Contact, droplet, and airborne precautions in the home care setting
Transmission-based precautions are added on top of standard precautions when a client has a known or suspected infection requiring additional protective measures. In home care, implementing these precautions in an uncontrolled home environment requires adaptation, creativity, and clear communication with clients and families. This lesson covers the three categories of transmission-based precautions and their application in the home setting.
Transmission-based precautions address three routes of transmission beyond the standard precaution baseline: contact transmission (direct or indirect touch), droplet transmission (large respiratory particles that settle within 6 feet), and airborne transmission (small particles that remain suspended in air and travel farther than 6 feet). Many infections require more than one category simultaneously.
For infections transmitted by direct contact (touching the client) or indirect contact (touching contaminated surfaces or equipment). Common indications: MRSA, VRE, C. difficile, scabies, wound infections with resistant organisms, and highly contagious skin conditions. Requirements: gown and gloves donned before entering the care area, doffed before leaving. Use dedicated equipment when possible (avoid sharing stethoscopes, blood pressure cuffs). Clean and disinfect shared equipment between client uses. Hand hygiene (soap and water, not ABHR, for C. diff) upon exiting.
For infections transmitted by large respiratory droplets that travel less than 6 feet and settle quickly. Common indications: influenza, RSV, pertussis, Group A Strep pharyngitis, and meningococcal disease. Requirements: surgical mask upon entering the care area (not required to be N95), eye protection when within 3–6 feet of the client, and spatial separation of at least 3 feet from other household members when possible. In the home: ask symptomatic household members to stay out of the care area during your visit.
For infections transmitted by small airborne particles that remain suspended in air and can travel beyond 6 feet. Indications: pulmonary tuberculosis, measles, varicella (chickenpox), disseminated herpes zoster, and — in certain procedures — COVID-19. Requirements: fit-tested N95 or higher respirator (or PAPR), negative pressure room in institutional settings. In the home setting: an N95 respirator is required, windows should be opened to maximize ventilation, care should be provided in a well-ventilated room, and clinicians with no immunity to varicella/measles should not care for clients with these conditions.
Complete this 5-question quiz with 80% or higher to earn your CEU credit for this lesson.