Topic 2.1 Standard and Transmission-Based Precautions

Standard and transmission-based precautions form the foundation of modern infection prevention and control. These precautions are designed to minimise the spread of infectious diseases within healthcare, community and occupational settings by reducing opportunities for microorganisms to move between people, animals and the environment. Unlike disease-specific interventions, standard precautions are applied during every interaction, regardless of whether an individual is known or suspected to have an infectious disease. This universal approach recognises that many infectious diseases can be transmitted before symptoms develop or by individuals who remain asymptomatic.

For Occupational Therapists (OTs), infection prevention is an integral component of safe, ethical and evidence-informed practice. OTs routinely work with clients across diverse settings, including hospitals, rehabilitation centres, schools, workplaces, residential aged care facilities, disability services, community organisations and clients’ homes. Assistance animals may accompany clients into many of these environments, introducing additional considerations for infection prevention while also providing significant therapeutic, functional and psychosocial benefits. Applying standard precautions consistently enables practitioners to minimise biological risks while supporting equitable access and meaningful participation.

Transmission-based precautions provide an additional level of protection when individuals are known or suspected to have infectious diseases that require enhanced infection control measures. These precautions are implemented alongside standard precautions and are tailored to the specific mode of disease transmission, such as contact, droplet or airborne spread. Understanding when additional precautions are necessary allows Occupational Therapists to modify service delivery appropriately while avoiding unnecessary restrictions based on assumptions or stigma.

This topic examines the principles underpinning standard and transmission-based precautions, their application within occupational therapy and assistance animal practice, and the role of clinical judgement in balancing infection prevention with person-centred, neuroaffirming and trauma-informed care.

What Are Standard Precautions?

Standard precautions are the minimum infection prevention measures that should be applied during all client interactions, regardless of the individual’s diagnosis, health status or perceived risk of infection.

Standard precautions are based on the assumption that:

• blood
• body fluids
• secretions
• excretions (excluding sweat)
• non-intact skin
• mucous membranes

may contain potentially infectious microorganisms.

Rather than attempting to identify which individuals may be infectious, standard precautions assume that every interaction has the potential to involve exposure to microorganisms. This approach protects clients, practitioners, assistance animals and the wider community while reducing reliance on subjective judgement or visible symptoms.

Components of Standard Precautions

Standard precautions consist of several complementary strategies that work together to interrupt the chain of infection.

These include:

• hand hygiene
• respiratory hygiene and cough etiquette
• use of personal protective equipment (PPE)
• environmental cleaning and disinfection
• safe handling of equipment
• safe management of linen
• appropriate waste disposal
• management of sharps
• risk assessment
• education and communication.

Each component contributes to reducing biological hazards and should be applied according to the level of risk present during each activity.

Risk Assessment as the Foundation of Standard Precautions

Standard precautions are not applied identically in every situation. Instead, Occupational Therapists should undertake a brief risk assessment before each interaction to determine which precautions are appropriate.

Factors to consider include:

• the client’s health status
• the presence of infectious symptoms
• the activity being undertaken
• likelihood of exposure to body fluids
• environmental conditions
• involvement of an assistance animal
• vulnerability of other people present
• current public health advice.

This dynamic approach ensures infection prevention measures remain proportionate to the actual level of risk.

Applying Standard Precautions in Occupational Therapy

Occupational Therapists apply standard precautions across a wide range of interventions.

Examples include:

• functional assessments
• mobility training
• transfers and manual handling
• activities of daily living
• cognitive rehabilitation
• home visits
• equipment prescription
• environmental assessments
• vocational rehabilitation
• group therapy.

Many interventions involve close physical proximity, shared equipment or contact with frequently touched surfaces. Consistent application of standard precautions reduces the likelihood of disease transmission while allowing therapy to proceed safely.

Applying Standard Precautions with Assistance Animals

When working alongside assistance animals, standard precautions should support both infection prevention and animal welfare.

Examples include:

• performing hand hygiene before and after interacting with the assistance animal
• ensuring the animal is clean, healthy and appropriately groomed
• avoiding contact with animal saliva, urine or faeces
• cleaning equipment that may be shared between clients
• ensuring water bowls and feeding equipment are hygienically maintained
• monitoring the animal for signs of illness
• postponing sessions if the animal has a suspected infectious disease until veterinary advice has been obtained.

Healthy assistance animals receiving appropriate veterinary care pose a very low infection risk. Standard precautions should therefore focus on routine hygiene rather than unnecessary restrictions.

Transmission-Based Precautions

While standard precautions are applied universally, transmission-based precautions provide additional protective measures when an individual is known or suspected to have an infectious disease that requires enhanced infection prevention.

These precautions are always used in addition to, not instead of, standard precautions.

Transmission-based precautions are categorised according to how the infectious agent spreads:

• contact precautions
• droplet precautions
• airborne precautions.

Selection of the appropriate precautions should be guided by current clinical evidence, organisational policies and public health advice.

Contact Precautions

Contact precautions are used when infectious organisms spread primarily through direct or indirect physical contact.

Examples include:

• gastroenteritis caused by norovirus
• methicillin-resistant Staphylococcus aureus (MRSA)
• some multidrug-resistant organisms
• certain skin infections.

Additional measures may include:

• gloves
• gowns or aprons
• dedicated equipment
• enhanced environmental cleaning
• minimising unnecessary movement between clinical areas.

Occupational Therapists should continue to facilitate participation wherever possible while implementing appropriate protective measures.

Droplet Precautions

Droplet precautions are used for infectious diseases spread through respiratory droplets produced during coughing, sneezing, talking or other respiratory activities.

Examples include:

• influenza
• COVID-19
• pertussis
• meningococcal disease.

Additional measures may include:

• surgical masks
• eye protection when indicated
• maintaining appropriate physical distance
• improving ventilation
• limiting exposure where appropriate.

When providing therapy, Occupational Therapists should consider alternative service delivery methods if face-to-face intervention presents unnecessary risk.

Airborne Precautions

Airborne precautions are required for diseases capable of remaining suspended in the air over extended periods.

Examples include:

• measles
• pulmonary tuberculosis
• varicella (chickenpox).

Airborne precautions may involve:

• fit-tested P2/N95 respirators
• negative pressure rooms
• minimising exposure
• limiting unnecessary entry
• specialised ventilation systems.

Occupational Therapists should follow organisational policies and public health guidance when airborne precautions are required.

Balancing Infection Prevention with Occupational Participation

A core principle of occupational therapy is enabling safe participation rather than eliminating all risk.

Infection prevention should therefore support, rather than unnecessarily restrict, access to occupational therapy and assistance animals.

Examples of reasonable adjustments include:

• modifying appointment times
• conducting sessions outdoors where appropriate
• improving ventilation
• using telehealth when clinically suitable
• reducing group sizes
• enhancing cleaning procedures
• temporarily adapting therapy activities.

These approaches allow practitioners to manage biological risks while maintaining client-centred care and supporting participation.

Common Misconceptions

One of the most common misconceptions is that transmission-based precautions automatically require exclusion of assistance animals.

In reality, decisions should be based on:

• the infectious disease involved
• the mode of transmission
• the health of the assistance animal
• the vulnerability of those present
• current public health advice
• veterinary recommendations where appropriate.

Blanket restrictions based solely on the presence of an assistance animal are rarely supported by scientific evidence and may unnecessarily disadvantage clients.

The Occupational Therapist’s Role

Occupational Therapists play an important role in ensuring infection prevention measures are implemented consistently and proportionately.

Responsibilities include:

• conducting infection risk assessments
• applying standard precautions during every client interaction
• recognising when transmission-based precautions are required
• modifying interventions to reduce biological risks
• educating clients and carers
• collaborating with multidisciplinary teams
• maintaining professional competence
• advocating for evidence-based, non-discriminatory practice.

Key Practice Principle

Standard precautions should be applied during every occupational therapy interaction, regardless of the perceived risk of infection. Transmission-based precautions provide additional protection when specific infectious diseases require enhanced control measures. By undertaking individual risk assessments and implementing evidence-informed precautions, Occupational Therapists can protect clients, assistance animals and the wider community while maintaining safe, inclusive and person-centred practice.