Breaking down standard and transmission-based precautions for infection control

A patient arrives at a crowded emergency department (ED) with a cough and other symptoms. At intake, the patient’s symptoms are considered routine, and the patient sits in the waiting room among the other patients until being seen. Hours later, multiple people who were in the ED with the patient are determined to have been exposed.

Preventable transmission events occur when disease vectors are overlooked or not identified by a facility’s surveillance systems. Failure to identify or interrupt contact transmissions, droplet transmissions, airborne transmissions, environmental spread, and transport-related exposure can lead to hospital-associated infections, illness among staff members, delayed treatment, and operational disruption.

The CDC has a two-tiered system for infection control in healthcare facilities. Tier one is standard precautions. According to the CDC, standard precautions “are used for all patient care. They're based on a risk assessment and make use of common sense practices and personal protective equipment (PPE) that protect healthcare providers from infection and prevent the spread of infection from patient to patient.” Standard precautions include using PPE when there is an expectation of exposure, performing hand hygiene, following cough and respiratory etiquette, and properly disinfecting rooms and equipment.

Because standard precautions are designed as a first layer of protection and don’t cover everything, the CDC also has a second tier: transmission-based precautions. These are to be used in conjunction with standard precautions for “patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection transmission.” Transmission-based precautions target pathogens with known transmission routes. They focus on contact, droplet, and airborne precautions, as well as the environmental or transport exposure risks that go along with them.

Editor’s note: This article was excerpted from our Patient Safety Monitor Journal newsletter.