Guidance

Transmission based precautions in adult social care

Published 28 October 2026

This section explains the additional infection prevention and control measures used when a person has, or may have, an infection that can spread to others. These precautions are used alongside standard infection control precautions to help prevent the spread of infection and keep people and staff safe.

Key summary

• transmission based precautions (TBPs) are extra precautions for known or suspected infections
• they are used in addition to standard infection control precautions
• actions depend on how the infection spreads
• most infections spread by contact
• use PPE and cleaning to limit spread where needed
• use good ventilation and respiratory hygiene for infections that spread through the air
• adapt to the risk and setting

Call for action

• use extra precautions when infection is suspected or confirmed
• always continue standard infection control precautions alongside TBPs
• follow advice based on how the infection spreads
• limit spread between people where possible (e.g. dedicated staff)
• seek advice for higher-risk infections

Transmission based precautions (TBPs) are additional infection prevention and control (IPC) precautions to standard infection control precautions (SICPs) implemented when a person is suspected or known to have an infection that can spread to others, for example through touch, coughs and sneezes and through the air. TBPs are to be used in addition to SICPs, not as a replacement for them.

The use of TBPs should be implemented in a manner that balances infection prevention and control requirements with the person’s dignity, rights, mental wellbeing, communication needs, end-of-life care preferences, and the principle of least restrictive practice.

TBPs are used based on how a pathogen spreads. Some pathogens can spread in more than one way. 

Choosing which TBPs to use should be based on: 

• the pathogen
• how the pathogen spreads
• the seriousness of the infection
• the care setting
• the care activity being done

Precautions used in the care of a person, whether standard or transmission-based, do not change after they have died.

Safeguarding statement

In keeping with the Mental Capacity Act 2005, care and support workers must presume capacity unless assessed otherwise, provide tailored support to enable understanding, and document any capacity assessments clearly. Where a person lacks capacity, decisions or protective measures must be made in their best interests and be proportionate, necessary, and least restrictive, with involvement from relevant professionals and those close to the person wherever appropriate.

Always ensure any information sharing about a person who is infectious is done so in a compassionate but proportionate way.

Contact precautions

Contact precautions are specific additional measures used to make contact with a person with an infection safer, rather than avoiding contact. They are applied when a person has an infection that can spread through direct contact with the person, or indirectly via their environment or equipment. This is the most common route of infection transmission. Examples of contact precautions include the use of additional PPE and increased environmental cleaning and disinfection. For more information on the types of PPE and when they should be used.

Where possible, dedicated staff should be assigned to care for people who are infectious (cohorting) each day. In domiciliary care, this means limiting the number of different care and support workers visiting a person whilst they are infectious.

Precautions for pathogens that transmit through the air 

Pathogens that transmit through the air are pathogens (usually viruses or bacteria) that can spread in the air and be breathed in by other people. Many acute respiratory infections (ARI) are caused by these pathogens. When an infected person breathes, talks, coughs, sneezes, sings, or shouts, tiny particles containing the pathogen can be released into the air. Other people may then breathe in those particles and become infected.

Support people with acute respiratory infections (ARI) to stay away from others if they are unwell or have a high temperature (above 37.8 degrees Celsius). 

Take all contact precautions plus these additional precautions for infections that transmit through the air:

• encourage and support people with respiratory and cough hygiene
• always consider TBPs within the hierarchy of controls  when planning care, such as ensuring there is good ventilation to reduce the amount of virus in the environment
• seek advice from IPC team or UKHSA local HPT to check if other respiratory protection is needed for the known pathogen and/or care activity
• contact your local IPC provider, ICB link or UKHSA local HPT to seek advice if unsure on what precautions to put in place or if measures cannot be implemented safely because of operational constraints, staffing, or a person’s distress

Cleaning during infectious period (communal settings)

The cleaning measures below should be used when a person accessing care is suspected or known to have an infection. This is additional cleaning needed to prevent spread of infection.

In a communal setting, clean bedrooms daily with a combined detergent disinfectant solution at a dilution of 1,000 parts per million (ppm) of chlorine or a general-purpose neutral detergent in warm water followed by solution of 1,000ppm of chlorine or a suitable alternative disinfectant agreed by local IPC advice . 

Increase cleaning of frequently touched surfaces such as door handles, light switches, bed rails, wheelchairs, bedside tables, and shared mobile devices. Appendix 4 of the NHS England National standards of healthcare cleanliness 2025 includes a useful list of frequently touched areas, which can help care providers prioritise cleaning. 

 Increase cleaning frequency in shared toilets and bathrooms from daily cleaning based on how much it is used and how visibly dirty it becomes. Cleaning during infectious period (domiciliary settings)

When a person accessing care is suspected or known to have an infection to support people and their families to increase cleaning of frequently touched surfaces, and toilets and bathrooms as needed. Document any advice that has been given in the person’s care records.

Terminal clean (deep clean) after the infectious period, as directed by a healthcare professional (communal settings)

In communal settings, perform a terminal (deep) clean using a combined detergent disinfectant solution at a dilution of 1,000ppm of chlorine or a general-purpose neutral detergent in warm water followed by a solution of 1,000ppm of chlorine (or a suitable alternative disinfectant ). Always follow the manufacturer’s instructions, including any recommended product ‘contact time’, for all cleaning and/or disinfection solutions.

Remove all waste, disposable items, bedding, curtains, linen, and reusable non-invasive equipment from the person’s room and replace items that have been removed. Make sure reusable equipment is decontaminated in the room before removal.

Terminal clean (deep clean) after the infectious period (domiciliary)

In domiciliary care, it is not usually the responsibility of care providers or care and support workers to carry out a terminal clean.  Only the waste can be realistically removed, but advice should be given to the persons and their family about the general principles of cleaning after an infectious period is over. 

Terminal clean (deep clean) principles for any ASC setting

Clean and disinfect from top to bottom. This means start with high surfaces like shelves or counters and clean floors last.

Always start with clean areas and move to the dirty areas last to prevent spreading pathogens.

Clean every part of the room thoroughly. 

Pay special attention to high-touch points such as door handles, light switches, and rails, bedside tables.

Soft furnishings and privacy curtains should be laundered, or steam cleaned where feasible.

Clean or replace mattresses, cushions, and pressure-relieving aids as per local guidance.

Vacuum carpets and upholstered furniture using HEPA filters where available, then steam clean if feasible. Clean this equipment afterwards as per manufacturer’s instructions.

Replace or dispose of any items that cannot be effectively cleaned or are visibly soiled. Always seek permission from the person before disposing of personal belongings.

See information for cleaning considerations during outbreak and at the end of an outbreak.

When to stop using transmission-based precautions

Transmission based precautions are no longer needed when the person is no longer considered infectious, based on relevant guidance or advice from a healthcare professional where required.