Isolation – Categories of Transmission-Based Precautions

Highlights Policy Statement

Standard Precautions shall be used when caring for residents at all times regardless of their
suspected or confirmed infection status. Transmission-Based Precautions shall be used when
caring for residents who are documented or suspected to have communicable diseases or
infections that can be transmitted to others.

The facility shall make every effort to use the least restrictive approach to managing
individuals with potentially communicable infections. Transmission-Based Precautions shall
only be used when transmission cannot be reasonably prevented by less restrictive measures.

Policy Interpretation and Implementation

Transmission-Based 1. Transmission-Based Precautions will be used whenever measures more stringent
Isolation Precautions than Standard Precautions are needed to prevent or control the spread of infection.

Types of Transmission- 2. Based on CDC definitions, three types of Transmission-Based Precautions

Based Isolation Precautions (airborne, droplet and contact) have been established.

Airborne Precautions Airborne Precautions

In addition to Standard Precautions, implement Airborne Precautions for anyone

who is documented or suspected to be infected with microorganisms transmitted by
airborne droplet nuclei (small-particle residue [5 microns or smaller in size] of
evaporated droplets containing microorganisms that remain suspended in the air
and can be widely dispersed by air currents within a room or over a long distance).

Examples of Infections a. Examples of infections requiring Airborne Precautions include, but are not
Requiring Airborne limited to:
Precautions
(1) Measles
(2) Varicella (including disseminated zoster)
(3) Tuberculosis

Resident Placement During b. Resident Placement

Airborne Precautions
(1) If necessary and if such a room is available, place the resident in a private
room that meets the following criteria:

(a) Monitored negative air pressure in relation to the surrounding areas;

(b) Six (6) to twelve (12) air changes per hour;
(c) Appropriate discharge of air outdoors or monitored high efficiency
filtration of room air before the air is circulated to other areas of the
facility.

(2) Keep the room door closed and the resident in the room.
(3) If there is not a room in the facility that meets these criteria, then cohort
the individual with someone else who is infected with the same
microorganism.
(4) If neither is possible and isolation is necessary, place the individual in a
private room (a room with no one else in it).
(5) If isolation in a negative pressure room is essential to prevent transmission
of the illness (for example, with active TB), transfer the individual to a
setting that can provide the appropriate kind of isolation room.
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Respiratory Protection
During Airborne
Precautions
Resident Transport During
Airborne Precautions
Resident-Care Equipment
During Airborne
Precautions
Signs to Use to Alert Staff
of Airborne Precautions
Contact Precautions
Examples of Infections
Requiring Contact
Precautions
c. Respiratory Protection
(1) All individuals must wear approved respiratory protection when entering
the room.
(2) Anyone who is susceptible (i.e., not immune) to measles (rubeola) or
varicella (chickenpox) may not enter the room of someone who has, or is
suspected of having, these infections.
d. Resident Transport
(1) The resident should only leave an isolation room when absolutely
essential.
(2) Someone who is on Airborne Precautions, should wear a mask when
leaving the room or coming into contact with others. Depending on the
organism, a special filtration mask may be necessary.
(3) If the resident is transported to another unit within the facility or to another
facility, the Infection Control Coordinator (or designee) will notify the unit
or facility of the type of precautions the resident is on and the resident’s
suspected or confirmed type of infection. The facility is also responsible
for notifying transport staff of residents that require special care due to
infectious conditions.
e. Resident-Care Equipment
(4) When possible, dedicate the use of non-critical resident-care equipment
items such as a stethoscope, sphygmomanometer, bedside commode, or
electronic rectal thermometer to a single resident (or cohort of residents) to
avoid sharing between residents.
(5) If use of common items is unavoidable, then adequately clean and
disinfect them before use for another resident.
f. Signs - Color coded signs will be used to alert staff of the implementation of
airborne precautions, while respecting the resident’s privacy. Blue is the color
code for Airborne Precautions.
(1) Place a blue sign at the doorway instructing visitors to report to the nurses’
station before entering the room.
(2) Place a blue sticker indicating Airborne Precautions on the head of the
resident’s bed and on the front of the resident’s chart.
Contact Precautions
In addition to Standard Precautions, implement Contact Precautions for residents
known or suspected to be infected or colonized with microorganisms that can be
transmitted by direct contact with the resident or indirect contact with
environmental surfaces or resident-care items in the resident’s environment.
a. Examples of infections requiring Contact Precautions include, but are not
limited to:
(1) Gastrointestinal, respiratory, skin, or wound infections or colonization
with multi-drug resistant organisms (e.g., MRSA, VISA, VRSA, VRE);
(2) Diarrhea associated with Clostridium difficile;
(3) Enterohemorrhagic Escherichia coli 0157:H7;
(4) Shigella;
(5) Hepatitis A;
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 (6) Diarrhea associated with Rotavirus;
(7) Abscesses, cellulitis, or decubiti with noncontained drainage;
(8) Pediculosis;
(9) Scabies;
(10) Cutaneous Zoster;
(11) Viral/Hemorrhagic Conjunctivitis; and
(12) Viral Hemorrhagic Infections (Ebola, Lassa, Marburg).

Resident Placement During b. Resident Placement

Contact Precautions
(1) Place the individual in a private room if it is not feasible to contain
drainage, excretions, blood or body fluids (e.g., the individual is
incontinent on the floor, or wanders and touches others).
(2) If a private room is not available, the Infection Control Coordinator will
assess various risks associated with other resident placement options (e.g.,
cohorting).

Gloves and Handwashing c. Gloves and Handwashing

During Contact Precautions
(1) In addition to wearing gloves as outlined under Standard Precautions, wear
gloves (clean, non-sterile) when entering the room.
(2) While caring for a resident, change gloves after having contact with
infective material (for example, fecal material and wound drainage).
(3) Remove gloves before leaving the room and wash hands immediately with
an antimicrobial agent or a waterless antiseptic agent.
(4) After removing gloves and washing hands, do not touch potentially
contaminated environmental surfaces or items in the resident’s room.

Gowns During Contact d. Gown

Precautions
(1) In addition to wearing a gown as outlined under Standard Precautions,
wear a gown (clean, nonsterile) for all interactions that may involve
contact with the resident or potentially contaminated items in the
resident’s environment. Remove the gown and perform hand hygiene
before leaving the resident’s environment.
(2) After removing the gown, do not allow clothing to contact potentially
contaminated environmental surfaces.

Resident Transport During e. Resident Transport

Contact Precautions
(1) For individuals with skin lesions, excretions, secretions, or drainage that is
difficult to contain, maintain precautions to minimize the risk of
transmission to other residents and contamination of environmental
surfaces or equipment.

(2) If the resident is transported to another unit within the facility or to another
facility, the Infection Control Coordinator (or designee) will notify the unit
or facility of the type of precautions the resident is on and the resident’s
suspected or confirmed type of infection. The facility is also responsible
for notifying transport staff of residents that require special care due to
infectious conditions.

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Resident-Care Equipment
During Contact Precautions
Signs Used to Alert Staff of
Contact Precautions
Droplet Precautions
Examples of Infections
Requiring Droplet
Precautions
Resident Placement During
Droplet Precautions
Masks During Droplet
Precautions
f. Resident-Care Equipment
(1) When possible, dedicate the use of non-critical resident-care equipment
items such as a stethoscope, sphygmomanometer, bedside commode, or
electronic rectal thermometer to a single resident (or cohort of residents) to
avoid sharing between residents.
(2) If use of common items is unavoidable, then adequately clean and
disinfect them before use for another resident.
g. Signs - Use color coded signs and/or other measures to alert staff of the
implementation of Transmission-Based Precautions, while respecting the
privacy of the resident. Orange is the color code for Contact Precautions.
(1) Place an orange sign at the doorway instructing visitors to report to the
nurses’ station before entering the room.
(2) Place an orange sticker indicating Contact Precautions on the head of the
resident’s bed and on the front of the resident’s chart.
Droplet Precautions
In addition to Standard Precautions, implement Droplet Precautions for an
individual documented or suspected to be infected with microorganisms transmitted
by droplets (large-particle droplets [larger than 5 microns in size] that can be
generated by the individual coughing, sneezing, talking, or by the performance of
procedures such as suctioning).
a. Examples of infections requiring Droplet Precautions include, but are not
limited to:
(1) Invasive Haemophilus influenzae type B disease including meningitis,
pneumonia, epiglottitis and sepsis;
(2) Invasive Neisseria meningitidis disease, including meningitis, pneumonia,
and sepsis;
(3) Mycoplasma pneumonia;
(4) B. Pertussis;
(5) Influenza;
(6) Mumps;
(7) Rubella.
b. Resident Placement
(1) Place the resident in a private room.
(2) When a private room is not available, residents with the same infection
with the same microorganism but with no other infection may be cohorted.
(3) When a private room is not available and cohorting is not achievable, use a
curtain and maintain at least 3 feet of space between the infected resident
and other residents and visitors.
(4) Special air handling and ventilation are unnecessary and the door to the
room may remain open.
c. Masks
(1) In addition to Standard Precautions, wear a mask when working within 3
feet of the resident.
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Resident Transport During
Droplet Precautions
Resident-Care Equipment
During Droplet Precautions
Signs Used to Alert Staff of
Droplet Precautions
OBRA Regulatory
Reference Numbers
Survey Tag Numbers
Related Documents
Policy
Revised
d. Resident Transport
(1) Limit movement of resident from the room to essential purposes only.
(2) If transport or movement from the room is necessary, place a mask on the
infected individual and encourage the resident to follow respiratory
hygiene/cough etiquette to minimize dispersal of droplets.
(3) If the resident is transported to another unit within the facility or to another
facility, the Infection Control Coordinator (or designee) will notify the unit
or facility of the type of precautions the resident is on and the resident’s
suspected or confirmed type of infection. The facility is also responsible
for notifying transport staff of residents that require special care due to
infectious conditions.
e. Resident-Care Equipment
(1) When possible, dedicate the use of non-critical resident-care equipment
items such as a stethoscope, sphygmomanometer, bedside commode, or
electronic rectal thermometer to a single resident (or cohort of residents) to
avoid sharing between residents.
(2) If use of common items is unavoidable, then adequately clean and
disinfect them before use for another resident.
f. Signs – Use color coded signs and/or other measures to alert staff of the
implementation of Isolation or Droplet Precautions, while protecting the
privacy of the resident. Yellow is the color code for Droplet Precautions.
(1) Place a yellow sign at the doorway instructing visitors to report to the
nurses’ station before entering the room.
(2) Place a yellow sticker indicating Droplet Precautions on the head of the
resident’s bed and on the front of the resident’s chart.
References
483.65(b); CDC Guideline for Isolation Precautions (See Centers for Disease Control
and Prevention’s websites at: www.cdc.gov/ncidod/dhqp/gl_isolation.html
F442
Isolation – Initiating Transmission-Based Precautions
Isolation – Notices of Transmission-Based Precautions
Date: 11-28-2016 By:__________________
Date:________________ By:__________________
Date:________________ By:__________________
Date:________________ By:__________________