WHO 5 moments, choosing contact, droplet or airborne precautions, and MDRO cohorting.
At the bedside
- 1
WHO 5 moments
Before touching a patient; before a clean/aseptic procedure; after body fluid exposure risk; after touching a patient; after touching patient surroundings.
- 2
Method
Alcohol-based hand rub 20-30 s for most situations; soap and water 40-60 s when hands are visibly soiled and for C. difficile or norovirus.
- 3
Standard precautions
Hand hygiene, PPE for anticipated exposure, respiratory hygiene, safe sharps, cleaning of equipment and environment, safe waste and linen handling.
- 4
Contact
Gloves and gown on entry; dedicated equipment; single room or cohort: MDR Gram-negatives (CRE, CRAB), MRSA, VRE, C. difficile, scabies.
- 5
Droplet
Surgical mask within 1-2 m; single room or cohort: influenza, meningococcal disease (first 24 h of effective therapy), pertussis, diphtheria.
- 6
Airborne
N95 respirator (fit-tested), airborne infection isolation room (negative pressure, ≥ 12 air changes/h where available): pulmonary/laryngeal TB, measles, varicella and disseminated zoster.
- 7
Aerosol-generating procedures
Intubation, NIV, bronchoscopy, open suctioning in patients with respiratory pathogens: N95, eye protection, gown and gloves.
- 8
Audit and feedback
Direct observation audits (WHO tool), surveillance of HAIs and MDROs, feedback to staff.
Transmission-based precautions
| Type | Examples | PPE and placement |
|---|---|---|
| Contact | CRE, CRAB, MRSA, VRE, C. difficile, scabies | Gown + gloves; single room or cohort; dedicated equipment |
| Droplet | Influenza, meningococcus, pertussis, diphtheria | Surgical mask; single room or cohort; ≥ 1 m spacing |
| Airborne | Pulmonary TB, measles, varicella, disseminated zoster | N95; negative-pressure room; door closed |
| Contact + airborne | Varicella, disseminated zoster | Gown, gloves and N95 |
Choosing isolation precautions
Step 1 of ~3
Decision: Pulmonary TB, measles, varicella or disseminated zoster?
Based on Siegel JD, Rhinehart E, Jackson M, Chiarello L; HICPAC. Educational use; follow local protocol.
Pathophysiology
Healthcare workers' hands are the main vehicle of cross-transmission; the patient environment (bed rails, monitors, ventilator surfaces) is a reservoir for MDR Gram-negatives and C. difficile spores.
Evidence
- WHO 2009 hand hygiene guideline and 5 moments [WHO 2009].
- CDC/HICPAC isolation precautions [Siegel 2007].
- NCDC national IPC guidelines for Indian healthcare facilities [NCDC 2020].
Controversies
- Contact precautions for endemic MRSA/VRE versus universal gloving; cohorting where single rooms are scarce.
🇮🇳 India notes
- Single rooms and negative-pressure rooms are scarce in Indian ICUs; NCDC 2020 supports cohorting of patients with the same organism, dedicated staff where possible and ≥ 1 m spacing between beds.
- High CRE/CRAB prevalence makes environmental cleaning and hand hygiene compliance the main control levers.
- Airborne precautions for TB are frequently needed given the high national TB burden.
References
Test yourself
Module quiz · score 70% to complete the module
Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.