Standard and transmission-based precautions in clinics

Two tiers

The NHMRC infection control guidelines use two tiers. Standard precautions apply to every patient, every time, because you can't tell who carries an infection. Transmission-based precautions are added on top when a patient has a known or suspected infection that standard precautions alone may not contain. Clinics follow the same approach; the RACGP's guidelines for general practices describe it as levels of precaution.

Standard precautions in a clinic

• Hand hygiene at the 5 moments.
• PPE chosen for the task: gloves for contact with blood, body fluids or broken skin, and eye protection and a mask when splashes are possible.
• Respiratory hygiene and cough etiquette for patients and staff.
• Safe handling and disposal of sharps.
• Aseptic technique for procedures such as injections, dressings and minor surgery.
• Cleaning shared equipment and the environment, and reprocessing reusable instruments.
• Safe handling of waste and linen.

Contact precautions

For infections spread by touch, such as some multi-resistant organisms, gastro or scabies. They add gloves and a gown or apron for contact with the patient or their surroundings, dedicated or carefully cleaned equipment, and a clean of the room before the next patient.

Droplet precautions

For infections spread by larger respiratory droplets, such as influenza and whooping cough. They add a surgical mask for staff within close range, a mask for the patient if they can tolerate one, and keeping them apart from other patients — ideally in a separate room rather than the shared waiting room.

Airborne precautions

For infections spread by tiny particles that stay in the air, such as measles, chickenpox and tuberculosis. They add a P2/N95 respirator that has been fit-checked, seeing the patient in a room with the door closed, and leaving the room empty for a period afterwards. Many clinics also limit contact to staff who are immune, for example through vaccination. How long the room stays empty depends on its ventilation, so follow your practice's procedure.

Who decides

The clinician, the practice's infection control lead or your procedures decide when transmission-based precautions start and stop. COVID-19 precautions in particular have changed over time and differ between workplaces. If a patient's symptoms suggest an infection and you don't know what precautions apply, ask before the patient enters a shared space.