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Airborne precautions are used (in addition to standard precautions) for patients with infections that are transmitted by small droplet nuclei of 5µm or smaller. Such droplets are generated when talking, coughing or sneezing and during procedures involving the respiratory tract such as suction, intubation or bronchoscopy. They can be widely dispersed by air currents. Infections spread by the airborne route are relatively uncommon in hospitals but include tuberculosis, chickenpox, measles and Aspergillus infections.

• Patient placement – place the patient in an individual room with adequate ventilation (this includes, where possible, negative pressure; door closed; at least six air exchanges per hour; exhaust to outside away from intake ducts).
• Respiratory protection – wear respiratory protection, (e.g. high efficiency filter mask) when entering the room. Susceptible people e.g. pregnant women, should not enter the room of a patient infected with chickenpox or measles.
• Patient transport – limit transport of the patient to essential purposes only. If movement is necessary, minimise the risk of infection to others by placing a mask on the patient.
• Environmental control – ensure appropriate environmental and equipment cleaning, disinfection and sterilisation.

Refer to CDC guidelines for preventing the transmission of tuberculosis in healthcare facilities (1994) and the British Thoracic Society code of practice (2000) for additional tuberculosis prevention strategies.

Droplet precautions are used (in addition to standard precautions) for patients with infections that are transmitted by large particle droplets (greater than 5µm). Large droplet nuclei do not remain suspended in the air for long and travel only short distances. Transmission from large droplets requires close contact (i.e. within one metre) between the infected source and the recipient. Examples of infections transmitted by large droplets are meningococcal meningitis, influenza, mumps, rubella, diphtheria, pneumonic plague and infections caused by multidrug-resistant Streptococcus pneumoniae.

Other infections where respiratory precautions, such as using particulate filter masks, need to be taken are severe acute respiratory syndrome (SARS) and avian flu.
  

• Patient placement – place the patient in an individual room, if available. Special air handling and ventilation are not necessary, and the door may remain open.
• Respiratory protection – wear a mask when working within one metre of the patient.
• Patient transport – limit transport of the patient to essential purposes only. If movement is necessary, minimise the risk of infection to others by placing a mask on the patient.
• Environmental control – ensure appropriate environmental and equipment cleaning, disinfection and sterilisation.

Contact precautions (as well as standard precautions) should be used for patients known or suspected to be infected or colonised with micro-organisms transmitted by direct or indirect contact. Examples of infectious diseases requiring contact precautions are gastrointestinal infections (including diarrhoea of unknown origin), wound and skin infections (e.g. impetigo) and colonisation with multidrug-resistant bacteria (e.g. MRSA). One of the most common organisms to cause outbreaks is norovirus.

• Patient placement – a single room is advisable for infectious patients who are likely to contaminate the environment. Patients with the same active infection can be nursed together (cohorted) in one room, rather than in individual rooms.
• Protective clothing and handwashing – wear gloves when entering the patient's room. Remove gloves before leaving the patient's room. Wash hands before and after patient contact and when leaving the room. Wear an apron if you might have contact with the patient, contaminated surfaces or materials.
• Patient transport – limit the movement and transport of the patient to essential purposes only. If the patient is moved out of the room, ensure that precautions are maintained.
• Patient care equipment – when possible, dedicate the use of non-critical patient-care equipment, and items such as stethoscopes and thermometers to a single patient (or to cohorted patients). If sharing equipment is unavoidable, ensure appropriate decontamination before use on another patient.
• Environmental control – ensure appropriate environmental and equipment cleaning, disinfection and sterilisation.

Specialist guidelines describe measures to contain antibiotic resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Refer to the US guideline for isolation precautions in hospitals (1996), the Royal College of Nursing’s MRSA guidance for nursing staff (2004) and the Combined Working Party report on control of MRSA in hospitals (1998).