Routine Practices to Reduce the Risk

of Infectious Diseases
Part of a series of information sheets on reporting of blood-borne virus infection

Definition: Routine Practices (also known as Standard Precautions)

 outine practices prevent the transmission of microorganisms that cause infections in health-care settings from patient to
R
health-care worker, patient to patient and health-care worker to patient. They are considered the foundation of infection pre-
vention and control in health-care settings. Currently, health-care workers use a variety of terms to refer to infection preven-
tion and control practices designed to reduce the risk of the transmission of microorganisms. Some refer to routine precau-
tions (or routine practices) and standard precautions (or standard practices) or, in some settings, to universal precautions. No
one term is consistently used. In Canada, the term “routine practices” was chosen to emphasize that this is the level of care
that should be provided for all patients.

Routine practices prevent contact with the blood, body fluids, secretions and excretions of other people. Universal precau-
tions were introduced to protect workers from exposure to blood-borne pathogens in health-care settings and were first
published in the U.S. and Canada in 1987 and 1988 respectively. These precautions focused on preventing the transmission
of microorganisms from the patient to health-care worker and stress that all patients should be assumed to be infectious for
blood-borne diseases such as HIV/AIDS and hepatitis B. Standard precautions were later published in the U.S. in 1996 and
Health Canada published routine practices in 1999. In both the U.S. and Canada, standard precautions and routine practices
are more encompassing and preferable to universal precautions. 

Applying Routine Practices


Routine practices should be consistently applied in the following situations:

• when there is a risk of exposure to any body fluids that could be the source of infection if they enter non-intact skin
(e.g. wounds or dermatitis) or mucous membranes (e.g. eyes, nose, or mouth)
• in all health-care settings (e.g. acute care hospitals, long-term care, mental health care, and community health care
offices or clinics) where there are body fluids that are capable of transmitting microorganisms that cause infection
• in conjunction with transmission-based precautions, that is where routes of transmission are known or presumed,
such as contact precautions, droplet precautions and airborne precautions

Additional Precautions
Certain pathogens or clinical presentations require additional precautions in conjunction with routine practices. Additional
precautions should be taken when specific pathogens are identified, but also empirically for clinical syndromes (e.g. diar-
rhea) in which pathogens are likely causes, until the specific etiology is confirmed. Additional precautions may be indicated
for certain organisms when routine practices are not sufficient to control transmission e.g. methicillin-resistant Staphylococ-
cus aureus (MRSA).

April 2009 www.nurses.ab.ca

Additional Precautions
 hree commonly known categories of additional precautions are contact transmission precautions, droplet transmission pre-
T
cautions and airborne transmission precautions: 

a. Contact transmission precautions 

Contact transmission is the most common route of transmission from symptomatic or asymptomatic patients in
hospital and can occur via direct or indirect contact.
• Direct contact precautions: helps to prevent the transmission of microorganisms from direct patient
contact between an infected or colonized individual and a susceptible host (body surface to body surface)
• Indirect contact precautions: helps to prevent the passive transfer of microorganisms to a susceptible host
via an intermediate object, such as contaminated hands that are not washed between patients, contaminated
instruments or other inanimate objects in the patient’s environment

Diseases transmitted by contact with the patient’s skin or contaminated environment include MRSA and Clostridium
difficile.

b. Droplet transmission precautions

This category of precautions helps to prevent the transmission of large droplets (greater than five microns in
diameter) from the patient’s respiratory tract during coughing or sneezing or during procedures such as suctioning
or bronchoscopy. These droplets are propelled a short distance (less than one meter) through the air and land on
the nasal or oral mucosa or conjunctiva of the new host. Although respiratory viruses may also be transmitted by
contaminated hands through direct or indirect contact, droplet transmission is considered separately because it
requires different precautions. Diseases transmitted by droplets include pertussis and influenza.

c. Airborne transmission precautions

This category of precautions helps to prevent the dissemination of microorganisms by aerosolization. The
organisms are contained in droplet nuclei that result from the evaporation of droplets, or in dust particles and
other debris. Such microorganisms are widely dispersed by air currents and inhaled by susceptible hosts who may
be some distance away from the source patient, even in different rooms or hospital units. Diseases transmitted by
the airborne route include tuberculosis and measles.

Some microorganisms may be transmitted by more than one route and therefore require more than one category of
transmission precaution, for example, varicella requires both airborne and contact transmission precautions.

April 2009 www.nurses.ab.ca

References
1 . Calgary Health Region. (2005). Guidelines for standard practice and isolation precautions. Accessed on March 12, 2009 at:
http://www.calgaryhealthregion.ca/programs/infectioncontrol/documents/manuals/community_standard_practice_Isolation.pdf

2. Canadian Centre for Occupational Health and Safety. (2007). Universal precautions. Accessed on Feb. 12. 2009 at:
http://www.ccohs.ca/oshanswers/prevention/ppe/universa.html#_1_1

3. Community and Hospital Infection Control Association - Canada. (2008). Information about hand hygiene. Accessed on March 4, 2009 at:
http://www.chica.org/links_handhygiene.html

4. Health Canada. (1998). Hand washing, cleaning, disinfection, and sterilization in health care. Canada Communicable Disease Report, 24S8.

5. Health Canada. (1999). Routine practices and additional precautions for preventing the transmission of infection in health care. Canada Communi-
cable Disease Report, 25S4.

6. Ontario Ministry of Health and Long-Term Care, Provincial Infectious Diseases Advisory Committee. Routine practices fact sheet for health care set-
tings. Queens Printer for Ontario (ISBN: 978-1-4249-3324-2). Accessed On Feb. 13, 2009 at:
http://www.health.gov.on.ca/english/providers/program/infectious/pidac/fact_sheet/fs_routine_010107.pdf

7. Siegel, J.D., Rhinehart, E., Jackson, M., Chiarello, L. & The Healthcare Infection Control Practices Advisory Committee. (2007). Guideline for Isola-
tion Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Accessed on Feb. 12, 2009 at:
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf

8. Winnipeg Regional Health Authority. (2005). Infection prevention and control: Routine practices self learning package acute/long term care. Ac-
cessed on Feb. 13, 2009 at: http://www.wrha.mb.ca/prog/pharmacy/files/RoutinePrac_SelfLearn.pdf

April 2009 www.nurses.ab.ca