Transmission-based Precaution

Contact Precautions are intended to prevent the transmission of infections that are spread by direct (e.g., person-to-person) or indirect contact (e.g., resident's environment and equipment). 

Diseases and microorganisms requiring Contact Precautions includes but are not limited to:

• Active infections with Multidrug-resistant Organisms (MDROs), MRSA; VRE; ESBL; CRE; VRSA or other gram-negative multi-drug resistant organisms 
• C. difficile; Rotavirus; Norovirus; Shigella; E. coli 0157:H7 
• Hepatitis A (Incontinent Residents only) 
• Conjunctivitis 
• Impetigo  
• Parasites including lice and scabies 
• Major (non-contained) abscesses, cellulitis, or decubiti

Precautions:

• Place the resident in a private room
• Restrict the resident to their room unless medically necessary 
• Residents may not participate in group activities or communal dining
• Isolation gowns and gloves are required for all resident interactions.

Enhanced Barrier Precautions are designed to prevent the spread of novel or targeted MDROs, and to address the challenges of Contact Precautions in the post-acute care settings. 

Microorganisms requiring Enhanced Barrier Precautions include but are not limited to:

• Pan-resistant organisms (resistant to all antibiotics) 
• Colonization with carbapenem-producing Enterobacter
• Colonization with carbapenem-producing E. coli
• Colonization with carbapenem-producing Klebsiella
• Colonization with Colistin-resistant organisms
• Colonization with drug-resistant Acinetobacter baumannii
• Colonization with Candida auris

Residents are not restricted to their rooms and may participate in group activities.

Isolation gowns and gloves are required for:

• Dressing 
• Bathing/showering 
• Transferring 
• Providing hygiene 
• Changing linens 
• Changing briefs or assisting with toileting 
• Device care or use e.g. central line, urinary catheter, feeding tube, tracheostomy/ventilator 
• Wound care or any skin openings requiring a dressing
• Perform environmental hygiene daily in residents’ room.

Droplet Precautions are applied when respiratory droplets containing viruses or bacteria particles may be spread to susceptible individuals. Respiratory droplets are generated when an infected person coughs, sneezes, or talks. The maximum distance for droplet transmission is currently unresolved, but the area of defined risk based on epidemiological findings is approximately 3-10 feet.  

Diseases requiring Droplet Precautions include but are not limited to:

• Influenza
• Group A Streptococcal invasive disease, pneumonia and pharyngitis  
• Pertussis (whooping cough)
• Meningitis (bacterial or viral)  
• RSV (plus Contact Precautions). 

Droplet Precautions include:

• Place the resident in a private room
• Restrict the resident to their room unless medically necessary 
• Residents may not participate in group activities or communal dining
• Procedure masks are required before entering the room
• Encourage source control by placing a mask on the resident.

• All residents who are positive for COVID-19 or have symptoms of COVID-19 should be placed on Droplet Plus Precautions
• Place the resident in their room and keep the door closed, if possible
• Restrict the resident to their room unless medically necessary
• Residents may not participate in group activities, communal dining or have visitors
• Gowns, gloves, masks and eye protection should be worn for all resident interactions
• A fit-tested N95 or higher-level respirator should be worn for any aerosolizing procedures
• Workflows should focus on providing care to negative residents first, followed by positive individuals
•  If staffing allows, employees should be assigned to either all negative or all positive individuals

Airborne transmission occurs when pathogens are so small that they can be easily dispersed in the air, where they ride the air currents and may be inhaled by individuals who have not had face-to-face contact with the infectious individual. 

Diseases requiring Airborne Precautions include but are not limited to:

• Mycobacterium tuberculosis (TB) (active infections only, not latent TB) 
• Measles
• Mumps
• Rubella
• Varicella (plus Contact Precautions)  
• Disseminated Shingles

Precautions:

• Place the resident in a private room and keep the door closed
• Restrict the resident to their room unless medically necessary
• Residents may not participate in group activities, communal dining or have visitors
• A fit-tested N95 or higher-level respirator should be worn inside the room 
• Transport the resident to a facility with a negative pressure room if you do not have one in the facility.

Cohorting, or sharing a room with a roommate, should be limited to like organisms, low risk organisms, limited mobility of the resident, and with limited risk factors for the resident (e.g., without indwelling devices, without pressure ulcers and not immunocompromised).  

 Precautions should be discontinued per CDC Duration of Precautions or until active infections clear.