All clients admitted to the hospital automatically are considered to be on standard precautions. The diseases listed below require standard precautions plus additional precautions that are noted in the isolation/precaution column. Infection/Condition Isolation/Precautions Infective Material Duration of Isolation Comments Amebiasis (Entamoeba histolytica) Dysentery Contact Precautions Feces Duration of illness-until Bronchiolitis Contact Precautions (for only). Duration of illness-until If respiratory syncytial virus (RSV) antigen positive, refer to RSV. Various etiologic agents have been associated with this syndrome, i.e., respiratory syncytial virus (RSV), parainfluenza viruses, adenoviruses, influenza viruses. Chickenpox (Varicella) Airborne and Contact Precautions Clostridium difficile enterocolitis Airborne droplets and skin lesions Until all lesions are crusted (at least 5 days after onset of lesions). Contact Isolation Feces Duration of illness-until symptom free Susceptible persons should not enter the room. Persons immune from previous varicella infection may enter the room without a mask. Those immune by vaccination should wear a mask when entering the room. A specially vented room is necessary. The door to the client s room should remain closed. The client must wear a mask when leaving their room. Susceptible clients who have been exposed should be placed on Airborne Precautions beginning 10 days after exposure and continuing through day 21 after last exposure (up to 28 days if VZIG has been given). Clients are considered infectious 2 days before onset of rash and up to 5 days after onset of lesions. After exposure, use varicella zoster immune globulin (VSIZ) as recommended by Infectious Diseases Service. 1
Common cold (for infants and young children only). Conjunctivitis, viral (acute hemorrhagic) Decubitus ulcer, infected, major Diphtheria Cutaneous Duration of illness-until Contact Isolation Eye drainage Duration of illness-until Contact Isolation Wound drainage Depends on the extent and condition of the ulcer. Contact Precautions Wound drainage Until cultures from infected sites are negative for Corynebacterium diphtheriae on two separate days. Collect cultures > 24 hours apart and not sooner than 24 hours after the last dose of antibiotics. Rhinoviruses are most frequently associated with the common cold. Infection is usually mild in adults, but may be severe in infants and young children. Other etiologic agents such as respiratory syncytial virus (RSV) and parainfluenza viruses may also cause this syndrome. Major: No dressing or dressing does not adequately contain drainage. Pharyngeal Until cultures are negative for Corynebacterium diphtheriae on two separate days. Collect cultures > 24 hours apart and not sooner than 24 hours after the last dose of antibiotics. Epiglottitis Escherichia coli gastroenteritis (enteropathogenic, enterotoxigenic, enteroinvasive, enterohemorrhagic) Contact Precautions Feces Epiglottis is often due to Haemophilus influenzae. 2
Fifth s Disease/Erythema Until onset of rash (not Infectiosum (Parvovirus considered infectious after B19) appearance of rash). German Measles and For 7 days after onset of rash. Rubella urine Congenital rubella (does not require room with negative pressure and external exhaust) Contact Precautions (does not require room with negative pressure and external exhaust) and urine Isolation is required during any admission for the first year after birth, unless nasopharyngeal and urine cultures after 3 months of age are negative for rubella Susceptible persons should not enter the room. Persons immune by vaccination or natural illness may enter the room without a mask. Susceptible clients who have been exposed should be placed on beginning 7 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious a few days before to7 days after onset of rash. Haemophilus influenzae, invasive Epiglottitis Meningitis and Occupational health (for Pneumonia (for only). and Occupational health (for 3
Hand, foot, and mouth Contact Precautions and For 7 days after onset. disease feces Hepatitis, viral Type A Contact Precautions (for diapered or incontinent clients) Feces Duration of illness Herpes simplex Mucocutaneous Disseminated severe or primary Contact Precautions Lesion secretions Duration of illness-until Neonatal Contact Precautions Until lesions dry and crusted Herpes zoster (Shingles) Disseminated Airborne and Contact Precautions Lesion and respiratory secretions Duration of -until all lesions are crusted. Persons susceptible to varicella should not enter the room. Clients who have been exposed should be managed in consultation with Infection Control. Impetigo Contact Precautions Lesions For 24 hours after start of effective antibiotic therapy. 4
Lice (pediculosis) Contact Precautions Infested area Until effective treatment has been completed and room/ personal items adequately disinfected. Measles (rubeola, red measles) Airborne Precautions (use a monitored room with negative pressure and external exhaust) For 4 days after onset of rash. For immunocompromised patients, maintain precautions for duration of illness. Infection/Condition Isolation/Precautions Infective Material Duration of Isolation Comments Influenza Duration of illness-until In the absence of an epidemic, influenza may be difficult to diagnose on clinical grounds. During epidemics, the accuracy of diagnosis increases. Cohorting of clients may be considered during periods of high census. Immunization is strongly encouraged for health care providers and clients at risk for serious complications. Contact Infectious Diseases Service for recommendations regarding the use of prophylaxis for nonimmunized persons. Employees with direct contact should be examined for infestation. Clothing and bedding may be disinfected by machine washing and drying *use hot cycles). Dry cleaning or storing items in a plastic bag for 10 days is also effective. Use of an environmental insecticide is not needed. Promptly notify Infection Control. Susceptible persons should stay out of the room. All other persons should wear a mask upon entry. A specially vented room is necessary. The client must wear a mask when leaving the room. The door to the client s room should remain closed. Susceptible clients who have been exposed should be placed on Airborne Precautions beginning 5 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious 4 days before to 4 days after onset of rash. 5
Meningitis Haemophilus influenzae, known or suspected Neisseria meningitis (meningococcal), known or suspected Viral (aseptic or nonbacterial) Contact Precautions (for only Feces Duration of illness-until symptoms free. Enteroviruses are the most common cause of aseptic meningitis. Meningococcal pneumonia (Neisseria meningitidis) Treatment for both system exposure, call infectious Diseases Meningococcemia (meningococcal sepsis) (Neisseria meningitidis) Treatment for both system exposure, call infectious Diseases 6
Multi Drug Resistant Contact Precautions Organisms (MDRO) Methicillin-resistant Staph. Aureus (MRSA) infection or colonization Vancomycin-resistant enterococcus (VRE) Contact Precautions Mumps (does not require a room with negative pressure and external exhaust) Wound drainage and/or secretions/excretions from colonized/infected sites Wound drainage and/or secretions/excretions from colonized/infected sites. Until 2 cultures obtained after completion of antibiotic treatment are negative on 2 separate days, from all previously colonized/infected sites (including nasal colonization, if applicable). For 9 days after onset of swelling. Previously positive clients must be placed on Contact Precautions when readmitted to the hospital until repeat cultures are negative as per criteria under Duration of Isolation. Susceptible personnel who have been exposed should be excluded from work from the 12 th day after exposure through the 26 th day after exposure, or if symptoms develop until 9 days after the onset of parotitis. Parvovirus B19 Fifth disease (erythema infectiosum) Until onset of rash occurs (not considered infectious after appearance of rash). Pregnant healthcare workers are not excluded from contact with clients, but must comply with. Pharyngitis (for only) effective therapy Plague Pneumonic If client requires transport, must have mask on. 7
Pneumonia Adenovirus Droplet and Contact Precautions (for infants and young children only) and feces Duration of illness-until Bacterial not listed elsewhere (including gram-negative bacteria) (for only) Duration of illness-until Etiology unknown (for only). Use Contact Precautions during RSV season, during an RSV outbreak, or if RSV is in the diagnostic differential. Resume if RSV is ruled out. Duration of illness-until If respiratory syncytial virus (RSV) antigen positive, refer to RSV. Haemophilus influenzae (for only) Herpes simplex Duration of illness-until symptom free Meningococcal (Neisseria meningitidis) Respiratory syncytial virus (RSV) infection or suspected Contact Precautions Until symptom free and nasopharyngeal antigen test is negative for RSV (at least 1 week after positive test) on 2 consecutive days. To avoid the possibility of falsenegative test results, the calgi swab method should be used to obtain nasopharyngeal specimens. Rotavirus infection Contact Precautions Feces Duration of illness and stool study negative for rotavirus on 2 separate days. 8
Rubella German Measles (does not require room with negative pressure and external exhaust) For 7 days after onset of rash. Susceptible persons should not enter the room. Persons immune by vaccination or natural illness may enter the room without a mask. The client must wear a mask when leaving the room. Susceptible clients who have been exposed should be placed on beginning 7 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious a few days before to 7 days after onset of rash. Congenital Rubella SARS (Severe Acute Respiratory Syndrome) Contact Precautions (does not require room with negative pressure and external exhaust) Airborne and Contact Precautions with goggles over eyes Respiratory droplets Isolation is required during any admission for the first year after birth, unless nasopharyngeal and urine cultures after 3 months of age are negative for rubella. Scabies Contact Precautions Infested area For 24 hours after start of effective therapy and room/ personal items adequately disinfected. Susceptible persons should not enter the room. Persons immune by vaccination or natural illness may enter the room without a mask. Susceptible clients who have been exposed should be placed on beginning 7 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious a few days before to 7 days after onset of rash. Employee with direct contact should be examined for infestation. Clothing and bedding may be disinfected by machine washing and drying (use hot cycles). Dry cleaning or storing items in a plastic bag for 10 days is also effective. Use of an environmental insecticide is not needed. 9
Scarlet fever (for only) For 24 hours after effective therapy. Shingles (Herpes zoster) Disseminated Airborne and Contact Precautions (use a monitored room with negative pressure and external exhaust) Lesion secretions Duration of illness until all lesions are crusted. Persons susceptible to varicella should not enter the room. Persons immune from prior natural illness or vaccination may enter without a mask. The door to the client s room should remain closed and the client must wear a mask when leaving. Susceptible clients who have been exposed should be managed in consultation with Infection Control. Clients are considered infectious 2 days before onset of rash and up to 5 days after onset of lesions. Smallpox Airborne and Contact Precautions (strict gown/glove) Syphilis Skin and mucous membrane, including congenital, primary, and secondary Large and small respiratory droplets, skin lesions, secretions. Contact Precautions Lesion secretions, blood, body fluids Onset of rash to separation of scabs (approximately 3 weeks) For 24 hours after start of Private rooms preferred. In event of large outbreak, clients with same diagnosis can share respiratory isolation room. Limit client transport, if necessary, client wears mask. 10
Tuberculosis Pulmonary, confirmed or suspected (sputum smear is AFB positive and/or chest x-ray appearance strongly suggests active TB, i.e., cavitary lesions; or laryngeal. Airborne Precautions (use a monitored room with negative pressure and external exhaust) Airborne droplet nuclei A specially vented room is necessary. The door to the patient s room should remain closed. Persons entering the room should wear specially fitted NIOSH approved respiratory protection. The client should leave the room only for essential purposes, particularly if the client has multidrug-resistant TB. When leaving the room, the client should wear a high-filtration surgical mask; for mechanicallysupported ventilation, add a bacterial filter to filter the client' exhaled air. Typhoid fever (Salmonella typhi) Contact Precautions (for diapered and incontinent children) Feces Duration of illness-until Whooping cough (pertussis) For 7 days after start of effective therapy. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for 11