Study guide
3.2 Transmission-Based Precautions (Contact, Droplet, Airborne)
NCLEX-RN Registered Nurse
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1 Introduction
About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course
2 Chapter 2: Management of Care
2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles
3 Chapter 3: Safety and Infection Prevention and Control
3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response
4 Chapter 4: Health Promotion and Maintenance
4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules
5 Chapter 5: Psychosocial Integrity
5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care
6 Chapter 6: Basic Care and Comfort
6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care
7 Chapter 7: Pharmacological and Parenteral Therapies
7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)
8 Chapter 8: Reduction of Risk Potential
8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures
9 Chapter 9: Physiological Adaptation
9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)
3.2 Transmission-Based Precautions (Contact, Droplet, Airborne)
Key Takeaways Explain This Topic AI
Transmission-based precautions are used IN ADDITION to standard precautions, never as a replacement
Contact precautions (gown and gloves) are used for MRSA, VRE, C. diff, RSV, and skin infections - remember MRS. WEE
Droplet precautions (a mask on entering the room; eye protection only as Standard Precautions require) are for pathogens spread by large respiratory droplets, traditionally >5 microns - remember SPIDERMAN, but check each organism
Airborne precautions (N95 respirator, negative pressure room) are for pathogens spread by droplet nuclei <5 microns - remember MTV
- Patients on airborne precautions must be in an Airborne Infection Isolation Room (AIIR) with negative pressure
- Last updated: October 2026
Transmission-Based Precautions
When standard precautions alone are insufficient, transmission-based precautions provide additional protection. These are used for patients with documented or suspected infections spread by specific routes.
Key Principle
Transmission-based precautions are used IN ADDITION TO standard precautions, never as a replacement. A patient on contact precautions still requires hand hygiene, PPE selection based on task, and all other standard precaution elements.
The Three Categories
- Category Transmission Route Key PPE Room Requirement
- Contact Direct/indirect touch Gown + Gloves Private room or cohort
- Droplet Large respiratory droplets (>5 microns) Mask on room entry Private room, door may remain open
- Airborne Droplet nuclei (<5 microns) N95 respirator Negative pressure AIIR, door closed
- Contact Precautions
Contact precautions prevent transmission of organisms spread through direct contact with the patient or indirect contact with contaminated surfaces.
When to Use
Use the mnemonic MRS. WEE to remember contact precaution pathogens:
- Letter Pathogen
- M Multidrug-resistant organisms (MRSA, VRE)
- R Respiratory infection (RSV)
- S Skin infections (Impetigo, Scabies, Lice; Herpes Simplex when neonatal or severe/disseminated mucocutaneous)
- W Wound infections (draining, not contained)
- E Enteric infections (C. difficile, Rotavirus; Hepatitis A only in diapered or incontinent patients)
- E Eye infections (Conjunctivitis/Pink eye)
- Required PPE and Environment
- Gown and gloves upon room entry
- Private room or cohort with patient with same organism
- Dedicated equipment (stethoscope, BP cuff) left in room
- Hand hygiene immediately after removing PPE
- Critical Points
- Remove gown and gloves BEFORE leaving the room
- For C. diff: use soap and water for hand hygiene (spores!)
- Equipment that must leave the room must be disinfected
- Droplet Precautions
Droplet precautions prevent transmission of organisms spread through large respiratory droplets (>5 microns) that travel short distances (historically defined as 3 feet or less, although some have reached 6 feet or more).
When to Use
Use the mnemonic SPIDERMAN to remember droplet precaution pathogens:
- Letter Pathogen
- S Sepsis (meningococcal), Scarlet fever and Streptococcal pharyngitis (group A, in infants and young children)
P Pertussis (whooping cough), Pneumonia (only certain agents, such as adenovirus, H. influenzae type b in children, meningococcus, Mycoplasma)
- I Influenza
- D Diphtheria (pharyngeal)
- E Epiglottitis
- R Rubella (German measles)
- M Mumps, Meningitis (H. influenzae type b or N. meningitidis, until 24 hours of effective therapy)
- A Adenovirus
- N Rhinovirus (common cold)
Exam Tip: Rubella (German measles) is DROPLET. Rubeola (regular measles) is AIRBORNE. This distinction is frequently tested!
- Required PPE and Environment
- Mask upon entry into the patient's room (3 feet is only an example of "close", not the rule for when to mask)
- Eye protection if splash/spray risk
- Private room preferred; door may remain open
- Patient wears surgical mask during transport
- Key Difference from Airborne
Droplets are large and heavy - they travel only short distances before falling. They do NOT remain suspended in the air. A regular surgical mask provides adequate protection because the particles cannot be inhaled from distance.
Airborne Precautions
Airborne precautions prevent transmission of organisms spread through droplet nuclei (<5 microns) that remain suspended in the air and can travel long distances through air currents.
When to Use
Use the mnemonic MTV to remember airborne precaution pathogens:
- Letter Pathogen
- M Measles (Rubeola)
- T Tuberculosis (TB)
- V Varicella (Chickenpox) and disseminated Herpes Zoster (Shingles)
- Required PPE and Environment
- N95 respirator (must be fit-tested) or PAPR
Airborne Infection Isolation Room (AIIR) with:
- Negative pressure (air flows INTO the room)
- Minimum 6-12 air changes per hour
- Direct exhaust to outside or HEPA filtration
- Door must remain CLOSED
- Patient wears surgical mask during transport (not N95)
- N95 Respirator Requirements
- Must be fit-tested annually for each user
- Requires seal check with each use
- Higher level of filtration than surgical mask
- Filters 95% of airborne particles
- Room Assignment and Cohorting
- Precaution Type Room Requirements Cohorting
- Contact Private or cohort Yes, with same organism
- Droplet Private preferred Yes, with same organism
- Airborne AIIR (negative pressure) No - single patient only
- Combining Precautions
Some patients require multiple precaution types :
- Condition Precautions Required
- Chickenpox (Varicella) Airborne + Contact (vesicles contain virus)
- Disseminated Shingles Airborne + Contact
Extrapulmonary TB with a draining lesion Airborne + Contact (pulmonary or laryngeal TB, drug-resistant or not, is Airborne)
Transport of Patients on Isolation
- Precaution Type Patient Requirements
- Contact Cover infected areas; staff maintain precautions
- Droplet Patient wears surgical mask
- Airborne Patient wears surgical mask (NOT N95); notify receiving department
- On the NCLEX
Common testing points include:
- Matching pathogens to correct precaution type
- Distinguishing between Rubella (droplet) and Rubeola (airborne)
- Understanding N95 vs surgical mask requirements
- Knowing that airborne requires negative pressure rooms
- Recognizing when to use soap and water vs. alcohol-based hand rub