Contact Precautions: You should know them forwards and backwards

One thing you are going to want to have down pat, is your contact precautions! Not only the PPE you should have on for each type of disease, but also what order to PPE off, what the patient should have on when being transported to another unit, what those transporting the patient should have on, the order in which you remove each piece of equipment, how often to perform hand hygiene and which diseases require which type of precaution. Nursing Students NCLEX Article

Updated:  

Standard Precautions

These are the safety measures that should be taken with all patients.

  1. Wash Your Hands - Most important step in infection control. It prevents nosocomial infections.
  2. DON Gloves - Before coming in contact with anything wet. ie. broken skin, mucous membranes, blood, body fluids, soiled instruments, contaminated waste materials
  3. Wash hands again upon removal of gloves and between patients.

Contact Precautions

Before entering

  1. Wash hands
  2. DON gown then gloves

Upon entering

  1. Use disposable equipment when possible
  2. When not available clean and disinfect all equipment before removing from room

Transporting patient

  1. PT should perform hand hygiene and wear a clean gown
  2. For direct contact with pt, nurse or care provider should wear a gown and gloves.
  3. Notify receiving area

Before leaving the patient's room

  1. Remove gloves then gown
  2. Wash hands

Contact Precautions Microorganisms

  1. Antibiotic Resistant Organisms (Methicillin resistant Staphylococcus aureu (MRSA), Extended spectrum beta-lactamase (ESBL), Penicillin resistant Streptococcus pneumoniae (PRSP), Multi-drug resistant Pseudomonas aeruginosa (MDRP))
  2. Scabies
  3. Herpes Zoster (Shingles) localized
  4. Diarrhea, Clostrididum difficile

Airborne Contact Precautions

Before entering

  1. Wash hands
  2. Don N95 Respirator (Mask)
  3. Don gown then gloves
  4. Negative Pressure Isolation Room KEEP DOOR CLOSED

Transporting patient

  1. Patient must wear a surgical or procedure mask and a clean gown
  2. Patient must wash hands
  3. For direct contact with pt, nurse or care provider should wear a gown and gloves.
  4. Notify receiving area

Before leaving pt's room

  1. Remove gloves then gown NOT N95 mask
  2. Wash hands

After leaving pt's room

  1. Shut door
  2. Wash hands
  3. Remove N95 mask
  4. Wash hands

Airborne Contact Precautions Microorganisms

  1. Measles (Rubeola)
  2. Tuberculosis (TB)
  3. Chicken Pox (Varicella-Zoster virus)
  4. Herpes Zoster (Shingles) disseminated

Droplet Contact Precautions

Before Entering

  1. Wash Hands
  2. DON Mask and Eye Protection
  3. DON Gown then Gloves

Patient Transport

  1. Pt must perform hand hygiene
  2. Pt must wear a surgical or procedure mask and a clean gown
  3. For direct contact with pt, nurse or care provider should wear a gown and gloves.
  4. Notify receiving area

Before Leaving Pt's Room

  1. Remove gloves then gown
  2. Wash Hands
  3. Remove eye protection and mask
  4. Wash Hands

Droplet Contact Precautions Microorganisms

  1. Influenza (Flu)
  2. Viral Respiratory tract infections (adenovirus, parainfluenza, rhinovirus, RSV)
  3. Streptococcus group A pharyngitis, pneumonia, scarlet fever
  4. Neisseria meningitidis invasive infections
  5. H. Influenzae type b invasive infections
  6. Pertussis
  7. Rubella
  8. Mumps

Happy Studying

 

beachbutterfly said:
anyway thank you David I just finished making flashcard with the info you posted,I think it will significantly increase my chance of passing the NCLEX that I'm scheduled for August 12.

One thing I don't understand why would we have to don the gown and gloves for a pt with airborne or droplet precautions...I thought we needed only masks,I mean can you catch chickenpox or mumps by taking someone radial pulse with your bare hands??

That's a good question beachbutterfly, thanks for asking. I know that not only can you get chicken pox through the air when someone who has chickenpox coughs or sneezes but you can also get it by touching the watery stuff that comes out of the pustules or by touching something that has the watery stuff that comes out on it. Therefore, it would seem that chickenpox can go both ways and contact precautions should indeed be maintained. This is why it is important to remember that a person with chickenpox is considered contagious until after all the pox including the last lesion has crusted over.

As for mumps, Mumps spreads through direct contact with saliva from an infected person. Infection can also result from kissing, or by sharing food or beverages.The virus can also survive on surfaces. Touching a surface

contaminated by the mumps virus and then touching your nose or mouth can cause infection. This is why contact precautions are important for this infection.

When thinking of islolation precautions remember that isolation precautions are categorized by severity (amount of PPE required). The worse category a disease can be classified as, and the more gear necessary to be but on, is the title it acquires a the precautions demanded. Therefore, even though Chickenpox and Mumps can be spread by contact, it is also import to wear a mask to prevent airborne transmission of Chickenpox and goggles for droplet transmission of Mumps.

Hope this helps. I might have the wording a bit off but I believe the concepts are on point.

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David.cummiskey you are an awesome Dude to post all the helpful information that you have posted. I have printed everything that you have posted on needed informaton for the TEST. :bowingpurThank you, Thank you!!!! You have any information on answering those terrible select all that apply questions???

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Hi David: Thanks for posting this, but some clarifications are needed. Per the CDC the three types of transmission you described are grouped under the heading of STANDARD and TRANSMISSION BASED PRECAUTIONS, i.e,

  • Contact Precautions
  • Droplet
  • Airborne

A gown and gloves are not necessary when working with a patient who is on airborne precautions, UNLESS they are also on contact precautions for another reason (MRSA, etc). Organisms spread by airborne transmission die as soon as they hit surfaces such as clothing, linen, intact skin, furniture, etc. Airborne organisms are only spread by direct transmission from the patient's respiratory tract to another person's respiratory tract.

Thanks for the chance to clarify....

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farleyj said:
Hi David: Thanks for posting this, but some clarifications are needed. Per the CDC the three types of transmission you described are grouped under the heading of STANDARD and TRANSMISSION BASED PRECAUTIONS, I.e,
  • Contact Precautions
  • Droplet
  • Airborne

A gown and gloves are not necessary when working with a patient who is on airborne precautions, UNLESS they are also on contact precautions for another reason (MRSA, etc). Organisms spread by airborne transmission die as soon as they hit surfaces such as clothing, linen, intact skin, furniture, etc. Airborne organisms are only spread by direct transmission from the patient's respiratory tract to another person's respiratory tract.

Thanks for the chance to clarify....

Well, according to Kaplan, nurses should use Standard precautions with all patients (hand washing + gloves) add that to a contact which require gown, and airborne which require mask, but particles may sit and deposits on your uniform. So, to be on the safe and perfect world (NCLEX), be perfect. No shortcuts. Don't use "ifs"

Hope I am right! :twocents:

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Thanks for the refresher. One of our residents was treated for dry skin long before any of us knew she had scabies. Fortunately it did not spread. I guess the only safe way is to wear gloves all of the time but that's too impractical.

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Just to reiterate, for airborne precautions, gown and gloves are not required unless a care situation exists that standard precautions are needed (eg, contact with anything "wet" per an earlier reply). So--if you were just going to enter the room of a pa tient on airborne precautions to take a history, meet with the family, etc, the only PPE needed is an N-95 mask. Of course it doesn't "hurt" the patient to put on a gown and gloves, but it is using supplies that are not needed and also sets up a literal barrier between the nurse and patient that doesn't need to be there.

Also, droplet nuclei transmitted by airborne route can not be transmitted from fomites (uniforms, patient gown, linen etc) to another person.

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lnmorr80 said:
David.cummiskey you are an awesome Dude to post all the helpful information that you have posted. I have printed everything that you have posted on needed informaton for the TEST. :bowingpurThank you, Thank you!! You have any information on answering those terrible select all that apply questions???

SATA(select all that apply) questions do suck my friend:down:. All I can tell you is if you want extra practice on SATA's and you haven't enrolled in the Kaplan NCLEX review course already, that it may interest you. Under the tool box option where you go to take Q-banks they have a section where you can generate you're own tests comprised of entirely SATA questions. Practice makes perfect. I hope this helps. 

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hey dave!

Thank you so much for all these wonderful post of awesome information. I too didn't pass my exam the first time and been studying to retake it on Aug. 24th. When do you retake yours? I took Kaplan before and I am redoing them again. I am aso using Saunders to review contents and also the videos that Kaplan provides online. I really hope I pass this time. How are you studying? When do you take your exam?

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I actually added this to my study guide and I was so glad to review this before the exam (and even on the day of the exam!).

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Hi Everyone,

I test on Wednesday and I think I am getting myself confused. I have memorized the Chicken TB, Spiderman, MrsWee and VCHIIP, but have questions regarding what to or not to wear...

For Airborne can the nurse just wear the mask (N95 for TB) or does the nurse need to don the whole outfit? I know that the door needs to be closed and - pressure room with 6-12 changes/hr.

For Droplet, is it all...mask, gown, gloves, eye protection? I know door can be open and visitors must have 3ft b/w pt and themselves.

For Contact, is it gown and gloves? Door can be open, but what else?

I feel like I knew this yesterday and now I am getting confused. HELP!

Oh, one more question...I know that each state is different regarding if an LPN/LVN can give IV meds, on NCLEX is it always no? I just don't want to assign an LPN/LVN a pt needing IV meds if it is a no no on NCLEX.

I feel so stupid today :banghead:...hope my brain is back by Wednesday!

Thanks for your help.

1 Votes
Specializes in L & D, Med-Surge, Dialysis.

contact precaution

private room: if possible or cohort if private room is not available.

gloves: when entering the pt room and remove before exit the pt room. change gloves after having contact with infective material that may contain high concentration of microorganism or fecal material or wound drainage.

hand washing: wash hands after removing gloves and before leaving the room.

gown: when entering the pt room, if anticipating that clothing will have contact with the pt such as incontinence, diarrhea, ileostomy, colostomy and wound drainage

pt transport: ensure precautions are maintained to reduce risk of transmission

equipment: single, but if common equipment is used, clean and disinfect between pt.

droplet precaution

pt placement: private room, cohort or maintain spatial separation of 3 feet from other pt or visitor. cohort if private room is not available.

mask: wear mask when working w/i 3 ft of a pt or upon entering the room

pt transport- limit transport of pt to essential purpose only. use surgical mask on the pt during transport.

airborne precaution

pt placement: private room with negative air pressure with 6-12 air change/ hr. discharge of air outdoors or hepa filtration. if air is recirculated, keep room door closed and pt in the room.

respiratory protection: wear n95 respirator when entering the room of a pt with known or suspected person with infection such as pulmonary tb. also suspected pt should not enter the room of a pt with known or suspected of having measles (rubeola), varicella (chickenpox). if suspected pt must enter, the pt must wear n95 respirator.

respirator or surgical mask is not required if immune to measles and varicella.

pt transport: limit transport of pt from to essential purpose only. use surgical mask on pt during transport .

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Relax! your doing good. yeah, your right IV meds is a BIG NO, NO, in NCLEX!!!!

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