Infection Control and Isolation
CDC standard and transmission-based precautions
Standard precautions: every patient
- Hand hygiene: alcohol-based rub for most care; soap and water when hands are visibly soiled, and for C. diff or norovirus (alcohol doesn't kill spores).
- PPE based on expected exposure to blood or body fluids.
- Respiratory hygiene and cough etiquette; safe injection practices; never recap needles.
- Clean and disinfect equipment between patients.
PPE order
Put on (don)
- Gown
- Mask or respirator
- Goggles or face shield
- Gloves
Take off (doff)
- Gloves
- Goggles or face shield
- Gown
- Mask or respirator (outside the room for airborne)
- Hand hygiene
Gloves come off first because they're the most contaminated. Perform hand hygiene any time hands become contaminated during removal.
Transmission-based precautions
| Type | Examples | Room and PPE |
|---|---|---|
| Contact | MRSA, VRE, other multidrug-resistant organisms, RSV, scabies, lice, draining wounds, impetigo | Private room or cohort; gown and gloves; dedicated equipment (stethoscope, BP cuff) |
| Contact enteric ("contact plus") | C. difficile, norovirus, rotavirus, infectious diarrhea | Gown and gloves; soap and water hand hygiene; bleach-based (sporicidal) cleaning |
| Droplet | Influenza, pertussis, mumps, rubella, N. meningitidis and Hib (first 24 h of antibiotics), adenovirus, Mycoplasma pneumonia, group A strep pharyngitis/scarlet fever (first 24 h) | Private room (or ≥3 ft spacing + curtain); surgical mask on entering; patient wears a mask during transport |
| Airborne | TB, measles, chickenpox, shingles that is disseminated or in an immunocompromised patient (airborne + contact) | Negative-pressure room (AIIR), door closed; fit-tested N95 or higher; patient wears a surgical mask during transport |
COVID-19: CDC recommends an N95, eye protection, gown and gloves. Localized shingles in a patient with a normal immune system, fully covered: standard precautions. Staff who aren't immune to measles or chickenpox shouldn't care for those patients.
Neutropenic (protective) precautions
- ANC = WBC × (% neutrophils + % bands) ÷ 100. <500/mm³ = severe neutropenia.
- Private room; strict hand hygiene; no sick visitors; mask for the patient outside the room.
- No fresh flowers or standing water; safe food handling (well-cooked meat, washed produce).
- Avoid rectal temps, suppositories and enemas.
- Fever ≥100.4°F (38°C) = emergency: cultures and antibiotics within 1 hour.
Memory hooks
Airborne = "MTV": Measles, TB, Varicella.
Droplet: think of anything spread by a sneeze or cough at close range: flu, pertussis, mumps, rubella, meningococcal.
Contact: anything you could pick up by touch: resistant bacteria, diarrhea, skin infestations, wounds.
Droplet: think of anything spread by a sneeze or cough at close range: flu, pertussis, mumps, rubella, meningococcal.
Contact: anything you could pick up by touch: resistant bacteria, diarrhea, skin infestations, wounds.
Sterile technique
A sterile field is only sterile if you can see it: keep it above waist level and in view; 1-inch border is non-sterile; don't reach across it; any doubt = contaminated; sterile touches sterile only; open the first flap of a package away from you.