Standard and transmission-based precautions

In all healthcare settings there is a risk of infection. Processes for preventing and controlling infections include ensuring training on how, and when, to apply the various elements of standard and transmission-based precautions relevant to the primary healthcare setting. 

The Australian Guidelines for the Prevention and Control of Infection in Healthcare is a key national resource that outlines critical aspects of infection prevention and control, focusing on core principles and priority areas for action. It provides evidence-based recommendations for healthcare workers and healthcare services.

Priority areas in the guideline are standard and transmission-based precautions. 

Standard precautions are work practices that provide a first-line approach to infection prevention and control in the healthcare environment and should be adopted by all healthcare workers for all patients, regardless of suspected or confirmed infection status.

Standard precautions include:

• Hand hygiene 
• The use of appropriate personal protective equipment
• The safe use and disposal of sharps
• Routine environmental cleaning
• Cleaning and reprocessing of reusable medical equipment and instruments
• Respiratory hygiene and cough etiquette
• Aseptic technique
• Waste management
• Appropriate handling of linen.

Transmission-based precautions are applied to patients suspected or confirmed to be infected with agents transmitted by the contact, droplet, or airborne routes (such as the use of contact precautions to mitigate contact transmission of methicillin-resistant Staphylococcus aureus). There are three categories of transmission-based precautions:

• Contact precautions are used when there is a known or suspected risk of transmission of infectious agents by direct or indirect contact
• Droplet precautions are used when there is a known or suspected risk of transmission of infectious agents by respiratory droplets
• Airborne precautions are used when there is a known or suspected risk of transmission of infectious agents by the airborne route.

Transmission-based precautions are used to respond to these specific means of transmission. For some infectious agents, a combination of precautions may be required (for example, seasonal influenza requires both contact and droplet precautions).

This action requires healthcare services to describe how the different elements of standard and transmission-based precautions are implemented. 

Healthcare services will also be required to adhere to relevant jurisdictional laws and policies relating to infection prevention and control, including work health and safety laws. 

• How does the workforce in your healthcare service implement standard and transmission-based precautions?
• What jurisdictional laws and policies regarding infection prevention and control are relevant to your healthcare service?

• Identify infection and prevention control jurisdictional laws and policies relevant to the healthcare service. 
• Describe how relevant standard and transmission-based precautions will be implemented in the healthcare service.
• Ensure that the equipment, supplies and products required by the workforce to work safely and minimise the risk of infection transmission are accessible, located where required and appropriate to the risks identified for the context and physical environment of the healthcare service.
• Develop or review signage, alert systems, and information/reminder systems and resources to raise awareness of standard and transmission-based precautions.
• Consider how the need for transmission-based precautions are communicated within the healthcare service and with other healthcare services who are providing care to the patient.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Policies and procedures regarding standard and transmission-based precautions 
• Evidence that policies and procedures are easily accessible by the workforce
• Observation of the workforce practising standard and transmission-based precautions 
• Training documents (for example, syllabus, attendance records, competency assessments) relating to standard and transmission-based precautions 
• Examples of improvement activities that have been implemented and evaluated to raise awareness and improve compliance with standard and transmission-based precautions 
• Examples of incidents relating to compliance with standard and transmission-based precautions being documented and discussed with appropriate actions taken to address the identified risks or improve clinical safety
• Observation of standardised signage and other forms of clinical communication informing about the need for standard and transmission-based precautions as part of patient care
• Processes to assess infection risk.

Commission resources

• Addendum NSQHS Standards Accreditation Workbook 2021 Infection Prevention and Control Standard – provides users with updated information on reflective questions and examples of evidence for the 2021 Preventing and Controlling Infections Standard within the NSQHS Standards. Principles and strategies are broadly applicable. 
• Infection Prevention and Control eLearning Modules: Basics of infection prevention and control course – an online learning module on hand hygiene and infection prevention and control.
• Infection Prevention and Control eLearning Modules: Principles of infection prevention and control course – an online learning module on hand hygiene and infection prevention and control.
• Use of the hierarchy of controls in infection prevention and control – a factsheet that provides guidance on using the hierarchy of controls, in conjunction with infection prevention and control systems, to identify and manage infection risks.
• Standard and transmission-based precaution posters – showing the key steps for standard precautions and when caring for patients who require transmission-based precautions, due to a known or suspected infection.

Other resource

• National Health and Medical Research Council in collaboration with the Commission: Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) – developed to specifically support improved infection prevention and control in acute health settings and provides a risk management framework to ensure that the basic principles of infection prevention and control can be applied to a wide range of healthcare settings.