The Hospital Infection Control Advisory Committee and the Centers for Disease Control and Prevention have concluded that some fluids, secretions, and excretions not covered under Universal Precautions (UP) represent a potential source of nosocomial and community-acquired infections. The term Universal Precautions has been replaced in the hospital setting by a two-tiered system of isolation: Standard Precautions for control of nosocomial infections; and Transmission-based Precautions for clients known or suspected to be infected with highly transmissible pathogens. Standard Precautions incorporate the major components of blood and body fluid precautions from Universal Precautions. Transmission-based Precautions may be combined for diseases that have multiple routes of transmission and are used in addition to Standard Precautions .

Standard Precautions

Use Standard Precautions, or the equivalent, for the care of all clients.

1. Handwashing.
   1. Wash hands after touching: blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Wash hands immediately: after gloves are removed, between client contacts, and when otherwise indicated to avoid transfer of microorganisms to other clients or environments. It may be necessary to wash hands between tasks and procedures on the same client to prevent cross-contamination of different body sites.
   2. Use a plain (non-antimicrobial) soap for routine hand washing.
   3. Use an antimicrobial agent or a waterless antiseptic agent for specific circumstances (e.g., control of outbreaks or hyperendemic infections), as defined by the infection control program (see Contact Precautionsfor additional recommendations on using antimicrobial and antiseptic agents).
2. Gloves. Wear gloves (clean, nonsterile gloves are adequate) when touching: blood, body fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and nonintact skin. Change gloves between tasks and procedures on the same client after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching noncontaminated items and environmental surfaces, and before going to another client; wash hands immediately to avoid transfer of microorganisms to other clients or environments.
3. Mask, eye protection, face shield. Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and client care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.
4. Gown. Wear a gown (a clean, nonsterile gown is adequate) to protect skin and to prevent soiling of clothing during procedures and client care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Select a gown that is appropriate for the activity and amount of fluid likely to be encountered. Remove a soiled gown as promptly as possible, and wash hands to avoid transfer of microorganisms to other clients or environments.
5. Client care equipment. Handle used client care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other clients and environments. Ensure that reusable equipment is not used for the care of another client until it has been cleaned and reprocessed appropriately. Ensure that single-use items are discarded properly.
6. Environmental control. Ensure that the hospital has adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces, beds, bed rails, bedside equipment, and other frequently touched surfaces, and ensure that these procedures are being followed.
7. Linens. Handle, transport, and process used linens soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures and contamination of clothing, and that avoids transfer of microorganisms to other clients and environments.
8. Occupational health and blood-borne pathogens.
   1. Take care to prevent injuries when using needles, scalpels, and sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles. Never recap used needles, or otherwise manipulate them using both hands, or use any other technique that involves directing the point of a needle toward any part of the body; rather, use either a one-handed “scoop” technique or a mechanical device designed for holding the needle sheath. Do not remove used needles from disposable syringes by hand, and do not bend, break, or otherwise manipulate used needles by hand. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers that are located as close as practical to the area in which the items were used, and place reusable syringes and needles in a puncture-resistant container for transport to the reprocessing area.
   2. Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable.
9. Client placement. Place a client who contaminates the environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control in a private room. If a private room is not available, consult with infection control professionals regarding client placement or other alternatives.

Transmission-Based Precautions

Airborne Precautions

In addition to Standard Precautions, use Airborne Precautions, or the equivalent, for clients known 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 that can be dispersed widely by air currents within a room or over a long distance).

1. Client placement. Place the client in a private room that has (1) monitored negative air pressure in relation to the surrounding area, (2) 6–12 air changes per hour, and (3) appropriate discharge of air outdoors or monitored high-efficiency filtration of room air before the air is circulated to other areas in the hospital. Keep the room door closed and the client in the room. When a private room is not available, place the client in a room with a client who has active infection with the same microorganism, unless otherwise recommended, but with no other infection (cohorting). When a private room is not available and cohorting is not desirable, consultation with infection control professionals is advised before client placement.
2. Respiratory protection. Wear respiratory protection when entering the room of a client with known or suspected infectious pulmonary tuberculosis. People who are susceptible should not enter the room of clients known or suspected to have measles (rubeola) or varicella (chickenpox) if other caregivers who are immune are available. If persons who are susceptible must enter the room of a client known or suspected to have measles (rubeola) or varicella, they should wear respiratory protection. Persons immune to measles (rubeola) or varicella need not wear respiratory protection.
3. Client transport. Limit the movement and transport of the client from the room to essential purposes only. If transport or movement is necessary, minimize client dispersal of droplet nuclei by placing a surgical mask on the client, if possible.
4. Additional precautions for preventing transmission of tuberculosis. Consult CDC “Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities” for additional prevention strategies.

Droplet Precautions

In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a client known 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 client during coughing, sneezing, talking, or the performance of procedures).

1. Client placement. Place the client in a private room. When a private room is not available, place the client in a room with a client who has active infection with the same microorganism but with no other infection (cohorting). When a private room is not available and cohorting is not achievable, maintain spatial separation of at least 3 ft between the client who is infected and other clients and visitors. Special air handling and ventilation are not necessary, and the door may remain open.
2. Mask. In addition to standard precautions, wear a mask when working within 3 ft of the client. (Logistically, some hospitals may want to implement the wearing of a mask to enter the room.)
3. Client transport. Limit the movement and transport of the client from the room to essential purposes only. If transport or movement is necessary, minimize client dispersal of droplets by masking the client, if possible.

Contact Precautions

In addition to Standard Precautions, use Contact Precautions, or the equivalent, for specified clients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct contact with the client (hand or skin-to-skin contact) that occurs when performing client care activities that require touching the client’s dry skin or indirect contact (touching) with environmental surfaces or client care items in the client’s environment.

1. Client placement. Place the client in a private room. When a private room is not available, place the client in a room with a client who has active infection with the same microorganism but with no other infection (cohorting). When a private room is not available and cohorting is not achievable, consider the epidemiology of the microorganism and the client population when determining client placement. Consultation with infection control professionals is advised before client placement.
2. Gloves and handwashing. In addition to wearing gloves as outlined under Standard Precautions, wear gloves (clean, nonsterile gloves are adequate) when entering the room. During the course of providing care for a client, change gloves after having contact with infective material that may contain high concentrations of microorganisms (fecal material and wound drainage). Remove gloves before leaving the client’s environment and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent. After glove removal and hand washing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the client’s room to avoid transfer of microorganisms to other clients or environments.
3. Gown. In addition to wearing a gown as outlined under Standard Precautions, wear a gown (a clean, nonsterile gown is adequate) when entering the room if you anticipate that your clothing will have substantial contact with the client, environmental surfaces, or items in the client’s room; or if the client is incontinent or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing. Remove the gown before leaving the client’s environment. After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of microorganisms to other clients or environments.
4. Client transport. Limit the movement and transport of the client from the room to essential purposes only. If the client is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other clients and contamination of environmental surfaces or equipment.
5. Client care equipment. When possible, dedicate the use of noncritical client care equipment to a single client (or cohort of clients infected or colonized with the pathogen requiring precautions) to avoid sharing between clients. If use of common equipment or items is unavoidable, adequately clean and disinfect them before use for another client.

Source: Centers for Disease Control and Prevention and Hospital Infection Control Practices Advisory Committee.