Emory Healthcare uses Standard and transmission-based isolation measures as outlined below to prevent spread of pathogens to patients, visitors and healthcare workers. As COVID-19 isolation practices may change over time, the module presents a brief overview of COVID-19 isolation and reviews traditional standard and transmission-based precautions. For the most current COVID-19 isolation measures, please search the COVID-19 icon on the Emory Healthcare intranet site.

Standard Precautions are based on the principle that all blood, body fluids, secretions, excretions (except sweat), non—intact skin, and mucous membranes may contain transmissible infectious agents. Standard Precautions apply to ALL patients, in ALL settings, regardless of suspected or confirmed infection and include: hand hygiene as previously discussed; the use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure; and safe injection practices. For some interactions (e.g., performing venipuncture), only gloves may be needed; during other interactions (e.g., intubation), use of gloves, gown, and face shield or mask and goggles may be necessary. Standard Precautions are intended to protect both healthcare workers and patients by ensuring that healthcare personnel do not carry infectious agents between patients on their hands or via equipment used during patient care.

Transmission-Based Precautions are used in addition to Standard Precautions when the route(s) of transmission of an infectious pathogen is(are) not completely interrupted using Standard Precautions alone, and are indicated by signs in patient rooms. Note that the absence of a sign does not mean that the patient does not have any transmissible infectious agents, which is why Standard Precautions should always be used. There are four categories of Transmission-Based Precautions: Contact Precautions (e.g. highly resistant Gram-negative bacterial pathogens), Enteric Contact Precautions for organisms resistant to hand hygiene with alcohol-based rubs (e.g. C. difficile, norovirus), Droplet Precautions (e.g. meningococcal meningitis, influenza, pertussis), and Airborne Precautions (e.g. pulmonary tuberculosis, measles, disseminated varicella). For some diseases that have multiple routes of transmission (e.g., varicella, viral hemorrhagic fever, RSV), more than one Transmission-Based Precautions category may be used. Entry into a patient’s room under Airborne Precautions requires a N95 respirator. The clinician must be properly fit tested and know their size. In the Emory Healthcare system, Occupational Injury Management/Employee Health screens employees for fit testing and unit based fit testers or the Safety Office performs fit testing.

For patients with known or suspected COVID-19 infection, a new category of isolation precautions called Droplet Plus is utilized, which combines an N-95 respirator (or equivalent) and Eye protection. Eye protection can be achieved by using a face shield, or approved glasses or goggles which must include top and side protection. In addition, because of the potential for transmission of COVID-19 and other respiratory viruses by persons who are asymptomatic or pre-symptomatic, procedure masks should be used by all healthcare personnel during all direct patient contact in the inpatient setting. Universal masking is now optional for healthcare personnel while providing patient care in the ambulatory setting, except for personnel working in designated areas that care for patients who are immunocompromised or at high risk of severe disease from COVID-19.

When Transmission-Based Precautions are indicated, efforts must be made to counteract possible adverse effects on patients (i.e., anxiety, depression, feelings of isolation or being stigmatized, and reduced contact with clinical staff) to improve acceptance by the patients and their families or visitors and adherence by healthcare workers.