On 3 August 2026, important updates to the Transmission Based Precautions, or TBPs, guidance came into effect across both the National Infection Prevention and Control Manual and the Care Home Infection Prevention and Control Manual.
These changes apply to all staff across health and care settings in Scotland and reflect the latest scientific understanding of how respiratory pathogens spread and introduce a number of important updates for staff working across health and care settings.
These changes are important to staff when caring for a patient with a known or suspected infection or colonisation.
There are three key changes:
- Changes to Transmission Categories
Historically, there were three modes of transmission:
- Contact
- Droplet
- Airborne
These have now been simplified into two transmission categories:
- Contact transmission
- Air transmission
- Introduction of Respiratory Categories
A new respiratory categorisation system has been introduced for respiratory pathogens:
- R1
- R2
- R3
These categories help determine whether a Fluid Resistant Surgical Mask, or FRSM, or Respiratory Protective Equipment, or RPE, should be worn.
- Removal of AGPs and Fallow Times
The concept of Aerosol Generating Procedures, or AGPs, and associated fallow times has been retired and removed from the guidance.
Instead of varying fallow times based on room ventilation rates, a 10-minute vacant period should be observed before environmental cleaning begins after a patient with a suspected or confirmed R1, R2 or R3 respiratory pathogen leaves the room.
For most staff, many aspects of Transmission Based Precautions remain unchanged. For example:
- Contact precautions
- Management of care equipment
- Linen handling
- Waste management
The most significant changes relate to:
- Introduction of Respiratory (R)categories that will guide the correct instances to use FRSM and RPE
- The introduction of the 10-minute vacant period
The new Transmission Based Precautions are being rolled out this week as we celebrate International Infection Prevention and Control Week which this year honours the dedicated professionals who protect patients, staff and communities from healthcare-associated infections.
It also celebrates the journey, from the plague doctors of the 1600s to the infection prevention teams of tomorrow.
