4812 Volume 10 Transmission Based Precautions Isolation Guidelines PDF

Volume 10 Infection Prevention and Control
Canterbury DHB
Transmission-Based Precautions (Isolation Guidelines)
1 Transmission-Based Precautions (Isolation Guidelines)

1.1
Transmission-based Precautions (Isolation Guidelines)

Transmission-based Precautions are applied to patients suspected or confirmed to be
infected with microorganisms transmitted by the contact, droplet or airborne routes. In
these instances the route(s) of transmission of the micro-organism is/are not
completely interrupted using Standard Precautions.
There are four categories of precautions that can be implemented in the CDHB
1. Contact Precautions
2. Droplet Precautions
3. Airborne Precautions
4. Protective (Environment) Precautions
Depending on the route of transmission, transmission-based precautions involves a
combination of the following precautions (Refer 1.1.5 Summary Chart for
Transmission-based Precautions)
a.
b.
c.
d.
e.
Authorised by
Ref: 4812
Allocation of single rooms or cohorting of patients

Appropriate air handling requirements
Appropriate use of PPE
Patient dedicated equipment
Enhanced cleaning and disinfection of the patient environment
Transmission-based Precautions are always used in addition to Standard

Precautions.
Some diseases have multiple routes of transmission and several categories of
Transmission-based Precautions may be combined, e.g. Chickenpox may
require airborne and contact precautions.
All staff members must comply with Transmission-based Precautions.
Extend duration of Transmission-based Precautions for immunosuppressed
patients with viral infections due to the prolonged shedding of viral agents that
may be transmitted to others.
It is important to advise the patients family, whanau and significant others
regarding Transmission-based Precautions rationale and procedures.
Ensure that the patient receives the information pamphlet: Why am I being
Nursed in Isolation (Ref. 0106) available from Supply Department or
download from the IP&C intranet site
Contact the Infection Prevention and Control Service to arrange staff education
sessions as required on the ward.
Where single room accommodation is not available a risk assessment in
consultation with IP&C is required.
Page 1 of 29
Issue 6: June 2012

Review Date: June 2014
Canterbury DHB

1.1.1
Contact Precautions
Contact Precautions are intended to prevent transmission of (known or suspected)
infectious agents including epidemiologically important micro-organisms, which are
spread by direct or indirect contact with the patient or the patients environment or
patient care items, e.g. multi-drug resistant organisms, scabies, excessive wound
drainage, drainage of body fluids causing extensive environmental contamination, and
gastrointestinal tract pathogens such as Norovirus, Clostridium difficile and Rotavirus.
1.1.2
Droplet Precautions
Droplet Precautions are intended to prevent transmission of (known or suspected)
infectious agents including epidemiologically important micro-organisms, which are
spread by close respiratory or mucous membrane contact with respiratory secretions,
e.g. influenza, Pertussis (whooping cough), meningococcal meningitis (for first 24
hours of effective antimicrobial therapy).
1.1.3
Airborne Precautions
Airborne Precautions are intended to prevent transmission of (known or suspected)
infectious agents that remain infectious over long distances when suspended in the air
and are transmitted person to person by inhalation of airborne particles, e.g. chicken
pox, measles, pulmonary tuberculosis.
NB Refer to separate section on care of patients with pulmonary tuberculosis and use
of negative pressure rooms for airborne isolation.
1.1.4
Protective (Environment) Precautions

A protective environment is most commonly used for stem cell transplant patients to
minimise fungal spore counts in the air and reduce the risk of invasive environmental
fungal infections; this usually requires HEPA filtered positive pressure rooms such as
those in the Bone Marrow Transplant Unit (BMTU).
Dependant on neutrophil count, only patients considered to be sufficiently
immunosuppressed by their clinical team should be placed in protective (environment)
precautions.
Generally there is no evidence to support the need for special diets for those in
protective environments and general good hygiene practice must be observed. Refer
to local dietician and NZ Food Safety Authority guidelines for advice.
Staff with upper respiratory tract infections should not enter a room in Protective
(Environment) precautions.
Authorised by
Ref: 4812
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Canterbury DHB

1.1.5
Summary Chart for Transmission-based Precautions

Action
Contact Precautions
Droplet Precautions
Protective (Environment)
Precautions
Single Room with ensuite

facilities
Yes, or cohort
If single room not available risk assessment
necessary in consultation with IP&C
Yes, or cohort
Yes
Yes
No ensuite facilities
available
Designate toilet/shower and label clearly for

individual room number OR use individually
assigned commode in patients room.
Shower last and terminally clean afterwards.
Patient to wear surgical mask while

transferring to WC/Shower
OR use individually assigned
commode in patients room.
Shower last, if possible.
Non applicable as should have

ensuite/dedicated bathroom.
Designate toilet/shower and label

clearly for individual room number
OR use individually assigned
commode in patients room. Shower in
freshly cleaned shower.
Negative Air Pressure
No
No
Yes
No positive pressure hepa filtered
Door
May be open. Closed during dust/aerosol

generating procedures, e.g. bed making.
May be open
Closed at all times
Closed at all times in positive pressure

room.
Equipment
Dedicated equipment or disinfect between use.

Limit equipment and furniture to
wipeable/impermeable only. Keep supplies in
room to a minimum. Patients records outside
room.
Dedicated equipment or disinfect

between use. Limit equipment and
furniture to wipeable /impermeable
only. Keep supplies in room to a
minimum. Patients records outside
room.
As per Standard Precautions
Ensure equipment is clean before being

taken into room.
Hand Hygiene
Antimicrobial liquid soap or

alcohol-based handrub for multi-drug resistant
bacteria. Plain liquid soap or alcohol-based
handrub for other infections. N.B. Hand
washing with liquid soap is required for
Clostridium difficile infection NOT alcoholbased handrub.
Plain liquid soap or

alcohol-based handrub.
Plain liquid soap or

alcohol-based handrub.
Liquid soap or alcohol-based handrub

before any contact with patient.
Gloves
For contact with patient or environment.

Remove before leaving room then perform
hand hygiene.
Clean gloves and no-touch technique

when handling high risk sites e.g. CVC
lines
Gowns/aprons
Wear gown when close physical contact, e.g.

manual handling is anticipated. Wear plastic
apron when limited contact with patient or
environment is planned. Remove and dispose
of before leaving room avoiding contact with
outer surface.
Mask
Not generally indicated. May be required in
Surgical mask when entering the
Particulate Respirator (N95) on
No mask required. Staff or visitors with
Authorised by
Ref: 4812
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Canterbury DHB

Action
Contact Precautions
Droplet Precautions
some circumstances, e.g. bed making or if

patient has respiratory infection with MDRO.
patients room. Remove at exit to the

room. Handle by the ties or earloops.
entering room (sized and fitted

correctly). Remove outside room.
upper respiratory tract infection should

not be visiting or care for patient.
Goggles/Face shield
As per Standard Precautions, i.e. if procedure

involves splash risk.
As per Standard Precautions, i.e. if

procedure involves splash risk.


Linen
Place in red linen bag with water soluble liner.

No label required.
Place in red linen bag with water

soluble liner. No label required.
No special precautions for linen.
No special precautions for linen.
Waste
As per infectious/medical waste disposal.

Dispose of inside room.
As per infectious/medical waste

disposal. Dispose of inside room.
Disposal as per infectious/medical

waste Dispose of inside room.
No special requirements, Follow

CDHB Waste Disposal policy.
Crockery/Utensils/Meal
Trays
Sanitise in approved dishwasher. Bagging not

required. Perform hand hygiene after
delivering or collecting meal trays.
Sanitise in approved dishwasher.

Bagging not required. Staff wear
appropriate mask when delivering or
collecting meal trays.
Sanitise in approved dishwasher.

Bagging not required .Staff wear
appropriate mask when delivering or
collecting meal trays.
Sanitise in approved dishwasher. Staff

performs hand hygiene on entry to
room.
Visitors
Perform hand hygiene. Not required to wear

PPE. See additional information.
Perform hand hygiene. Not required

to wear PPE. Discourage visiting
whilst patient actively symptomatic.
See 1.2.4.
Perform hand hygiene. Not required

to wear N95 if they have been in
contact prior to identification of
causative organism. Visitors may
need to be restricted.
Perform hand hygiene. Do not visit if

unwell.
Transfer to other
departments/ hospitals
Limit to essential transportation only.

Ensure receiving area is aware of status of
Contact Precautions prior to transfer.
Patient to wear surgical mask only if
respiratory symptoms present.

Ensure receiving area is aware of
status of Droplet Precautions prior to
transfer.
Patient to wear surgical mask.
Limit to essential transportation

only.
Ensure receiving area is aware of
status of Airborne Precautions prior
to transfer.
Patient to wear surgical mask.

Ensure receiving area is aware of status
of Protective Environment prior to
transfer.
Patient to wear surgical mask or N95
mask (risk assess).
Authorised by
Ref: 4812
Page 4 of 29
Issue 6: June 2012

Protective (Environment)
Precautions
Canterbury DHB
1.2
1.2.1
Additional General Information

Points to Consider when Working in Transmission-Based Precautions
1. Minimise the frequency of entrances into the room by collecting all the
equipment required before entering the room.
2. Have the minimum amount of people in the room.
3. Have minimum amount of equipment in the room. When admitting into
an isolation room, remove surplus equipment where possible.
4. Spend a minimum amount of time in the room if the person is acutely
unwell with an infectious disease such as Norovirus.
5. When patients are placed in transmission-based precautions due to an
infection or colonisation with an MDRO, efforts should be made to
ensure patients continue to receive adequate medical and nursing care to
counteract potential psychological adverse effects such as anxiety and
depression and feeling of stigmatisation.
6. Consider nominating a buddy or runner who can assist staff working in
Transmission-Based Precautions, e.g. collecting and removing supplies
or equipment.
1.2.2
Use of PPE in Isolation Rooms

Make sure that neither the environment outside isolation room, nor other persons can
be contaminated from the used PPE.
Generally, PPE should be removed inside the room, hand hygiene

performed then room exited.
Remove PPE in a manner that prevents self-contamination or selfinoculation with contaminated PPE or hands see 1.2.3.
Discard disposable items immediately into a foot controlled lidded
rubbish bin.
Remove the most heavily contaminated items first, i.e. gloves.
Hand hygiene must be performed immediately after glove removal.
If wearing full PPE, the last item to be removed should be the mask
and hand hygiene must be repeated.
Do NOT remove PPE prior to leaving a room when transporting blood
or body fluid substance to the sluice for disposal e.g. a bedpan. Go
directly to the sluice and remove PPE in the sluice after completion of
task.
Disposable Particulate Respirator (N95) Masks

This is a protective tight fitting device worn on the face which covers the nose
and the mouth and protects the wearer from inhaling hazardous/infectious
airborne particles by filtering the air before it reaches the wearer.
Authorised by
Ref: 4812
Page 5 of 29
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Canterbury DHB
Authorised by
Ref: 4812
Used respirators are considered contaminated and must be discarded following

a patient episode of care DO NOT REUSE
The respirator mask should be worn by staff performing aerosol generating
procedures with patients with respiratory infection
Do not touch the front of the mask once fitted on the face to avoid
contamination of the hands
Remove the respirator mask by the elastic
Mask fit testing of staff is no longer a routine requirement. However, staff
must ensure that the mask worn forms a tight seal around nose/mouth before
entering isolation room.
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Issue 6: June 2012

Canterbury DHB
1.2.3
Sequence for Putting on and Removing PPE
Authorised by
Ref: 4812
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Canterbury DHB
1.2.4
1.2.5
Visitors
Visitors wishing to see other inpatients are requested to do so prior to

visiting the patient in transmission-based precautions.
Visitors, especially children, should consider delaying their visiting for

patients in the acute phase of highly transmissible diseases such as
Norovirus, Rotavirus, Influenza, Mumps and Measles.
Visitors must not be discouraged from visiting patients with

MDRO/MRSA.
Prior to entering a transmission-based precautions room, visitors require

instructions on performing hand hygiene.
Visitors generally do not need to wear PPE (Refer Summary Chart for
Isolation Precautions). There may be exceptions to this based on risk
assessment e.g. TB discuss with Infection Prevention and Control or
Charge Nurse Manager.
Visitors should not use ward toilets or enter staff areas.
Visitors should not visit if they have symptoms of an infectious disease

in the last two days.
All visitors must wash their hands or use alcohol-based hand rub prior
to leaving a transmission based precautions room.
Cohort Isolation (Sharing Rooms)
1.2.6
When a single room is not available, an infected or colonised patient

may be placed with another patient who is infected with the same microorganism provided that:
Neither patient is infected with other potentially transmissible

micro-organisms.
The likelihood of re-infection with the same micro-organism is

minimal.
Ensure the patients are physically separated.
Change PPE and perform hand hygiene between contact with

patients in the same room.
It is important to be certain of the mode of transmission of the known or

suspected pathogens. Contact the Infection Prevention and Control
Service if cohorting of patients is being considered.
Laboratory Specimens
Authorised by
Ref: 4812
All human blood and body substances must be treated as if they are
infected or contaminated with infectious agents; therefore there is no
need to label as infectious.
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Canterbury DHB
1.2.7
Care should be taken when collecting specimens to avoid contamination

of the outside of the container. Ensure specimen container is closed
securely.
Deceased Patients and Infectious Diseases

Body bags are only required in the following circumstances:
The body is:
Leaking body fluids which are not containable or where gross external
contamination of blood is present, OR
Deemed to be at high risk of leaking body fluids by nature of
condition, e.g. oedema, aspiration, extensive burns, trauma, OR
The patient:
Had or was suspected of having a Viral Haemorrhagic Fever, OR

Has confirmed/suspected Emerging New Infectious Disease (ENID)
which may have resulted in death.
Body bags are available from Mortuary or Undertaker and can be requested via the
Mortuary staff or orderlies out-of-hours.
Authorised by
Ref: 4812
The ward staff must advise the Mortuary if a patient is known or

strongly suspected of having one of the following infectious diseases.
However, a body bag is not necessary unless any of the criteria
above are present.
Spongiform encephalitis, e.g. Creutzfeld Jacob disease
Hepatitis B
HIV/AIDS
Hepatitis C
Tuberculosis
Typhoid/paratyphoid
Meningococcal meningitis/septicaemia (if death occurs before 48
hours of suitable antibiotics given).
Invasive Beta-haemolytic Streptococcus Group A disease (if death
occurs before 24 hours of suitable antibiotics given).
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Issue 6: June 2012

Canterbury DHB

1.3
1.3.1
Transmission-Based Precautions Cleaning and Disinfection

Daily Cleaning
1.3.2
Clean room last.

No special cleaning solutions are required for daily cleaning of room.
Disposable cloths must be used.
Focus on frequently touched surfaces and equipment such as bed rails,
over bed tables, commodes, door knobs, call bells.
Protective clothing is worn by cleaning staff in accordance with
Transmission-Based Precautions sign outside room.
Launder mop head after use.
Terminal Cleaning
Terminal Cleaning occurs on patient discharge from Contact Precautions. Refer to A
to Z for conditions requiring Contact Precautions.
Nurse-in-Charge contacts cleaning services to arrange.

Privacy, window, shower curtains (if applicable) require removing
prior to terminal clean.
Curtains to be sent to laundry in black laundry bags.
Clean surfaces using a disinfectant as follows:

Options for Disinfection (refer to disinfection chart):
Viral- Sodium hypochlorite (Presept/Chlorwhite) 1000ppm
Bacterial- Phenolic (Prephen) NOTE: not to be used on infants
incubators/bassinettes
70% alcohol wipes NOTE: not to be used on display panels of
electronic equipment
Steam cleaning
1.3.3
Bed Space Disinfection

The disinfection of the bed space follows the identification of an infectious patient in a
multi bed room and their subsequent transfer to a single room or discharge. The multi
bed room in these instances is not in Contact Precautions.
Authorised by
Ref: 4812
Transfer or Discharge
privacy curtains are removed for laundering
bed, locker, chair and equipment transferred to a single room
horizontal and touch points disinfected
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Canterbury DHB
References
Department of Labour (2000) Managing Health and Safety Risks in New Zealand
Mortuaries, Occupational Safety and Health Service, Wellington
Guidelines for the Control of Multidrug-resistant Organisms in New Zealand, 2007 MOH
http://www.moh.govt.nz/moh.nsf/indexmh/guidelines-for-the-control-of-multidrug-resistantorganisms-in-nz
Guidelines for the Control of methicillin-resistant Staphylococcus aureus in New Zealand,
2002. MOH http://www.moh.govt.nz/moh.nsf/pagesmh/1804?Open
Guidelines for preventing the transmission of mycobacterium tuberculosis in healthcare
settings (2005) MMWR, 54, RR-17, 1-141.
Management of Multi Drug resistant Organisms in Healthcare settings, 2006 CDC
Hannum D et al (1996)
The effect of respirator training on the ability of healthcare workers to pass a
qualitative fit test. Infect Control Hosp Epidemiology, 17, 636-40
Health and Safety Executive (2005) Controlling the risks of infection at work from
human remains - A guide for those involved in funeral services (including embalmers)
and those involved in exhumation Infection prevention and control of epidemic- and
pandemic-prone acute respiratory diseases in health care. WHO Interim Guidelines2007
http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html
Occupational Safety and Health Service of the Department of Labour (2000) Managing
Health and Safety Risks in New Zealand Mortuaries.
Guideline to promote safe working conditions.
Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Prevention and
Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings, June 2007
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf
Authorised by
Ref: 4812
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Canterbury DHB
1.4 Alphabetical List of Diseases

See also www.cdc.gov for a comprehensive, detailed and continuously updated A Z Index.
Disease
Mode of Transmission
Recommended Precautions
Acquired Immunodeficiency Syndrome

(HIV)
Blood & body fluids
Standard
Adenovirus
infection in infants and young children
Respiratory secretions and

infections
Contact and Droplet
Amebiasis (Dysentery)
Faeces
Standard
Cutaneous
Pus
Standard
Pulmonary
Environmental/soil
Standard
Arthropod borne Viral Fevers (see Dengue

Fever, Yellow Fever, Ross River Virus)
Blood
Standard
Aspergillosis
Environmental
Standard
Botulism (Clostridium botulinum)
Food
Standard
Bronchiolitis
Respiratory Secretions
Contact (Paediatrics)
Standard (adults)
Brucellosis
(undulant, Malta, Mediterranean fever)
Body fluid
Standard
Skin and mucous membrane
Standard
Uncontrolled drainage
Controlled drainage
Serous ooze
Contact
Serous ooze
Standard
Chancroid (soft chancre)
Pus
Standard
Precaution Duration
Duration of illness
Anthrax
Antibiotic-associated colitis
(see Clostridium difficile)
Duration of illness
Campylobacter (see Gastroenteritis)

Candidiasis, all forms including
mucocutaneous
Cellulitis
Authorised by
Ref: 4812
Page 12 of 29
Issue 6: June 2012

Until drainage contained
Canterbury DHB

Disease
Precaution Duration
Chickenpox (Varicella)
Respiratory and direct contact with

lesion.
Airborne and Contact if non immune

staff.
Susceptible HCWs should not enter
room if immune caregivers are
available.
Maintain precautions until all lesions are crusted.

If immunoglobulin required for susceptible exposed
individuals, egg. neonates, discuss with Microbiology or
Infectious Diseases staff.
Chlamydia trachomatis
Conjunctivitis
Genital
Pneumonia (infants < 3 mths of age)
Pus
Standard
Genital Discharge
Standard
Respiratory secretions
Standard
Foodborne
Standard
Faeces
Contact with dedicated

toilet/commode.
Discontinue antibiotics if appropriate.
Ensure consistent environment
cleaning and disinfection.
Handwashing with liquid soap and
water instead of alcohol -based hand
rub.
Food poisoning
Food
Standard
Gas Gangrene
Environment (e.g. soil)
Standard
Congenital rubella
Contact and Droplet
Acute bacterial
Purulent exudate
Standard
Chlamydia
Purulent exudate
Standard
Gonococcal
Purulent exudate
Standard
Viral (e.g. adenovirus)
Purulent exudate
Contact
Cholera (see Gastroenteritis)

Clostridium
C. botulinum
C. difficile
Duration of clinical symptoms + 48 hrs asymptomatic.

Note: No further specimens required once asymptomatic
C. perfringens
Until 1 yr of age
Standard precautions if nasopharyngeal and urine cultures
repeatedly negative > 3 months of age.
Conjunctivitis
Authorised by
Ref: 4812
Page 13 of 29
Issue 6: June 2012

Duration of illness
Canterbury DHB

Disease
Precaution Duration
Coxsackievirus disease - Hand, Foot &

Mouth (see Enteroviral infections)
Faeces and respiratory secretions
Creutzfeldt-Jakob disease
(see CJD guidelines on IP&C intranet for
further information)
CNS or neurological tissue
Standard
Use disposable instruments or special
sterilisation/disinfection for surfaces,
objects contaminated with neural
tissue if CJD or vCJD suspected.
Duration of illness
Croup
Presumed by inhalation.
Contact and droplet
Duration of clinical illness
Standard
Cryptococcosis
Cryptosporidiosis (see Gastroenteritis)
Cytomegalovirus infection, neonatal or
immunosuppressed
Mucosal contact with infectious

tissue, secretions (urine) and
excretions
Standard
Dengue Fever
Blood via bite from infected

mosquito.
Standard
Lesions
Contact
Droplet
Endometritis (see also Group A

Streptococcus)
Vaginal Discharge
Standard
Enterobiasis (pinworm disease, oxyuriasis)
Faecal/oral
Standard
Diarrhoea acute Infective etiology suspected

(see Gastroenteritis)
Adult with history of recent antibiotic use
(see Clostridium difficile)
Diphtheria
Cutaneous
Pharyngeal
Encephalitis or encephalomyelitis
(see specific etiologic agents)
Enterococcus species
(see multidrug-resistant organisms if
epidemiologically significant or vancomycin
resistant)
Authorised by
Ref: 4812
Page 14 of 29
Issue 6: June 2012

Until two cultures taken at least 24 hours apart are

negative.
Canterbury DHB

Disease
Precaution Duration
Adults
Faeces
Standard
Infants and young children (in nappies)
Faeces
Contact
Duration of clinical illness
Epiglottitis, due to Haemophilus influenzae,

Type B
Droplet
24hrs after start of effective treatment
Epstein-Barr virus infection, including

infectious mononucleosis (glandular fever)
Respiratory secretions including

saliva
Standard
Staphylococcal
Food
Food
Food
Standard
Standard
Standard
Furunculosis Staphylococcal (adults)

Infants and young children
Contact with lesions

Contact with lesions
Contact
Contact
Campylobacter species
Faeces
Standard - with dedicated toilet/commode

Contact Precautions for diapered or
Duration of clinical symptoms.
incontinent children and adults.
Cholera
Faeces
Standard.
Enteroviral infections, i.e. Group A and B

Coxsackieviruses and echo viruses.
Excludes polio virus)
Erythema infectiosum
(See Parvovirus B19)
Food poisoning
Botulism Clostridium botulinum
Clostridium perfringens
Duration of illness
Duration of illness
Gastroenteritis
Clostridium difficile
Cryptosporidium species
See Clostridium previously listed

Faeces

Faeces

Issue 6: June 2012
Escherichia coli
Enterohemorrhagic O157:H7
Authorised by
Ref: 4812
Page 15 of 29
Canterbury DHB

Disease
Giardia lamblia
Faeces

Norovirus
Faeces/Vomit
Contact and Droplet with dedicated

toilet/commode
Duration of clinical symptoms and until asymptomatic for

at least 48-72 hours. Prolonged shedding may occur in
immunocompromised children and the elderly.
Rotavirus
Faeces/Vomit
Contact and Droplet with dedicated

toilet/commode
Duration of clinical symptoms and until asymptomatic for

at least 48 hours. Prolonged shedding may occur in
immuno compromised children and the elderly.
Salmonella species (including S. typhi,
Faeces

Shigella species
Faeces

Vibrio parahaemolyticus
Faeces
Standard
Viral (if not covered elsewhere)
Faeces

Yersinia entercolitica
Faeces
Standard
(see Norovirus Guidelines on IP&C

Intranet for further information)
S.paratyphi)
German measles (see Rubella)

Gonococcal ophthalmia neonatorum
(gonorrheal ophthalmia, acute conjunctivitis
of newborn)
Mucous membranes & pus
Standard
Gonorrhea
Mucous membranes/sexual contact
Standard
Authorised by
Ref: 4812
Page 16 of 29
Issue 6: June 2012

Precaution Duration
Canterbury DHB

Disease
Precaution Duration
Guillain-Barr syndrome
Respiratory secretions/faeces
Not person to person spread
Standard
Haemorrhagic fevers
(eg. Ebola, Lassa Fever, Marburg)
Blood and body fluid and

respiratory secretions.
Contact and Airborne including

protective eyewear.
Negative air pressure room during
infectious period. Notify Infection
Prevention and Control for further
advice. Notify Medical Officer of
Health.
Duration of illness
Hantavirus pulmonary syndrome
Rodents/ blood
Standard
Duration of illness
Helicobacter pylori
Faecal/oral
Standard
Duration of illness
Faeces
Standard - with dedicated toilet/commode For one week of jaundice.

Maintain precautions
Contact
Hand, foot and mouth disease

(see Enteroviral infection)
Hepatitis, viral
Type A
Diapered or incontinent patients
Faeces
In infants & children <3 yrs of age for duration of

hospitalisation.
In children 3-14yrs, until 2 weeks after onset of
symptoms
In others until one week after onset of symptoms.
Type B (HBSAG Positive)

Type C and other non-specified
Blood/body fluids
Standard
Blood/body fluids
Standard
Blood/body fluids
Standard
Faeces
(non-A, non-B)
Type D (co infection with Type B)

Type E see Type A
Type G
Authorised by
Ref: 4812
Standard
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Canterbury DHB

Disease
Precaution Duration
Herpes simplex (cold sore)

Encephalitis
Lesions & mucous membranes
Standard
Neonatal Exposure
Lesion secretions
Standard
Contact
For asymptomatic, exposed infants delivered vaginally or

by C-section to mother with active infection and
membranes which have been ruptured for more than 4 to 6
hours, monitor closely for signs of infection.
For symptomatic infants contact precautions until lesions
dry.
Mucotaneous, disseminated or primary

severe
Lesion secretions
Contact
Mucotaneous, recurrent (skin, oral, genital)
Lesion secretions
Standard
Lesion secretions
Contact and Airborne
Until all lesions crusted.

Avoid contact unless immune to chickenpox
Contact
Until all lesions crusted.

Lesion secretions
Standard
HIV (Human immunodeficiency virus)
Blood borne virus direct contact

with blood or body substances
Standard
Impetigo
Lesions
Contact
Infectious mononucleosis
Respiratory secretions and saliva
Standard
Influenza
(see Influenza Guidelines on IP&C intranet
for further information)
Droplet
Kawasaki syndrome
No known person-to-person spread
Standard
Legionnaires' disease
Contaminated water from

environment, aspirated/inhaled.
Not person to person transmission
Standard
Leprosy
Long term close contact
Standard
Until all lesions crusted
Herpes zoster (varicella-zoster/shingles)
Disseminated (wide spread) usually in

immuno compromised patients
Area cannot be contained by an occlusive Lesion secretions

dressing
Localised in normal patient and area

covered by occlusive dressing
Authorised by
Ref: 4812
Page 18 of 29
Issue 6: June 2012

Until 24hrs after effective treatment

5 days from onset of illness without chemoprophylaxis.
Duration of clinical illness in immunocompromised
persons
Canterbury DHB

Disease
Leptospirosis
Standard
Lice (Pediculosis)
head lice
pubic lice
body lice
Head to head
Sexual/intimate contact
Clothing
Standard
Standard
Standard
Listeriosis
Contaminated foods
Standard
Lyme Disease
Ticks
Standard
Malaria
Mosquito
Standard
Measles (Rubeola, Morbilli)
Airborne spread
Airborne
Faeces/oral
Standard
Precaution Duration
Person not infectious to close contacts 24 hours after

effective treatment
4 days after onset of rash.

Duration of clinical illness for immune compromised.
Avoid contact unless immune.
Meningitis
Aseptic nonbacterial or viral meningitis

(also see enteroviral infections)
Bacterial, gram-negative enteric, in
Standard
neonates
Fungal
Inhalation from environmental after

aerosolation
Standard
Haemophilus influenzae, known or
Droplet
Food or faecal/oral
Standard
Droplet
Until 24 hrs after initiation of effective treatment
M.Tuberculosis
Standard
Patient should be examined for evidence of current (active)

pulmonary tuberculosis. If evidence exists, see
Tuberculosis
Other diagnosed bacterial
Depends on organism
Standard
Meningococcal pneumonia or sepsis

(Meningococcemia)
Blood/Respiratory secretions
Droplet
suspected
Listeria monocytogenes
Neisseria meningitidis (meningococcal)
Until 24hrs after initiation of effective treatment

See meningococcal disease below
known or suspected
Authorised by
Ref: 4812
Page 19 of 29
Issue 6: June 2012

Until 24hrs after initiation of effective therapy.

Post exposure chemoprophylaxis may be required for
HCWs. Contact the Infection Prevention and Control
Service.
Canterbury DHB

Disease
Molluscum contagiosum
Close contact/lesions
Standard
Precaution Duration
Multidrug-resistant organisms, infection or As per site identified.

colonisation (e.g. MRSA, VRE,
Multi site colonisation cannot be
VISA/VRSA, ESBLs, resistant S.
excluded
pneumoniae
Contact
On advice from IP&C team/Infectious Diseases
Mumps (infectious parotitis)
Saliva
Droplet
For 9 days after onset of swelling. Avoid contact unless

immune.
Mycobacteria, nontuberculosis (atypical)
Pulmonary
Standard
Wound
Drainage
Standard
Mycoplasma pneumonia
Droplet and contact
Duration of illness
Necrotizing enterocolitis
Faeces
Standard
Contact Precautions when cases temporarily clustered.
Contact
Duration of illness
Viral shedding may be prolonged in immunosuppressed
patients.
Norovirus gastroenteritis
Parainfluenza virus infection, respiratory in Respiratory secretions
infants and young children
Parvovirus B19 (erythema infectiosum)
Droplet
Pregnant staff should avoid caring for
these patients.
Maintain precautions for duration of hospitalisation when

chronic disease occurs in an immunocompromised patient.
For patients with transient aplastic crisis or red cell crisis,
maintain precautions for 7 days
Pertussis
(whooping cough)
Droplet
Until 5 days after effective treatment
Pharyngitis
Contact and Droplet until aetiology

known
Until aetiology known
Pus
Standard
Respiratory infections
Droplet
Pinworm infection (See Enterobiosis)

Plague
Bubonic
Pneumonic
Authorised by
Ref: 4812
Page 20 of 29
Issue 6: June 2012

Until 48 hours after initiation of effective treatment
Canterbury DHB

Disease
Precaution Duration
Droplet and Contact
Duration of illness
Standard
Contact
Avoid exposure to other CF patient.
Persons with CF who visit or provide
care and are not infected or colonised
with B. cepacia may elect to wear a
mask when within a metre of a
colonised or infected patient.
Chlamydia
Fungal
Haemophilus influenzae Type B
Standard
Standard
Adults
Infants & children any age
Standard
Droplet
Droplet
Droplet and Contact
Duration of illness
Pneumonia
Adenovirus
Bacterial not listed elsewhere (including
gram negative bacteria)
Burkholderia cepacia in cystic fibrosis

(CF) pts including respiratory tract
colonisation
Legionella (See Legionnaires Disease)

Meningococcal
Multi-drug resistant bacteria
(see Multidrug resistant organism)
Mycoplasma (primary atypical

pneumonia)
Pneumococcal pneumonia
Pneumocystis carinii
Standard
Do not place in room with
immunocompromised patient.
Staphylococcus aureus
Standard
Authorised by
Ref: 4812
Standard
Page 21 of 29
Issue 6: June 2012

Canterbury DHB

Disease
Precaution Duration
Droplet
Droplet
24 hours after start of effective therapy
Viral
Standard
Poliomyelitis
Faeces
Contact
Psittacosis (ornithosis)
Zoonoses
Not transmitted person to person
Standard
Rabies
Standard
Respiratory syncytial virus infection
Streptococcus, Group A
Adults
Infants & young children
Adult
Child or imunocompromised adults
Duration of illness
Standard/Risk Assessment
Discuss with Infection Prevention and Control Service.
Contact
Rheumatic fever (Group A Streptococcal)
Not person-to-person transmission
Standard
Rhinovirus
Standard
Respiratory hygiene and cough
etiquette encouraged.
Ringworm
(dermatophytosis, dermatomycosis, tinea)
Lesions
Standard
Roseola infantum
(exanthem subitum)
Oral secretions
Standard
Droplet
Until 7 days after onset of rash.
Non immune staff should avoid caring Susceptible case who has known exposure - precautions for
for these patients.
7 days or until rash appears then 7 days after onset of rash.
Scabies
Skin contact
Contact
Scalded skin syndrome

staphylococcal (Ritters disease)
Lesion drainage
Contact
Duration of clinical symptoms
Schistosomiasis
(bilharziasis)
Environmental (water)
Standard
Rotavirus infection (see Gastroenteritis)

Rubella
(German measles; also see congenital
rubella)
Rubeola (see measles)
Salmonellosis (see Gastroenteritis)
Authorised by
Ref: 4812
Page 22 of 29
Issue 6: June 2012

Canterbury DHB

Disease
Precaution Duration
Severe Acute Respiratory Syndrome

(SARS) Probable or confirmed case
Respiratory Secretions
Faecal /Oral
Blood/Body Fluids
Environmental
Airborne and Contact

including protective eyewear
Duration of illness plus 10 days after resolution of fever,

provided respiratory symptoms are absent or improving
(and discuss with Infectious Diseases Physician).
Pus/exudate
Contact
Until drainage contained
Shigellosis (see Gastroenteritis)

Shingles (see Herpes Zoster)
Staphylococcal disease (S.aureus)
Skin, wound or burn

Major (No dressing or dressing does not
contain drainage adequately)
Minor (dressing covers and contains drainage Pus/exudate

adequately)
Standard
Entercolitis
Faeces
Standard
incontinent children for duration of
illness
Multi-drug resistant
Pus/exudate
Contact
Pneumonia
Scalded Skin Syndrome (not MRSA)
Toxic Shock Syndrome (not MRSA)
Standard
Lesion, drainage
Contact
Duration of illness
Vaginal discharge or pus
Standard
Duration of illness
Duration of illness but reassess risk as required

Discuss with Infection Prevention and Control.
N.B. Ensure disinfection of articles likely to have been

contaminated by lesions/secretions
Streptococcal disease
(Group A Streptococcus)
Skin, wound or burn

Pus/exudate
Contact
Until 24 hours after initiation of effective therapy and

drainage contained

adequately)
Standard
Endometritis (puerperal sepsis)

Pharyngitis in infants, young children
Pneumonia
Vaginal discharge
Standard
Droplet
Until 24 hours after initiation of effective therapy
Droplet
Authorised by
Ref: 4812
Page 23 of 29
Issue 6: June 2012

Canterbury DHB

Disease
Precaution Duration
Scarlet fever in infants, young children

Serious invasive disease
Droplet

Streptococcal disease (not group A or B)

unless covered elsewhere
Lesions/secretions
Droplet
Plus Contact if draining wound
Standard
Skin and mucous membrane, including

congenital, primary, secondary
Lesion secretions and blood
Standard
Latent (tertiary) and seropositivity without

lesions
Blood
Standard
Tapeworm Disease
Hymenolepis nana
Taenia solium (pork)
Other
Ingestion of parasite from

undercooked meat
Standard
Standard
Standard
Tetanus
Environmental via skin injury
Standard
Tinea (fungus infection dermatophytosis,

dermatomycosis, ringworm)
Direct skin-to-skin contact or

indirect contact from infected
fomites from people or animals.
Standard
Toxoplasmosis
Cat faeces, undercooked meat
Standard.
No restrictions for pregnant staff.
Syphilis
Toxic Shock syndrome (see Staphylococcal

disease, Streptococcal disease)
Trachoma (acute)
Standard
Purulent exudate
Standard
Extra pulmonary, draining lesion (including

scrofula)
Pus/Exudate
Standard
Contact for wound care
Airborne for wound care that may
involve aerosol, e.g. irrigation.
Extra pulmonary and meningitis
Drainage from infected area
If Group A streptococcus likely then Droplet Precautions

Until 24 hours after initiation of effective therapy.
Tuberculosis
(refer also to Care of Patients with
Pulmonary Tuberculosis, CDHB Policies,
Volume 10, IP&C)
Authorised by
Ref: 4812
Page 24 of 29
Standard
Issue 6: June 2012
Discontinue precautions when drainage has ceased.
Patients should be examined for evidence of current

(Active) pulmonary TB.
Canterbury DHB

Disease
Precaution Duration
Until all of the following has been met:
The patient has had a minimum of 2 weeks
effective chemotherapy
The patient has stopped coughing
Patient is infected with a fully sensitive strain of
Mycobacterium tuberculosis
The patient is responding well to treatment
At least 2 of the patients sputum specimens are
smear-negative or the patient remains smearpositive but is culture negative.
Pulmonary or laryngeal disease confirmed
Airborne, Droplet nuclei
Airborne
Pulmonary or laryngeal disease suspected
Airborne, Droplet nuclei
Airborne
When likelihood of infectious TB disease deemed

negligible and either:
1. There is another diagnosis that explains the clinical
syndrome OR
2. The results of two consecutive sputum specs are smear
negative on separate days. (at least one of these should
be an early morning specimen)
Pus/exudate
Contact
Until drainage contained.
Typhoid (Salmonella typhi)

Varicella (see Chickenpox)
Vibrio parahaemolyticus
Whooping cough (see Pertussis)
Wound/Skin Infection/Abscess/Decubitus
Ulcer

adequately)
Standard
Yersinia enterocolitica gastroenteritis

Authorised by
Ref: 4812
Page 25 of 29
Issue 6: June 2012

Canterbury DHB

References
Heymann D: Control of Communicable Disease Manual, 18th Edition, 2004.
Ministry of Health Tuberculosis Control in New Zealand http://www.moh.govt.nz/cd/tbcontrol
Siegel, J.D., Rhinehart, E., Jackson, M., Chiarello, L. and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for
Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007
http://www.cdc.gov/ncidod/dhqp/gl_isolation.html
Policy Owner
CDHB Infection Prevention & Control Service
Date of Authorisation
11 June 2012
Authorised by
Ref: 4812
Page 26 of 29
Issue 6: June 2012

Canterbury DHB
1.5
Notifiable Diseases in New Zealand (includes suspected cases)*
Policy
All diseases identified in this document must be notified to the Medical Officer of
Health. This includes suspected cases.
Scope
All Canterbury DHB staff
Notifiable Infectious Diseases under the Health Act 1956
Section A Infectious Diseases Notifiable to Medical Officer of Health and Local Authority
Acute gastroenteritis**
Campylobacteriosis
Cholera
Cryptosporidosis
Giardiasis
Hepatitis A
Legionellosis
Listeriosis
Meningoencephalitis primary amoebic
Salmonellosis
Shigellosis
Typhoid and paratyphoid fever
Yersiniosis
Section B Infectious Diseases Notifiable to Medical Officer of Health
Acquired Immunodeficiency Syndrome (AIDS)
Anthrax
Arboviral diseases
Brucellosis
Creutzfeldt-Jakob Disease and other Spongiform
Diphtheria
encephalopathies
Haemophilus Influenzae b
Enterobacter sakazakii invasive disease
Hepatitis C
Hepatitis B
Highly pathogenic Avian Influenza (HPAI)
Hepatitis (viral) not otherwise specified
Invasive pneumococcal Disease
Hydatid disease
Leprosy
Leptospirosis
Malaria
Measles
Mumps
Neisseria meningitidis invasive disease
Non-seasonal influenza (capable of being
transmitted between human beings)
Plague
Pertussis
Rabies
Poliomyelitis
Rickettsial diseases
Rheumatic Fever
Severe Acute Respiratory Syndrome (SARS)
Rubella
Viral haemorrhagic fevers
Tetanus
Yellow Fever
Notifiable to Medical Officer of Health
Cysticercosis
Taeniasis
Trichinosis
Decompression sickness
Lead absorption equal to or in excess of 10mcg/dl (0.48mcmol/L)***
Poisoning arising from chemical contamination of the environment
Notifiable Diseases under the Tuberculosis Act 1948
Notifiable to the Medical Officer of Health
Tuberculosis (all forms)
* During times of increased incidence, practitioners may be requested to report, with informed consent,
to their local Medical Officer of Health of cases of other communicable diseases not on this list.
Authorised by
Ref: 4812
Page 27 of 29
Issue 6: June 2012

Canterbury DHB

** Not every case of acute gastroenteritis is necessarily notifiable only those where there is a suspected
common source or from a person in a high risk category (e.g. food handler, child care work, etc.) or
single cases of chemical, bacterial, or toxic food poisoning such as botulism, toxic shellfish
poisoning (any type) and disease caused by verocytotoxic E.coli.
*** Blood lead levels to be reported to the Medical Officer of Health, i.e. 10mcg/dl (0.48mcmol/L) are
for environmental exposure. Where occupational exposure is suspected, please notify OSH through
the NODS network.
References
Ministry of Health, Schedule of Notifiable Diseases, 2009. Accessed 23rd July 2012
http://www.health.govt.nz/our-work/diseases-and-conditions/notifiable-diseases
Authorised by
Ref: 4812
Page 28 of 29
Issue 6: June 2012

Canterbury DHB

1.5.1
Notifiable Disease Fax Form
Authorised by
Ref: 4812
Page 29 of 29
Issue 6: June 2012


4812 Volume 10 Transmission Based Precautions Isolation Guidelines PDF

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Volume 10 Infection Prevention and Control

Transmission-Based Precautions (Isolation Guidelines)

1 Transmission-Based Precautions (Isolation Guidelines)

Transmission-based Precautions (Isolation Guidelines)

Allocation of single rooms or cohorting of patients

Transmission-based Precautions are always used in addition to Standard

Issue 6: June 2012

Volume 10 Infection Prevention and Control

Transmission-Based Precautions (Isolation Guidelines)

Protective (Environment) Precautions

Issue 6: June 2012

Volume 10 Infection Prevention and Control

Transmission-Based Precautions (Isolation Guidelines)

Summary Chart for Transmission-based Precautions

Single Room with ensuite

Designate toilet/shower and label clearly for

Patient to wear surgical mask while

Non applicable as should have

Designate toilet/shower and label

Negative Air Pressure

No positive pressure hepa filtered

May be open. Closed during dust/aerosol

Closed at all times

Closed at all times in positive pressure

Dedicated equipment or disinfect between use.

Dedicated equipment or disinfect

As per Standard Precautions

Ensure equipment is clean before being

Antimicrobial liquid soap or

Plain liquid soap or

Plain liquid soap or

Liquid soap or alcohol-based handrub

For contact with patient or environment.

As per Standard Precautions

As per Standard Precautions

Clean gloves and no-touch technique

Wear gown when close physical contact, e.g.

As per Standard Precautions

As per Standard Precautions

As per Standard Precautions

Not generally indicated. May be required in

Surgical mask when entering the

Particulate Respirator (N95) on

No mask required. Staff or visitors with

Issue 6: June 2012

Volume 10 Infection Prevention and Control

Transmission-Based Precautions (Isolation Guidelines)

some circumstances, e.g. bed making or if

patients room. Remove at exit to the

entering room (sized and fitted

upper respiratory tract infection should

As per Standard Precautions, i.e. if procedure

As per Standard Precautions, i.e. if

As per Standard Precautions, i.e. if

As per Standard Precautions, i.e. if

Place in red linen bag with water soluble liner.

Place in red linen bag with water

No special precautions for linen.

No special precautions for linen.

As per infectious/medical waste disposal.

As per infectious/medical waste

Disposal as per infectious/medical