Isolation Precautions: Droplet (Ambulatory) - CE/NCPD

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OVERVIEW

Pathogens may be transmitted by one of three routes: contact (including contact with contaminated surfaces), droplet, or airborne. The transmission-based precautions—airborne, droplet, and contact—may be used alone or in combination for diseases that have multiple routes of transmission (e.g., chickenpox) (Table 1).^{undefined#ref2">2} Whether used alone or in combination, these isolation precautions should be employed in conjunction with standard precautions (Box 1). Precautions include measures for the care of a patient who is known to be or suspected of being infected or is colonized with highly transmissible or epidemiologically important pathogens for which additional precautions are needed to prevent transmission (Table 1).²

Droplet transmission is a form of contact transmission (direct or indirect) when an infectious agent is transmitted by droplet route. Respiratory droplets carrying infectious pathogens transmit infection when they travel directly from the infectious person’s respiratory tract (e.g., coughing, sneezing, talking, or during procedures such as suctioning, endotracheal intubation, and cardiopulmonary resuscitation) to another person’s mucosal membranes.²

The difference between droplet precautions and airborne precautions is related to the size of the respiratory droplets. Droplet-transmitted pathogens have a particle size greater than 5 microns² and do not hang suspended in the air. Airborne-transmitted pathogens are less than 5 microns² and are able to hang suspended in the air for long periods of time. Airborne precautions require special air handling and ventilation.²

Research shows that droplets do not travel as far as airborne particles.² The distance droplets can travel depends on how they are released into the air, the speed at which they are released, where they come from, the thickness of the respiratory secretions, and the environment (e.g., temperature, humidity). The exact distance that droplets can spread infection is still being studied.² According to the research, a mask should be put on when within 6 to 10 feet of infectious patients or environments.²

SUPPLIES

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EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
• Explain the purpose of droplet isolation to the patient and any precautions that the family should take when entering the patient’s room.
• Teach the patient about modes of infection transmission.
• Teach the patient about possible exposure of other individuals before the diagnosis.

PROCEDURE

1. Review the patient’s medical record (if available) for indications and risk factors for droplet isolation precautions (e.g., influenza, adenovirus, rhinovirus).²

   Rationale: The mode of transmission for an infectious microorganism determines the type and degree of precautions used.

   1. Review the precautions for the specific isolation criteria, including the appropriate personal protective equipment (PPE) to apply (Table 1).
   2. Review the patient’s laboratory test results, as applicable.
   3. Determine whether the patient has a known latex allergy.
   4. Put up droplet isolation signs on the patient’s room and bathroom doors, as applicable.
2. Collaborate with other health care team members regarding the patient’s emotional state and reaction and adjustment to droplet isolation, as applicable.
3. Get the necessary disposable or dedicated equipment, supplies, and labels before going into the patient’s room to reduce the risk of transmitting infectious pathogens.

   Rationale: Using equipment that is disposable or dedicated for use only with the patient on isolation precautions minimizes the risk of infection transmission to other patients.²

4. Be sure to have all the needed PPE in the correct sizes and check that it is intact before putting it on.
5. Clean hands.
6. Put on PPE, as applicable (Figure 1).^1,2
7. Determine if the patient has health literacy needs or requires tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
8. Review the patient’s previous experience and knowledge of droplet isolation precautions and understanding of the care to be provided.
9. Use environmental and transport measures while providing patient care, as applicable (Table 1).
10. Remove PPE in the correct sequence depending on the type of gown used before leaving the patient’s room (Figure 2) (Figure 3).^1,2
11. Clean the patient’s room and reusable patient care items as appropriate (Table 1).

EXPECTED OUTCOMES

• Health care team members put on and take off PPE correctly.

UNEXPECTED OUTCOMES

• Health care team members do not put on or take off PPE correctly.

DOCUMENTATION

• Education
• Evidence or suspected breach of isolation precautions (as applicable)
• Unexpected outcomes and related interventions

PEDIATRIC CONSIDERATIONS

• All isolation precautions should be shown to pediatric patients. Health care team members should let pediatric patients see their faces before applying masks so that patients do not become frightened.

OLDER ADULT CONSIDERATIONS

• Many older adults may become confused when they are confronted with a health care team member using isolation precautions or when left in a room with the door closed. The need to close the door should be evaluated, along with the patient’s safety needs.

REFERENCES

1. Centers for Disease Control and Prevention (CDC). (n.d.). PPE sequence. Retrieved December 17, 2024, from www.cdc.gov/healthcare-associated-infections/media/pdfs/ppe-sequence-p.pdf?CDC_AAref_Val=https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
2. Siegel, J.D. and others. (2007, updated 2024). 2007 Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Retrieved December 17, 2024, from https://www.cdc.gov/infection-control/media/pdfs/guideline-isolation-h.pdf?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

ADDITIONAL READINGS

Centers for Disease Control and Prevention (CDC). (2016). Guide to infection prevention for outpatient settings: Minimum expectations for safe care. Retrieved December 17, 2024, from https://www.cdc.gov/infection-control/media/pdfs/Outpatient-Guide-508.pdf

Clinical Review: Kerrie L. Chambers, MSN, RN, CNOR, CNS-CP(E)

Published: January 2025