What are the isolation precautions for a patient with a suspected infection?

Isolation Precautions for Patients with Suspected Infection

For any patient with suspected infection, immediately implement standard precautions with hand hygiene and personal protective equipment (PPE), then escalate to transmission-based precautions (contact, droplet, or airborne) based on the suspected pathogen and clinical presentation. 1, 2

Initial Assessment and Triage

When a patient presents with suspected infection, begin isolation considerations at the point of scheduling or arrival:

• Screen immediately for fever, cough, difficulty breathing, and recent exposure to known infectious cases 3
• Separate symptomatic patients from well patients in waiting areas to prevent cross-transmission 4
• Identify the suspected pathogen based on clinical presentation to determine appropriate precaution level 5

Standard Precautions (Apply to ALL Patients)

Standard precautions form the foundation and must be used for every patient encounter, regardless of suspected infection status 4, 6:

Hand Hygiene

• Perform hand hygiene before and after every patient contact using soap and water for at least 20 seconds or alcohol-based hand rub with >60% ethanol 4, 3
• Soap and water is mandatory (not alcohol-based sanitizer) when caring for patients with Clostridioides difficile infection, as alcohol does not kill spores 4
• Hand hygiene is required: before patient contact, after touching contaminated surfaces, before donning gloves, and immediately after removing gloves 4

Personal Protective Equipment (PPE)

• Wear gloves when potential contact with blood, body fluids, mucous membranes, or contaminated surfaces exists 4
• Change gloves between patients and never reuse or wash gloves 4
• Wear gown or protective clothing that covers forearms and personal clothing when soiling is anticipated 4
• Use surgical mask and eye protection (goggles or face shield with side shields) during procedures likely to generate splashes or sprays of body fluids 4

Transmission-Based Precautions

Contact Precautions

Indicated for infections spread by direct or indirect contact (e.g., MRSA, VRE, C. difficile, Group A Streptococcus):

• Place patient in single room with dedicated toilet and hand basin 4
• Wear gloves and gown for all room entry and patient contact 4, 5
• Use dedicated equipment (stethoscope, blood pressure cuff, thermometer) that remains in the room 4
• Maintain isolation for minimum 24 hours of effective antibiotic therapy for most bacterial infections 4
• Extend isolation until culture-negative for necrotizing fasciitis, infected eczema with high shedding risk, burns patients, and maternity cases 4
• Environmental cleaning with sodium hypochlorite (bleach) solutions for C. difficile 4

Droplet Precautions

Indicated for respiratory infections transmitted by large droplets (e.g., influenza, pertussis, Group A Streptococcus pharyngitis):

• Single room isolation with door that may remain open 1, 2
• Maintain ≥1 meter distance from patient if single room unavailable 1
• Patient wears surgical mask when outside room or in presence of others 1, 2
• Healthcare workers wear surgical mask within 1 meter of patient 1
• Implement respiratory hygiene/cough etiquette: cover coughs with tissue or elbow, dispose of tissues immediately, perform hand hygiene after coughing 1, 3

Airborne Precautions

Indicated for infections transmitted by small airborne particles (e.g., tuberculosis, measles, varicella, COVID-19):

• Airborne infection isolation room (AIIR) with negative pressure and ≥12 air changes per hour 2, 5
• N95 respirator required for all healthcare workers entering room 2
• Patient wears N95 mask (preferred) or surgical mask when leaving room 1, 2
• Keep door closed at all times 5
• Well-ventilated single room with open windows if AIIR unavailable 1, 2

Specific Clinical Scenarios

COVID-19 or Suspected Viral Respiratory Infection

• Isolate for minimum 5 days from symptom onset 2
• May end isolation when: fever absent ≥24 hours without antipyretics, symptoms resolving, and ideally negative rapid antigen test 2
• Extend to 10 days if symptoms persist or testing remains positive 2
• Patient wears N95 mask (preferred) or surgical mask when around others 2
• Caregivers wear N95 masks when in same room 2
• Maintain ≥2 meters (6 feet) physical distance when possible 3

Cough and Cold Without Pneumonia

• Home isolation in well-ventilated single room with restricted activity 1
• Maintain ≥1 meter distance if single room unavailable 1
• Patient wears medical mask and performs hand hygiene after coughing/sneezing 1
• Monitor temperature and symptoms daily; seek care if fever >38°C persists or breathing worsens 1
• Avoid public transportation if medical care needed; use private vehicle with windows open 1

Clostridioides difficile Infection

• Contact precautions with single room and dedicated toilet 4
• Hand hygiene with soap and water only (alcohol ineffective against spores) 4
• Environmental cleaning with bleach (sodium hypochlorite) solutions 4
• Screen asymptomatic carriers on admission in outbreak settings and maintain contact precautions 4

Group A Streptococcal Infection

• Single room isolation for minimum 24 hours of effective antibiotic therapy 4
• Extend until culture-negative for necrotizing fasciitis, maternity cases, and burns patients 4
• Gloves, gown, and fluid-repellent mask with visor for operative debridement or highly exudative wounds 4
• Cover any breaks in healthcare worker skin with waterproof dressing 4

Environmental and Equipment Management

• Clean and disinfect high-touch surfaces frequently with appropriate disinfectant 4, 3
• Use 500 mg/L chlorine-containing disinfectant for household surfaces in isolation settings 1, 2
• Dedicate equipment to isolated patients when possible 4
• Clean reusable equipment between patients (e.g., protective eyewear, face shields) 4
• Dispose of medical waste in sealed double-layer yellow bags per regulated procedures 4

Critical Pitfalls to Avoid

• Never use alcohol-based hand rub alone for C. difficile - soap and water is mandatory 4
• Do not delay isolation while awaiting test results if clinical suspicion is high 4, 5
• Never reuse or wash gloves between patients 4
• Do not "top off" partially empty soap dispensers - use closed containers that can be washed before refilling 4
• Avoid artificial fingernails when caring for high-risk patients 4
• Do not separate mother and baby on maternity units unless ICU admission required 4

Duration and Discontinuation

• Most bacterial infections: 24 hours of effective antibiotics 4
• High-shedding infections: Until culture-negative 4
• COVID-19: Minimum 5 days, up to 10 days based on clinical criteria 2
• Contact quarantine: 14 days after last exposure to confirmed case 3, 2