In certain circumstances using standard infection control precautions (SICPs) won’t be enough to stop an infection spreading and you will need to use some extra precautions. These extra precautions are called Transmission Based Precautions or TBPs.

Clinical judgement and decisions should be made by staff to determine the necessary IPC precautions required (the local IPCT and/or the HPT should be contacted for advice and support where required).

Clinical judgement and decisions should be based on the:

• suspected or known infectious agent
• transmission route of the infectious agent
• care setting and procedures undertaken
• severity of the illness caused

When TBPs should be used

TBPs should be used if a resident has a suspected or known infection or colonisation.  

Important words and what they meanColonisation is the presence of microorganisms on a body surface (such as the skin, mouth, intestines or airway) that does not cause disease in the person or signs of infection.

Infection transmission routes

Infections can be transmitted or spread by:

• contact with microorganisms (germs) on hands or from contaminated equipment or environment
• droplet infection by inhaling infectious droplets, for example flu or COVID-19
• aerosol infection which are inhaled or directly contaminate a mucosal surface or conjunctivae (eyes, nose, and mouth)

Different transmission routes need different TBPs

TBPs are categorised by the route of transmission of infectious agents (some infectious agents can be transmitted by more than one route). Appendix 11 provides details of the type of precautions, optimal resident placement, isolation requirements and any respiratory precautions required. Application of TBPs may differ depending on the setting and the known or suspected infectious agent.

• Contact precautions are used to prevent infections that spread through direct contact with the resident or indirectly from the resident’s immediate care environment and care equipment. This is the most common route of cross-infection transmission.
• Droplet precautions are used to prevent and control infections spread over short distances (at least 3 feet or 1 metre) via small droplets from the respiratory tract of one individual directly onto the mucosal surface of another person’s mouth or nose or eyes. Droplets penetrate the respiratory system to above the alveolar level.
• Airborne precautions are used to prevent and control infections spread without necessarily having close contact via from the respiratory tract of one individual directly onto the surface of another person’s mouth or nose or eyes. Aerosols penetrate the respiratory system to deep into the lung.

Different infections need different TBPs

You might have heard of some infections like norovirus, Meticillin-resistant Staphylococcus aureus (MRSA), Clostridioides. difficile (C.diff/CDI) and flu but there are lots of others. 

You can find out more information about the infection the individual has and the precautions you should use in Appendix 11 and/or A-Z of pathogens in the NIPCM.

You can also contact your local IPCT or HPT for further advice if required. 

Before using transmission based precautions you need to find out:

• what the suspected or known infection/colonisation is?
• how is it transmitted?
• how severe is the resident’s illness?
• what is the care setting and required procedures?

There are different ways you can find out if a resident has an infection that needs TBPs to be put in place. You can get information about a resident’s infection status from:

• their GP 
• local health protection team
• local infection prevention and control team
• laboratory
• hospital or care homes staff from where the resident has been discharged or transferred

Local processes should be followed when obtaining this information.

 

Further information on transmission based precautions can be found in the definitions of Transmission Based Precautions literature review.