Isolation precautions interrupt the mode of transmission in the chain of infection. The CDC/HICPAC guideline uses two tiers:

1. Standard Precautions — for every client, every time, regardless of diagnosis. Blood, all body fluids, secretions, and excretions (except sweat), nonintact skin, and mucous membranes are treated as potentially infectious.
2. Transmission-Based Precautions — added to Standard Precautions for known or suspected pathogens: Contact, Droplet, Airborne. Start them on suspicion (syndromic approach), not only after laboratory confirmation.

Components of Standard Precautions

• Hand hygiene
• PPE based on anticipated exposure (gloves, gown, mask, eye protection)
• Respiratory hygiene / cough etiquette — mask coughing clients, tissues, hand hygiene, spatial separation in waiting areas
• Safe injection practices — one needle, one syringe, one time; single-dose vials for one client
• Safe handling of sharps (no recapping) and client-care equipment
• Environmental cleaning, safe laundry handling
• Client placement based on transmission risk
• Mask for procedures such as lumbar puncture or epidural catheter insertion

Bloodborne pathogens (HIV, hepatitis B and C) need Standard Precautions only — no transmission-based isolation.

Screen on admission and during stay for syndromes that call for empiric precautions:

• Cultures, PCR panels, and antigen tests (e.g., C. difficile toxin/PCR, respiratory viral panels) guide when precautions can be changed or discontinued
• Tuberculosis: airborne precautions continue until TB is excluded or the client is no longer infectious (commonly three consecutive negative AFB sputum smears collected 8–24 hours apart, with at least one early-morning specimen, plus adequate therapy and clinical improvement)
• MDRO screening (e.g., nasal swab for MRSA) per facility policy
• Surveillance data identify clusters and outbreaks

Transmission-Based Precautions (added to Standard Precautions)

Duration examples (CDC Appendix A): pertussis — droplet until 5 days of effective antibiotics (or 21 days after cough onset if untreated); mumps — 5 days after onset of swelling; rubella — 7 days after rash onset; measles — 4 days after rash onset (duration of illness if immunocompromised); varicella — until all lesions are dry and crusted; norovirus — at least 48 hours after symptoms resolve; C. difficile — duration of illness (many facilities longer).

Special situations

• COVID-19: N95 respirator, gown, gloves, and eye protection; AIIR for aerosol-generating procedures when available
• Novel or avian influenza, MERS: airborne + contact + eye protection in an AIIR
• Protective environment (e.g., allogeneic stem cell transplant): positive-pressure, HEPA-filtered room to protect the immunocompromised client — the opposite of an AIIR
• Healthcare workers who are not immune should not care for clients with measles or varicella when immune staff are available

PPE sequence (CDC)

• Remove all PPE except the respirator at the doorway or in the anteroom; remove the respirator after leaving the room and closing the door
• Gown and gloves may also be removed together in one motion, rolling the gown inside out
• Perform hand hygiene immediately after removing all PPE (and between steps if hands become contaminated)

Listed in priority order.

1. Place the client in the right room and start precautions on suspicion; post a sign listing the precaution type and PPE needed — not the diagnosis (privacy)
2. Hand hygiene before and after contact and after removing PPE; soap and water for C. difficile and norovirus (alcohol does not kill spores)
3. Correct PPE use, with the donning and doffing sequence; fit-tested respirators for airborne precautions
4. Limit transport to essential purposes; notify the receiving department; mask the client for droplet or airborne diseases
5. Dedicate or disinfect equipment; clean the room with an appropriate agent (sporicidal for C. difficile)
6. Psychosocial care: isolation causes loneliness, anxiety, depression, and fewer staff visits — check on the client regularly, explain the reason, encourage family contact
7. Teach visitors hand hygiene and PPE; screen visitors for illness and immunity
8. Discontinue precautions only per policy criteria

Blood and body fluid exposure (needlestick or splash)

1. Immediately wash the wound or skin with soap and water; flush mucous membranes or eyes with water or saline. Do not squeeze or apply bleach
2. Report at once to the supervisor and occupational health
3. Source and exposed-person testing and HIV post-exposure prophylaxis started as soon as possible, ideally within hours and no later than 72 hours; hepatitis B vaccine or immune globulin per immune status

Medical (health care) waste management

• Most waste from isolation rooms is not automatically infectious; classify by what it is, not where it came from
• Treatment methods: autoclaving, incineration, chemical treatment, microwave; waste must be stored securely and transported in closed, labeled containers along routes away from clients and visitors

• Explain the reason for isolation, how long it will last, and what visitors must do
• Teach respiratory hygiene: cover coughs and sneezes, use tissues, wear a mask outside the room, hand hygiene after
• Teach hand hygiene at home, especially after toileting and before eating
• Home sharps: use a heavy plastic container with a screw-on lid (or commercial sharps container), keep away from children, follow local disposal rules; never put loose needles in household trash or recycling
• Complete the full course of prescribed treatment (e.g., TB therapy) to end infectiousness

• Standard Precautions = every client; transmission-based precautions are added
• Airborne = "MTV": Measles, Tuberculosis, Varicella (and disseminated zoster) → N95, negative-pressure AIIR, door closed
• Droplet: influenza, pertussis, meningococcal disease, mumps, rubella, strep → surgical mask
• Contact: MDROs, C. difficile, norovirus, RSV, scabies, draining wounds → gown and gloves, dedicated equipment
• C. difficile and norovirus: soap-and-water hand hygiene and sporicidal cleaning for C. difficile
• HIV and hepatitis B/C → Standard Precautions only
• Transport: client wears a surgical mask for droplet and airborne diseases
• Donning: gown → mask → goggles → gloves. Doffing: gloves → goggles → gown → mask/respirator last (respirator removed outside the room), then hand hygiene
• Signs show the precaution type, not the diagnosis
• Never recap needles; sharps container at point of use, replace at 3/4 full
• Needlestick: wash with soap and water first, then report; HIV PEP as soon as possible