AORN Guideline in Focus: Transmission-Based Precautions

Transmission-Based Precautions AORN Guideline

By: AORN Staff

Published: 5/21/2025

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Infectious diseases—both emerging and well-known—continue to pose risks in the perioperative setting. AORN’s Guideline for Transmission-Based Precautions, updated in January 2025, provides evidence-based strategies for preventing the spread of infection through standard and transmission-based precautions, including contact, droplet, and airborne protections.

It includes guidance on PPE selection and use, risk identification, and emergency preparedness for emerging infectious diseases.

Key recommendations include:

  • Standard precautions for all patients
  • PPE selection and usage
  • Contact precaution protocols
  • Droplet and airborne precautions
  • Emergency planning for infectious disease outbreaks 

What to Know About Standard Precautions

Standard precautions form the baseline for infection prevention and must be followed for every patient, regardless of known infection status. This includes hand hygiene (1.2), safe injection practices (1.6), cleaning of reusable equipment (1.7), and respiratory etiquette (1.5). 

Proper Use of Personal Protective Equipment

PPE must be worn whenever contact with blood, body fluids, or infectious materials is anticipated (2.1). 

Required PPE includes gloves (2.3), gowns (2.5), surgical masks (2.7), and eye protection (2.6). 

Applying Contact Precautions

When caring for patients known or suspected to carry pathogens transmitted by direct or indirect contact, staff should wear gloves and gowns and use enhanced cleaning procedures (3.1–3.5). 

Single-patient rooms are preferred, and equipment must be disinfected between uses (3.7). 

Contact precautions can impact patients emotionally, so staff should be prepared to address any resulting concerns (3.8).

Droplet and Airborne Precautions

Masks must be worn when caring for patients with known or suspected droplet-transmitted infections (4.1–4.2). 

Patients under droplet precautions should be in single-patient rooms, and transport should be minimized (4.3–4.4). 

Be Prepared for the Next Outbreak

Facilities are required to have an emerging infectious disease (EID) plan in place that outlines how to identify, isolate, and contain new pathogens (7.1). 

This includes education for perioperative personnel (7.4) and policy templates that can be customized based on the specific EID (7.3).

Stay Compliant with OSHA Standards

Perioperative staff must follow all OSHA Bloodborne Pathogens Standard requirements, including engineering controls, exposure plans, and appropriate PPE use (8.1–8.8). Staff must also avoid eating, drinking, or handling cosmetics in any area where exposure risk exists (8.6–8.7).

Ongoing Education and Monitoring

Facilities should provide initial and ongoing education, including competency verification and active training on PPE donning and doffing (11.1–11.2).

References

  • Siegel JD, Rhinehart E, Jackson M, Chiarello L; the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Centers for Disease Control and Prevention. Updated September 2024. Accessed December 19, 2024. [IVA]
  • Infection control in health care: an overview. Project Firstline. Centers for Disease Control and Prevention. February 7, 2024. Accessed December 19, 2024. 
  • CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings. Centers for Disease Control and Prevention. April 12, 2024. Accessed December 19, 2024. [IVA]
  • Guideline for hand hygiene. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2025:277–314 [IVA]
  • Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51(RR-16):1–45. [IVA] 

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