What infections require droplet precautions?

Transmission-Based Precautions should be used when standard precautions alone are insufficient to interrupt the transmission of a microorganism. Transmission-Based Precautions are to be applied in addition to standard precautions.

Table of Contents Show

Contact precautions
Before entering patient zone
After entering patient zone
On leaving patient zone
Droplet precautions
Airborne precautions
Specific requirements for airborne precautions are:

There are three types of Transmission-Based Precautions, tailored to the different forms of transmission;

Contact precautions

Contact precautions, when used with standard precautions, are designed to reduce the risk of transmission of microorganisms by direct and/or indirect contact. Perform a risk assessment based on patients' communicability or risk of transmitting infection to others and to healthcare workers.

Contact precautions should be considered for patients colonised or infected with a multi-resistant organism (MRO) where there is significant patient and/or environmental contact.

Assessment of the patient's risk factors that potentially contribute to the spread of organisms in addition to local epidemiology will guide clinicians to whether patients require contact precautions with isolation, cohorting or management using standard precautions.

Contact precautions consist of:

Before entering patient zone

Perform hand hygiene
Preform a risk assessment on the need for apron/gown i.e. type of patient contact (contact with body substance), type of MRO (new or emerging), patient status (wet or dry).

After entering patient zone

Perform hand hygiene
Perform a risk assessment on the need for gloves i.e. type of patient contact (contact with body substance), type of MRO (new or emerging), and patient status (wet or dry)
Change or remove glove (if worn) and perform hand hygiene in between dirty and clean task.

On leaving patient zone

Remove and dispose gloves (if worn)
Perform hand hygiene
Dispose apron/gown (if worn)
Perform hand hygiene
Clean shared equipment (if used) and perform hand hygiene.

When transporting patient outside of the room remove PPE and perform hand hygiene after placing patient on trolley/stretcher/wheelchair.

Use patient-dedicated or single-use non-critical patient-care equipment.

Ensure consistent cleaning and disinfection of surfaces in close proximity to the patient and those likely to be touched by the patient and healthcare workers..

Droplet precautions

Droplet precautions should be employed in addition to standard precautions when caring for any patient known to be or suspected of being infected with a microorganism that can be transmitted by the respiratory droplet transmission route.

Specific requirements for droplet precautions are:

Preferentially, the patient should be placed in a single room with ensuite bathroom. If not possible, the patient should be cohorted with patients infected or colonised with same microorganism and have access to a designated bathroom. Maintain a spatial separation of greater than 2.4 m between mid-points of the beds in cohorted patients or draw bed curtains between patients to impede the direct spread of droplets and space beds at least 2.4m apart.
HWs are to wear a disposable fluid repellent level 1 or level 2 surgical mask. Masks should be removed and disposed of on leaving the patient's zone (e.g. at the door, curtain or the anteroom) and perform hand hygiene
Protective eyewear (goggles or face shield) is to be worn as part of standard precautions.

If a patient who is being cared for under droplet precautions requires an aerosol generating procedure (AGP), this procedure should be undertaken in a dedicated treatment room away from other patients. If aerosol generating-procedures are anticipated, a P2/N95 mask should be worn by attending HWs.

Protective eyewear should be worn as part of standard precautions. The following should be adhered to when managing patients on droplet precautions;

Symptomatic patient should be transported of their own or with patients infected or colonised with same microorganism.
If clinically able, patient should wear surgical mask when outside of the usual patient zone (including outpatient and emergency settings).
Depending on the microorganism, disinfection may be required in addition to cleaning.
Visitors are recommended to wear a surgical mask if within 1m of patient and practice hand hygiene.
Use droplet precautions signage at entrance of patient's zone.

Given that droplets do not remain suspended in the air, special air handling and ventilation is not required under droplet precautions.

Airborne precautions

Airborne precautions are designed to interrupt the airborne transmission route. Airborne precautions should be employed in addition to standard precautions when caring for patients who are known or suspected to be infected with a microorganism that can be transmitted by the airborne route.

Specific requirements for airborne precautions are:

The patient should be placed in a negatively pressurised single room with ensuite bathroom. If not possible, place the patient in a single room with door should be closed at all times. In this second instance, the patient should have access to an ensuite or designated bathroom. HWs are to wear a P2/N95 mask on entering the patient's zone. P2/N95 masks require a proper seal to the face and all HWs are to be instructed on fit check of a P2/N95 mask. Masks should be removed and disposed in the anteroom or outside the patient's room.
Visitors are recommended to wear a surgical mask. P2/N95 respirators may be an alternative, but must be accompanied with training and fit checking. P2/N95 mask requires a proper seal to the face and instruction should be given on how to perform a fit check. This should include a demonstration of donning, removing and disposing of PPE in addition to hand hygiene.
Patients in airborne precautions are to be transported or transferred on their own.
If the patient can tolerate wearing a surgical mask, this should be worn when outside of the isolation zone (including transport, outpatient and emergency settings). Patients are never to wear a P2/N95 mask.
Depending on the microorganism, disinfection may be required in addition to cleaning.
Protective eyewear should be worn as part of standard precautions
Adequate time must be allowed after patient discharge or transfer for removal of at least 99% of airborne contaminants. This time period will vary; depending on the amount of air exhausted from the room, room air mixing, and the size of the room
P2/N95 mask should be worn by all HWs entering these rooms until terminal cleaning is completed and the time period has elapsed.

For further information visit ACSQHC - 6.4 Type and duration of precautions for specific infections and conditions. Please see the Resources page for signs and posters.

It is known that COVID-19 spreads through droplet transmission. Centers for Disease Control indicates early reports suggest person-to-person transmission most commonly happens during close exposure to a person infected with COVID-19, primarily via respiratory droplets produced when the infected person coughs, sneezes, or talks. Droplets can land in the mouths, noses, or eyes of people who are nearby or possibly be inhaled into the lungs of those within close proximity. Evidence also suggests that people who are infected, but remain asymptomatic play a role in the spread of COVID-19.

Droplets are heavy, think of a wet cough, typically the heavy particle will not carry far. The droplets which are generated by a patient who is coughing, sneezing, or talking can land on surfaces and you can also contaminate yourself by touching the surface followed by touching your face.

Patients in droplet isolation require healthcare workers to wear surgical mask, gloves, and gown. During times when available PPE is limited, it is recommended, if possible, to cohort COVID positive patients, one measure to preserve limited PPE. Other diseases that require droplet precautions include seasonal flu, bacterial meningitis, and pertussis.

There is much discussion about COVID-19 also having properties which require airborne precautions due to aerosolized particles. An aerosol, which are micro-droplets, weigh much less, these may stay suspended in the air for longer period of time or even have the ability to travel by air currents. These small droplets are produced during normal breathing. Evidence also suggests that people who are infected, but remain asymptomatic play a role in the spread of COVID-19. In addition, certain medical procedures, such as collecting respiratory specimens are considered aerosol generating procedures and would require airborne precautions.

When airborne transmission is known, the isolation protocols are stricter. Precautions include wearing an N95 or higher level respirator, eye covering, gloves, and gown, and if possible, isolating the patient in a negative pressure airborne infection isolation room. Other diseases requiring airborne precautions include measles, chickenpox, and TB.

The attached picture are the recommendations for COVID. When N95 masks are in limited supply, they should be reserved for use when known aerosolized generating procedures will be performed.

Author: Lisa Chadwick, RN, MS, Director of Safety and Risk Management, Privacy Officer