When determining the type and duration of precautions for selected infections and conditions, as well as appropriate disinfectants for environmental cleaning, start with these resources:
- CDC Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions
- Selected EPA-Registered Disinfectants
Then use the information on this webpage to learn how to implement the appropriate level of precautions needed. For any questions on appropriate precautions need for a specific infection or condition email hai-ar@hhs.iowa.gov.
- Best Practices: Supplemental Disinfection Techniques Webinar
- Environmental Services Personnel Webinar
- Food Services Personnel Webinar
- Hand Hygiene Basics Webinar
- How to Find and Select a Surface Disinfectant and Audit for Appropriate Use Webinar
- Infection Prevention and Control Precautions Webinar
- Safe Injection Practices Webinar
- Working with Patients in Isolation Webinar
Standard Precautions
The Centers for Disease Control and Prevention’s (CDC) standard precautions are the minimum infection control safeguards used when caring for patients, whether they appear infectious or symptomatic. Standard precautions always apply in all healthcare locations.
Proper hand hygiene requires cleaning your hands with soap and water or using an alcohol-based hand rub. In most clinical situations, the alcohol-based hand rub is the preferred method. However, use soap and water when hands are visibly soiled, after using the bathroom and before eating.
When caring for someone with known or suspected infectious diarrhea or exposure to spores like Clostridium difficile (C. diff), soap and water are the preferred method of hand hygiene.
Resources
- About Hand Hygiene for Patients in Healthcare Settings, CDC
- Clean Hands in Healthcare Training, CDC
- Clinical Safety: Hand Hygiene for Healthcare Workers, CDC
- Guideline for Hand Hygiene in Healthcare Settings, CDC
- Hand Hygiene Frequently Asked Questions, CDC
- Hand Sanitizer Guidelines and Recommendations, CDC
- Health Promotion Materials, CDC
- Graphics, posters, videos and more
When a person infected with a virus coughs or sneezes, they can spread a respiratory infection. The droplets released can travel several feet, reaching the nose and mouth of others or landing on objects in the environment another person can touch.
Healthcare facilities should ensure the availability of materials for adhering to respiratory hygiene at entrances, triage areas and waiting areas for patients and visitors:
- Provide facemasks to people with respiratory infection symptoms (e.g., cough).
- To facilitate hand hygiene, provide dispensers of alcohol-based hand sanitizer in convenient locations. Where sinks are available, ensure supplies for hand washing (e.g., soap, disposable towels) are consistently available.
- Provide tissues and no-touch receptacles for used tissue disposal.
Resources
When used correctly, personal protective equipment (PPE) acts as a barrier for bacteria, viruses and other microorganisms that can be carried in blood, body fluids, air, on the skin or in the mouth, in the nose and eyes, or the environment.
Eye Protection
Goggles or a face shield are the appropriate PPE for protecting the eyes and face.
- Correctly fitted goggles with anti-fog coating offer good eye protection from splashes, sprays and respiratory droplets in the air.
- Regular eyeglasses do not provide appropriate protection since the gaps between the glasses and the face do not stop germs, allowing the person wearing them to become exposed. Face shields address these gaps by helping protect the eyes and the front and sides of the face.
- Some types of eye protection are reusable. When that’s the case, they should be cleaned and disinfected following the manufacturer’s guidelines before every patient encounter.
Gloves
Wearing gloves helps protect the skin and reduces the spread of germs from hands to other people and surfaces.
- Always wear gloves when you reasonably anticipate contact with any of the following:
- Blood
- Certain hazardous drugs
- Contaminated equipment or items
- Feces
- Mucous membranes
- Non-intact skin
- Potentially contaminated skin
- Respiratory secretions
- Urine
- Vomit
- Wearing gloves is never a substitute for good hand hygiene. Always clean your hands before putting on (donning) gloves. Carefully remove (doff) contaminated gloves after providing patient care, discard them immediately and clean your hands again.
Gowns
Body protection as part of routine PPE use means wearing an isolation gown.
- Gowns protect clothing from germs, body fluids and other contaminants. When doffed and disposed of properly, they also protect the healthcare worker and others by preventing the spread of germs from one patient care area to the next.
- Always don a gown when there is a risk of splashing or spraying and when caring for patients with certain illnesses.
Always don a gown before entering a patient’s room, then doff and properly discard it before exiting the care area.
Masks and Respirators
When protecting the lungs and airways, the type of mask and how it is worn depends on whether respiratory protection or source control is the goal.
- Wearing a well-fitting surgical or facemask to reduce the spread of germs from your mouth and nose to others is source control. In this situation, you can use the mask for an entire shift unless it becomes soiled, damaged or difficult to breathe through.
- For respiratory protection, wearing a new NIOSH-approved N95 or higher respirator is the recommended routine use for protection during certain procedures or when caring for patients with select diseases, like measles.
- For routine use, the respirator should be donned before a new patient encounter and doffed and disposed of when leaving the patient’s care area.
- The respirator should fit the face of the person using it and have a tight seal. Ask your employer about their respiratory protection program and how you can be fit-tested for the correct respirator if you perform duties that could put you at risk. To learn how to perform fit testing, visit the Respirators and Fit Testing page on this website.
Disposal of PPE
In general, PPE used to prevent the spread of disease may be discarded as routine non-infectious waste – in the general trash and not in a biohazard bag – assuming that it would not otherwise classify as regulated medical waste.
According to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard, “regulated waste” refers to the following categories requiring special handling:
- Liquid or semi-liquid blood or other potentially infectious materials (OPIM)
- Items contaminated with blood or OPIM and which would release these substances in a liquid or semi-liquid state if compressed
- Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling
- Contaminated sharps
- Pathological and microbiological wastes containing blood or OPIM
One and Done
“One and Done” is a best practice for limiting the spread of HAIs. With routine use, one person uses PPE one time for one patient encounter, then discards or thoroughly cleans the equipment, as directed.
Learn more about the Iowa HHS “One and Done” campaign and find educational materials to share at your healthcare facility.
Resources
Avoid the contamination of clothing and the transfer of microorganisms to other patients, surfaces and environments by handling used patient care equipment soiled with blood, body fluids, secretions and excretions in a manner that prevents:
- Skin and mucous membrane exposures
- Contamination of clothing
- Transfer of microorganisms to other patients and environments
Always clean and reprocess reusable equipment appropriately before using it for another patient. Discard single-use items properly. Handle textiles and laundry carefully.
Resources
Ensure the proper placement of patients to reduce the transmission of microorganisms in healthcare settings.
Resources
Unsafe injection practices put patients and healthcare workers at risk of infections. This harm can be prevented by following standard precautions.
Resources
- Blood Glucose Monitoring and Insulin Administration Resources, CDC
- Injection Safety, CDC
- Isolation Precautions Guideline, CDC
- Safe Injection Practices to Prevent Transmission of Infections to Patients, CDC
- Sharps Safety for Healthcare Settings, CDC
- Worker Protections Against Occupational Exposure to Infectious Diseases, OSHA
Transmission-Based Precautions
Transmission-based precautions, the second tier of basic infection control, are used with standard precautions for patients who may harbor certain infectious agents requiring extra measures to prevent transmission.
Use contact precautions for patients with known or suspected infections that represent an increased risk for contact transmission.
- Ensure appropriate patient placement in a single patient space or room in acute care hospitals. In long-term settings, make room placement decisions to balance risks for other patients. In ambulatory settings, patients requiring contact precautions should be placed in an exam room or cubicle as soon as possible.
- Use PPE appropriately. Wear a gown and gloves for all interactions involving contact with the patient or the patient’s environment. Donning PPE upon room entry and properly discarding before exiting the patient room is done to contain pathogens.
- Limit patient transport and movement outside the room for medically necessary purposes. If transport or movement outside the room is needed, cover or contain the infected or colonized areas of the patient’s body. Remove and dispose of contaminated PPE and perform hand hygiene before transporting patients on contact precautions. Don clean PPE to handle the patient at the transport location.
- Use disposable or dedicated patient-care equipment (e.g., blood pressure cuffs). If using equipment for multiple patients is unavoidable, clean and disinfect the equipment between patients.
- Prioritize the cleaning and disinfection of rooms with patients who are on contact precautions. Ensure rooms are cleaned regularly and disinfected (e.g., at least daily or before use by another patient if in an outpatient setting), focusing on frequently touched surfaces and equipment in the immediate vicinity of the patient.
Source: Transmission-Based Precautions, CDC
Resources
Use droplet precautions for patients with known or suspected infections with pathogens spread through respiratory droplets produced when the patient coughs, sneezes or talks.
- Source control: Put a mask on the patient.
- Ensure appropriate patient placement in a single room if possible. If single rooms are unavailable, acute care hospitals should utilize the recommendations for alternative patient placement considerations in the Guideline for Isolation Precautions. In long-term care settings, decisions regarding patient placement should be made on a case-by-case basis, considering infection risks to other patients in the room and available alternatives. In ambulatory settings, place patients who require droplet precautions in an exam room or cubicle as soon as possible and instruct patients to follow respiratory hygiene recommendations.
- Use PPE appropriately. Don mask upon entry into the patient room or patient space.
- Limit patient transport and movement outside the room for medically necessary purposes. If transport or movement outside the room is needed, instruct the patient to wear a mask and follow respiratory hygiene etiquette.
Source: Transmission-Based Precautions, CDC
Resources
Use airborne precautions for patients with known or suspected infections with pathogens transmitted by the airborne route (e.g., tuberculosis, measles, chickenpox, disseminated herpes zoster).
- Source control: Put a mask on the patient.
- Ensure appropriate patient placement in an airborne infection isolation room (AIIR) constructed according to the Isolation Precautions Guideline. In settings where airborne precautions cannot be implemented due to limited engineering resources, masking the patient and placing the patient in a private room with the door closed will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned home.
- Restrict susceptible healthcare workers from entering the room of patients known or suspected to have measles, chickenpox, disseminated zoster or smallpox if other immune healthcare personnel are available.
- Use PPE appropriately, including a fit-tested NIOSH-approved N95 or higher-level respirator for healthcare personnel.
- Limit patient transport and movement outside the room for medically necessary purposes. If transport or movement outside an AIIR is essential, instruct patients to wear a surgical mask, if possible, and observe respiratory hygiene etiquette. Healthcare workers transporting patients on airborne precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and has covered infectious skin lesions.
- Immunize susceptible persons as soon as possible following unprotected contact with vaccine-preventable infections (e.g., measles, varicella or smallpox).
Source: Transmission-Based Precautions, CDC
Resources
Enhanced barrier precautions expand the use of PPE to include a gown and gloves during high-contact resident care activities that provide opportunities to transfer multidrug-resistant organisms (MDROs) to staff hands and clothing.
Standard precautions continue to apply to the care of all residents, regardless of suspected or confirmed infection or colonization status.
- Use enhanced barrier precautions for nursing home residents with any of the following:
- Infection or colonization with an MDRO when contact precautions do not otherwise apply.
- Wounds and/or indwelling medical devices.
- High-contact resident care activities include:
- Dressing
- Bathing/showering
- Transferring
- Providing hygiene
- Changing linens
- Changing briefs or assisting with toileting
- Device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator
- Wound care: any skin opening requiring a dressing
- Change PPE before caring for another resident.
- Face protection may also be needed if performing an activity with a risk of splash or spray.
Source: Implementation of PPE Use in Nursing Homes to Prevent Spread of MDROs, CDC
Iowa Enhanced Barrier Precautions 101, Iowa HHS
Resources
- Consideration for Use of Enhanced Barrier Precautions in Skilled Nursing Facilities, CDC
- Enhanced Barrier Precautions Pocket Guide, CDC
- EBP (Iowa HHS Algorithm)
- EBP (True Cost of an Outbreak)
- Frequently Asked Questions about Enhanced Barrier Precautions in Nursing Homes, CDC
- Implementation of PPE Use in Nursing Homes to Prevent Spread of MDROs, CDC
- Viral Respiratory Pathogens Toolkit for Nursing Homes, CDC