Implementing new Transmission Based Precautions-time to rethink our focus.

Mrs Kirsty Thomson1, Associate Professor Rhonda L Stuart1

1Monash Health, Clayton, Australia


For years, transmission based precautions (TBP) have been practiced for patients with known multi drug resistant organisms (MDRO). However, patients captured for TBP are only the tip of the ice-berg and TBP comes with its own risk to patient safety. Recent studies have shown that TBP may not be required for otherwise well patient colonised with VRE and MRSA. Following a review of the risk, we determined that if stringent standard precautions are adhered to, the risk of transmission should be minimal if TBPs are relaxed in certain situations.


The TBP policy was amended with discontinuation of red precautions and implementation of yellow precautions (contact) only.

A 45-bed renal unit was chosen as the pilot area to trial the new TBP procedure. A point-prevalence VRE survey was completed to ascertain the burden of VRE pre and post implementation. Following extensive education sessions, improved access to PPE (personal protective equipment) at point of care, and weekly reviews of cleaning using fluorescent marking, the changes in precautions were introduced.  Patient and staff satisfaction was also investigated.


There was no difference in VRE incidence with the TBP changes (p=0.7) and both staff and patient satisfaction improved.

The implications were that patients with VRE or MRSA were now managed with standard precautions if there were no additional transmission risk factors. This reduced the demand on limited single rooms and placed the emphasis on standard infection control practices.


Changes to TBP have the opportunity to improve patient safety and quality without impacting on transmission risk if standard precautions are stringently practiced.


I am an Infection Control Consultant in Monash Health. I joined Infection Prevention and Control in Ireland in 2013. I completed by Higher Diploma in Infection Prevention and Control in 2014 and was employed in Cavan General hospital , Ireland as a Clinical Nurse Manager in Infection Prevention.

In 2017 I ventured to Australia and joined the Monash Health team in May of 2018. Previous to my time in Infection Control I enjoyed theatre nursing over a number of years and specialities.

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