Quick Reference
Transmission-Based Precautions are additional infection-prevention measures for residents with known or suspected transmissible infections.
Always used in addition to Standard Precautions.
| Type | Transmission | Core PPE | Room Requirements |
|---|---|---|---|
| Contact | Direct contact or contaminated surfaces | Gown and gloves | Private room when indicated; no special air pressure |
| Droplet | Infectious respiratory droplets | Surgical/procedure mask | Private room when indicated; no special air pressure |
| Airborne | Infectious particles that can remain suspended in air | Fit-tested N95 or higher-level respirator | Negative-pressure room (AIIR) when required |
Contact Precautions
Prevent transmission through direct contact with residents or contaminated surfaces.
- PPE: Gown and gloves, as directed.
- Room: Private room preferred when indicated; placement depends on the setting.
- Examples: C. difficile, norovirus, certain MDROs.
- Equipment: Dedicated or properly disinfected shared equipment.
Droplet Precautions
Prevent transmission through infectious respiratory droplets.
- PPE: Surgical/procedure mask upon room entry; additional PPE based on exposure risks.
- Room: Private room preferred when indicated.
- Examples: Influenza, pertussis, meningococcal infection.
- Transport: Resident wears a mask if tolerated and appropriate.
Airborne Precautions
Prevent transmission through infectious airborne particles.
- PPE: Fit-tested N95 respirator or higher-level respiratory protection, as required.
- Room: Airborne Infection Isolation Room (AIIR), also called a negative-pressure room.
- Examples: Infectious pulmonary or laryngeal tuberculosis, measles, chickenpox (varicella), and disseminated shingles.
- Transport: Limit unnecessary movement; resident wears a surgical/procedure mask when appropriate and tolerated.
Negative-Pressure Rooms (AIIR)
A negative-pressure room is designed to keep infectious airborne particles from spreading into surrounding areas.
- Airflow: Air flows from the hallway into the room, rather than from the room into the hallway.
- Purpose: Protects other residents, healthcare workers, and visitors from airborne infection.
- Ventilation: Air is exhausted outdoors or filtered through appropriate HEPA filtration before recirculation.
- Door: Keep closed except when entering or exiting.
- Monitoring: Facilities monitor airflow and pressure to ensure the room operates correctly.
- PPE: Negative pressure does not replace the need for a fit-tested N95 or other required respirator.
CNA Considerations:
- Follow the isolation signage and facility’s PPE requirements before entering.
- Keep the room door closed.
- Report open doors, airflow alarms, or suspected ventilation problems to the nurse.
- Do not change ventilation settings or disable alarms.
Negative vs. Positive Pressure
| Room Type | Direction of Airflow | Purpose |
|---|---|---|
| Negative Pressure | Hallway → Room | Keeps airborne infectious particles contained |
| Positive Pressure | Room → Hallway | Helps protect vulnerable patients from outside contaminants |
Remember: Negative pressure protects people outside the room. Positive pressure protects the patient inside the room.
Transporting Residents Under Precautions
- Limit transport outside the room when required by the isolation plan.
- Perform hand hygiene and prepare the resident according to the required precautions.
- Use appropriate source control, such as a mask for respiratory infections when indicated.
- Cover or contain wounds, drainage, and contaminated areas.
- Ensure clean clothing or coverings as needed.
- Notify receiving personnel of required precautions before transport.
- Follow facility policy for transport staff PPE.
- Clean and disinfect transport equipment appropriately.
Important: Transport precautions depend on the infectious agent and the resident’s needs.
Additional PPE Safety
- Inspect PPE before use.
- Change gloves when torn, contaminated, or when moving from dirty to clean tasks.
- Avoid touching contaminated PPE surfaces.
- Remove PPE carefully to prevent self-contamination.
- Perform hand hygiene after removal and whenever hands become contaminated.
- Follow approved reprocessing instructions for reusable protection.
Important Considerations
- Contact: Gown + gloves.
- Droplet: Surgical/procedure mask.
- Airborne: Fit-tested N95 or higher respirator.
- Some infections require multiple precaution types.
- For C. difficile and norovirus, follow facility guidance regarding soap-and-water handwashing.
- Follow isolation signage and facility-specific requirements.
- Maintain resident dignity and minimize unnecessary isolation-related distress.
Related
- Standard Precautions
- Enhanced Barrier Precautions
- Hand Hygiene
- Donning & Doffing PPE
- Chain of Infection
Sources
- CNA Module 6 — Infection Prevention & Control
- CDC — Transmission-Based Precautions
- CDC — Isolation Precautions
Flashcards
What are the three main transmission-based precaution categories?01-foundations / reference-guidelines
Answer
Contact, droplet, and airborne.
Why are transmission-based precautions used in addition to standard precautions?02-mechanisms / reference-guidelines
Answer
Certain organisms need extra measures based on their transmission route.
What is the purpose of a negative-pressure room?01-foundations / reference-guidelines
Answer
Prevent airborne infectious particles from escaping into surrounding areas.
In which direction does air flow in a negative-pressure room?01-foundations / reference-guidelines
Answer
From the hallway into the patient room.
Which transmission-based precaution typically requires a negative-pressure room?01-foundations / reference-guidelines
Answer
Airborne Precautions.
What does AIIR stand for?01-foundations / reference-guidelines
Answer
Airborne Infection Isolation Room.
Why should the door of a negative-pressure room remain closed?03-application / reference-guidelines
Answer
To maintain controlled airflow and help contain infectious particles.
Does a negative-pressure room replace the need for an N95 respirator?03-application / reference-guidelines
Answer
No. Required respiratory PPE must still be worn.
What is the difference between negative-pressure and positive-pressure rooms?02-mechanisms / reference-guidelines
Answer
Negative pressure contains airborne infection; positive pressure protects vulnerable patients from outside contaminants.