Quality and Population Health

Precautions and Personal Protective Equipment (PPE)

Fundamental infection prevention principles include the use of Standard and Transmission-Based Precautions. Standard Precautions represent the minimum infection prevention measures for all patient care, regardless of the patient’s infection status. These evidence-based practices—meant to prevent the spread of infections among patients and protect healthcare personnel—include:

  • hand hygiene
  • the use of personal protective equipment (e.g. gowns, gloves, facemasks), depending on the anticipated exposure
  • respiratory hygiene and cough etiquette
  • safe injection practices
  • safe handling of potentially contaminated equipment or surfaces in the patient environment
Key Points
  • Standard and Transmission-Based Precautions are essential to infection prevention.
  • Transmission-Based Precautions include Contact, Droplet, and Airborne precautions.
  • The use of personal protective equipment (PPE) is part of any isolation precautions.
  • To be effective, PPE needs to be used correctly, including properly putting it on and taking off.

Transmission-Based Precautions supplement Standard Precautions for patients with known or suspected colonization or infection with highly transmissible or epidemiologically important pathogens (e.g. C dif, MRSA, VRE, ESBLs, Flu). The three categories of Transmission-Based Precautions are Contact, Droplet, and Airborne. When diseases have multiple routes of transmission, a combination may be used. Whether used alone or in combination, they are always in addition to Standard Precautions.

Personal protective equipment (PPE), sometimes referred to as barrier precautions, is part of any isolation precautions. PPE is meant to protect patients and staff from coming into contact with infectious organisms. It includes gloves, masks, gowns, and eye protection. Select the PPE required for the level of isolation and task at hand.

To be effective, PPE needs to be used correctly. The sequence for putting on (donning) PPE is: gown, mask, goggles/eye protection then gloves. The sequence for removing soiled PPE is: gloves, goggles, gown and mask. PPE is single patient use (if two patients infected with the same organism, for example MRSA, are sharing a room, you must change your PPE when going from one patient to the next). Most PPE is disposable and should be discarded as close to the point of care as possible.

When a patient is on Transmission-Based Precautions, a cart or an over-the-door caddy is placed at the entrance to the room and should contain the PPE needed to care for the patient. The cart or caddy contents may need additions (e.g. N95 masks for TB) for specific cases. These additional supplies are available in the clean utility room or the unit store room.  A container of bleach wipes should be readily available to wipe any equipment removed from the room.