Which isolation precautions does each infection need?
NCLEX-RN topic: Standard/transmission-based precautions, asepsis
- Standard precautions apply to every client, every time.
- Contact: gown and gloves at room entry (C. difficile, MRSA).
- Droplet: mask at room entry (pertussis, influenza).
- Airborne: fit-tested N95, airborne isolation room, door closed (TB, measles).
- PPE comes off gloves first, mask or respirator last.
Key facts
- Standard precautions apply to every client in every setting, infected or not, because blood, body fluids except sweat, nonintact skin and mucous membranes may carry germs.
- Contact precautions: gown and gloves put on at room entry, dedicated equipment, and a single room when available; examples are C. difficile, MRSA, norovirus, RSV and scabies.
- Droplet precautions: a mask put on at room entry and a mask on the client during transport; examples are pertussis, influenza, mumps and meningococcal meningitis.
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- Airborne precautions: an airborne infection isolation room with the door closed and a fit-tested N95 (or higher) respirator; examples are pulmonary tuberculosis and measles.
- Chickenpox needs airborne plus contact precautions until the lesions are dry and crusted; disseminated shingles needs both for the duration of illness.
- For C. difficile, gloves and a gown are the key barrier, because no hand-hygiene method removes every spore; CDC still prefers alcohol hand rub unless hands are visibly soiled, and calls for soap and water during outbreaks.
- Enhanced barrier precautions (nursing homes) mean gown and gloves only during high-contact care for residents with an MDRO, a wound or an indwelling device; the resident is not confined to the room.
Quick check1 question · 2 more at the end
A client with a productive cough is admitted, and the provider documents suspected pulmonary tuberculosis. Which room placement and staff protection should the nurse arrange?
Correct answer: C.
Suspected or confirmed pulmonary tuberculosis requires airborne precautions plus standard precautions. The client goes into an airborne infection isolation room with the door closed, and staff wear a fit-tested N95 or higher respirator. Precautions start on suspicion; the nurse does not wait for sputum results.
A A surgical mask is droplet-level protection and does not protect staff from airborne tuberculosis particles; the door should also stay closed.
B Gown and gloves are contact precautions, and a curtain does not stop airborne particles from reaching a roommate.
C Correct: tuberculosis spreads by small airborne particles, so the client needs an airborne infection isolation room and staff need a fit-tested N95 respirator.
D A face shield with gown and gloves does not filter airborne particles; a fit-tested respirator is required.
Full lesson
Each part starts with its main idea. Open a part when you want the details.
The short answer: Standard precautions apply to every client: hand hygiene, PPE whenever exposure is possible, safe injections and clean equipment. Add contact precautions (gown, gloves) for germs such as C. difficile or MRSA, droplet precautions (mask on room entry) for pertussis or influenza, and airborne precautions (fit-tested N95 respirator, airborne infection isolation room) for tuberculosis or measles.
1 What do standard precautions cover?Standard precautions are the baseline for every client, every time, in every care setting. 1 min
Standard precautions are the baseline for every client, every time, in every care setting. They assume that blood, body fluids other than sweat, broken skin and mucous membranes may carry germs, diagnosed or not.
They include:
- Hand hygiene before touching a client, before an aseptic task, after body fluid exposure, after touching the client or their surroundings, and right after removing gloves.
- Personal protective equipment (PPE), such as gloves, gown, mask or eye protection, whenever contact with infectious material is possible.
- Respiratory hygiene and cough etiquette, safe injection practices, and proper cleaning of equipment, surfaces and linens.
Gloves never replace hand hygiene, because used nonsterile gloves pick up germs that spread to the next task.
2 How do you choose contact, droplet or airborne precautions?Pick the category by how the germ travels, by touch, by large droplets or by tiny particles that stay in the air. 1 min
Pick the category by how the germ travels, by touch, by large droplets or by tiny particles that stay in the air. Transmission-based precautions are added on top of standard precautions, never in place of them.
| Precaution | Room | What staff wear | Examples |
|---|---|---|---|
| Contact | Single room if available; equipment stays in the room | Gown and gloves, put on at room entry | C. difficile, MRSA, norovirus, RSV, scabies |
| Droplet | Single room if possible | Mask at room entry; goggles or face shield | Pertussis, influenza, mumps, meningococcal meningitis |
| Airborne | Airborne infection isolation room (AIIR), door closed | Fit-tested N95 or higher respirator | Pulmonary tuberculosis, measles |
Some infections need two categories. Chickenpox needs airborne and contact precautions until the lesions are dry and crusted, and disseminated shingles needs both for the duration of illness.
For C. difficile, gloves and a gown matter most, because alcohol does not kill its spores and even handwashing does not remove every spore. CDC still prefers alcohol hand rub for routine care unless hands are visibly soiled, and encourages soap and water during C. difficile outbreaks.
Limit trips out of the room to essential tests. A client on droplet or airborne precautions wears a mask during transport, and the receiving area is warned ahead of time.
3 What are enhanced barrier precautions?Enhanced barrier precautions (EBP) are a nursing home approach that uses gown and gloves only during high-contact care to slow the spread of multidrug-resistant organisms (MDROs). 1 min
Enhanced barrier precautions (EBP) are a nursing home approach that uses gown and gloves only during high-contact care to slow the spread of multidrug-resistant organisms (MDROs). They apply to residents infected or colonized with an MDRO. They also apply to residents with a wound or an indwelling device (central line, urinary catheter, feeding tube, tracheostomy), even when no MDRO has been found.
High-contact care includes dressing, bathing, transferring, hygiene, changing linens or briefs, toileting help, device care and wound care. Unlike contact precautions, EBP do not keep the resident in the room or out of group activities.
Contact precautions replace EBP for acute diarrhea, draining wounds that cannot be covered, and infections such as C. difficile, norovirus or scabies.
4 In what order does PPE go on and come off?PPE comes off with the dirtiest item first, and hand hygiene happens twice. 1 min
PPE comes off with the dirtiest item first, and hand hygiene happens twice.
- On: hand hygiene, gown, mask or respirator, goggles or face shield, then gloves pulled over the gown cuffs.
- Off: gloves, gown, hand hygiene, goggles or face shield, mask or respirator, then hand hygiene again.
Touch only ties, straps and the inside of each item while you remove it.
5 What the nurse doesThe nurse matches the precautions to the suspected route before any test result comes back. 1 min
The nurse matches the precautions to the suspected route before any test result comes back.
- Assess: check the precaution order against the client's diagnosis and symptoms. Suspected tuberculosis or measles needs an AIIR right away, before results return.
- Act: place the client, post the precaution sign on the door, stock PPE at the entrance and keep a dedicated stethoscope, cuff and thermometer in the room.
- Protect immunocompromised clients: neutropenic (reverse) precautions use a private or positive-pressure room, strict hand hygiene, and no fresh flowers, live plants or raw fruits and vegetables.
- Teach: explain why isolation is needed. Isolation can raise anxiety, depression and feelings of stigma, so keep up regular contact with the client.
Common mistakes
The traps students fall into most. Read these before you practice.
Watch out: Tuberculosis and measles need a fit-tested N95 respirator, not a surgical mask; the surgical mask is the droplet-precaution item.
Watch out: For C. difficile, gloves come first, not a switch of hand cleaner; outside an outbreak, alcohol hand rub is still preferred unless hands are visibly soiled.
Watch out: Enhanced barrier precautions call for gown and gloves during high-contact care, not on every room entry, and they do not keep the resident in the room.
Watch out: Gloves come off first, not the mask; the mask or respirator is the last item removed.
Watch out: Chickenpox needs airborne plus contact precautions, not airborne alone.
How to remember it
Memory hook: "The smaller the germ's ride, the bigger the gear." Touch needs gown and gloves, a droplet needs a mask, and air needs an N95 plus a special room. And for C. difficile, spores shrug off every hand cleaner, so gloves go on first.
Self-check:
- Name the room and the face protection for a client with suspected pulmonary tuberculosis.
- List the PPE removal order out loud, including both hand hygiene steps.
- Explain one way enhanced barrier precautions differ from contact precautions.