Guidelines for Isolation Precautions in Hospitals*
In 1996, the Centers for Disease Control and Prevention (CDC) revised its Guidelines for Isolation Precautions in Hospitals to meet the following objectives: (1) to be epidemiologically sound; (2) to recognize the importance of all bodily fluids, secretions, and excretions in the transmission of nosocomial pathogens; (3) to contain adequate precautions for infections transmitted by the airborne, droplet, and contact routes of transmission; (4) to be as simple and user friendly as possible; and (5) to use new terms to avoid confusion with existing infection control and isolation systems.
The revised guidelines contain two tiers of precautions. The first and most important precautions are those designed for the care of all patients regardless of their diagnosis or presumed infection status. These standard precautions are designed to prevent the occurrence of nosocomial infections. The second tier is designed to implement isolation precautions for specific patients with certain diagnoses. Included are airborne, droplet, and contact modes of transmission.
Standard Precautions (Tier One) 
- Standard precautions apply to all blood, bodily fluids, secretions, excretions, nonintact skin, and mucous membranes.
- Handwashing is to be done between all client contacts, and after contact with blood, bodily fluids, secretions, excretions, or contaminated equipment.
- Gloves are worn at all times when in contact with blood, bodily fluids, secretions, excretions, nonintact skin, and mucous membranes. Handwashing is to be done after removal of gloves.
- Masks and eye protection are worn if splashing of blood or bodily fluids is possible.
- Gowns are worn if contact with blood, bodily fluids, secretions, or excretions is possible.
- Proper disinfection of equipment is necessary, and single-use items should be used and properly disposed of after use.
- Contaminated linens are to be placed in leakproof bags and appropriately tagged.
- Sharp instruments and needles are to be disposed of in a puncture-resistant container. This container should be placed in every client room. The CDC recommends that needles be disposed of uncapped or that a mechanical device be used for recapping.
- Private rooms are generally not necessary unless client hygiene practices are inadequate or in cases of specific Tier Two situations.
Transmission Categories (Tier Two)
- Droplet nuclei smaller than 5 microns (measles, chickenpox, disseminated varicella zoster, pulmonary or laryngeal tuberculosis).
- Clients require a private room, negative airflow with at least six changes per hour, and a mask or other respiratory protection for the nurse. The client may also require a mask if coughing is excessive.
- Droplets larger than 5 microns (diphtheria, rubella, streptococcal pharyngitis, pneumonia, scarlet fever, pertussis, mumps, mycoplasma or meningococcal pneumonia, or sepsis).
- Private room or cohort (isolated grouping) of clients and a mask for the nurse are required.
- Direct client contact or environmental contact, colonization or infection with drug-resistant organisms, Shigella and other enteric pathogens, herpes simplex, scabies, varicella zoster.
- Private room, cohort of clients, gloves, and gown for the nurse are required.
*Adapted from Centers for Disease Control and Prevention (http://www.cdc.gov).
Author's Note: This is an excellent web site for up-to-date information on precaution guidelines and statistical data on infectious diseases.