Infectious Disease · Topic 2 of 10

Isolation Precautions & Multidrug-Resistant Organisms

Infectious disease · infection prevention

Isolation Precautions & Multidrug-Resistant Organisms

Match the precaution to the route: gown and gloves for contact, a mask for droplets, an N95 in a negative-pressure room for airborne spread.

Key numbers

Airborne: N95 in a negative-pressure roomN95 + AIIR

C. difficile: contact precautions, soap and water≥ 48 h after diarrhea

01 · The ruleContact precautions: gown and gloves on entry

Contact precautions (MRSA, VRE, CRE, C. difficile, C. auris, uncontained draining wounds): single room when available, gown and gloves for any contact with the patient or environment, donned on entry, and dedicated equipment.

02 · The ruleDroplet precautions: surgical mask on entry

Droplet precautions (influenza, Neisseria meningitidis, Haemophilus influenzae type b, pertussis): single room if possible, surgical mask on entering the room, and a mask on the patient during transport.

03 · The ruleAirborne: N95 in a negative-pressure room

Airborne precautions (tuberculosis, measles, varicella, disseminated zoster): an airborne infection isolation room — monitored negative pressure, 6–12 air changes per hour — and a fit-tested N95 or higher respirator for staff.

The rules

Know these

C. difficile: contact precautions, soap and water must knowC. difficile: contact precautions until at least 48 hours after diarrhea resolves; alcohol rub does not remove spores, so prefer soap and water after care; use sporicidal cleaning (eg, bleach) in outbreaks.

Varicella and disseminated zoster: airborne plus contactVaricella and disseminated zoster (or localized zoster in an immunocompromised patient until dissemination is excluded): airborne plus contact precautions until lesions crust. Covered localized zoster in an immunocompetent patient: standard precautions.

Measles: airborne until 4 days after rashMeasles: airborne precautions until 4 days after rash onset (for the whole illness if immunocompromised); every staff member entering wears a respirator regardless of immunity, and susceptible staff stay out.

TB: release after 3 negative smearsKeep suspected or confirmed pulmonary or laryngeal TB on airborne precautions until the patient is on effective therapy, improving clinically, and has 3 consecutive negative AFB sputum smears collected on separate days.

Droplet: 24 h for meningococcus, 5 days pertussisContinue droplet precautions until 24 hours of effective therapy for N. meningitidis and H. influenzae type b, and until 5 days of effective antibiotics for pertussis.

MRSA: contact precautions remain essentialUse contact precautions for MRSA-colonized and MRSA-infected patients; a hospital that modifies this practice needs a MRSA risk assessment, ongoing monitoring, and should reinstate precautions during an outbreak or rising rates.

Contact precautions for significant MDROsUse contact precautions for multidrug-resistant organisms the infection control program judges significant — MRSA, VRE, VISA/VRSA, ESBL producers — especially with ongoing transmission, high-risk units or drainage that dressings cannot contain.

Candida auris: contact precautions for the whole stayCandida auris: contact precautions for the entire hospital stay because colonization persists for months; clean with an EPA List P disinfectant — quaternary ammonium products alone do not work.

CRE: isolate and screen after care abroadPlace CRE patients on contact precautions, follow public health reporting rules, and screen and pre-emptively isolate patients hospitalized overnight or treated invasively in another country within the past 6 months.

Alcohol rub unless soiled or C. difficilePerform hand hygiene before and after patient contact and after removing gloves — gloves never replace it. Alcohol-based rub is preferred (including for C. auris) unless hands are visibly soiled or after C. difficile care.

Management

Orders

ICU universal decolonization: chlorhexidine plus nasal mupirocinUniversal decolonization of adult ICU patients — daily chlorhexidine bathing plus 5 days of twice-daily nasal mupirocin — reduces MRSA clinical cultures and all-cause bloodstream infection (REDUCE MRSA trial).

Droplet or airborne precautions?

Commonly confused

Room	Single room if possible
Staff protection	Surgical mask on entry
Transport	Patient wears a mask
Classic organisms	Influenza, N. meningitidis, pertussis

More detail

Reference

Show 6 reference facts

Nursing homes may use enhanced barrier precautions — gown and gloves during high-contact care — for residents with an MDRO, wounds or indwelling devices, instead of full contact precautions when those do not otherwise apply.

Antimicrobial stewardship is now an essential practice in the SHEA 2022 compendia for preventing both MRSA and C. difficile transmission and infection.

For transport, patients on droplet or airborne precautions wear a surgical mask and infectious skin lesions are covered; staff remove contaminated PPE and clean hands before moving a patient on contact precautions.

Droplet risk was historically defined as within 3 feet of the patient, but droplets can travel 6 feet or more, so masks are donned on entry to the room rather than by distance.

Some hospitals extend C. difficile contact precautions until discharge, an additional approach in SHEA 2022; contact precautions apply to any patient with diarrhea and a positive NAAT, even if colonization is suspected.

Extrapulmonary TB with a draining lesion needs airborne plus contact precautions; extrapulmonary TB without drainage, including meningitis, needs only standard precautions once pulmonary disease is excluded.

Pearl

Contact = gown and gloves; droplet = mask; airborne = N95 plus a negative-pressure room — and C. difficile spores need soap and water.

Sources · Siegel JD et al. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (HICPAC/CDC; last update Sept 2024), incl. Appendix A · CDC — Transmission-Based Precautions (Infection Control Basics, 2024) · Popovich KJ et al. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent MRSA transmission and infection in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023 · Kociolek LK et al. Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update (SHEA/IDSA/APIC). Infect Control Hosp Epidemiol 2023 · CDC — Infection Control Guidance: Candida auris (reviewed Sept 30, 2026) · CDC — CRE: Infection Control (Dec 2025) · Buetti N et al. Strategies to prevent CLABSI in acute-care hospitals: 2022 Update (gloves do not obviate hand hygiene) · CDC — Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of MDROs (Enhanced Barrier Precautions), 2024 · Starter sheet built from the verified AGACNP fact map (facts reviewed 2026-10-15).