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Patient placement decisions must be made for patients with confirmed or suspected communicable diseases that present a risk to other patients. The Guideline for Isolation Precautions provides an isolation scheme for patients (Siegel, Rhinehart, Jackson, & Chiarello, 2007).

• Standard precautions are used for all patient interactions and address six imperatives:
  • Clean hands at all the appropriate times, for the appropriate length of time, using the appropriate agent (see previous).
  • Disinfect surfaces at all appropriate times, for the appropriate length of time, using the appropriate agent (see previous).
  • Use PPE based upon assessed risk.
  • Use safe injection practices (“one needle one time”) when accessing multiuse vials and administering injectable medications.
  • Perform and require respiratory hygiene/cough etiquette.
  • Use masks to cover the mouth and nose when performing lumbar punctures.
• Transmission-based precautions consist of three types of precautions, which are used in addition to standard precautions. Any combination or all of the precautions types may be applied to a patient:
  • Airborne precautions are applied to patients with diseases transmitted by the airborne route.
  • Airborne transmission occurs when droplet nuclei (<0.5 micron) are released via cough, sneeze, spit, or speech, then desiccate and travel on air currents to locations away from the infected patient.
  • Patients with confirmed or suspected pulmonary tuberculosis, measles, or varicella zoster virus (chicken pox or disseminated [shingles]) should be placed in airborne precautions in an airborne infection isolation (negative pressure) private room (AIIR).
  • When caring for a patient with confirmed or suspected tuberculosis, the healthcare worker must wear a fit-tested respirator.
  • When caring for a patient with measles or varicella (vaccine-preventable diseases), the nonimmune healthcare worker should not care for the patient until vaccinated.
  • The reader will recall that an airborne isolation room is not required in a PACU. However, facility-specific policies must be developed to recover a patient with confirmed or suspected airborne-transmitted disease. Some facilities will recover such a patient in the operating room (OR) or in an airborne isolation room in another area of the facility.
  • Contact precautions are applied to patients with diseases transmitted by direct or indirect touch.
  • Patients diagnosed with multiple drug-resistant organisms (MDRO) should be placed according to the facility’s policy, which may include placing patients with MDRO in contact precautions.
  • Patients with confirmed or suspected Norovirus or CDAD, patients with draining wounds not contained by dressings, and patients with skin lesions are nearly universally placed in contact precautions.
  • The appropriate application of standard and contact precautions precludes the necessity for special placement consideration (e.g., cohorts, specific spatial separation). However, workflow stresses should be taken into consideration when placing patients requiring the healthcare worker to wear PPE. For example, if two patients in contact precautions are adjacent to each other, the healthcare worker may be tempted to wear the same gown and gloves for both patients, thereby increasing the potential for pathogen transmission between the patients.
  • Droplet precautions are applied to patients with diseases spread by the droplet route of transmission. Droplet transmission occurs when large, macroscopic droplets are released via cough, sneeze, shout, or spit. The droplets travel only a few feet, then drop. Therefore, when the healthcare worker is in the “cough zone,” or within about 3 feet of the patient who is infected with a droplet-transmitted disease (such as influenza, pertussis, bacterial meningitis), they should wear a surgical mask and eye protection. Because infectious droplets contaminate the area around the patient, gloves may be worn to decrease the risk of insensate touch contamination. Even if gloves are worn, hand hygiene must be performed as previously outlined. The use of gloves does not preclude hand hygiene.