7.3 Standard Precautions and Transmission-Based Precautions

Standard Precautions and Transmission-Based Precautions

Quick Answer: Standard precautions apply to EVERY resident — treat all blood and body fluids as if infectious. Transmission-based precautions layer on top when a resident has a known or suspected contagious pathogen: contact (MRSA, VRE, C. diff), droplet (influenza, mumps), or airborne (TB, chickenpox). Each has its own signage and PPE. In Indiana, outbreaks and certain communicable diseases are reported to the Indiana Department of Health (IDOH) — the CNA's role is to recognize and report up the chain of command.

Standard Precautions — The Baseline

Standard precautions (formerly called "universal precautions") are the minimum set of practices applied to ALL residents regardless of diagnosis. They include:

• Hand hygiene before and after every resident contact and after removing gloves
• Gloves for any anticipated contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated surfaces
• Gown, mask, and eye protection when splash or spray is anticipated
• Safe sharps handling — no recapping, deposit directly in sharps container
• Respiratory etiquette — cover coughs, wear a mask if coughing
• Environmental cleaning — clean and disinfect high-touch surfaces and shared equipment between residents
• Soiled linen handled at the point of origin, bagged before transport

Trap: Standard precautions do not depend on a resident looking sick. Many colonized residents (MRSA carriers) have no symptoms. The standard is universal — apply it the same way to every resident.

Transmission-Based Precautions — When Standard Is Not Enough

Transmission-based precautions layer on top of standard precautions based on the pathogen's primary mode of transmission. Use them when standard precautions alone would not stop spread.

Comparison Table

Contact Precautions in Depth

Used for pathogens spread by direct or indirect contact — the most common type in LTC. The CNA dons gown and gloves before entering the room, removes them at the doorway, and immediately performs hand hygiene. Dedicated equipment stays in the room (BP cuff, stethoscope, thermometer) — if shared equipment must be used, disinfect before removing.

Trap: For C. diff, hand hygiene MUST be soap and water (not ABHR). Alcohol does not kill C. diff spores. Some Indiana facilities post "WASH WITH SOAP AND WATER" signs on C. diff rooms to override the ABHR dispenser at the door — follow the sign, not the dispenser.

Droplet Precautions in Depth

Large droplets travel only about 3–6 feet, so a surgical mask is sufficient (not an N95). The door may remain open as long as the 6-foot separation is maintained. Residents with influenza can leave the room for essential tests only if they wear a mask.

Airborne Precautions in Depth

The strictest tier. Airborne nuclei travel long distances on air currents, so a negative-pressure Airborne Infection Isolation Room (AIIR) is required, with the door kept closed. Anyone entering wears a fit-tested N95 respirator. If you have not been fit-tested, do not enter — notify the nurse so a fit-tested staff member can provide care. The resident wears a surgical mask (not an N95) if leaving the room for a procedure.

Isolation Signage

Indiana LTC facilities follow CDC signage conventions. Every isolation room has a colored sign at the door indicating the precautions in effect and the required PPE. Never enter an isolation room without checking the sign and gathering the correct PPE. If you are unsure what the sign means or what PPE is required, ask the nurse — do not guess.

Standard Precautions in Practice — the CNA Workflow

A typical shift:

1. Enter room — perform hand hygiene at the door
2. Don gloves for any contact (standard precaution)
3. Provide care (vital signs, ambulation, ADLs)
4. Remove gloves, perform hand hygiene
5. Wipe down any shared equipment (BP cuff, stethoscope) with EPA-registered disinfectant
6. Exit and perform hand hygiene again

For a contact-precautions resident, add gown and gloves at the door; remove and dispose before exiting; perform soap-and-water hand hygiene (especially for C. diff).

Indiana IDOH Outbreak Reporting

The Indiana Department of Health (IDOH) requires reporting of outbreaks and certain communicable diseases. In LTC, the facility infection preventionist (often the charge nurse or director of nursing) is responsible for the formal report, but the CNA is the front-line recognizer.

What the CNA Reports Up the Chain

The CNA does NOT call IDOH directly. The CNA reports observations to the licensed nurse promptly:

• Cluster of symptoms — 3 or more residents with similar symptoms (e.g., 3 residents with vomiting and diarrhea in 48 hours suggests a norovirus or foodborne outbreak)
• Single cases of reportable disease symptoms — TB symptoms (persistent cough >3 weeks, night sweats, weight loss), chickenpox lesions, suspected scabies outbreak (multiple residents with intense itching, especially between fingers and at the wrist)
• Unusual infection signs — wound with new drainage, fever spikes in multiple residents, sudden change in mental status with fever (possible sepsis)

IDOH Reporting Timeframes (for the facility)

The facility infection preventionist reports via the Indiana NBS (National Electronic Disease Surveillance System — Indiana version) or by phone:

• Immediately for high-priority diseases (TB, measles, chickenpox, foodborne outbreaks)
• Within 24 hours for most reportable communicable diseases
• Outbreaks — 2 or more linked cases; for LTC, IDOH defines an outbreak as 3 or more epidemiologically linked cases. Influenza-like illness (ILI) outbreaks in LTC are reportable.

Trap: The CNA's job is to report UP to the nurse — not to IDOH directly. But the CNA's recognition of the pattern is what triggers the facility's report. A CNA who notices three residents with diarrhea in one shift and says nothing may delay an IDOH outbreak report by hours, allowing further spread.

The Big Picture

Standard precautions are universal. Transmission-based precautions target specific pathogens. Isolation signage tells you what to wear. Soap-and-water (not ABHR) for C. diff. Report suspected outbreaks up the chain of command promptly — the nurse and infection preventionist handle the IDOH report, but it starts with you.