Isolation Precautions

Isolation Precautions in Health Care Facilities (HCF)

Introduction
As highlighted in the chapter on Importance of Infection Control in the Health Care Setting, there are three elements needed to allow transmission of microorganisms within a health care facility. These are a source of the microorganism (e.g., patients, personnel, visitors, equipment or the inanimate environment), a susceptible host and a mode of transmission. The former two elements are more difficult to control or prevent; therefore, the emphasis on interrupting transmission is to prevent the mode of transmission. This is accomplished by two main tiers of precautions: Standard Precautions (SP) and Transmission-Based Precautions. Standard precautions (SP) are the primary strategy for preventing transmission of microorganisms to patients, personnel, and others in the health care facility (HCF). They are applied to all patients because microorganisms are likely present in patients with recognized and unrecognized infection. In addition, far greater numbers of patients are colonized with epidemiologically important microorganisms in HCF than those with clinical signs of infection. The purpose of this chapter is to outline components of SP and Transmissionbased precautions. The latter are designed for patients with documented or suspected infection with communicable or epidemiologically important pathogens for which additional precautions beyond SP are needed to interrupt transmission. 9 The aim of isolating a patient is to prevent the spread of communicable diseases. Some key aspects of transmission-based precautious include: An understanding of the epidemiology of communicable diseases is helpful to assist with decisions regarding specific isolation precaution procedures. 47 The essence of a successful isolation policy is to create a barrier between the patient and other people, e.g., staff and patients. Isolating the patient in a single cubicle or in a room with en suite facilities, when available, is optimal. A high index of suspicion-often using clinical clues alone at the time of admission- should trigger an assessment for need for precautions 76

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beyond SP. Appropriate infection precautions must commence on clinical suspicion; laboratory confirmation is not necessary. All the recommendations of an isolation precautions program should be based on the real capabilities of the hospital. A continuing education program must first be directed to nurses, as they are the personnel with the greatest physical contact with patients. 48 In addition, HCP should recognize that isolation precautions have disadvantages for the patient including negative psychological aspects of separation from others and additional equipment for care.

Note: If more than one patient is affected (e.g. in an outbreak) they should be nursed together in one room (cohort isolation) and looked after by dedicated staff. 9 Limited movement and transport of isolated patients is essential. They must leave their rooms only for essential purposes in order to minimize spread in the hospital. 11

Notification of Communicable Diseases to District Health Office

Medical practitioners attending patients known to be suffering from or suspected to be suffering from a notifiable communicable disease, have an obligation to inform the District Surveillance Unit (at the district health office). It is also important that all such cases are reported to a member of the Infection Control Team. This should be done as soon as possible. Notification should occur on clinical suspicion of the disease and not dependent on laboratory confirmation. 11

Transmission of Infection
Microorganisms are transmitted in HCF by several routes and the same microorganism may be transmitted by more than one route. There are five main routes of transmission: Contact a) Direct-contact: Direct body surface-to-body surface contact and physical transfer of microorganisms between susceptible host and infected or colonized person. b) Indirect-contact: Contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as a contaminated instrument, needle, or dressing, or contaminated hands of HCP. Droplet: Droplets generated by the infected person by cough, sneeze, talking,

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or during a procedure such as suctioning the persons respiratory tract travel a short distance (1-2 meters) and are deposited on a susceptible hosts conjunctivae, nasal mucosa, or mouth. Airborne Dissemination of either droplet nuclei (small particle residue <5 microns) or dust particles containing microorganisms into the air are then inhaled by a susceptible host. This can occur over significant distances via normal air and ventilation systems. Common vehicle Transmission via contaminated food, water, medications, blood products, devices, and equipment. Vector-borne Transmission of microorganisms via mosquitoes, flies, ticks, etc.

Neither common vehicle nor vector-borne transmission play a significant role in typical hospital-associated infections (HAI) and will not be discussed here. Routes of transmission of infection from infected hospital patients: Hands of the HCP (the most common route); Contact with contaminated instruments; Exposure of the respiratory tract; Environmental factors (dust, fluids) and skin scales. (Environmental factors contribute when the colonization rates are high and when the bacteria are widely dispersed).

[For more details see chapter Importance and Purpose of Infection Control in the Health Care Setting]

Standard Precautions (SP)

A significant proportion of infectious diseases can be incubating, can cause no symptoms, or can result in chronic infection (e.g. hepatitis C virus) among patients who are exposed to these pathogens. SP is the foundation of protection for personnel against exposure to infectious agents during all patient care activity. SP is a system of precautions that is designed to reduce the risk of transmission of blood-borne pathogens and other pathogens present in body substances. Terminology applied to precautions against blood-borne pathogens that often is confused with SP, is universal precautions (UP). UP were developed originally to focus attention on precautions against occupational exposure to body fluids that were likely to contain blood-borne pathogens (i.e. blood, semen and vaginal secretions, cerebrospinal, pericardial, peritoneal, pleural, and synovial fluids, and

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other body fluids visibly contaminated with blood). 49, 50 UP against blood-borne pathogens did not apply to feces, nasal secretions, sputum, sweat, tears, urine, or vomitus unless visibly contaminated with blood. In the mid-1980s a group of infection control professionals in the US developed a system of precautions called body substance isolation (BSI) whose aim was to interrupt transmission of endemic infection in HCFs and to protect HCP and others. BSI was applied to all moist and potentially infectious body substances (blood, secretions and excretions) and surfaces and equipment -if contaminated. SP is a synthesis of these two systems. They apply to: 1) blood; 2) all body fluids, secretions, and excretions regardless of whether they contain visible blood, 3) nonintact skin, 4) mucous membranes and contaminated surfaces or equipment.
The components of SP are discussed earlier in chapter 1 Importance of Infection Control in the Health Care Setting, page 22.

Practical Issues and Considerations

Hand Hygiene
Hand hygiene is essential in reducing the risk of infection transmission from patient to patient or from one site to another site on the same patient. Routine handwashing or antiseptic hand wash should be performed promptly between patient contacts, after contact with infective material (blood, body fluids, secretions or excretion), and after contact with contaminated items used for patient care. Hands should be washed or an alcohol based handrub should be used immediately after removing gloves.

Covering Cuts
Cover cuts or areas of broken skin with waterproof dressings while at work. Health care personnel with large areas of broken skin must avoid invasive procedures. Staff with eczema or other skin conditions or with large wounds which cannot be adequately protected by plastic gloves or impermeable dressings should refrain from patient care and from handling patient care equipment until the condition resolves.

Personnel Protective Equipment (PPE)

Appropriate PPE, e.g., gloves, masks, gowns, protective eyewear, should be worn for the procedures that are likely to generate droplets, splashes, or sprays of blood or body fluids in order to protect skin and mucous membranes.
(For more details see below: PPE for Isolation Procedures)

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Safe Use of Sharps

Avoid sharps usage whenever possible. If the use of sharps is necessary, then sharps must be used and handled with care. Never leave sharps lying around; dispose of them carefully into a designated sharps container. HCP should be instructed that it is the personal responsibility of the person using a sharp to dispose of it safely as soon as possible after use or to ensure that it has been safely discarded.
[For more details see chapter Waste Management II Sharps Disposal]

Monitoring Staff Health

It is important that HCP are appropriately and adequately immunized against infectious diseases, both for their own protection and for the protection of others. Staff who are suffering from a known or suspected infectious disease must report this to the Occupational Health Department, which will advise on the management and on exclusion from work if necessary. Sharps injuries and any exposure of non-intact skin, conjunctiva, or mucous membrane to blood or highrisk body fluids should be recorded and reported to a responsible person from the Occupational Health Department.
[For more details see chapter Occupational Safety and Employee Health]

Removing Spills of Blood and Body Fluids

Spillage of blood and body fluids must be cleaned carefully and promptly using a safe method including protective measures for housekeeping staff.

Cleaning and Disinfecting Patient Care Equipment

Patient care equipment is either single-use disposable or re-usable. Single-use items should be discarded as clinical waste while non-disposable items should be appropriately cleaned and disinfected or sterilized before re-use.

Disposing of Waste Safely

Waste from patients with a known or suspected infection should not be treated any differently than waste from patients without known infection. Studies of waste from patients under isolation precautions have shown it carries no greater microbial load than from those who are not on isolation precautions.
[For more details see chapters Waste Management II Sharps Disposal and Environmental Cleaning]

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Collecting and Reprocessing Linen Safely

Although soiled linen may be contaminated with pathogenic microorganisms, the risk of transmission is negligible. Soiled linen should be handled with a minimum of agitation and should be placed in a laundry bag.
[For more details see Linen Management]

Cleaning the Environment

Special attention must be given to ensure the environment is maintained in a clean state and is in line with good housekeeping practices. Terminal cleaning of the patient rooms should be carried out at the discharge of the patient before admitting another patient: When visibly soiled, all the surfaces and walls must be washed thoroughly with warm water and detergent and be dried (wiped over with a disinfectant if indicated). Launder all bed linen and cubicle curtains, etc. when visibly soiled The covers of bed mattresses and pillows should be wiped with warm water and detergent and dried thoroughly. Occasionally, a disinfectant may be indicated. Where special cleaning arrangements are required, the supervisor must be informed of the infection risk (not of the patients diagnosis) and of any protective measures necessary for the staff.

[For more information see chapter Environmental Cleaning]

Dishes, Glasses, Cups, and Eating Utensils

No special precautions are needed for dishes, glasses, cups, or eating utensils. Either disposable or reusable dishes or utensils can be used for patients on isolation precautions. The combination of hot water and detergents used in hospital dishwashers is sufficient to decontaminate dishes, glasses, cups, and eating utensils.

PPE for Isolation Procedures

The indications for the use of protective clothing for isolation aseptic procedures are uniform. Recommendations for protective clothing for different isolation categories are discussed later in the transmission based precautions sections. 9

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Deceased Patients
As a general rule the infection control precautions prescribed during life are continued after death. In cases where there is an infection risk from the body, a Danger of Infection label must be attached to the patients armband. If a person that is known to be infected or that is suspected to be infected dies, either in the hospital or elsewhere, it is the duty of those with knowledge of the case to ensure that those who handle the body are aware that there is a potential risk of infection that is minimized by using the appropriate control measures. Even without any information about the presence of infection in the deceased, SP should always be used. 11

Transmission-Based Precautions
Whenever isolation of a patient is considered, assessment of risk should be carried out and the disadvantages should be weighed against the benefits. The placement of a patient into isolation should never be undertaken as a matter of convenience. Second tier precautions are designed only for patients that are known or suspected to be infected with highly transmissible or epidemiologically important pathogens for which additional precautions beyond Standard Precautions are needed in order to interrupt transmission in hospitals. 11, 48 Please note however that SP still need to be employed even for patients placed on transmission-based precautions. There are three types of Transmission-Based Precautions: Airborne precautions (prevent transmission by air current). Droplet precautions (prevent transmission by small and large droplets). Contact precautions (prevent transmission by direct or indirect contact). Combination of airborne and contact precautions

Airborne Precautions
Airborne precautions (AP) are used for infections which are transmitted by droplet nuclei. Droplets are generated in the course of talking, coughing, or sneezing and during procedures that involve the respiratory tract such as suction, physiotherapy, intubation, or bronchoscopy. Small droplet nuclei size of 5 can be widely dispersed by air currents and can reach the alveoli of the susceptible host and cause infection. Patients under airborne isolation precautions should be in a single room with negative airflow ventilation with respect to the surrounding areas. The door must be kept closed.

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Examples of diseases in this category include: Tuberculosis Measles

Large droplet nuclei particle size is 5 in diameter containing infectious particles. These droplets do not remain suspended in the air long and travel only short distances. Transmission from larger droplets requires close contact (e.g. within 2 m) between the infected source and the recipient. Examples of diseases in this category include: Meningococcal meningitis Pertussis Streptococcal pharyngitis, and Multidrug resistant Streptococcus pneumoniae Table 7: Summary of Airborne Precautions A single room under negative pressure ventilation with a wash hand basin and preferably with an en suite toilet. The door must be kept closed at all times except during necessary entrances and exits. Unnecessary items of equipment must be removed before the patient occupies the room. Disposable paper towels and an antiseptic/detergent hand cleanser in an elbow operated pump dispenser should be provided.

Location

Staff Visitors

When applicable, only personnel that have immunity against varicella and measles should care for these patients. All visitors must seek advice from the nurse-in-charge of the ward before visiting the patient. A high efficiency mask, if available, should be worn when entering the room of a patient with known or suspected tuberculosis. Other PPE should be used consistent with SP.

Protective clothing

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Table 7: Summary of Airborne Precautions (continued) Hands must be washed with an antiseptic preparation and must be dried thoroughly with a disposable paper towel, or use a waterless alcohol hand rub/gel Hand hygiene Linen AFTER touching the patient or potentially contaminated items, AFTER removing gloves, and BEFORE taking care of another patient.

No special handling is needed for used or soiled linen.

Limit the movement and the transport of the patient to Inter-departmental essential purposes only. Seek advice of the Infection visits Control team Laboratory specimens No special labeling or precautions are needed. The infection control precautions employed during life must be continued after death. In the case of open tuberculosis, the body must be labeled with a Danger of infection label on the wrapping sheet or shroud and on the information sheet.

Last offices

Droplet Precautions
For those infections which are spread by large droplets. Examples Pneumonic plague Influenza Rubella Invasive miningococcal disease (meningitis, pneumonia meningococcemia etc.)

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Table 8: Summary of Droplet Precautions Location Staff Visitors PPE A private room with a wash hand basin and an en suite toilet is necessary. No exclusions. Visitors must always report to the nurse in charge before entering the room. Put on a standard mask prior to entering the isolation room. Hands must be washed with an antiseptic preparation and must be dried thoroughly with a disposable paper towel or washed with a waterless alcohol hand rub/gel: Hand hygiene AFTER contact with the patient or potentially contaminated items, AFTER removing gloves, and BEFORE taking care of another patient.

Decontamination and No specific precautions. waste disposal

Contact Precautions (CP)

These precautions are used for patients to prevent the transmission of communicable diseases and of epidemiologically important microorganisms which are causing infection or colonization and which are transmitted by direct patient contact or by indirect contact with the patient or the patients environment, excretion, and secretion. Examples of these infections include: Respiratory syncytial virus Disseminated herpes simplex (e.g., neonatal) Streptococcal and staphylococcal infections (e.g., major skin infection) Methicillin-resistant Staphylococcus aureus (MRSA) Multi-resistant Gram-negative bacteria, Vancomycin resistant enterococci (VRE) Clostridium difficile associated diarrhea

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Table 9: Summary of Contact Precautions A single room with an en suite toilet is necessary if the infective agent might be disseminated into the Location environment or if the microorganism has epidemiological importance at the HCF. Staff Visitors There are no special qualifications for personnel. Visitors must always report to the nurse-in-charge before entering the room. Non-sterile, disposable gloves are needed when there is contact with an infected site, with dressings, or with secretions. A mask when performing procedures that may generate aerosols or when performing suctioning is recommended. Hands must be washed with an antiseptic preparation and must be dried thoroughly with a disposable paper towel or washed with a waterless alcohol hand rub especially: Hand hygiene Linen Decontamination and waste disposal AFTER contact with the patient or potentially contaminated items, AFTER removing gloves, and BEFORE taking care of another patient. Non-disposable items should be sent to Sterile Service Department (SSD) for disinfection/sterilization. Waste: Contaminated waste is disposed of as clinical waste according to local policy.

PPE

No special handling is needed for used or soiled linen.

Combination of Airborne + Contact (A+C) Precautions

This type of isolation is used to prevent transmission of diseases spread both by air and by contact and is used for patients with highly transmissible and dangerous infections. Diseases requiring combination Airborne & Contact isolation include: Chicken pox (Varicella). Others as determined by Hospital Infection Control team.

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Table 10: Summary of Airborne & Contact precautions11 Patients must be admitted into a single room under negative pressure ventilation and, if available, with an ante room with wash hand basin and en suite toilet facilities. Location The door must be kept closed except during necessary entrances and exits. Unnecessary items of equipment must be removed before the patient occupies the room. The mattress and pillows must have non-permeable, intact covers. Disposable paper towels and an antiseptic/detergent hand cleanser in an elbow operated pump dispenser must be provided. The patients charts should be kept outside the room.

Staff

Minimize the number of personnel needed for care and assure those assigned are immune to the disease for which the patient is isolated, if applicable. Visitors must be kept to a minimum and must always report to the sister or nurse-in-charge before entering the room. Visitors must observe the same infection control precautions as personnel. Non-sterile gloves, a gown, or disposable apron, and a high-filtration mask, if available. Eye protection is needed for any procedure that might cause splashes of blood and body fluids.

Visitors

PPE

Hands must be washed or a hand rub containing an antiseptic applied: Hand Hygiene BEFORE leaving the room. This is extremely important. AFTER touching the patient or touching potentially contaminated items, AFTER removing gloves and AFTER removing protective clothing.

When leaving the room the door should be pushed open from the outside by an assistant in order to avoid touching the door handle which may be contaminated. When outside, repeat the hand-disinfection.

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Table 10: Summary of Airborne & Contact precautions ( continued) Decontamination and Waste Disposal Laundry Inter-departmental visits Laboratory specimens Non-disposable items should be sent to Sterile Service Department (SSD) for disinfection/sterilization. Waste: Contaminated waste is disposed of as clinical waste according to local policy.

Routine laundering is sufficient for used linen. The patient must not leave the room without prior consultation with the Infection Control Physician. Routine procedures should be used for laboratory specimen. Special labeling is not indicated and only promotes a false sense of security. The infection control measures employed during life must be continued after death. Any bleeding part must be covered with an occlusive dressing. The body must be transported in an appropriate sealed cadaver bag and labeled with a Danger of Infection-sticker.

Last offices

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Table 11: Summary of components of standard infection control precautions and of transmission based precautions in isolation procedures: 51

Standard Hand Hygiene When likely to touch blood, body fluids and contaminated items
During procedures likely to generate contamination with blood and body fluids During procedures likely to generate contamination with blood and body fluids During procedures likely to generate contamination with blood and body fluids

Contact
On entering room, during care

Droplet
As per Standard

Airborne
As per Standard

Gloves

As per Standard

Mask

As per Standard and if present within 1 meter of patient As per Standard

On enteringthe room. Non-essential susceptible people should be excluded. For TB wear highefficiency mask As per Standard

Eye protection /face shield

As per Standard

Apron/gown

On entering if contact with patient or environment anticipated

As per Standard

As per Standard

Equipment Environment (Cleaning, etc.) Linen

Single room not required

Single room and minimize time outside

Single room, minimize time outside to when patient may wear mask

Single room with negative pressure ventilation, minimize time outside to when patient may wear mask. Exclude nonessential susceptible people

Isolation room

= According to description in text

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Practical Guidance for Decision Makers on Isolation

At any one time hospitals might have more patients with potentially transmissible infections needing isolation rooms than they have rooms available. Consistent and evidence-based decisions should therefore be made on prioritization for the use of such isolation. Limited resources available and competing priorities might make the decision difficult to make. In the absence of widely used accepted guidelines, these decisions may not be consistent. When faced with the need to prioritize the use of isolation facilities, the following factors, which influence transmission and its impact, should be considered, e.g., a risk assessment should be performed: 1. Advisory Committee of Dangerous Pathogens (ACDP) Classification of Pathogens: The ACDP classification provides an acknowledged system of classifying organisms based on their transmissibility, pathogenicity, and on our ability to protect against or treat individual infections. 2. The probable route of transmission: Air-borne infections are those most likely to spread readily if not isolated; blood-borne infections are least likely to do so. 3. Evidence for transmission: Although 1) and 2) may suggest transmission, the emphasis placed on evidence-based medicine now supports a requirement to demonstrate that transmission of specific infections has indeed occurred in hospitals. 4. Occurrence of infection in the hospital: The incidence or prevalence of an infection/colonization in a hospital is frequently a consideration when deciding whether or not to isolate a patient. In a sporadic infection, isolation of a patient will have a higher priority than in endemic or epidemic situation. 5. Antibiotic resistance: Emergence of antibiotic resistant bacteria is one of the principal causes of the increased demand on isolation facilities. 6. Susceptibility of other patients: When deciding whether or not to isolate a case, the presence of a susceptible patient population promotes the isolation of the potential source of sepsis. 7. Dispersal characteristics of patient: While transmissibility of various infections has been addressed in 1,2, and 3, it is well recognized that for a given infection certain patients present greater transmission hazards than others. The table below shows an example of a scoring system applied to risk assessment for the prioritization of potential isolation cases.

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Table 12: Risk Assessment Scoring System for Assigning the Priority of Isolation (Lewisham Isolation Priority System-LIPS) CRITERIA CLASSIFICATION
2 ACDP category 3 4 Air-borne Route Droplet Contact Blood-borne Published evidence Consensus or likelihood No consensus or likelihood No evidence Significant resistance High susceptibility of other patients with serious consequences Yes No Yes No Sporadic Endemic Prevalence 5 10 40 15 10 5 0 10 5 0 - 10 5 0 10 0 0 -5 This reflects the burden of infection in the hospital and cohort measures are more applicable See above Only for contact and droplet transmission, e.g. eczema, fecal, incontinence, tracheostomy, etc. Specific for various infections and patient populations Such as MRSA, GRE, etc. Include fecal-oral transmission

SCORE

COMMENTS

Evidence of transmission

Epidemic High risk

-5 10

Dispersal Medium risk Low risk TOTAL SCORE 5 0

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Category of priority for isolation Low Medium High

Score 0 20 21 39 40 - 50

Table 13: Isolation Precautions Reference Table

Standard Precautions must be applied in all circumstances Disease

Acute Respiratory Infections Anthrax Bacillus anthracis Chickenpox

Type of isolation precaution

Droplet & Contact Standard

Infective Material
Respiratory secretions and feces Respiratory and/or lesion secretions Respiratory and/or lesion secretions

Duration of Isolation
For 7 days after onset of illness Duration of illness

Comments
Infants and young children only No additional precautions Persons susceptible to varicella should not enter the room

Airborne + Contact

Until all lesions are crusted. For exposed, susceptible patients from 10 until 21 days after last day of exposure. Duration of hospitalization

Disseminated Herpes Zoster

Airborne + Contact

Lesion secretions

Persons susceptible to varicella should not enter the room Persons susceptible to varicella should not enter the room

Localized Herpes Zoster (Shingles) (immunosuppressed patient) Localized Herpes Zoster (Shingles) Clostridium botulium Clostridium difficile Creutzfeldt-Jakob disease

Airborne

Lesion secretions

Duration of hospitalization

Standard Standard Contact Standard

Lesion secretions Secretions Feces, Pus Blood, brain, tissue, and spinal fluid Duration of illness Duration of hospitalization OR, Materiel Services, Pathology have specific procedures. No special precautions

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Table 13: Isolation Precautions Reference Table (continued) Disease

Diphtheria (pharyngeal)

Type of isolation precaution

Droplet

Infective Material
Respiratory secretions

Duration of Isolation
Until after 2 cultures, taken at least 24 hrs apart, are negative (following appropriate therapy For 7 days after onset Until after 24 hrs of appropriate antibiotic therapy Duration of hospitalization

Comments

Erythema infectiosum (Fifth Disease) (also Parvovirus B19) Haemophilus influenzae pneumonia/meningitis, Pediatrics only Hemorrhagic fevers (for example, Lassa and Ebola) Hepatitis A

Standard

Respiratory secretions Respiratory secretions Blood, body fluids, and respiratory secretions Feces may be

Droplet

Contact

Report immediately to epidemiological and surveillance unit Hepatitis A is most contagious before symptoms and jaundice appear. Use caution when handling blood and blood-soiled articles. Take special care to avoid needlestickinjuries For neonate or severe mucocutaneous Contact Precautions

Standard

For 7 days after onset of jaundice

Hepatitis B (including hepatitis B antigen HBsAg carrier)

Standard

Blood and body fluids

Until patient is HBsAg-negative

Herpes simplex

Standard

Lesion secretions

Herpes Zoster HIV, AIDS, Hepatitis C Standard Blood and body fluids

See Chickenpox Use caution when handling blood and blood-soiled articles. Take special care to avoid needle stick injuries.

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Table 13: Isolation Precautions Reference Table (continued) Disease

Viral influenza (A,B,C) Legionella

Type of isolation precaution

Droplet

Infective Material
Respiratory secretions No person to person transmission

Duration of Isolation
7 days after the symptoms

Comments
Group of patients during epidemics

Standard

Lice (pediculosis)

Contact

Gown/glove for direct patient care x24 hrs after treatment Respiratory secretions For 5 days after rash; if patient is immunosuppressed, duration of hospitalization For 7 days after onset Only susceptible persons should wear a mask, or if possible stay out of the room Enteroviruses are the most common cause of aseptic meningitis

Measles (rubeola), all presentations

Airborne

Meningitis Aseptic (nonbacterial or viral meningitis) Fungal Suspected or confirmed meningitis due to Neisseria meningitidis Mumps (infectious parotitis)

See enterovirus infections

Feces

Droplet

Respiratory secretions

Until after 24 hrs of appropriate antibiotic therapy

Droplet

Respiratory secretions

Until 9 days after onset of swelling. Mask not required if immune Until after 24 hrs of appropriate antibiotic therapy

Personnel who are not susceptible do not have to wear a mask

MRSA (Methicillin resistant S. aureus infections) NRSA (Nafcillin resistant S. aureus infections) Neisseria meningitidis, invasive (meningitis, pneumonia, sepsis)

Contact

Droplet

Respiratory secretion

Until after 24 hrs of appropriate antibiotic therapy

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Table 13: Isolation Precautions Reference Table (continued) Disease

Parvovirus B19 (Fifth disease) (patients in aplastic crisis)

Type of isolation precaution

Droplet

Infective Material
Blood and respiratory secretions

Duration of Isolation
For 7 days if patient is in aplastic crisis. For duration of hospitalization when chronic disease occurs in an immune deficient patient Until after 5 days of appropriate antibiotic therapy Duration of Hospitalization Duration of hospitalization 7 days after onset rash. [Infants with congenital Rubella may shed virus for months, call I.C.]

Comments

Pertussis (whooping cough) Pneumonic plague Rabies Rubella (German measles)/ Rubella Syndrome

Droplet

Respiratory secretions Respiratory secretions Respiratory secretions Respiratory secretions

Standard Standard Droplet

Mask not required if immune. Susceptible person should stay out of the room if possible

Scabies

Contact

Gown/glove for direct patient care x 24 hours after treatment Lesion secretions Purulent material Duration of Hospitalization Until cultures are negative for group A streptococcus.

Small pox Streptococcus, Group A *Necrotizing Fasciitis, Wound Respiratory, Pharyngitis

A+C Contact

Droplet

Respiratory secretions

Until cultures are negative for group A streptococcus.

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Table 13: Isolation Precautions Reference Table (continued) Disease

Tuberculosis Pulmonary, pharyngeal

Type of isolation precaution

Airborne

Infective Material
Respiratory/AFB

Duration of Isolation
Minimum of 14 days after chemotherapy is begun. Reduction in number of TB organisms on sputum smear and clinical response must also be present. If patient is smear negative and demonstrates clinical improvement, duration of precautions may be 5 days. If MDRTB, duration of hospitalization. See chickenpox Duration of hospitalization Duration of hospitalization or until original site and 3 perianal cultures are negative

Comments

Extrapulmonary

Standard

Pus

Varicella Zoster Viral hemorrhagic infection (Ebola, Lassa, Marburg) Vancomycin Resistant Enterococcus (VRE)

Airborne Contact

See chickenpox

Contact

Whooping cough (pertussis)

Droplet

Respiratory secretions

See pertussis

If patient has any respiratory symptoms, implement Respiratory Secretion Precautions until group A streptococcal respiratory infection is ruled out.

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