Principles of infection control, including hand hygiene

Hierarchy of precautions

Infection control operates on a hierarchy of standard precautions (applied to every patient encounter regardless of known infection status) plus transmission-based precautions (contact, droplet, airborne - added based on the specific known or suspected pathogen's transmission route)
The foundational framework underlying all infection prevention practice in healthcare settings, applied continuously rather than only during recognised outbreaks

Transmission route determines the specific precaution type required - contact (direct/indirect touch transmission, e.g. MRSA, C. difficile), droplet (larger respiratory droplets over short distances, e.g. influenza, pertussis), and airborne (small aerosolised particles travelling further distances and requiring negative-pressure rooms, e.g. tuberculosis, measles, varicella) - each requiring different PPE and room placement

Correct precaution assignment requires accurate, prompt clinical suspicion of the causative organism/syndrome, since precautions are generally implemented empirically at the point of suspicion rather than waiting for microbiological confirmation
Cohorting (grouping patients with the same confirmed infection) can be used in outbreak settings when single-room isolation capacity is exceeded

Correct application of transmission-based precautions from the point of clinical suspicion (not waiting for confirmatory testing) is essential to limiting healthcare-associated spread, particularly for airborne pathogens where even brief unprotected exposure can transmit infection
De-escalation of precautions once an alternative diagnosis is confirmed or the infectious period has passed avoids unnecessary resource use and patient isolation burden

Airborne precaution pathogens (TB, measles, varicella - requiring N95/P2 respirator and negative pressure room), droplet precaution pathogens (influenza, pertussis, meningococcal disease), contact precaution pathogens (MRSA, VRE, C. difficile)

Transmission-based precautions should be applied based on clinical suspicion at first contact, not delayed until microbiological confirmation - this is particularly critical for airborne pathogens, where waiting for a positive test result before implementing appropriate precautions risks preventable healthcare-associated transmission

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