Standard Precautions (Tier One)

• Designed for all clients in hospital.
• These precautions apply to (a) blood; (b) all body fluids, excretions, and secretions except sweat; (c) nonintact (broken) skin; and (d) mucous membranes.
• Designed to reduce risk of transmission of microorganisms from recognized and unrecognized sources.

1. Wash hands after contact with blood, body fluids, secretions, excretions, and contaminated objects whether or not gloves are worn.
   • Wash hands immediately after removing gloves.
   • Use a nonantimicrobial soap for routine hand washing.
   • Use an antimicrobial agent or an antiseptic agent for the control of specific outbreaks of infection.
2. Wear clean gloves when touching blood, body fluids, secretions, excretions, and contaminated items (i.e., soiled gowns).
   • Clean gloves can be unsterile unless their use is intended to prevent the entrance of microorganisms into the body. See the discussion of sterile gloves in this chapter.
   • Remove gloves before touching noncontaminated items and surfaces.
   • Wash hands immediately after removing gloves.
3. Wear a mask, eye protection, or a face shield if splashes or sprays of blood, body fluids, secretions, or excretions can be expected.
4. Wear clean, nonsterile gown if client is likely to result in splashes or sprays of blood, body fluids, secretions, or excretions. The gown is intended to protect clothing.
   • Remove a soiled gown carefully to avoid the transfer of microorganisms to others (i.e., clients or other health care workers).
   • Wash hands after removing gown.
5. Handle client care equipment that is soiled with blood, body fluids, secretions, or excretions carefully to prevent the transfer of microorganism to others and to the environment.
   • Make sure reusable equipment is cleaned and reprocessed correctly.
   • Dispose of single-use equipment correctly.
6. Handle, transport, and process linen that is soiled with blood, body fluids, secretions, or excretions in a manner to prevent contamination of clothing and the transfer of microorganisms to others and to the environment.
7. Prevent injuries from used scalpels, needles, or other equipment, and place in puncture-resistant containers.

Transmission-Based Precautions (Tier Two)

Airborne Precautions

Use the Tier One precautions as well as the following:

1. Place client in a private room that has negative air pressure, 6 to 12 air changes per hour, and either discharge of air to the outside or a filtration system for the room air.
2. If a private room is not available, place client with another client who is infected with the same microorganism.
3. Wear a respiratory device (N95 respirator) when entering the room of client who is known or suspected of having primary tuberculosis.
4. Susceptible people should not enter the room of a client who has rubeola (measles) or varicella (chickenpox). If they must enter, they should wear a respirator.
5. Limit movement of client outside the room to essential purposes. Place a surgical mask on the client during transport.

Droplet Precautions

Use the Tier One precautions as well as the following:

1. Place client in private room.
2. If a private room is not available, place client with another client who is infected with the same microorganism.
3. Wear a mask if working within 3 feet of the client.
4. Limit movement of client outside the room to essential purposes. Place a surgical mask on the client during transport.

Contact Precautions

Use the tier one precautions as well as the following:

1. Place client in private room.
2. If a private room is not available, place client with another client who is infected with the same microorganism.
3. Wear gloves as described in Standard Precautions.
   • Change gloves after contact with infectious material.
   • Remove gloves before leaving client’s room.
   • Wash hands immediately after removing gloves. Use an antimicrobial agent.
   • After hand washing, do not touch possibly contaminated surfaces or items in the room.
4. Wear a gown (see Standard Precautions) when entering a room if there is a possibility of contact with infected surfaces or items, or if the client is incontinent, has diarrhea, a colostomy, or wound drainage not contained by a dressing.
   • Remove gown in the client’s room
   • Make sure uniform does not contact possible contaminated surfaces.
5. Limit movement of client outside the room.
6. Dedicate the use of noncritical client care equipment to a single client or to clients with the same infecting microorganisms.

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