Reference — Infection Control
Isolation Precautions Reference
Transmission-based precautions are added on top of standard precautions when a patient has a known or suspected infection requiring additional containment. This reference focuses on how contact, droplet, and airborne precautions differ — in transmission mechanism, PPE requirements, room specifications, and conditions where more than one type applies simultaneously.
Educational use only. PPE requirements and precaution assignments may vary by institution and evolving guidance. Always follow current CDC guidelines and facility infection control policies. For standard precautions and hand hygiene, see Isolation Precautions. 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.
Transmission-Based Precautions — Side-by-Side Comparison
| Feature | Contact | Droplet | Airborne |
|---|---|---|---|
| Particle size | No airborne component — spread by touch | Large droplets (>5 µm) — fall within 3–6 ft | Droplet nuclei (≤5 µm) — remain suspended, travel >6 ft |
| Transmission route | Direct body contact or indirect contact with contaminated surfaces/equipment | Expelled during coughing, sneezing, talking — land on mucous membranes | Inhaled into respiratory tract — can travel on air currents throughout a room or building |
| Minimum PPE | Gloves + Gown — don on room entry; doff before exit | Surgical mask — worn on room entry or within 3–6 ft of patient | Fit-tested N95 respirator (or PAPR) — donned before entering room; door must be closed |
| Room requirement | Private room preferred; cohorting with same organism acceptable; dedicated equipment | Private room preferred; door may remain open; cohorting acceptable | AIIR required: negative pressure, ≥12 air changes/hour, exhaust directly outside or HEPA-filtered; door closed at all times |
| Patient transport | Minimize; cover wounds/drains; notify receiving area | Patient wears surgical mask; minimize time outside room | Patient wears surgical mask (not N95) during transport; minimize transport |
| Equipment | Dedicate stethoscope, BP cuff, thermometer to room | Standard precautions for equipment handling | Standard precautions for equipment handling; AIIR setup maintained |
Contact Precautions — Detail
Common conditions:
- MRSA — skin, wound, or respiratory colonization/infection
- VRE — vancomycin-resistant Enterococcus
- C. difficile — requires soap and water for hand hygiene; ABHR does not kill spores
- RSV in pediatric patients
- Scabies, lice
- MDROs — multi-drug resistant organisms
- Draining wounds with resistant organisms
Key nursing considerations:
- C. diff rooms: use sodium hypochlorite (bleach) products for terminal cleaning — sporicidal agent required
- Increase frequency of high-touch surface disinfection throughout the patient's stay
- Notify receiving areas before any patient transport outside the room
Droplet Precautions — Detail
Common conditions:
- Influenza
- Pertussis (whooping cough)
- Meningococcal meningitis
- Mumps, rubella
- Group A streptococcal pharyngitis
- Adenovirus
- COVID-19 — follow current institutional guidance; may require combined precautions
Key distinction:
A surgical mask is sufficient for droplet precautions — N95 is not required unless an aerosol-generating procedure (AGP) is being performed. AGPs include intubation, bronchoscopy, suctioning, and high-flow oxygen.
Airborne Precautions — Detail
Conditions requiring airborne precautions (MMMTV):
- Measles — only immune staff should enter; highly contagious
- MERS (Middle East Respiratory Syndrome)
- Monkeypox (mpox) — current CDC guidance does NOT require routine airborne precautions/AIIR: use standard precautions in a single-person room (special air handling not required) plus gown, gloves, eye protection, and a NIOSH-approved N95 respirator; an AIIR is recommended only for aerosol-generating procedures (e.g., intubation)
- Tuberculosis (TB) — pulmonary or laryngeal; patient stays in AIIR until three consecutive negative AFB sputum smears are confirmed
- Varicella — also requires contact precautions; only immune staff should enter
AIIR specifications:
- Negative air pressure relative to surrounding corridor
- Minimum 12 air changes per hour (6 minimum older facilities)
- Air exhausted directly outside or through HEPA filtration before recirculation
- Door closed at all times — post signage; brief all visitors
NCLEX priority — Immune status:
Non-immune staff (susceptible to measles or varicella) should not be assigned to these patients if immune staff are available. If reassignment is not possible, an N95 is the minimum — but verified immunity remains the safest solution.
Combined Precautions
Some conditions require more than one type of transmission-based precaution simultaneously. When combined, apply the most stringent requirement for each element.
| Condition | Precaution Types | Combined PPE |
|---|---|---|
| Varicella (chickenpox) | Airborne + Contact | N95 + Gloves + Gown + AIIR |
| Disseminated zoster | Airborne + Contact | N95 + Gloves + Gown + AIIR |
| COVID-19 (many protocols) | Droplet + Contact | Surgical mask + Gloves + Gown (N95 for AGPs) |
| RSV (severe/immunocompromised) | Droplet + Contact | Surgical mask + Gloves + Gown |
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 →