Infection control precautions for the NCLEX
Choose infection-control precautions from the suspected or confirmed organism, route of transmission, care setting and current facility policy. Standard Precautions apply to every client; add one or more Transmission-Based Precautions when Standard Precautions alone do not interrupt transmission. When the diagnosis is not yet confirmed, use the indicated empiric precautions while testing is pending.
Safety boundary
This is an NCLEX study framework, not a substitute for the isolation sign, infection-prevention direction or facility policy. Precaution type, PPE and duration can change with the organism, symptoms, immune status, procedure and care setting.
The three transmission-based categories
| Precaution | Placement | Healthcare personnel | Patient movement |
|---|---|---|---|
| Airborne | Airborne infection isolation room (AIIR) with monitored negative pressure; keep the door closed. | Put on disease-specific respiratory protection before entry. Current tuberculosis and measles guidance uses a fit-tested N95 or more protective respirator. | Limit transport. If transport is necessary, place a mask on the patient if tolerated and cover infectious skin lesions. |
| Droplet | Single-patient room if available; special air handling is not required. | Wear a mask for close contact, generally upon room entry. Add eye protection when Standard Precautions or the organism-specific protocol indicates it. | Limit transport and have the patient wear a mask if tolerated; follow respiratory hygiene. |
| Contact | Single-patient room if available; use dedicated or appropriately disinfected equipment. | Put on gown and gloves on entry when contact with the patient or contaminated environment is expected; remove and discard them before exit. | Contain infected or colonized areas and communicate the precaution status during transfer. |
Evidence for this section: CDC Transmission-Based Precautions and the CDC disease-specific Appendix A.
High-yield disease examples and qualifiers
Airborne, with Standard Precautions
- Suspected or confirmed pulmonary or laryngeal tuberculosis: use an AIIR and the respiratory protection required by the tuberculosis and facility protocol.
- Measles (rubeola): Airborne Precautions through four days after rash onset; use the duration of illness when the patient is immunocompromised.
- Varicella (chickenpox): Airborne plus Contact Precautions until lesions are dry and crusted.
- Disseminated herpes zoster: Airborne plus Contact Precautions. Use the same combination for localized zoster in an immunocompromised patient until dissemination is ruled out.
Localized zoster in an immunocompetent patient is different: if lesions can be completely covered, CDC lists Standard Precautions until they are dry and crusted. When possible, susceptible healthcare personnel should not care for measles, varicella or zoster when immune caregivers are available.
Droplet, with Standard Precautions
- Seasonal influenza: follow current influenza and facility guidance.
- Pertussis: continue through five days after effective antibiotic therapy begins.
- Known or suspected meningococcal disease: continue through 24 hours after effective therapy begins.
- Mumps: continue through five days after swelling begins.
- Rubella: continue through seven days after rash onset.
- Group A streptococcal pharyngitis: use Droplet Precautions for the first 24 hours of effective antimicrobial therapy.
Contact, with Standard Precautions
- Clostridioides difficile infection: initiate Contact Precautions for suspected or confirmed infection and use dedicated equipment.
- MRSA, VRE and other clinically significant MDROs: use Contact Precautions when indicated by the acute-care setting, transmission risk and infection-prevention program.
- Scabies and head lice: continue through 24 hours after effective therapy begins.
- Respiratory syncytial virus: use Contact Precautions for infants, young children and immunocompromised adults for the duration of illness; prolonged shedding may extend the duration.
- Major wounds or skin infections: use Contact Precautions when drainage cannot be covered or contained. Standard Precautions may be sufficient when a dressing fully contains limited drainage.
Evidence for these examples: the CDC disease-specific precaution and duration table. Always verify the posted isolation order and current institutional protocol.
C. difficile: separate spores from hand-hygiene policy
Alcohol-based hand sanitizer does not have sporicidal activity, and soap-and-water washing removes spores better. However, CDC still prefers alcohol-based hand sanitizer for routine healthcare hand hygiene when hands are not visibly soiled because eliminating it can reduce overall compliance. Wash with soap and water when hands are visibly soiled and during care of patients with suspected or confirmed C. difficile in an outbreak; CDC encourages soap-and-water washing after care as an additional outbreak precaution without restricting access to alcohol-based sanitizer.
Use gown and gloves, dedicated equipment and an EPA-registered sporicidal disinfectant according to the product instructions and facility protocol. In acute care, CDC recommends maintaining Contact Precautions for confirmed infection for at least 48 hours after diarrhea resolves, or longer when the facility policy requires it.
Evidence for this section: CDC acute-care C. difficile guidance, CDC clinical hand-hygiene guidance, and the CDC isolation appendix.
Protective environment is a specific designation
Do not use “protective environment” as a generic synonym for neutropenic precautions. CDC's protective-environment table applies to allogeneic hematopoietic stem-cell transplant recipients. It specifies HEPA-filtered incoming air, at least 12 air changes per hour, positive pressure relative to the corridor, a well-sealed room, a self-closing door, and no fresh or dried flowers or potted plants. It does not require masks, gowns or gloves in the absence of suspected or confirmed infection unless Standard Precautions or source control indicates them. Other immunocompromised patients require individualized precautions under facility and infection-prevention guidance.
Evidence for this section: CDC Components of a Protective Environment.
PPE sequence: learn the example and follow the protocol
A CDC example for putting on PPE is gown, mask or respirator, goggles or face shield, then gloves. One CDC example for removal is gloves, goggles or face shield, gown, then mask or respirator, followed immediately by hand hygiene.
Use the posted isolation procedure because more than one safe removal method can be acceptable and organism-specific protocols can differ. Keep contaminated surfaces away from clothing and mucous membranes; perform hand hygiene between steps if the hands become contaminated. For an AIIR, keep respiratory protection on until after leaving the room and closing the door unless the applicable protocol directs otherwise.
Evidence for this section: CDC's safe donning and removal example and CDC Transmission-Based Precautions.
Common questions
What precautions are used for C. difficile?
Use Standard plus Contact Precautions, gown and gloves, dedicated equipment, and an EPA-registered sporicidal disinfectant under facility policy. Soap and water removes spores better and is emphasized when hands are visibly soiled and during outbreaks, but CDC does not recommend removing access to alcohol-based hand sanitizer.
What is the correct order for putting on PPE?
One CDC example is gown, mask or respirator, goggles or face shield, then gloves. Follow the posted protocol because organism-specific procedures and safe removal methods can differ.
Which conditions commonly require Airborne Precautions?
Suspected or confirmed pulmonary or laryngeal tuberculosis, measles, varicella, disseminated zoster, and localized zoster in an immunocompromised patient until dissemination is ruled out. Varicella and the applicable zoster presentations also require Contact Precautions.
Does every neutropenic patient need a protective-environment room?
No. CDC's protective-environment table specifically applies to allogeneic hematopoietic stem-cell transplant recipients. Other immunocompromised patients need individualized precautions based on facility and infection-prevention guidance.
Sources and further reading
- CDC — Precautions to Prevent Transmission of Infectious Agents — Centers for Disease Control and Prevention; evidence locator: III.B. Transmission-Based Precautions; Contact, Droplet, Airborne, placement, PPE, transport, and discontinuation sections; source updated ; accessed
- CDC — Type and Duration of Precautions for Selected Infections — Centers for Disease Control and Prevention; evidence locator: Disease-specific entries for tuberculosis, measles, varicella, zoster, influenza, pertussis, meningococcal disease, mumps, rubella, group A streptococcus, MDROs, C. difficile, scabies, lice, RSV, and wounds; source updated ; accessed
- CDC — Example of Safe Donning and Removal of PPE — Centers for Disease Control and Prevention; evidence locator: Donning of PPE; Removing PPE; Safe Work Practices; Hand Hygiene; source updated ; accessed
- CDC — C. diff Infection Prevention in Acute Care Facilities — Centers for Disease Control and Prevention; evidence locator: Isolate and initiate contact precautions; dedicated equipment; environmental cleaning; transfer communication; duration after diarrhea resolves; source updated ; accessed
- CDC — Clinical Safety: Hand Hygiene for Healthcare Workers — Centers for Disease Control and Prevention; evidence locator: When to wash with soap and water; C. difficile outbreaks; continued access to alcohol-based hand sanitizer; source updated ; accessed
- CDC — Components of a Protective Environment — Centers for Disease Control and Prevention; evidence locator: Allogeneic HSCT population; Standard and Expanded Precautions; engineering controls; flowers and plants; source updated ; accessed
- NCSBN — 2026 RN Test Plan — National Council of State Boards of Nursing; evidence locator: 2026 RN Test Plan; effective April 1, 2026–March 31, 2029; source updated ; accessed
Practice this for real. PulseRN drills infection-control scenarios and PPE sequencing as ordered, drag-and-drop items.