Infection control - standard and

transmission-based precautions
On this page
 Key messages
 Standard precautions
 Transmission-based precautions

Key messages
•Standard precautions are the work practices required to achieve a basic level of infection
prevention and control.
•Standard precautions are the minimum infection prevention and control practices that must be
used at all times for all patients in all situations.
•Transmission-based precautions are used when standard precautions alone are not sufficient to
prevent the spread of an infectious agent.
•Transmission-based precautions are based upon the mode of transmission of the infectious
agent.

Infection prevention and control uses a risk management approach to minimise or prevent the
transmission of infection. The two-tiered approach of standard and transmission-based
precautions provides a high level of protection to patients, healthcare workers and other people
in healthcare settings.

For further information regarding infection prevention and control practices in the healthcare
setting see the National Health and Medical Research (NHMRC) Australian guidelines for the
prevention and control of infection in healthcare (2010).

The use of standard precautions is also applicable to and essential for many non-health care
settings, such as personal care and body art industries. For further information regarding
infection prevention and control guidelines for these industries see the department's Health
guidelines for personal care and body art industries.

Standard precautions
All people potentially harbour infectious microorganisms. As such, it must be assumed that all
blood and body fluids/substances are potentially infectious. Standard precautions are the work
practices required to achieve a basic level of infection prevention and control. The use of
standard precautions aims to minimise, and where possible, eliminate the risk of transmission of
infection, particularly those caused by blood borne viruses.

Standard precautions apply to all patients regardless of their diagnosis or presumed infection
status. Standard precautions must be used in the handling of:
  blood (including dried blood)
 all other body fluids/substances (except sweat), regardless of whether they contain visible
blood
 non-intact skin
 mucous membranes.

Standard precautions consist of the following practices:

 hand hygiene before and after all patient contact

 the use of personal protective equipment, which may include gloves, impermeable
gowns, plastic aprons, masks, face shields and eye protection
 the safe use and disposal of sharps
 the use of aseptic "non-touch" technique for all invasive procedures, including
appropriate use of skin disinfectants
 reprocessing of reusable instruments and equipment
 routine environmental cleaning
 waste management
 respiratory hygiene and cough etiquette
 appropriate handling of linen.

Standard precautions are the minimum infection prevention and control practices that must be
used at all times for all patients in all situations.

Hand hygiene

Hand hygiene is considered one of the most important infection control measures for reducing
the spread of infection. Hand hygiene is a general term that refers to any action of hand
cleansing, such as handwashing or handrubbing.

Microorganisms are either present on hands most of the time (resident flora) or acquired during
healthcare activities (transient flora). The aim of hand hygiene is to reduce the number of
microorganisms on your hands, particularly transient flora which may present the greater risk for
infection transmission.

Handwashing: Hands should be washed with soap and water when visibly soiled and after using
the toilet.

Handrubbing: Handrubbing with an alcohol-based hand rub (ABHR) is the preferred method for
hand cleansing in the healthcare setting when hands are not visibly soiled. ABHRs are more
effective against most bacteria and many viruses than either medicated or non-medicated soaps.
ABHRs are also less drying on hands than washing hands with soap and water, and consequently
cause less irritation to the skin. ABHRs should be applied to dry hands.

The 5 Moments for hand hygiene, or times when hand hygiene should be attended to, was
developed by the World Health Organisation (WHO). The 5 moments are:
  before touching a client
 before performing a procedure
 after a procedure or exposure to body fluids/substances
 after touching a client
 after touching the environment around a client.

See Hand Hygiene Australia for more information on hand hygiene and for ‘How to handwash’
and ‘How to handrub’ posters.

Personal protective equipment (PPE)

PPE protects the healthcare worker from exposure to blood and body fluids/substances. PPE that
complies with relevant Australian Standards should be readily available and accessible in all
health services.

Gloves

 The use of gloves should not be considered an alternative to performing hand hygiene.
Hand hygiene is required before putting on gloves and immediately after removal.
 Wear gloves (single-use non-sterile) when there is the potential for contact with blood,
body fluids/substances, mucous membranes or non-intact skin.
 Sterile gloves are only required for certain invasive procedures, otherwise non-sterile
gloves may be used if a aseptic non-touch technique is used.
 Change gloves between tasks and procedures on the same patient. Gloves should be
removed immediately after a procedure and hand hygiene performed so as to avoid
contaminating the environment, other
 patients or other sites on the same patient.
 Gloves used for healthcare activities are to be single-use only. ABHR should not be used
on gloves to decontaminate them, nor should gloves be washed with soap and water and
continued to be used.

Gowns and aprons

 Wear an apron or gown to protect skin and prevent soiling of clothing during procedures
and patient care activities that are likely to generate splashing or sprays of blood, body
fluids, secretions or excretions, or cause soiling of clothing.
 Select a gown or apron (i.e., long or short sleeves) that is appropriate for the activity and
the amount of fluid likely to be encountered. If an apron is used, staff should ensure they
are “bare-below-the-elbows”.
 Remove the used gown as promptly as possible and roll it up carefully and discard
appropriately.
 Perform hand hygiene immediately after removal.

Masks, eye protection, face shields

  Wear a mask and eye protection, or a face shield to protect mucous membranes of the
eyes, nose and mouth during procedures, patient-care activities and cleaning procedures
that are likely to generate splashes or sprays of blood, body fluids, secretions and
excretions.
 Remove the mask by holding the ties only and dispose of the mask into a waste bin.
 Perform hand hygiene immediately after removal.

Environmental control

 Ensure that the health service has adequate procedures for the routine care, cleaning and
disinfection of environmental surfaces, beds, bedrails, bedside equipment and other
frequently touched surfaces, and that these procedures are being followed. See
also Cleaning and waste disposal for further information.

Transmission-based precautions
Transmission-based precautions (TBPs) are used in addition to standard precautions when
standard precautions alone may be insufficient to prevent transmission of infection. TBPs are
used for patients known or suspected to be infected or colonised with epidemiologically
important or highly transmissible pathogens that can transmit or cause infection.

TBPs are not required for patients with bloodborne viruses, such as HIV, hepatitis B virus or
hepatitis C virus.

The type of TBPs applied is based upon the mode of transmission of the pathogen. For diseases
that have multiple routes of transmission, more than one TBP category is applied. The following
are the routes of transmission.

 airborne transmission, e.g. pulmonary tuberculosis, chickenpox, measles

 droplet transmission, e.g. influenza, pertussis (whooping cough), rubella
 contact transmission (direct or indirect), e.g. viral gastroenteritis, Clostridium difficile,
MRSA, scabies

TBPs should be tailored to the particular infectious agent involved and the mode of transmission.
To minimise the exposure time of other people in office-based practices or hospital waiting
rooms, people identified as at risk of transmitting droplet or airborne diseases (for example, a
child with suspected chickenpox) should be attended to immediately and placed into appropriate
transmission-based precautions to prevent further spread of disease.

Table 1 outlines the TBPs to be taken for infections with airborne, droplet or contact
transmission.

Table 1: Transmission-based precautions required according to route of transmission

Infection control Route of transmission
measure Airborne Droplet Contact
Gloves As per standard As per standard For all manual contact with patient,
precautions precautions associated devices and immediate
environmental surfaces
Impermeable As per standard As per standard When healthcare worker's clothing is
apron/gown precautions precautions in substantial contact with the patient,
items in contact with the patient, and
their immediate environment
P2 Respirator Yes Not required Not required

Refer to AS/NZS
1715 for additional
information
Mask (surgical- No (P2 Yes As per standard precautions
style) respirator)

Refer to AS
4381:2015 for
additional
information
Goggles/face As per standard As per standard As per standard precautions
shields precautions precautions
Standard single No (negative Yes or cohort Yes or cohort patients with same
room with own pressure patients with infection
ensuite ventilation same infection
required)
Door closed
Negative pressure Essential Not required Not required
ventilation room

For information on infection prevention and control precautions required for carbapenemase-
producing Enterobacteriaceae (CPE) see the Victorian guideline on CPE for health services
(2017) or Victorian guideline on CPE for long-term residential care facilities (2017).

For information on infection prevention and control precautions for other multi-resistant
organisms see the Patient-centred risk management strategy for multi-resistant organisms (2011).

For more information regarding which other infectious agents require transmission-based
precautions, see the NHMRC Australian guidelines for the prevention and control of infection in
healthcare (2010).

Signage
Signage should be positioned prominently outside the room of a patient in TBPs. This is to
ensure staff and visitors do not enter without appropriate PPE. Note: visitors may not always be
required to wear PPE when visiting patients in TBPs. Please consult local health service policies
and procedures.

Standardised TBPs signage has been developed by the Australian Commission on Safety and
Quality in Health Care and are available in portrait style or landscape style.

If a health service uses their own signage, ensure that signage clearly notes the type of TBPs and
PPE required.

Reviewed 21 August 2023