Infection prevention is one of the most critical aspects of patient care in healthcare settings. Correctly identifying whether a patient requires airborne or droplet precautions can protect both healthcare providers and other patients from highly contagious diseases.
This guide explains:
- What airborne and droplet precautions are
- The diseases that require each type
- Personal protective equipment (PPE) guidelines
- Key differences between the two
- NCLEX-style nursing tips and exam question breakdowns
Understanding Transmission-Based Precautions
Transmission-based precautions are infection control measures used in addition to standard precautions when dealing with patients with known or suspected infections that can be spread in specific ways.
- Airborne Precautions: For pathogens that remain infectious over long distances when suspended in the air.
- Droplet Precautions: For pathogens spread through large respiratory droplets that travel short distances.
Droplet Precautions
Diseases Spread by Droplets
Use the mnemonic PIMP:
- P – Pertussis (Whooping cough)
- I – Influenza
- M – Meningitis (bacterial)
- P – Pneumonia
Mode of Transmission
- Large respiratory droplets (>5 microns)
- Travel short distances (about 3–6 feet)
- Spread by coughing, sneezing, or talking
Required PPE
- Surgical mask (worn by staff when within close contact)
- Goggles or face shield if risk of splashes
- Single patient room
NCLEX Tip:
Teach unlicensed personnel to wear a surgical mask before entering the patient’s room.
Airborne Precautions
Diseases Spread by Airborne Transmission
Use the mnemonic MTV:
- M – Measles
- T – Tuberculosis (TB)
- V – Varicella (chickenpox/shingles)
Mode of Transmission
- Very small particles (<5 microns)
- Remain suspended in air for long periods
- Spread over distances greater than 6 feet
Required PPE
- N95 respirator (staff must be fit-tested)
- Negative pressure room (air flows into room but not out)
- Door must remain closed
- Patient wears a surgical mask during transport
NCLEX Tip:
Airborne precautions require negative pressure rooms, unlike droplet precautions.
Key Differences – Airborne vs. Droplet Precautions
| Feature | Droplet Precautions | Airborne Precautions |
|---|---|---|
| Diseases | Pertussis, Influenza, Meningitis, Pneumonia | Measles, Tuberculosis, Varicella |
| Particle Size | >5 microns (large droplets) | <5 microns (airborne particles) |
| Travel Distance | 3–6 feet | Long distances in air |
| PPE | Surgical mask, goggles, single room | N95 mask, negative pressure room |
| Transport Protocol | Patient may not need mask unless coughing | Patient wears surgical mask during transport |
Top NCLEX-Style Exam Questions
Case 1: Tuberculin Skin Test
Scenario:
A patient returns 48 hours after a tuberculin skin test with a red, raised site and 19 mm induration.
Correct Actions:
- Anticipate orders for a chest X-ray or sputum samples
- Understand that a positive skin test indicates TB infection, not necessarily active disease
- Do not place immediately on droplet precautions – TB is airborne
Case 2: Bacterial Meningitis
Scenario:
A patient is diagnosed with bacterial meningococcal meningitis.
Correct Nursing Actions:
- Advise unlicensed personnel to wear a surgical mask
- Implement padded side rails (due to seizure risk)
- Keep light and noise low in the room (reduce stimulation)
Rationale:
- Meningococcal meningitis spreads via droplet transmission
- Sensory reduction helps manage neurological symptoms
Infection Control Tips for Nurses
- Always verify the mode of transmission before donning PPE.
- Educate all healthcare staff, including non-licensed personnel, on proper PPE use.
- Keep signage outside patient rooms to indicate required precautions.
- Ensure fit testing for N95 respirators is up to date for airborne precaution care.
- For patient transport, follow CDC protocols: mask the patient, limit movement, and notify receiving departments.
Patient Education
Patients should understand:
- Why isolation is needed
- How precautions prevent spread
- What PPE their visitors and staff will wear
- Hand hygiene importance before and after contact
Frequently Asked Questions (FAQs)
Q1. Can a patient require both airborne and droplet precautions?
Yes. Some diseases, such as varicella pneumonia, require both airborne and contact precautions due to multiple transmission routes.
Q2. Why is a negative pressure room important?
It prevents airborne pathogens from escaping into hallways and infecting others.
Q3. Do visitors have to follow the same PPE rules as staff?
Yes. Visitors should follow the same precautions to avoid exposure.
Q4. How often should a TB patient’s room air be exchanged?
Negative pressure rooms typically require 6–12 air exchanges per hour, depending on guidelines.
Q5. When can airborne precautions be discontinued for TB?
After three consecutive negative sputum smears taken at least 8 hours apart, and symptoms improve.
