residents, in order to reduce the spread of contact transmitted diseases. For patients with airborne and droplet transmitted diseases in long-term care facilities, they should wear masks when around other residents, and proper PPE and standard precautions should be maintained throughout facilities. In addition, residents of long-term care facilities who are identified as at-risk for these diseases should be immunized if possible.
==Side effects==
▲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,<ref>Catalano G, Houston SH, Catalano MC, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96(2):141-5.</ref><ref>Tarzi S, Kennedy P, Stone S, Evans M. [[Methicillin-resistant Staphylococcus aureus]]: psychological impact of hospitalization and isolation in an older adult population. J Hosp Infect 2001;49(4):250-4.</ref><ref>Kelly-Rossini L, Perlman DC, Mason DJ. The experience of respiratory isolation for HIV-infected persons with tuberculosis. J Assoc Nurses AIDS Care 1996;Jan-Feb; 7(1):29-36.</ref> perceptions of stigma,<ref>Knowles HE. The experience of infectious patients in isolation. Nurs Times 1993;89(30):53-6.</ref> reduced contact with clinical staff,<ref>Evans HL, Shaffer MM, Hughes MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134(2):180-8.</ref><ref>Kirkland KB, Weinstein JM. Adverse effects of contact isolation. Lancet 1999;354(9185):1177-8.</ref><ref>Saint S, Higgins LA, Nallamothu BK, Chenoweth C. Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control 2003;31(6):354-6.</ref> and increases in preventable adverse events<ref>Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infection control. JAMA 2003;290(14):1899-905.</ref> in order to improve acceptance by the patients and adherence by health care workers).
Footnotes:{{Reflist|30em}}
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