Contact precautions require two pieces of personal protective equipment: a disposable gown and gloves. You put both on before entering the patient’s room and wear them for any interaction that involves contact with the patient or anything in the patient’s environment, including bedrails, IV poles, and bedside tables. This applies every time you enter the room, even if you’re just dropping off a meal tray or checking a monitor.
How to Gown and Glove Correctly
The gown goes on first. It should cover your torso from neck to knees and wrap around your back, with ties or snaps securing it at the neck and waist. The goal is to prevent your clothing and exposed skin from picking up organisms during care. Gloves go on second and should extend over the cuffs of the gown so there’s no gap of exposed skin at your wrists.
When leaving the room, the order reverses. Remove the gown and gloves before you step out, and dispose of them in the waste container inside the room. Then perform hand hygiene immediately. For most situations, an alcohol-based hand rub works fine. The important exception is C. diff: alcohol-based sanitizers cannot kill C. diff spores, so you need to wash with soap and water instead. The same soap-and-water rule applies whenever you’re dealing with a suspected spore-forming pathogen or during outbreaks of infectious diarrhea.
When Contact Precautions Apply
Contact precautions are triggered by specific infections and organisms that spread through direct physical contact or through contaminated surfaces. The most common reasons you’ll see them in practice include:
- Drug-resistant bacteria: MRSA, VRE, and other multidrug-resistant organisms, particularly in facilities with evidence of ongoing transmission.
- C. diff: The leading cause of healthcare-associated diarrhea. Contact precautions stay in place for the duration of illness.
- Norovirus and rotavirus: Both cause highly contagious gastroenteritis and spread easily through contaminated surfaces.
- Scabies and lice: Contact precautions continue until 24 hours after effective treatment begins.
- Certain viral infections: Disseminated herpes simplex, varicella zoster (chickenpox/shingles), and adenoviral conjunctivitis all require contact precautions for the duration of illness.
Room Setup and Equipment
Patients on contact precautions are ideally placed in a private room. When private rooms aren’t available, patients infected or colonized with the same organism can share a room. Patients who are immunocompromised, have open wounds, or are expected to stay a long time should not be paired with a contact precautions patient.
Equipment like stethoscopes, blood pressure cuffs, and thermometers should be dedicated to that patient’s room. If equipment must be shared between patients, it needs to be thoroughly cleaned and disinfected before leaving the room. For rooms with C. diff, standard disinfectants aren’t enough. You need a product specifically registered to kill C. diff spores, typically bleach-based (sodium hypochlorite) solutions or hydrogen peroxide/peracetic acid combinations. The EPA maintains a specific list of products proven effective against C. diff spores.
Patients on contact precautions are generally restricted to their room except for medically necessary care, including restriction from group activities. This is one reason contact precautions are intended to be time-limited, with a plan in place for when to step them down or discontinue them.
Enhanced Barrier Precautions: A Lower-Intensity Option
In nursing homes and long-term care facilities, full contact precautions can significantly affect quality of life. Keeping residents confined to their rooms for weeks or months isn’t practical or humane. That’s where enhanced barrier precautions come in.
Enhanced barrier precautions still call for gowns and gloves, but only during high-contact care activities like bathing, dressing, wound care, or changing linens. You don’t need to gown up every time you walk into the room. Residents aren’t restricted to their rooms, don’t need private rooms, and can participate in group dining and activities. Because these precautions are less disruptive, they’re designed to stay in place for the duration of a resident’s stay or until the risk factor (such as an open wound or an indwelling medical device) resolves.
The key distinction: contact precautions require gown and gloves on every room entry, while enhanced barrier precautions require them only during specific hands-on care tasks.
What Visitors Need to Know
Visitors to a contact precautions room are typically asked to wear the same PPE as staff: gown and gloves. Most hospitals post a sign on the door with instructions. Visitors should put on PPE before entering, avoid sitting on the bed or touching surfaces unnecessarily, remove and dispose of PPE inside the room before leaving, and wash their hands or use hand sanitizer immediately after exiting. If the patient has C. diff, visitors should wash with soap and water rather than relying on hand sanitizer.