Infection prevention and control is the foundation of safe nursing. It protects patients from healthcare-associated infections and protects nurses from infections such as TB, hepatitis, Ebola and COVID-19. The system has two layers: standard precautions for every patient, and transmission-based precautions added when a specific infection is suspected or confirmed.
Standard precautions: for every patient, every time
Standard precautions assume that any patient’s blood, body fluids, secretions, excretions, non-intact skin and mucous membranes may be infectious, whether or not a diagnosis is known. They include:
- Hand hygiene using the WHO 5 Moments. The single most important measure.
- PPE based on risk assessment: gloves when touching blood or body fluids; an apron or gown if clothing may be soiled; a mask and eye protection if splashes are likely.
- Respiratory hygiene and cough etiquette: tissues, masks for coughing patients, spacing in waiting areas.
- Safe sharps handling: no recapping, disposal at point of use.
- Safe injection practices: one needle, one syringe, one patient; single-dose vials where possible.
- Cleaning and disinfecting equipment between patients and the care environment.
- Safe handling of linen and waste.
- Patient placement that considers infection risk.
Transmission-based precautions
When an infection spreads in a way standard precautions may not stop, you add precautions based on how it spreads. Start them as soon as the infection is suspected, not after it is confirmed.
| Contact | Droplet | Airborne | |
|---|---|---|---|
| How it spreads | Touching the patient or contaminated surfaces and equipment | Large respiratory droplets over short distances (usually within about 1–2 metres) | Small particles that stay in the air and travel further |
| Examples | MRSA, C. difficile, multidrug-resistant gram-negatives (e.g. CRE), scabies, norovirus, many diarrhoeal infections | Influenza, meningococcal infection, pertussis (whooping cough), diphtheria (respiratory), mumps | Tuberculosis (lung or throat), measles, chickenpox, disseminated shingles |
| Room | Single room or cohort | Single room or cohort, with spacing | Airborne infection isolation room (negative pressure) if available, or a well-ventilated single room, door closed |
| PPE | Gloves and gown/apron on entering | Surgical mask within close range, plus eye protection as indicated | Respirator (N95, FFP2 or FFP3), fit-tested; non-immune staff should avoid caring for measles or chickenpox patients |
| Equipment | Dedicated (e.g. own stethoscope, BP cuff) | Standard cleaning | Standard cleaning |
| Patient transport | Limit; cover wounds | Patient wears a surgical mask | Patient wears a surgical mask |
Some infections need more than one category. For example, COVID-19 is commonly managed with contact and droplet precautions, with airborne precautions (respirators) for aerosol-generating procedures and in many settings for routine care, depending on local policy. Chickenpox needs both airborne and contact precautions.
C. difficile: a special case
Clostridioides difficile forms spores that alcohol hand rub does not kill. Wash hands with soap and water after caring for these patients, and use a sporicidal agent (often chlorine-based) for cleaning. Remember the acronym SIGHT from UK guidance: Suspect, Isolate, Gloves and aprons, Hand washing, Test.
Viral haemorrhagic fevers (Ebola, Lassa, Marburg)
These need enhanced contact and droplet precautions with full-body PPE in a designated isolation unit, plus strict donning and doffing procedures with a trained observer. See our Ebola PPE guide.
Putting on and taking off PPE
A common sequence (follow your local policy and posters):
- Donning: hand hygiene → gown or apron → mask or respirator (fit check) → eye protection → gloves.
- Doffing (the riskiest part): gloves → hand hygiene → gown or apron → eye protection → mask or respirator (by the straps, outside the room for airborne) → hand hygiene.
Don’t forget the patient
- Explain why precautions are needed. Isolation can be frightening and lonely, and patients in isolation can receive less frequent care.
- Check on isolated patients regularly, and make sure call bells are within reach.
- Teach visitors what to do, such as hand hygiene and any PPE required.
- Stop precautions when no longer needed, according to policy.
A note on resources
In many hospitals, single rooms and respirators are scarce. Prioritise: use available single rooms for the most infectious patients (e.g. suspected TB, measles, haemorrhagic fevers), cohort patients with the same infection, maximise ventilation, and keep hand hygiene supplies stocked. If PPE is missing, report it formally. You should not be asked to care for patients with dangerous infections without protection.
Related: TB nursing care · Needlestick injury and PEP · Nigeria’s Ebola readiness drive
Based on WHO standard precautions guidance, the CDC Guideline for Isolation Precautions and the NHS England National Infection Prevention and Control Manual. Educational content: follow your local IPC policy.