What are Transmission-Based Precautions (TBPs) in Health and Social Care

Transmission-Based Precautions (TBPs) are specialised infection control measures used alongside Standard Infection Control Precautions (SICPs) in health and social care settings. TBPs are used when an infection has been identified or is strongly suspected. These precautions aim to prevent the spread of specific infections that cannot be adequately contained by SICPs alone.

TBPs are implemented based on the way an infection spreads. This includes contact, droplet, or airborne transmission. By tailoring precautions to the mode of transmission, healthcare providers can reduce risks more effectively and protect staff, patients, and visitors. TBPs are particularly critical in stopping outbreaks of severe or highly contagious diseases, such as COVID-19, tuberculosis, or norovirus.

What is the Purpose of Transmission-Based Precautions (TBPs)?

The goal of TBPs is to enhance the protection offered by SICPs in situations involving confirmed or suspected infections. SICPs are general measures, but TBPs add another layer of safety by addressing specific routes of transmission.

TBPs serve to:

• Prevent infections spreading within healthcare facilities
• Protect vulnerable patients from becoming infected
• Ensure staff remain safe from exposure to contagious diseases

TBPs are only used when an infection has been confirmed through diagnosis or when there is strong evidence suggesting one is present.

What are the Types of Transmission?

Certain infections spread in specific ways. Understanding these routes of transmission is key to applying TBPs effectively. The three main types of transmission are:

Contact Transmission

Contact transmission is the most common method of infection spread. It occurs through direct skin-to-skin contact or indirect contact with contaminated surfaces, objects, or equipment.

Examples of infections spread via contact include:

• MRSA (Methicillin-resistant Staphylococcus aureus)
• Norovirus
• Clostridium difficile

In these cases, extra precautions like gloves, gowns, and enhanced cleaning protocols are needed to stop the spread.

Droplet Transmission

Droplet transmission happens when large respiratory droplets containing infectious agents are expelled during coughing, sneezing, talking, or breathing. These droplets travel short distances (up to 2 metres) before settling on surfaces or entering another person’s respiratory system.

Examples of infections spread via droplets include:

• Influenza
• COVID-19
• Respiratory syncytial virus (RSV)

Using masks and maintaining physical distance are key practices for managing droplet-based infections.

Airborne Transmission

Airborne transmission occurs when smaller particles (aerosols) containing infectious agents remain suspended in the air for long periods and travel over greater distances. These particles can be inhaled, leading to infections.

Examples of infections spread via airborne transmission include:

• Tuberculosis
• Chickenpox
• Measles

In these cases, specialised precautions like negative-pressure isolation rooms and respirators may be necessary.

What are the Precautions?

TBPs involve several measures tailored to how an infection spreads. These precautions vary depending on whether the transmission is via contact, droplets, or airborne particles.

Contact Precautions

Contact precautions aim to stop infections caused by direct or indirect contact. Staff follow additional measures such as:

• Wearing gloves and long-sleeved gowns during patient care
• Using dedicated or single-use equipment for infected patients
• Cleaning rooms and surfaces more thoroughly and frequently

Patients with contact-based infections might be placed in isolation or cohorted with others who have the same infection.

Droplet Precautions

Droplet precautions are used when infections can spread via expelled droplets from coughing or sneezing. Extra steps include:

• Wearing fluid-resistant surgical masks within 2 metres of the patient
• Providing masks to infected patients to reduce droplet spread
• Keeping the patient in a single room, with the door shut

These precautions help limit short-range spread of respiratory infections.

Airborne Precautions

Airborne precautions are the most specialised form of TBPs. They prevent the spread of diseases that can travel over long distances and remain airborne. Practices include:

• Using respirators (FFP3 masks) instead of standard surgical masks
• Isolating patients in negative-pressure rooms, which prevent air from escaping into other parts of the building
• Restricting access to the patient’s room to essential staff only

Airborne precautions require advanced equipment and systems to ensure safety.

Isolation and Cohorting

TBPs often involve isolating patients to minimise contact with others. Isolation can be single-room isolation, or grouping (cohorting) patients with the same infection together.

Isolation helps to:

• Prevent cross-infection within shared spaces
• Control outbreaks
• Create a safer environment for staff and other patients

For airborne infections, specialised isolation facilities, such as negative-pressure rooms, may be required to stop contaminated air from spreading.

Personal Protective Equipment (PPE) in TBPs

PPE plays a critical role in TBPs, as it acts as a barrier against infections. The type of PPE used depends on the transmission mode of the infection:

• For contact infections: Gloves and gowns
• For droplet infections: Fluid-resistant masks
• For airborne infections: Respirators and eyewear

Proper training on how to put on, remove, and dispose of PPE is essential to prevent contamination.

Cleaning and Disinfecting Requirements

Enhanced cleaning is a cornerstone of TBPs. The environment (floors, surfaces, and equipment) can harbour infectious agents, so rigorous cleaning schedules are needed. Disinfectants with proven effectiveness, such as chlorine-based solutions, are used to kill microorganisms.

High-touch areas, like door handles, bed rails, and chairs, are cleaned frequently as they pose a higher risk of harbouring germs.

Staff Training and Compliance

Effective implementation of TBPs relies on well-trained staff who understand the infection risks and appropriate precautions. Training involves:

• Recognising types of infections and modes of transmission
• Learning how to use PPE correctly
• Following procedures for isolation and cleaning

Regular audits and checks further ensure that staff comply with TBPs. Employers have a duty to make staff feel confident in following all precautions.

Legal and Professional Duties

As with SICPs, healthcare providers are legally required to follow TBPs under the Health and Safety at Work Act 1974 and related public health laws. Failure to apply TBPs correctly may lead to legal consequences, including fines, investigations, or enforcement actions by health authorities such as the Care Quality Commission (CQC).

Healthcare staff also have professional obligations under their regulatory bodies, such as the Nursing and Midwifery Council (NMC), to maintain infection control standards.

Challenges in TBPs

Implementing TBPs can be challenging because they require extra resources, time, and effort. Some common challenges include:

• Limited access to isolation rooms or specialised facilities
• Equipment shortages, such as respirators or FFP3 masks
• Staff fatigue, especially during large-scale outbreaks

Organisations must plan and allocate resources effectively to address these challenges.

Impact of TBPs on Infection Control

The use of TBPs has been shown to significantly reduce transmission of infections in healthcare settings. For example:

• Isolation and airborne precautions have been key in controlling diseases like tuberculosis and COVID-19.
• Enhanced cleaning under TBPs has reduced hospital-acquired infections like MRSA.

While TBPs are resource-intensive, the benefits they bring in preventing illness and saving lives outweigh the costs.

Final Thoughts

Transmission-Based Precautions (TBPs) are additional infection control measures designed to prevent the spread of specific infections. Used alongside SICPs, TBPs focus on managing contact, droplet, and airborne infections.

By adopting practices such as isolation, tailored PPE, and enhanced cleaning, health and social care providers can safeguard their environments and protect patients, staff, and visitors. Although implementing TBPs can be challenging, they are crucial for controlling outbreaks and managing serious infectious diseases.

Like SICPs, TBPs are a lifeline in the fight against healthcare-associated infections, ensuring patient and staff safety remains a top priority.