Contact vs Droplet vs Airborne Precautions: CNA Cheat Sheet

The NNAAP Infection Control section tests transmission-based precautions consistently — and it does so with questions that require more than just memorizing a list. You need to know which precaution type applies to specific diseases, which PPE each type requires, and when standard precautions alone are sufficient. There are three transmission-based precaution types, each designed for a different route of pathogen spread: • **Contact precautions** — for pathogens spread by touching the patient or contaminated surfaces • **Droplet precautions** — for pathogens spread through large respiratory droplets (coughing, sneezing, talking) • **Airborne precautions** — for pathogens spread through small particles that remain suspended in air for extended distances and time The key word in each name tells you the transmission route — and that determines the PPE.

**Route:** Direct contact with the patient's skin or body fluids, or indirect contact with contaminated surfaces and equipment in the room. **PPE required:** Gloves and gown — put on before entering the room, removed before leaving. **Room requirement:** Private room preferred. Cohort (group) patients with the same infection if private rooms are unavailable. **Common diseases requiring contact precautions:** • MRSA (methicillin-resistant Staphylococcus aureus) • C. difficile (Clostridioides difficile — also requires soap and water for hand hygiene, not sanitizer) • VRE (vancomycin-resistant enterococcus) • Scabies • Wound infections with copious, uncontained drainage • RSV (respiratory syncytial virus) — contact + droplet **Memory anchor:** Contact = Touching. If the pathogen lives on surfaces and spreads hand-to-patient, you need gloves and gown.

**Route:** Large respiratory droplets (>5 microns) produced when an infected person coughs, sneezes, talks, or is suctioned. These droplets travel up to 3 feet and land on mucous membranes (nose, mouth, eyes). **PPE required:** Surgical mask (worn within 3 feet of the patient), gloves, and gown. Eye protection is added if splashing is possible. **Room requirement:** Private room. Door may remain open. Mask is required within 3 feet of the patient. **Common diseases requiring droplet precautions:** • Influenza (flu) • COVID-19 • RSV — contact + droplet • Pertussis (whooping cough) • Mumps • Rubella • Meningococcal meningitis (Neisseria meningitidis) **Memory anchor:** Droplet = 3 feet, surgical mask. Not airborne — these particles fall out of the air within 3 feet and don't require a negative pressure room. **Critical exam point:** Influenza requires DROPLET precautions — not airborne. Students frequently get this wrong.

**Route:** Small particle droplet nuclei (<5 microns) that remain suspended in the air for long distances and extended periods. Standard ventilation can carry these particles throughout a room or down a hallway. **PPE required:** N95 respirator (not a surgical mask — a surgical mask does not filter airborne particles effectively), gloves, gown, and eye protection. **Room requirement:** Negative pressure private room — air flows inward and is exhausted outside (or HEPA-filtered). Door must remain closed at all times. **Additional consideration:** A CNA who has no immunity to varicella (chickenpox) should not enter the room of a patient on airborne precautions for varicella. If you must enter, use an N95. **Common diseases requiring airborne precautions:** • Tuberculosis (TB) — the classic airborne disease • Measles (rubeola) • Varicella/chickenpox — airborne AND contact (contact for direct lesion exposure) • Disseminated herpes zoster (shingles) — airborne AND contact **Memory anchor:** Airborne = N95 + Negative pressure. If you can catch it across a room without touching the patient, it's airborne. **Critical exam point:** Chickenpox requires BOTH airborne and contact precautions — not just one or the other.

Use this chart to compare all three precaution types at once.

Before transmission-based precautions apply, standard precautions apply to every patient, every time — regardless of diagnosis. Standard precautions assume all blood and body fluids (except sweat) are potentially infectious. Standard precautions include: • Hand hygiene before and after every patient contact • Gloves when contacting blood, body fluids, non-intact skin, or mucous membranes • Gown when splashing or spraying is possible • Mask and eye protection when splashing near your face is possible • Safe sharps handling and proper waste disposal Transmission-based precautions are added ON TOP of standard precautions — they do not replace them. A patient on airborne precautions still receives all standard precaution protections, plus the N95 and negative pressure room.

These specific diseases generate the most wrong answers on the NNAAP exam: **Influenza → Droplet** (not airborne). Flu spreads through large droplets from coughing and sneezing, not airborne nuclei. A surgical mask within 3 feet is the correct protection — not an N95. **Chickenpox (varicella) → Airborne + Contact** (not just contact or just droplet). Varicella spreads through airborne particles AND through direct contact with lesions. Both precaution types apply simultaneously. **Tuberculosis → Airborne** (N95, negative pressure room, door closed). A surgical mask is not enough for TB. **C. difficile → Contact** (plus soap and water for hand hygiene — alcohol sanitizer does not kill C. diff spores). **MRSA → Contact** (gloves and gown, private room preferred). MRSA is not airborne. **RSV → Contact + Droplet** (both types apply for RSV in most settings).

C. difficile (C. diff) requires contact precautions — gloves and gown must be worn before entering the room. Importantly, hand hygiene for C. diff patients must use soap and water, not alcohol-based hand sanitizer. C. diff forms spores that alcohol cannot kill. Soap and water mechanically removes spores from hands. This is one of the most tested exceptions in the Infection Control section.

Airborne precautions require an N95 respirator — not a standard surgical mask. An N95 is a fitted respirator that filters at least 95% of airborne particles. A surgical mask is only designed to block large droplets and does not provide adequate protection against airborne pathogens like TB, measles, or chickenpox. This distinction — N95 vs. surgical mask — is directly tested on the NNAAP exam.

No. Standard seasonal influenza requires droplet precautions, not airborne precautions. Influenza spreads through large respiratory droplets produced by coughing and sneezing. These droplets typically travel no more than 3 feet and settle quickly. Droplet precautions (surgical mask, gloves, gown) are appropriate. An N95 respirator and negative pressure room are required for airborne diseases like TB and chickenpox — not the flu.

Chickenpox (varicella) requires both airborne precautions AND contact precautions simultaneously. The varicella-zoster virus spreads through airborne droplet nuclei (which can travel across a room and remain suspended in air) and through direct contact with the fluid inside skin lesions. This dual requirement — airborne AND contact — is a frequent NNAAP exam question. An N95 respirator and negative pressure room are required for the airborne component; gloves and gown are required for the contact component.