Guide — Infection Control
Transmission-Based Precautions
Transmission-based precautions are added on top of standard precautions when specific pathogens or clinical presentations require additional containment. They are organized around the primary route of transmission: direct contact, large respiratory droplets, or small airborne particles.
11 min read · Infection Control
Educational use only. Based on CDC Transmission-Based Precautions guidelines. Facility policies may require stricter precautions for certain pathogens. Always consult current CDC guidance and facility infection control protocols, especially for emerging or novel pathogens. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
Transmission-based precautions are selected based on how a pathogen spreads. The three types can be used alone or in combination when multiple transmission routes are possible. Standard precautions remain in effect throughout — they are never replaced by transmission-based precautions.
Contact
Direct or indirect contact with patient or environment
Droplet
Large droplets >5 µm — travel <3–6 feet
Airborne
Small particles ≤5 µm — remain suspended in air
Contact Precautions
Contact precautions are used when pathogens spread through direct contact with the patient or indirect contact with contaminated surfaces and equipment.
| Element | Requirement |
|---|---|
| Gloves | Required upon room entry — don before entering |
| Gown | Required upon room entry — don before entering |
| Mask | Not required for contact precautions alone |
| Room | Private room preferred; cohort with same organism if no private room available |
| Equipment | Dedicated patient equipment (stethoscope, BP cuff, glucometer) when possible |
| Hand hygiene | ABHR for most organisms; soap and water for C. difficile and norovirus |
Common organisms requiring contact precautions
Droplet Precautions
Droplet precautions are used for pathogens spread via large respiratory droplets (>5 µm) generated during coughing, sneezing, talking, or procedures. These droplets travel a short distance (typically <3–6 feet) before settling.
| Element | Requirement |
|---|---|
| Mask | Surgical mask when within 3–6 feet of the patient or upon entering the room |
| N95 | Not required for droplet precautions alone (unless performing aerosol-generating procedures) |
| Gloves/Gown | Use when contact with secretions is anticipated |
| Room | Private room preferred; door does NOT need to be under negative pressure |
| Spatial separation | Maintain ≥3–6 feet distance from other patients if no private room available |
Common organisms requiring droplet precautions
Airborne Precautions
Airborne precautions are used for pathogens carried on tiny particles (≤5 µm) that remain suspended in the air for long distances and periods. These require the highest level of respiratory protection and special room requirements.
Critical requirements:
- N95 respirator (fit-tested) — surgical mask is NOT sufficient for airborne precautions
- Negative pressure room (AIIR) — Airborne Infection Isolation Room with ≥12 air changes per hour; keep door CLOSED at all times
- Gown and gloves if contact with patient or secretions anticipated
- Immune staff preferred for measles and varicella when available
| Element | Requirement |
|---|---|
| Respirator | Fit-tested N95 or higher — required before entering room |
| Room | AIIR (negative pressure, ≥12 ACH, monitored); door CLOSED at all times |
| Gloves/Gown | Required if contact with patient or surfaces anticipated |
| Door | Must remain closed — negative pressure is lost if door is open |
Organisms requiring airborne precautions
Patient Placement Priorities
| Precaution | Ideal Placement | When No Private Room |
|---|---|---|
| Contact | Private room, private bathroom | Cohort with patient with same confirmed organism; consult infection control |
| Droplet | Private room | Maintain ≥3–6 feet spatial separation from other patients; keep curtains closed |
| Airborne | AIIR (negative pressure room) — mandatory | Transfer to facility with AIIR; do not place in shared room — safety risk |
Transport Considerations
Transport of patients on isolation precautions requires planning to prevent transmission to staff, other patients, and the environment:
- Contact: Cover wounds or draining lesions; don PPE appropriate to the organism; notify receiving department in advance
- Droplet: Patient wears a surgical mask during transport; notify receiving department
- Airborne: Patient wears a surgical mask during transport (this limits dispersal of large particles); use a designated route when possible; notify receiving department to prepare before patient arrives
- Limit transport to medically necessary procedures only
- Clean and disinfect transport equipment (wheelchair, stretcher) after use
NCLEX Pearls
- ✦TB requires airborne precautions — N95 (fit-tested) + negative pressure room. This is the #1 airborne NCLEX question.
- ✦C. diff = contact precautions + soap and water hand hygiene. ABHR is not effective against spores.
- ✦Airborne room door must stay CLOSED at all times — opening it neutralizes negative pressure.
- ✦For droplet precautions: surgical mask is sufficient — N95 is not required unless performing an aerosol-generating procedure.
- ✦Varicella and disseminated zoster = airborne + contact precautions combined.
- ✦Standard precautions remain in effect alongside transmission-based precautions — they are additive, not replaced.
- ✦When transporting a droplet or airborne patient, the patient wears a surgical mask — the nurse does not need to wear the N95 during transport in open air.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with CDC / HICPAC · Infectious Diseases Society of America (IDSA) / SHEA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →