Infection prevention and control guidelines

5. Levels of precaution

Transmission-based precautions

      1. Transmission-based precautions

Transmission-based precautions

Transmission-based precautions are used with standard precautions to further reduce the risk of infection via a specific mode of transmission: contact, droplet or airborne. Droplet and airborne modes of transmission are closely interrelated because the relevant infectious matter represents a continuum from large droplets to small particles. Infection prevention and control strategies for these modes overlap substantially. While some experts consider them as one mode of transmission, this guideline retains the distinction between droplet and airborne transmission for consistency with current national guidelines.

Preventing staff and patients with relevant infections from entering the practice

Practices could develop and implement a protocol to elicit self-reporting by staff and patients of any symptoms that could be due to an infectious disease (eg respiratory symptoms, gastrointestinal symptoms or rashes) before they enter the practice. Strategies include routine questioning by reception staff when booking appointments by telephone, a telephone ‘on hold’ recorded message, questions or instructions added to the online booking system, and notices on the practice website and main door.

These communications must explain that this information is necessary to keep staff and other patients safe, and reassure patients that they will still be given a consultation even if they report such symptoms. For patients who report symptoms, consultations can be arranged to take place by phone, videoconference, in a separate area, or outside the facility.


Practices could develop and implement a protocol to elicit self-reporting by staff and patients of any symptoms that could be due to an infectious disease (eg respiratory symptoms, gastrointestinal symptoms or rashes) before they enter the practice. Strategies include routine questioning by reception staff when booking appointments by telephone, a telephone ‘on hold’ recorded message, questions or instructions added to the online booking system, and notices on the practice website and main door.

These communications must explain that this information is necessary to keep staff and other patients safe, and reassure patients that they will still be given a consultation even if they report such symptoms. For patients who report symptoms, consultations can be arranged to take place by phone, videoconference, in a separate area, or outside the facility.


Practices must identify and follow the latest advice on infection prevention and control when performing aerosol-generating procedures (eg nebulisation, spirometry, peak expiratory flow, oxygen supplementation via nasal cannulas or mask) from national and state/territory health departments. Guidance is also published by the Australian and New Zealand Society of Respiratory Science and the Thoracic Society of Australia and New Zealand.

The Australian guidelines for the prevention and control of infection in health care provide guidance on the type and duration of precautions for specific infections and conditions.


Contact precautions must be used if there is a risk of direct or indirect contact transmission of pathogenic microorganisms that are not effectively contained by standard precautions alone, such as when a patient presents with suspected norovirus or Clostridioides difficile infection, influenza, impetigo, or parvovirus infection, and whenever the presence of methicillin-resistant Staphylococcus aureus is likely or possible.

In addition to standard precautions, including hand hygiene, contact precautions include:

  • appropriate use of personal protective equipment including gloves for all contact with patients, equipment and surfaces, a fluid-resistant apron or gown if contact with the patient or their immediate environment is likely, and a fluid-resistant surgical mask and eye protection if splash is likely (see Personal protective equipment)
  • segregating patients with suspected infectious diseases as appropriate and feasible (eg physical distancing in general waiting area or moving to a spare room, scheduling the visit a the end of the day when other patients will not be present, using telehealth).
  • communicating the patient’s infectious status to other health professionals involved in the patient’s care (eg the primary health care nurse, or ambulance and emergency department staff if being transferred to another healthcare facility) so that appropriate transmission-based precautions can be maintained
  • ensuring that infected or colonised areas of the patient’s body are contained and covered if transfer between rooms or to another facility is necessary (for example, a suppurating wound or a baby with a leaking nappy).


Droplet precautions must be used if there is a risk of infectious microorganisms being transmitted by droplets generated by coughing, sneezing or talking (eg patients with pertussis) or vomitus.

In addition to standard precautions, including hand hygiene, droplet precautions include:

  • appropriate immunisation of staff
  • staff use of fluid-repellent surgical masks or filtering respirators as appropriate or as directed by health departments during outbreaks (see Personal protective equipment)
  • requiring all patients to wear surgical masks covering the nose and mouth, and to leave them on until after leaving the clinic
  • segregating patients with suspected infectious diseases (or any patient with violent or frequent coughing), as appropriate and feasible (eg in a separate room before the consultation, or by arranging consultations offsite or outside)
  • physical distancing in general waiting area (at least 1 metre between infectious person and others in the waiting area)
  • requiring patients to observe respiratory hygiene and cough/sneeze etiquette by displaying signs and providing tissues, alcohol-based handrub and a waste bin within sight
  • communicating the patient’s infectious status to other health professionals involved in the patient’s care (eg the primary health care nurse, or ambulance and emergency department staff if being transferred to another healthcare facility) so that appropriate transmission-based precautions can be maintained.


Airborne precautions must be used where there is a risk of transmitting microorganisms via aerosols that are generated by coughing, sneezing, talking, shouting, vomiting, and even breathing, and can remain infectious over time and distance when suspended in air (eg transmission of measles, varicella, tuberculosis, influenza or COVID-19).

In addition to standard precautions, including hand hygiene, airborne precautions include:

  • appropriate immunisation of staff
  • use of appropriate personal protective equipment (see Personal protective equipment), including:
    • filtering respirators as appropriate or as directed by health departments during outbreaks. Standard surgical masks are less effective for protecting against smaller particles.
    • eye protection (including face shield, if needed) where splash is likely
  • implementation of processes to minimise exposure to other patients (eg arranging at the end of the day after other patients have left or making a home visit, segregating into a separate area such as a spare room, requiring the infectious patient to wear a surgical mask)
  • ensuring that all reusable equipment is cleaned or reprocessed before use on the next patient
  • communicating the patient’s infectious status to other health professionals involved in the patient’s care (eg the primary health care nurse, or ambulance and emergency department staff if being transferred to another healthcare facility) so that appropriate transmission-based precautions can be maintained.

Note: During a respiratory infection outbreak, follow advice on infection prevention and control from national and state or territory health authorities, as well as accessing up-to-date guidance from expert groups such as the Australian and New Zealand Society of Respiratory Science. Office-based spirometry may be discontinued during a respiratory pandemic or restricted to specialised facilities with a negative-pressure room and/or appropriate ventilation. Where appropriate to perform (eg in nonfebrile patients at low risk), precautions may include the use of full personal protective equipment.

Advertising