Why the Updated 2025 AORN Guideline for Transmission-Based Precautions Matters For Every Nurse

Why This Guideline Is a Must-Read for Nurses

The updated AORN Guideline for Transmission-Based Precautions comes as a direct response to the evolving landscape of infectious disease prevention. It incorporates a wealth of new evidence—much of it from the COVID-19 pandemic—that challenges long-held assumptions and introduces more nuanced, risk-based strategies for contact, droplet, and airborne precautions.

For perioperative nurses, the guideline reinforces the importance of evaluating risks and selecting PPE accordingly. It also introduces an airborne particle risk assessment framework to guide tailored interventions, a section shaped by pandemic-era research. In this new section, the interdisciplinary team is guided in collaboratively conducting this risk assessment and developing tailored interventions to mitigate identified risks.

The guideline introduces new recommendations for using the CMS-required plan for managing emerging infectious disease in the perioperative setting, CDC Core Infection Prevention strategies, and WHO guidance on droplet- and aerosol-transmitted particles. It also integrates elements of the CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings and the WHO Global Technical Consultation Report on Proposed Terminology for Pathogens that Transmit Through the Air.

What Should Nurses Outside the OR Know?

Although published in the Guidelines for Perioperative Practice, this guideline’s impact extends far beyond the OR. Nurses in ambulatory care, procedural units, emergency departments, and inpatient settings will find valuable direction on:

• Physical distancing for droplet precautions: The old “three feet” standard has been replaced with a more flexible directive— “as much distance as possible”—reflecting evidence that pathogens travel farther than once believed.
• Respiratory protection programs: The guideline emphasizes the need for interdisciplinary teams to develop facility-wide frameworks for assessing airborne transmission risks. This is not limited to surgical teams. Infection preventionists, nurse managers, and clinical educators in all settings should be involved in shaping these protocols.
• Rethinking aerosol-generating procedures: Real-world OR studies show that intubation, extubation, and supraglottic airway use often generate fewer airborne particles than a voluntary cough—often no more than normal tidal breathing. This evidence has shifted the focus from labeling certain procedures as inherently “aerosol-generating” to evaluating the broader clinical context. The guideline now emphasizes individualized risk assessments for patients with potential respiratory infections, considering procedural, environmental, and patient-specific factors.
• Emerging Infectious Disease (EID) planning: The pandemic highlighted the need for proactive, coordinated responses novel pathogens. The guideline outlines how to build an EID plan, in partnership with an interdisciplinary team, that includes measures to identify, isolate, and control the transmission of an emerging infectious disease, while simultaneously providing safe perioperative care (e.g. screening, isolation, testing, and decisions about whether to delay elective procedures).

The Evidence Behind the Updates

The number of updates may feel overwhelming, but they are both significant, necessary, and overdue.

The pandemic generated a surge of research on transmission risks, PPE effectiveness, and environmental controls. The 2025 guideline translates these findings for everyday practice, bridging crisis-era data with conventional care. Its emphasis on building interdisciplinary frameworks ensures teams are ready when the next infectious threat emerges.

What It Means for Patient Safety

At its core, this guideline is about protecting patients. Every recommendation, whether it concerns PPE selection, room assignment, or risk assessment, is designed to reduce the likelihood of healthcare-associated infections (HAIs), which remain a leading cause of morbidity and mortality in surgical and procedural care.

Consider:

• Ineffective PPE use can lead to cross-contamination during patient transport or intraoperative care.
• Not adopting a comprehensive risk framework for organizational risk assessment of infective airborne particles as part of the respiratory program can result in ineffective situation-specific preparedness and risk mitigation.
• Failure to recognize an emerging infectious disease can result in delayed isolation and uncontrolled transmission within a facility
• By following the updated guideline, nurses can help ensure that every patient encounter is as safe as possible. This is especially critical in the perioperative environment, where patients are vulnerable to surgical site infection.
• Moreover, the guideline empowers nurses to advocate for the resources and policies they need to implement these practices effectively. Whether it’s requesting fit-testing for N95 respirators, participating in airborne infectious particle risk assessment framework design and EID planning, or educating colleagues on updated recommendations, nurses are uniquely positioned to lead in the OR and beyond.

What This Means for Perioperative Nursing

The 2025 Guideline for Transmission-Based Precautions is not just a document—it is a call to action. It challenges us to rethink what we know, to question outdated practices, and to embrace a more agile, evidence-informed risk-based approach to infection prevention where indicated.

For perioperative nurses, it reinforces our role as stewards of patient safety. For nurses in other settings, it offers a framework for collaboration and consistency throughout organizations and across the continuum of care.

As we look to the future, one thing is clear: the lessons of the pandemic must not be forgotten. This guideline ensures that they are not only remembered—but applied.

References

1. AORN. Guideline for transmission-based precautions. In: Guidelines for Perioperative Practice. AORN, Inc; 2025.
2. 42 CFR §482.15. Condition of participation: Emergency preparedness. Code of Federal Regulations. Accessed December 19, 2024.
3. Centers for Disease Control and Prevention. CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings. April 12, 2024. Accessed December 19, 2024.
4. World Health Organization. Global Technical Consultation Report on Proposed Terminology for Pathogens that Transmit Through the Air. World Health Organization; 2024.
5. Siegel JD, Rhinehart E, Jackson M, Chiarello L; 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.
6. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health. Hospital Respiratory Protection Program Toolkit: Resources for Respirator Program Administrators. DHHS (NIOSH) Publication No. 2015-117; 2022.
7. Dhillon RS, Rowin WA, Humphries RS, et al. Aerosolisation during tracheal intubation and extubation in an operating theatre setting. Anaesthesia. 2021;76(2):182–188.
8. Brown J, Gregson FKA, Shrimpton A, et al. A quantitative evaluation of aerosol generation during tracheal intubation and extubation. Anaesthesia. 2021;76(2):174–181.
9. Shrimpton AJ, Gregson FKA, Brown JM, et al. A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal. Anaesthesia. 2021;76(12):1577–1584.
10. Hamilton F, Arnold D, Bzdek BR, et al. Aerosol generating procedures: are they of relevance for transmission of SARS-CoV-2? Lancet Respir Med. 2021;9(7):687–689.
11. Klompas M, Baker M, Rhee C. What is an aerosol-generating procedure? JAMA Surg. 2021;156(2):113–114.
12. Silvers A, Brewster DJ, Ford A, Licina A, Andrews C, Adams M. Re-evaluating our language when reducing risk of SARS-CoV-2 transmission to healthcare workers: time to rethink the term, “aerosol-generating procedures”. Virol J. 2022;19(1):189.
13. Sanmark E, Oksanen LAH, Rantanen N, et al. Aerosol generation during coughing: an observational study. J Laryngol Otol. 2023;137(4):442–447.