B2 Transmission-Based Precautions


  • Transmission-based precautions are applied in addition to standard precautions.
  • The aim of instituting early transmission-based precautions is to reduce further transmission opportunities that may arise due to the specific route of transmission of a particular pathogen.
  • While it is not possible to prospectively identify all patients needing transmission-based precautions, in certain settings, recognising an increased risk warrants their use while confirmatory tests are pending.
  • Section B5.2 (see page 165) outlines recommended precautions for specific infectious agents.

Patient-care tip

When transmission-based precautions are applied during the care of an individual patient, there is potential for adverse effects such as anxiety, mood disturbances, perceptions of stigma and reduced contact with clinical staff. Clearly explaining to patients why these precautions are necessary may help to alleviate these effects.

Evidence supporting practice

The majority of the recommendations in this section have been adapted from:12

  • Siegel JD, Rhinehart E, Jackson M et al (Health Care Infection Control Practices Advisory Committee) (2007) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007. United States Centers for Disease Control and Prevention. http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf; and
  • Pratt et al (2007) Epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England.

Further review of the evidence concerning certain aspects of implementation of transmission-based precautions allowed the development of recommendations and good practice points specific to the Australian context. Literature reviews conducted as part of the development of these guidelines or that were released during the guideline development process identified the following:13

  • good quality evidence on the use of alcohol-based hand rubs in reducing transmission of infectious agents;
  • a lack of human clinical trials into the benefit of P2 respirators in reducing the risk of transmission of influenza; and
  • a paucity of studies evaluating the effectiveness of negative pressure rooms in reducing the transmission of infectious agents in health care settings.
  1. These guidelines were selected based on analysis using the AGREE tool, which ensures that guidelines have been developed in a rigorous, transparent and robust manner. This process is discussed in detail in Appendix 2.
  2. Due to a paucity of evidence or low quality evidence some systematic reviews were not used to draft recommendations. The reports of those reviews that were used are available from the NHMRC upon request.