Transmission-Based Precautions

Transmission-based precautions covers droplets, airborne and physical contact. For this CPG, we will only describe the use of contact precautions for epidemiologically important organisms to include Clostridium difficile (C. difficile).

- Cohorting: Cluster host nation patients (who are not eligible to evacuate from theater) and U.S. and coalition patients (who are eligible for evacuation from theater) and separate when possible to reduce the risk of cross-contamination with MDROs.
- Contact Precautions: Gloves and gowns should be worn with all patients suspected or known to have MDRO colonization or infection with C. difficile- infection (CDI) and immediately placed into contact precautions.8 Refer to Appendix A of the 2007 Isolation Guidelines published by the Centers for Disease Control and Prevention (CDC) for a list of all diseases requiring contact precautions.6

NOTE: U.S. personnel with skin and soft tissue infections presenting with abscess or furuncles should be assumed to have community-associated Methicillin-Resistant Staphylococcus Aureus (MRSA).

- Skin care: Intensive care unit (ICU) patients should undergo daily bathing with topical chlorhexidine gluconate (CHG). CHG-impregnated wipes are available commercially. CHG has broad activity against gram-positive and gram-negative bacteria, facultative anaerobes and aerobes. Daily bathing of ICU patients has shown a reduction of infections with vancomycin-resistant enterococci (VRE) and methicillin-resistant staphylococcus aureus (MRSA). Daily bathing with CHG washcloths significantly reduces the risk of acquisition of MDROs.9-11 See Appendix E: Antiseptic Body Cleaning.11