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Infection prevention: Precautions for preventing transmission of infection

Deverick J Anderson, MD, MPH
Section Editor
Anthony Harris, MD, MPH
Deputy Editor
Elinor L Baron, MD, DTMH


The risk of transmission of pathogens and subsequent infection in healthcare facilities is substantial. Pathogens may be transmitted from other patients, the hospital personnel, and/or the hospital environment. The risk is variable and depends on a patient's immune status, the local prevalence of various pathogens, and the infection control practices and antimicrobial stewardship utilized during hospitalization.

Issues related to precautions devised to minimize risk for transmission of infection are reviewed here.

Issues related to the prevention of specific infections, prophylaxis after exposure to bloodborne pathogens, and immunizations for healthcare workers are discussed in detail separately. (See related topics.)


Standard precautions should be followed for the care of all patients (table 1) even when the presence of an infectious agent is not apparent or is thought to be minimal [1].

Standard precautions entail [1-3]:

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Literature review current through: Oct 2017. | This topic last updated: Nov 16, 2017.
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  1. Siegel JD, Rhinehart E, Jackson M, et al. Healthcare Infection Control Practices Advisory Committee 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007. http://www.cdc.gov/hicpac/pdf/Isolation/Isolation2007.pdf
  2. Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996; 17:53.
  3. Whitehouse JD, Sexton DJ, Kirkland KB. Infection control: past, present, and future issues. Compr Ther 1998; 24:71.
  4. Pittet D, Allegranzi B, Sax H, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006; 6:641.
  5. Luangasanatip N, Hongsuwan M, Limmathurotsakul D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ 2015; 351:h3728.
  6. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep 2002; 51:1.
  7. Gould DJ, Chudleigh JH, Moralejo D, Drey N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2007; :CD005186.
  8. World Health Organization. SAVE LIVES: Clean Your Hands: WHO's global annual campaign http://www.who.int/gpsc/5may/en/ (Accessed on December 06, 2011).
  9. Boyce JM. Hand hygiene compliance monitoring: current perspectives from the USA. J Hosp Infect 2008; 70 Suppl 1:2.
  10. Walker JL, Sistrunk WW, Higginbotham MA, et al. Hospital hand hygiene compliance improves with increased monitoring and immediate feedback. Am J Infect Control 2014; 42:1074.
  11. Gavrieli E, Drach-Zahavy A, Tal I, et al. The effects of immediate and delayed feedback on hand hygiene compliance. Antimicrob Resist Infect Control 2015; 4:P287.
  12. Srigley JA, Furness CD, Baker GR, Gardam M. Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. BMJ Qual Saf 2014; 23:974.
  13. Ward MA, Schweizer ML, Polgreen PM, et al. Automated and electronically assisted hand hygiene monitoring systems: a systematic review. Am J Infect Control 2014; 42:472.
  14. Armellino D, Hussain E, Schilling ME, et al. Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare. Clin Infect Dis 2012; 54:1.
  15. Pineles LL, Morgan DJ, Limper HM, et al. Accuracy of a radiofrequency identification (RFID) badge system to monitor hand hygiene behavior during routine clinical activities. Am J Infect Control 2014; 42:144.
  16. http://www.cdc.gov/handwashing/when-how-handwashing.html (Accessed on September 15, 2016).
  17. Voss A, Widmer AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997; 18:205.
  18. Gordin FM, Schultz ME, Huber RA, Gill JA. Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub. Infect Control Hosp Epidemiol 2005; 26:650.
  19. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000; 356:1307.
  20. Grayson ML, Melvani S, Druce J, et al. Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis 2009; 48:285.
  21. http://www.cdc.gov/handwashing/when-how-handwashing.html (Accessed on April 26, 2016).
  22. http://www.who.int/gpsc/clean_hands_protection/en/ (Accessed on April 26, 2016).
  23. Reilly JS, Price L, Lang S, et al. A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom. Infect Control Hosp Epidemiol 2016; 37:661.
  24. Rubin DM. Prosthetic fingernails in the OR. A research study. AORN J 1988; 47:944.
  25. Loveday HP, Wilson JA, Pratt RJ, et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014; 86 Suppl 1:S1.
  26. Tacconelli E, Cataldo MA, Dancer SJ, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014; 20 Suppl 1:1.
  27. Pottinger J, Burns S, Manske C. Bacterial carriage by artificial versus natural nails. Am J Infect Control 1989; 17:340.
  28. McNeil SA, Phelps A, Barnes AL, Kauffman CA. The effect of fingernail length on microbial colonization of the hands of healthcare workers [abstract]. 39th Annual IDSA, October 25-28, San Francisco, CA.
  29. Moolenaar RL, Crutcher JM, San Joaquin VH, et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 2000; 21:80.
  30. Parry MF, Grant B, Yukna M, et al. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis 2001; 32:352.
  31. Passaro DJ, Waring L, Armstrong R, et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis 1997; 175:992.
  32. Emergency Care Research Institute. Special Report: Reuse of single-use medical devices: Making informed decisions. Plymouth Meeting, PA: ECRI; 1997:1.
  33. Alrawi S, Houshan L, Satheesan R, et al. Glove reinforcement: an alternative to double gloving. Infect Control Hosp Epidemiol 2001; 22:526.
  34. Fuller C, Savage J, Besser S, et al. "The dirty hand in the latex glove": a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol 2011; 32:1194.
  35. Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP. Removal of nosocomial pathogens from the contaminated glove. Implications for glove reuse and handwashing. Ann Intern Med 1988; 109:394.
  36. Muto CA, Jernigan JA, Ostrowsky BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003; 24:362.
  37. Croft LD, Harris AD, Pineles L, et al. The Effect of Universal Glove and Gown Use on Adverse Events in Intensive Care Unit Patients. Clin Infect Dis 2015; 61:545.
  38. Sprague E, Reynolds S, Brindley P. Patient Isolation Precautions: Are They Worth It? Can Respir J 2016; 2016:5352625.
  39. Dashiell-Earp CN, Bell DS, Ang AO, Uslan DZ. Do physicians spend less time with patients in contact isolation?: a time-motion study of internal medicine interns. JAMA Intern Med 2014; 174:814.
  40. Morgan DJ, Pineles L, Shardell M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013; 34:69.
  41. Karki S, Leder K, Cheng AC. Patients under contact precautions have an increased risk of injuries and medication errors: a retrospective cohort study. Infect Control Hosp Epidemiol 2013; 34:1118.
  42. Day HR, Morgan DJ, Himelhoch S, et al. Association between depression and contact precautions in veterans at hospital admission. Am J Infect Control 2011; 39:163.
  43. Catalano G, Houston SH, Catalano MC, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003; 96:141.
  44. McLemore A, Bearman G, Edmond MB. Effect of contact precautions on wait time from emergency room disposition to inpatient admission. Infect Control Hosp Epidemiol 2011; 32:298.
  45. Dhar S, Marchaim D, Tansek R, et al. Contact precautions: more is not necessarily better. Infect Control Hosp Epidemiol 2014; 35:213.
  46. Hall CB. Nosocomial respiratory syncytial virus infections: the "Cold War" has not ended. Clin Infect Dis 2000; 31:590.
  47. Leclair JM, Freeman J, Sullivan BF, et al. Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med 1987; 317:329.
  48. Madge P, Paton JY, McColl JH, Mackie PL. Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus. Lancet 1992; 340:1079.
  49. Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005; 54:1.
  50. http://www.cdc.gov/shingles/hcp/hc-settings.html (Accessed on October 04, 2016).
  51. Wilder-Smith A, Low JG. Risk of respiratory infections in health care workers: lessons on infection control emerge from the SARS outbreak. Southeast Asian J Trop Med Public Health 2005; 36:481.
  52. Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) http://www.cdc.gov/ncidod/sars/guidance/I/index.htm (Accessed on December 06, 2011).
  53. Climo MW, Yokoe DS, Warren DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013; 368:533.
  54. Vernon MO, Hayden MK, Trick WE, et al. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006; 166:306.
  55. Bleasdale SC, Trick WE, Gonzalez IM, et al. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007; 167:2073.
  56. Climo MW, Sepkowitz KA, Zuccotti G, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009; 37:1858.
  57. Batra R, Cooper BS, Whiteley C, et al. Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillin-resistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010; 50:210.
  58. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008; 46:274.
  59. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013; 368:2255.
  60. Wilson JA, Loveday HP, Hoffman PN, Pratt RJ. Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England). J Hosp Infect 2007; 66:301.
  61. Wiener-Well Y, Galuty M, Rudensky B, et al. Nursing and physician attire as possible source of nosocomial infections. Am J Infect Control 2011; 39:555.
  62. Treakle AM, Thom KA, Furuno JP, et al. Bacterial contamination of health care workers' white coats. Am J Infect Control 2009; 37:101.
  63. Lopez PJ, Ron O, Parthasarathy P, et al. Bacterial counts from hospital doctors' ties are higher than those from shirts. Am J Infect Control 2009; 37:79.
  64. Gaspard P, Eschbach E, Gunther D, et al. Meticillin-resistant Staphylococcus aureus contamination of healthcare workers' uniforms in long-term care facilities. J Hosp Infect 2009; 71:170.
  65. Brady RR, Verran J, Damani NN, Gibb AP. Review of mobile communication devices as potential reservoirs of nosocomial pathogens. J Hosp Infect 2009; 71:295.
  66. Kotsanas D, Scott C, Gillespie EE, et al. What's hanging around your neck? Pathogenic bacteria on identity badges and lanyards. Med J Aust 2008; 188:5.
  67. Longtin Y, Schneider A, Tschopp C, et al. Contamination of stethoscopes and physicians' hands after a physical examination. Mayo Clin Proc 2014; 89:291.
  68. Jacob G. Uniforms and workwear: An evidence base for developing local policy. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_078435.pdf (Accessed on October 04, 2016).
  69. Burden M, Cervantes L, Weed D, et al. Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: a randomized controlled trial. J Hosp Med 2011; 6:177.
  70. Bearman GM, Rosato A, Elam K, et al. A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infect Control Hosp Epidemiol 2012; 33:268.
  71. Burger A, Wijewardena C, Clayson S, Greatorex RA. Bare below elbows: does this policy affect handwashing efficacy and reduce bacterial colonisation? Ann R Coll Surg Engl 2011; 93:13.
  72. Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol 2014; 35:107.