Tables summarizing the recommendations from the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007).
These recommendations are designed to prevent transmission of infectious agents among patients and healthcare personnel inpatients with suspected or proven SARS all settings where healthcare is delivered. As in other CDC/HICPAC guidelines, each recommendation is categorized on the basis of existing scientific data, theoretical rationale, applicability, and when possible, economic impact. The CDC/HICPAC system for categorizing recommendations is as follows:
Rating Explanation Category IAStrongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.
Category IBStrongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale.
Category ICSuggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.
No recommendation; Unresolved issue.Healthcare organization administrators should ensure the implementation of recommendations in this section.
| # | Recommendation | Category |
|---|---|---|
| I.A. | Incorporate preventing transmission of infectious agents into the objectives of the organization’s patient and occupational safety programs | IB/IC |
| I.B. | Make preventing transmission of infectious agents a priority for the healthcare organization. Provide administrative support, including fiscal and human resources for maintaining infection control programs | IB/IC |
| I.B.1. | Assure that individuals with training in infection control are employed by or are available by contract to all healthcare facilities so that the infection control program is managed by one or more qualified individuals | IB/IC |
| I.B.1.a. | Determine the specific infection control full-time equivalents (FTEs) according to the scope of the infection control program, the complexity of the healthcare facility or system, the characteristics of the patient population, the unique or urgent needs of the facility and community, and proposed staffing levels based on survey results and recommendations from professional organizations | IB |
| I.B.2. | Include prevention of healthcare-associated infections (HAI) as one determinant of bedside nurse staffing levels and composition, especially in high-risk units | IB |
| I.B.3. | Delegate authority to infection control personnel or their designees (e.g., patient care unit charge nurses) for making infection control decisions concerning patient placement and assignment of Transmission-Based Precautions | IC |
| I.B.4. | Involve infection control personnel in decisions on facility construction and design, determination of AIIR and Protective Environment capacity needs and environmental assessments | IB/IC |
| I.B.4.a. | Provide ventilation systems required for a sufficient number of airborne infection isolation rooms (AIIR)s (as determined by a risk assessment) and Protective Environments in healthcare facilities that provide care to patients for whom such rooms are indicated, according to published recommendations | IB/IC |
| I.B.5. | Involve infection control personnel in the selection and post-implementation evaluation of medical equipment and supplies and changes in practice that could affect the risk of HAI | IC |
| I.B.6. | Ensure availability of human and fiscal resources to provide clinical microbiology laboratory support, including a sufficient number of medical technologists trained in microbiology, appropriate to the healthcare setting, for monitoring transmission of microorganisms, planning and conducting epidemiologic investigations, and detecting emerging pathogens. Identify resources for performing surveillance cultures, rapid diagnostic testing for viral and other selected pathogens, preparation of antimicrobial susceptibility summary reports, trend analysis, and molecular typing of clustered isolates (performed either on-site or in a reference laboratory) and use these resources according to facility-specific epidemiologic needs, in consultation with clinical microbiologists | IB |
| I.B.7. | Provide human and fiscal resources to meet occupational health needs related to infection control (e.g., healthcare personnel immunization, post-exposure evaluation and care, evaluation and management of healthcare personnel with communicable infections | IB/IC |
| I.B.8. | In all areas where healthcare is delivered, provide supplies and equipment necessary for the consistent observance of Standard Precautions, including hand hygiene products and personal protective equipment (e.g., gloves, gowns, face and eye protection) | IB/IC |
| I.B.9. | Develop and implement policies and procedures to ensure that reusable patient care equipment is cleaned and reprocessed appropriately before use on another patient | IA/IC |
| I.C. | Develop and implement processes to ensure oversight of infection control activities appropriate to the healthcare setting and assign responsibility for oversight of infection control activities to an individual or group within the healthcare organization that is knowledgeable about infection control | II |
| I.D. | Develop and implement systems for early detection and management (e.g., use of appropriate infection control measures, including isolation precautions, personal protective equipment [PPE]) of potentially infectious persons at initial points of patient encounter in outpatient settings (e.g., triage areas, emergency departments, outpatient clinics, physician offices) and at the time of admission to hospitals and long-term care facilities (LTCF) | IB |
| I.E. | Develop and implement policies and procedures to limit patient visitation by persons with signs or symptoms of a communicable infection. Screen visitors to high-risk patient care areas (e.g., oncology units, hematopoietic stem cell transplant [HSCT] units, intensive care units, other severely immunocompromised patients) for possible infection. | IB |
| I.F. | Identify performance indicators of the effectiveness of organization-specific measures to prevent transmission of infectious agents (Standard and Transmission-Based Precautions), establish processes to monitor adherence to those performance measures and provide feedback to staff members. | IB |
| # | Recommendation | Category |
|---|---|---|
| II.A. | Provide job- or task-specific education and training on preventing transmission of infectious agents associated with healthcare during orientation to the healthcare facility; update information periodically during ongoing education programs. Target all healthcare personnel for education and training, including but not limited to medical, nursing, clinical technicians, laboratory staff; property service (housekeeping), laundry, maintenance and dietary workers; students, contract staff and volunteers. Document competency initially and repeatedly, as appropriate, for the specific staff positions. Develop a system to ensure that healthcare personnel employed by outside agencies meet these education and training requirements through programs offered by the agencies or by participation in the healthcare facility’s program designed for full-time personnel | IB |
| II.A.1. | Include in education and training programs, information concerning use of vaccines as an adjunctive infection control measure | IB |
| II.A.2. | Enhance education and training by applying principles of adult learning, using reading level and language appropriate material for the target audience, and using online educational tools available to the institution | IB |
| II.B. | Provide instructional materials for patients and visitors on recommended hand hygiene and Respiratory Hygiene/Cough Etiquette practices and the application of Transmission-Based Precautions | II |
Assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting and apply the following infection control practices during the delivery of health care.
Edit: These recommendations contain minor edits in order to clarify the meaning. The edits do not constitute any change to the intent of the recommendations.
* Indicates a change to the numbering system.
~ Indicates a text change.
| # | Recommendation | Category |
|---|---|---|
| IV.A.1. | During the delivery of healthcare, avoid unnecessary touching of surfaces in close proximity to the patient to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces | IB/IC |
| IV.A.2. | When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water | IA |
| IV.A.3. | If hands are not visibly soiled, or after removing visible material with nonantimicrobial soap and water, decontaminate hands in the clinical situations described in IV.A.4.a-f. The preferred method of hand decontamination is with an alcohol-based hand rub. Alternatively, hands may be washed with an antimicrobial soap and water. Frequent use of alcohol-based hand rub immediately following handwashing with nonantimicrobial soap may increase the frequency of dermatitis. | IB |
| IV.A.3 | Perform hand hygiene ~ in the following clinical situations: | n/a |
| IV.A.3.a. | Before having direct contact with patients | IB |
| IV.A.3.b. | After contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings | IA |
| IV.A.3.c. | After contact with a patient’s intact skin (e.g., when taking a pulse or blood pressure or lifting a patient) | IB |
| IV.A.3.d. | If hands will be moving from a contaminated-body site to a clean-body site during patient care. | II |
| IV.A.3.e. | After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient | II |
| IV.A.3.f. | After removing gloves | IB |
| IV.A.4. | Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if contact with spores (e.g., C. difficile or Bacillus anthracis) is likely to have occurred. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores | II |
| IV.A.5. | Do not wear artificial fingernails or extenders if duties include direct contact with patients at high risk for infection and associated adverse outcomes (e.g., those in ICUs or operating rooms) | IA |
| IV.A.5.a. | Develop an organizational policy on the wearing of non-natural nails by healthcare personnel who have direct contact with patients outside of the groups specified above | II |
| # | Recommendation | Category |
|---|---|---|
| IV.C.1. | Educate healthcare personnel on the importance of source control measures to contain respiratory secretions to prevent droplet and fomite transmission of respiratory pathogens, especially during seasonal outbreaks of viral respiratory tract infections (e.g., influenza, RSV, adenovirus, parainfluenza virus) in communities | IB |
| IV.C.2. | Implement the following measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at the point of initial encounter in a healthcare setting (e.g., triage, reception and waiting areas in emergency departments, outpatient clinics and physician offices) | n/a |
| IV.C.2.a. | Post signs at entrances and in strategic places (e.g., elevators, cafeterias) within ambulatory and inpatient settings with instructions to patients and other persons with symptoms of a respiratory infection to cover their mouths/noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after hands have been in contact with respiratory secretions. | II |
| IV.C.2.b. | Provide tissues and no-touch receptacles (e.g., foot-pedal-operated lid or open, plastic-lined waste basket) for disposal of tissues | II |
| IV.C.2.c. | Provide resources and instructions for performing hand hygiene in or near waiting areas in ambulatory and inpatient settings; provide conveniently-located dispensers of alcohol-based hand rubs and, where sinks are available, supplies for handwashing | IB |
| IV.C.2.d. | During periods of increased prevalence of respiratory infections in the community (e.g., as indicated by increased school absenteeism, increased number of patients seeking care for a respiratory infection), offer masks to coughing patients and other symptomatic persons (e.g., persons who accompany ill patients) upon entry into the facility or medical office 126, 899 898 and encourage them to maintain special separation, ideally a distance of at least 3 feet, from others in common waiting areas | IB |
| IV.C.2.d.i. | Some facilities may find it logistically easier to institute this recommendation year-round as a standard of practice. | II |
| # | Recommendation | Category |
|---|---|---|
| IV.E.1. | Establish policies and procedures for containing, transporting, and handling patient-care equipment and instruments/devices that may be contaminated with blood or body fluids | IB/IC |
| IV.E.2. | Remove organic material from critical and semi-critical instrument/devices, using recommended cleaning agents before high level disinfection and sterilization to enable effective disinfection and sterilization processes | IA |
| IV.E.3. | Wear PPE (e.g., gloves, gown), according to the level of anticipated contamination, when handling patient-care equipment and instruments/devices that is visibly soiled or may have been in contact with blood or body fluids | IB/IC |
An * indicates recommendations that were renumbered for clarity. The renumbering does not constitute change to the intent of the recommendations.
| # | Recommendation | Category |
|---|---|---|
| IV.G.1. | Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces and persons | IB/IC |
| IV.G.2. | If laundry chutes are used, ensure that they are properly designed, maintained, and used in a manner to minimize dispersion of aerosols from contaminated laundry | IB/IC |
The following recommendations apply to the use of needles, cannulas that replace needles, and, where applicable, intravenous delivery systems. 454
| # | Recommendation | Category |
|---|---|---|
| IV.H.1. | Use aseptic technique to avoid contamination of sterile injection equipment | IA |
| IV.H.2. | Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient | IA |
| IV.H.3. | Use fluid infusion and administration sets (i.e., intravenous bags, tubing and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient’s intravenous infusion bag or administration set | IB |
| IV.H.4. | Use single-dose vials for parenteral medications whenever possible | IA |
| IV.H.5. | Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use | IA |
| IV.H.6. | If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile | IA |
| IV.H.7. | Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer’s recommendations; discard if sterility is compromised or questionable | IA |
| IV.H.8. | Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients | IB |
| # | Recommendation | Category |
|---|---|---|
| IV.I. | Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space (i.e., during myelograms, lumbar puncture and spinal or epidural anesthesia) | IB |
| # | Recommendation | Category |
|---|---|---|
| IV.J. | Adhere to federal and state requirements for protection of healthcare personnel from exposure to bloodborne pathogens | IC |
| # | Recommendation | Category |
|---|---|---|
| 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) | IA |
| 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 | IA |
An * indicates recommendations that were renumbered for clarity. The renumbering does not constitute change to the intent of the recommendations.
| # | Recommendation | Category |
|---|---|---|
| V.B.1. | Use Contact Precautions as recommended in Appendix A for patients with known or suspected infections or evidence of syndromes that represent an increased risk for contact transmission. For specific recommendations for use of Contact Precautions for colonization or infection with MDROs, go to Management of Multidrug- Resistant Organisms in Healthcare Settings 2006 | n/a |
V.B.2. Patient placement
V.B.3. Use of personal protective equipment
| # | Recommendation | Category |
|---|---|---|
| V.B.3.a. | Gloves |
Wear gloves whenever touching the patient’s intact skin or surfaces and articles in close proximity to the patient (e.g., medical equipment, bed rails). Don gloves upon entry into the room or cubicle.
V.B.4. Patient transport
| # | Recommendation | Category |
|---|---|---|
| V.B.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. | II |
| V.B.4.b. | When transport or movement in any healthcare setting is necessary, ensure that infected or colonized areas of the patient’s body are contained and covered. | II |
| V.B.4.c. | Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. | II |
| V.B.4.d. | Don clean PPE to handle the patient at the transport destination. | II |
V.B.5. Patient-care equipment and instruments/devices
| # | Recommendation | Category |
|---|---|---|
| V.B.5.a. | Handle patient-care equipment and instruments/devices according to Standard Precautions | IB/IC |
| V.B.5.b. | In acute care hospitals and long-term care and other residential settings, use disposable noncritical patient-care equipment (e.g., blood pressure cuffs) or implement patient-dedicated use of such equipment. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient | IB |
| V.B.5.c. | In home care settings | n/a |
| V.B.5.c.i. | Limit the amount of non-disposable patient-care equipment brought into the home of patients on Contact Precautions. Whenever possible, leave patient-care equipment in the home until discharge from home care services. | II |
| V.B.5.c.ii. | If noncritical patient-care equipment (e.g., stethoscope) cannot remain in the home, clean and disinfect items before taking them from the home using a low- to intermediate-level disinfectant. Alternatively, place contaminated reusable items in a plastic bag for transport and subsequent cleaning and disinfection. | II |
| V.B.5.d. | In ambulatory settings, place contaminated reusable noncritical patient-care equipment in a plastic bag for transport to a soiled utility area for reprocessing. | II |
| V.B.6. | Environmental measures |
Ensure that rooms of patients on Contact Precautions are prioritized for frequent cleaning and disinfection (e.g., at least daily) with a focus on frequently-touched surfaces (e.g., bed rails, overbed table, bedside commode, lavatory surfaces in patient bathrooms, doorknobs) and equipment in the immediate vicinity of the patient.
An * indicates recommendations that were renumbered for clarity. The renumbering does not constitute change to the intent of the recommendations.
These recommendations contain minor edits in order to clarify the meaning. The edits do not constitute any change to the intent of the recommendations.
* Indicates a change to the numbering system.
~ Indicates a text change.
Restrict susceptible healthcare personnel from entering the rooms of patients known or suspected to have measles (rubeola), varicella (chickenpox), disseminated zoster, or smallpox if other immune healthcare personnel are available
Interim Measles Infection Control [July 2019]
For current recommendations on face protection for measles, see Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings
No recommendation is made regarding the type of personal protective equipment (i.e., surgical mask or respiratory protection with a N95 or higher respirator) to be worn by susceptible healthcare personnel who must have contact with patients with known or suspected measles, chickenpox or disseminated herpes zoster.
Interim Measles Infection Control [July 2019]
For current recommendations on face protection for measles, see Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings
Immunize or provide the appropriate immune globulin to susceptible persons as soon as possible following unprotected contact (i.e., exposed) to a patient with measles, varicella or smallpox:
An ~ indicates text that was edited for clarity. The edit does not constitute change to the intent of the recommendations.
| # | Recommendation | Category |
|---|---|---|
| VI.A. | Place allogeneic hematopoietic stem cell transplant (HSCT) patients in a Protective Environment as described in the “Guideline to Prevent Opportunistic Infections in HSCT Patients,” the “Guideline for Environmental Infection Control in Health-Care Facilities,” and the “Guidelines for Preventing Health-Care-Associated Pneumonia, 2003” to reduce exposure to environmental fungi (e.g., Aspergillus spp.) | IB |
| VI.B. | No recommendation for placing patients with other medical conditions that are associated with increased risk for environmental fungal infections (e.g., aspergillosis) in a Protective Environment | Unresolved issue |
| VI.C. | For Patients Who Require a Protective Environment, Implement the Following (see Table 5) | n/a |
| # | Recommendation | Category |
|---|---|---|
| VI.C.1. | Environmental controls | n/a |
| VI.C.1.a. | Filter incoming air using central or point-of-use high efficiency particulate (HEPA) filters capable of removing 99.97% of particles ≥0.3 µm in diameter | IB |
| VI.C.1.b. | Direct room airflow with the air supply on one side of the room that moves air across the patient bed and out through an exhaust on the opposite side of the room | IB |
| VI.C.1.c. | Ensure positive air pressure in room relative to the corridor (pressure differential of ≥2.5 Pa [0.01-in water gauge])  Correction [April 2019]: Pressure differential changed from ≥ 12.5 to ≥ 2.5. | IB |
| VI.C.1.c.i. | Monitor air pressure daily with visual indicators (e.g., smoke tubes, flutter strips) | IA |
| VI.C.1.d. | Ensure well-sealed rooms that prevent infiltration of outside air | IB |
| VI.C.1.e. | Ensure at least 12 air changes per hour | IB |
| # | Recommendation | Category |
|---|---|---|
| VI.C.2. | Lower dust levels by using smooth, nonporous surfaces and finishes that can be scrubbed, rather than textured material (e.g., upholstery). Wet dust horizontal surfaces whenever dust detected and routinely clean crevices and sprinkler heads where dust may accumulate | II |
| VI.C.3. | Avoid carpeting in hallways and patient rooms in areas | IB |
| VI.C.4. | Prohibit dried and fresh flowers and potted plants | II |
| VI.D. | Minimize the length of time that patients who require a Protective Environment are outside their rooms for diagnostic procedures and other activities | IB |
| VI.E. | During periods of construction, to prevent inhalation of respirable particles that could contain infectious spores, provide respiratory protection (e.g., N95 respirator) to patients who are medically fit to tolerate a respirator when they are required to leave the Protective Environment | II |
| * VI.E.1.a. | No recommendation for fit-testing of patients who are using respirators. | Unresolved issue |
| * VI.E.1.b. | No recommendation for use of particulate respirators when leaving the Protective Environment in the absence of construction. | Unresolved issue |
| # | Recommendation | Category |
|---|---|---|
| VI.F. | Use of Standard and Transmission-Based Precautions in a Protective Environment. | n/a |
| VI.F.1. | Use Standard Precautions as recommended for all patient interactions. | IA |
| VI.F.2. | Implement Droplet and Contact Precautions as recommended for diseases listed in Appendix A. Transmission-Based precautions for viral infections may need to be prolonged because of the patient’s immunocompromised state and prolonged shedding of viruses | IB |
| VI.F.3. | ~ Barrier precautions (e.g., masks, gowns, gloves) are not required for healthcare personnel in the absence of suspected or confirmed infection unless indicated according to Standard Precautions or if recommended for source control (e.g., mask) for any individual entering the protective environment room. | II |
| VI.F.4. | Implement Airborne Precautions for patients who require a Protective Environment room and who also have an airborne infectious disease (e.g., pulmonary or laryngeal tuberculosis, acute varicella-zoster). | IA |
| VI.F.4.a. | Ensure that the Protective Environment is designed to maintain positive pressure | IB |
| VI.F.4.b. | Use an anteroom to further support the appropriate air-balance relative to the corridor and the Protective Environment; provide independent exhaust of contaminated air to the outside or place a HEPA filter in the exhaust duct if the return air must be recirculated | IB |
| VI.F.4.c. | If an anteroom is not available, place the patient in an AIIR and use portable, industrial-grade HEPA filters in the room to enhance filtration of spores | II |
