Droplet Precautions



III.B. Transmission-Based Precautions There are three categories of Transmission-Based Precautions: Contact Precautions, Droplet Precautions, and Airborne Precautions. Transmission-Based Precautions are used when the route(s) of transmission is (are) not completely interrupted using Standard Precautions alone. For some diseases that have multiple routes of transmission (e.g., SARS), more than one Transmission-Based Precautions category may be used. When used either singly or in combination, they are always used in addition to Standard Precautions. See Appendix A of the HICPAC/CDC Isolation Guideline for recommended precautions for specific infections. When Transmission-Based Precautions are indicated, efforts must be made to counteract possible adverse effects on patients (e.g., anxiety, depression and other mood disturbances, perceptions of stigma, reduced contact with clinical staff, and increases in preventable adverse events) in order to improve acceptance by the patients and adherence by healthcare personnel (HCPs).

III.B.2. Droplet Precautions Droplet Precautions are intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions as described in I.B.3.b. Because these pathogens do not remain infectious over long distances in a healthcare facility, special air handling and ventilation are not required to prevent droplet transmission. Infectious agents for which Droplet Precautions are indicated are found in Appendix A of the HICPAC/CDC Isolation guideline and include B. pertussis, influenza virus, adenovirus, rhinovirus, N. meningitides, and group A streptococcus (for the first 24 hours of antimicrobial therapy). A single patient room is preferred for patients who require Droplet Precautions. When a single-patient room is not available, consultation with infection control personnel is recommended to assess the various risks associated with other patient placement options (e.g., cohorting, keeping the patient with an existing roommate). Spatial separation of patients by > 3 feet and drawing the curtain between patient beds is especially important for patients in multi-bed rooms with infections transmitted by the droplet route. Healthcare personnel wear a mask (a respirator is not necessary) for close contact with infectious patient; the mask is generally donned upon room entry. Patients on Droplet Precautions who must be transported outside of the room should wear a mask if tolerated and follow Respiratory Hygiene/Cough Etiquette.


V. Transmission-Based Precautions

V.A. General principles
V.A.1. In addition to Standard Precautions, use Transmission-Based Precautions for patients with documented or suspected infection or colonization with highly transmissible or epidemiologically-important pathogens for which additional precautions are needed to prevent transmission (see Appendix A of the HICPAC/CDC Isolation Guideline).
V.A.2. Extend duration of Transmission-Based Precautions, (e.g., Droplet, Contact) for immunosuppressed patients with viral infections due to prolonged shedding of viral agents that may be transmitted to others.
V.C. Droplet Precautions
V.C.1. Use Droplet Precautions as recommended in Appendix A of the HICPAC/CDC Isolation Guidelinefor patients known or suspected to be infected with pathogens transmitted by respiratory droplets (i.e., large-particle droplets >5ยต in size) that are generated by a patient who is coughing, sneezing or talking.
V.C.2. Patient placement
V.C.2.a. In acute care hospitals, place patients who require Droplet Precautions in a single-patient room when available When single-patient rooms are in short supply, apply the following principles for making decisions on patient placement:
  • Prioritize patients who have excessive cough and sputum production for single-patient room placement.
  • Place together in the same room (cohort) patients who are infected the same pathogen and are suitable roommates.
  • If it becomes necessary to place patients who require Droplet Precautions in a room with a patient who does not have the same infection:
  • Avoid placing patients on Droplet Precautions in the same room with patients who have conditions that may increase the risk of adverse outcome from infection or that may facilitate transmission (e.g., those who are immunocompromised, have or have anticipated prolonged lengths of stay). Category II
  • Ensure that patients are physically separated (i.e., >3 feet apart) from each other. Draw the privacy curtain between beds to minimize opportunities for close contact.
  • Change protective attire and perform hand hygiene between contact with patients in the same room, regardless of whether one patient or both patients are on Droplet Precautions.
V.C.2.b. In long-term care and other residential settings, make decisions regarding patient placement on a case-by-case basis after considering infection risks to other patients in the room and available alternatives
V.C.2.c. In ambulatory settings, place patients who require Droplet Precautions in an examination room or cubicle as soon as possible. Instruct patients to follow recommendations for Respiratory Hygiene/Cough Etiquette.
V.C.3. Use of personal protective equipment
V.C.3.a. Don a mask upon entry into the patient room or cubicle.
V.C.3.b. No recommendation for routinely wearing eye protection (e.g., goggle or face shield), in addition to a mask, for close contact with patients who require Droplet Precautions.
V.C.3.c. For patients with suspected or proven SARS, avian influenza or pandemic influenza, refer to the following websites for the most current recommendations (http://www.cdc.gov/ncidod/sars/ ; http://www.cdc.gov/flu/avian; http://www.pandemicflu.gov).
V.C.4. Patient transport
V.C.4.a. In acute care hospitals and long-term care and other residential settings, limit transport and movement of patients outside of the room to medically-necessary purposes.
V.C.4.b. If transport or movement in any healthcare setting is necessary, instruct patient to wear a mask and follow Respiratory Hygiene/Cough Etiquette)
V.C.4.c. No mask is required for persons transporting patients on Droplet Precautions.
V.C.4.d. Discontinue Droplet Precautions after signs and symptoms have resolved or according to pathogen-specific recommendations in Appendix A of the HICPAC/CDC Isolation Guideline.


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Date last modified: October 12, 2007
Content source: 
Division of Healthcare Quality Promotion (DHQP)
National Center for Preparedness, Detection, and Control of Infectious Diseases