Isolation Precautions: Droplet (Pediatric) - CE/NCPD

The content in Clinical Skills is evidence based and intended to be a guide to clinical practice. Always follow your organization’s practice.

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 designed 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 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 the droplet isolation to the patient and family and any precautions that the family should take when entering the patient’s room.
• Teach the patient and family about modes of infection transmission.
• Teach the patient and family about possible exposure of other individuals before the diagnosis.

ASSESSMENT AND PREPARATION

Assessment

1. Review the patient’s medical record 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. Request the participation of a child life specialist, if available.

Preparation

1. 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

2. Be sure to have all the needed PPE in the correct sizes and check that it is intact before putting it on.

PROCEDURE

1. Clean hands.
2. Put on PPE, as applicable (Figure 1).^1,2
3. For young children, delay masking until in the room so the patient can see one’s face.

   Rationale: Showing one’s face to a young child before masking may limit anxiety.

4. Determine if the patient or family has health literacy needs or requires tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
5. Review the patient’s and family’s previous experience and knowledge of droplet isolation precautions and understanding of the care to be provided.
6. Use environmental and transport measures while providing patient care, as applicable (Table 1).
7. 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
8. Clean the patient’s room and reusable patient care items as appropriate (Table 1).

EXPECTED OUTCOMES

• Patient and family cooperate with isolation precautions.
• No evidence or breach of isolation precautions occurs.
• Health care team members are free from infection.

UNEXPECTED OUTCOMES

• Patient and family do not cooperate with isolation precautions.
• Breach of isolation precautions exists.
• Health care team member contracts an infection.

DOCUMENTATION

• Education
• Care provided
• Evidence or suspected breach of isolation precautions
• Unexpected outcomes and related interventions

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

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

Published: January 2025