Standard Precautions and Transmission-Based Precautions in Practice

Why Precautions Matter in Sterile Processing

Sterile Processing Technicians (SPTs) handle instruments that have been used on patients—including patients under isolation precautions. Understanding and correctly applying Standard Precautions and Transmission-Based Precautions protects you from exposure to infectious agents and prevents cross-contamination in the decontamination area. Patient safety and worker safety are inseparable: a lapse in PPE technique can spread a pathogen from a soiled instrument tray to you, to coworkers, or—through improperly handled equipment—back to other patients.

Standard Precautions

Standard Precautions apply to every patient encounter and every soiled instrument, regardless of known diagnosis. They are based on the principle that blood, all body fluids, non-intact skin, and mucous membranes are potentially infectious.

For sterile processing, Standard Precautions require:

• Gloves whenever handling soiled instruments or contaminated surfaces
• Fluid-resistant gown to protect clothing and skin
• Surgical mask and eye protection or face shield to guard against splashes and sprays during decontamination (cleaning, rinsing, manual scrubbing)
• Hand hygiene before donning and immediately after doffing PPE
• Safe handling and disposal of sharps

These elements are non-negotiable for every tray that enters the decontamination zone.

Transmission-Based Precautions: An Overview

When a patient's known or suspected illness requires additional controls beyond Standard Precautions, the care team assigns Transmission-Based Precautions. The CDC recognizes three categories: Contact, Droplet, and Airborne. As an SPT receiving instruments from these patients, you must understand which additional PPE each category requires.

Contact Precautions

Used for pathogens spread by direct or indirect touch—including organisms such as MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomycin-resistant Enterococcus), Clostridioides difficile, and certain multidrug-resistant organisms (MDROs).

PPE additions beyond Standard Precautions: Gown and gloves must be donned before entering the workspace or contacting the tray. Instruments from Contact Precaution patients should be transported in clearly labeled, sealed/closed containers. Exercise extreme care not to touch environmental surfaces with contaminated gloves.

For C. difficile specifically: alcohol-based hand rubs are not effective against C. diff spores. Handwashing with soap and water is required after removing gloves.

Droplet Precautions

Used for pathogens transmitted by large respiratory droplets (generally traveling about 3–6 feet), such as influenza, pertussis, and certain streptococcal infections.

PPE additions: A surgical mask (in addition to standard eye protection or face shield) must be worn when handling trays and instruments that may carry respiratory secretions. Instruments from the airway or upper respiratory tract of these patients carry elevated splash risk during decontamination.

Airborne Precautions

Used for pathogens spread by small airborne particles that can remain suspended for longer distances—tuberculosis (Mycobacterium tuberculosis), measles, and varicella (chickenpox).

PPE additions: An N95 respirator (or higher-level respirator) replaces the surgical mask. N95 respirators must be fit-tested before use, and you should perform a user seal check each time you don one. Never substitute a surgical mask when Airborne Precautions apply.

Donning Sequence (General)

Don PPE in this order to minimize self-contamination:

1. Gown – Tie at neck, then waist.

2. Mask or N95 respirator – Secure straps; perform seal check for N95.

3. Eye protection / face shield – Position over mask.

4. Gloves – Pull cuffs over gown cuffs.

Doffing Sequence (General)

Doffing carries the highest contamination risk because the outside of PPE is considered contaminated. Proceed in this order:

1. Gloves – Peel the first glove inside-out; use the bare-hand-to-inner-surface technique for the second.

2. Hand hygiene – Perform immediately.

3. Face shield or goggles – Remove by the clean headband or earpieces; avoid touching the front.

4. Gown – Untie, roll outward away from you, and discard without shaking.

5. Mask or respirator – Remove by the straps/ties only; do not touch the front.

6. Hand hygiene – Perform again.

Critical safety rule: At no point during doffing should your hands (gloved or bare) touch your face, neck, hair, or any clean surface in the work environment. Any such contact is a critical contamination error.

Handling Instrument Trays from Isolation Patients

When a tray is labeled with an isolation category:

• Select PPE based on the precaution level before you accept or open the container.
• Verbalize or document the precaution category on the decontamination log.
• Keep trays separated from other soiled instruments until fully decontaminated.
• For spore-forming organisms (e.g., C. diff), follow facility policy which may include extended sterilization validation or specific chemical disinfectant compatibility.
• Never assume Standard Precautions alone are sufficient just because the container looks the same as any other tray.

Hand Hygiene: The Foundation

Hand hygiene is performed before donning and after every step of doffing. Use alcohol-based hand rub for most organisms; use soap and water for C. difficile and when hands are visibly soiled. This single step prevents the most common route of pathogen spread in healthcare settings.

Competency Expectations

For your live competency check, you must complete the full donning and doffing sequence with zero critical contamination errors. Practice the sequence until it is automatic—muscle memory protects both you and your patients.