Transmission-Based Precautions and Resistant Organisms

Contact Precautions and Enteric Transmission

Transmission-based precautions are implemented in addition to standard precautions whenever a client has an identified or suspected pathogen that spreads through specific routes. Contact precautions are designed to stop the transmission of infectious agents that move from direct physical contact between individuals or indirect contact with contaminated surfaces and items. For example, when a practical nurse enters the care area of a client with an infection spread by touch, pathogens can easily transfer to hands, clothing, or diagnostic tools if barriers are not used.

Healthcare personnel must don clean gloves and a gown before entering the room of any client on contact precautions. These barriers must remain in place throughout the visit and be removed before leaving the client's room or within a designated exit area. Immediately following glove and gown removal, hand hygiene must be performed. Because the process of removing gloves frequently contaminates the hands, immediate hand hygiene is an indispensable safeguard. Whenever available, a private room is used; if unavailable, the client may be cohorted with another individual who has the exact same confirmed organism, guided by facility infection-prevention policies.

Specific infections dictate the use of contact precautions. These include methicillin-resistant Staphylococcus aureus (MRSA) present in wounds, skin, or sputum, and vancomycin-resistant enterococci (VRE), which is particularly dangerous because of its high survivability on equipment and surfaces. Contact precautions are also required for draining wounds that cannot be fully contained by dressings. Parasitic infestations such as scabies and pediculosis require contact precautions until 24 hours after effective treatment is initiated.

Clostridioides difficile infection requires a specialized tier known as contact enteric precautions. Clostridioides difficile produces spores, and alcohol-based hand rub does not reliably inactivate these spores. For this reason, soap-and-water handwashing is preferred after caring for a client with Clostridioides difficile, especially during facility outbreaks. Additionally, environmental surfaces in the room of a client with Clostridioides difficile must be disinfected using an EPA-registered sporicidal disinfectant according to facility policy. Reusable equipment should ideally be dedicated to a single client; if any reusable equipment is removed from a contact isolation room or shared, it must be cleaned and disinfected before it is used for another client.