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Transmission Based Precautions: Initiation and Discontinuance (1101) Addenda VI, Alphabetical Disease/Organism Listing for Transmission-Based Precautions of 46

Addendum No.: 1

For Policy No.: 929

Originally Issued: 10/01/1988

Last Revision: May 2016

Transmission Based Precautions (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions

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Use the table below as a guide for applying the appropriate transmission-based precautions; additional measures may be required and assessed on a case by case basis. Upper respiratory viral infections in young pediatric patients (infants through 5 years of age) require contact and droplet precautions for the duration of illness.

DISEASE/ORGANISM CATEGORY OF PRECAUTIONS

INFECTIVE MATERIAL

DURATION OF PRECAUTIONS

COMMENTS

Abscess If specific organism isolated, see specific listing for further precautions.

Draining, major Contact Drainage Duration of drainage or until contained by dressing

Major = no dressing or dressing does not adequately contain the drainage.

Draining, minor or limited; not draining

Standard Drainage Minor or limited = dressing covers the wound and adequately contains the drainage, closed drainage system adequately contains the drainage, or infected area is small such as a stitch abscess.

Acquired Immunodeficiency Syndrome (AIDS) (See Human Immunodeficiency Virus)

Actinomycosis Standard No person to person transmission.

Adenovirus Infection (See agent specific guidance under conjunctivitis, gastroenteritis, respiratory infection, pneumonia)

Droplet and Contact

Respiratory secretions and feces

Duration of hospitalization

In infants and immunocompromised patients, see Respiratory Syncytical Virus (RSV). During epidemics patients believed to have adenovirus infection may share the same room. Consult with Hospital Epidemiology at such times.

AIDS (See Human Immunodeficiency Virus Infection)

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DISEASE/ORGANISM CATEGORY OF

PRECAUTIONS INFECTIVE

MATERIAL DURATION OF

PRECAUTIONS COMMENTS

Addendum No.: 1

For Policy No.: 929


Last Revision: July 2016

Amebiasis

Dysentery/colitis Contact Cysts in the feces

See Notifiable Diseases.

Liver abscess Standard If patient has concurrent colitis, initiate Contact

Precautions. See Notifiable Diseases.

Anthrax Bioterrorism Agent; Post-exposure prophylaxis; Consider post-exposure vaccine.

Cutaneous (skin lesions) Standard See comments

Drainage Contact Precautions if large amount of drainage that cannot be contained. Contaminated dressings and bed clothes should be incinerated or steam sterilized to destroy spores. Hand hygiene with soap and water is

preferred to alcohol-based sanitizers. See Notifiable

Diseases.

Pulmonary Standard See comments

Respiratory secretions (potentially)

See cutaneous anthrax; if patient has concurrent skin lesions. Autopsies performed on patients with systemic anthrax require special precautions. Consult with Hospital Epidemiology (1-2224) when autopsies are

necessary. See Notifiable Diseases.

Aerosolizable Spore-Containing Powder

Airborne and Contact

Spores Until environment is completely decontaminated

Wear N-95 mask or higher respiratory protection, protective clothing; decontaminate persons with powder on them. Hand hygiene for 30-60 seconds with sap and water or 2% chlorhexidine gluconate after spore contact.


Antibiotic-Associated Colitis (See Clostridium difficile)

Arthropod-borne Viral Encephalitides

Standard; Droplet for

CSF Blood

Not transmitted from person to person except rarely by transfusion and for West Nile Virus by organ transplant,


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(Eastern, Western, and Venezuelan Equine Encephalitis; St. Louis and California Encephalitis)

Venezuelan equine encephalitis (VEE)

Throat (VEE) by breast milk or transplacentally. Instruct those living in endemic areas to install screens in windows and doors. Instruct those living in/visiting endemic areas to use DEET-containing mosquito repellents and clothing to

cover extremities. See Notifiable Diseases.

Arthropod-borne Viral Fevers (Dengue, Yellow Fever, and Colorado Tick Fever)

Standard Not transmitted from person to person except by transfusion, which rarely occurs.

Ascariasis Standard Feces Not transmitted from person to person.

Aspergillosis Standard See comments

Contact and Airborne if massive soft tissue infection with drainage and/or requiring repeated irrigations.

Avian Influenza (See Influenza)

Babesiosis Standard Blood Not transmitted from person to person except rarely by transfusion.

Bacteremia, Primary and Secondary

Standard The presence of bacteremia is not, by itself, an indication for Precautions. If a specific organism is isolated, see specific listing for further precautions. Secondary bacteremia results from infection with the same organism at another body site. See the appropriate listing by site (for example, pneumonia). Some bacteremias are

reportable; see Notifiable Diseases

Bedbugs (cimex lectularius) Contact Patient and all belongings


Bed bugs (Cimex lectularius) are small, flat, parasitic

insects that feed solely on the blood of people and animals while they sleep. Bedbugs are transmitted from person to person; they travel in the seams and folds of luggage and overnight bags, folded clothes, bedding, furniture, even carpeting, and anywhere else where they can hide; subsequently they infect areas as they travel. Every effort must be made to identify and isolate suspect


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bedbug activity, and treat accordingly once confirmed. Please see the Bedbug Prevention and Response Policy #1091 in Policy Tech for more specific guidance.

Blastomycosis, North American, Cutaneous or Pulmonary

Standard Not transmitted from person to person

Botulism Standard Stool, gastric secretions, blood

Not transmitted from person to person; food borne;

potential bioterrorism agent. See Notifiable Diseases.

Bronchiolitis, Etiology Unknown in Infants and Young Children

Contact and Droplet(until etiologic agent is identified)

Respiratory secretions

Duration of illness

Various etiologic agents, such as respiratory syncytial virus, parainfluenza viruses, adenoviruses, and influenza virus, have been associated with this syndrome; therefore, Precautions to prevent the spread of these agents are generally indicated. If etiology identified, see specific listing.

Bronchitis Standard Not transmitted from person to person

Brucellosis (Undulant Fever, Malta Fever, Mediterranean Fever)

Standard; Contact if draining skin lesions or drainage devices

Pus and wound drainage

Consult Hospital Epidemiology

Typically zoonotic, but a potential bioterrorism agent; see

Notifiable Diseases. All blood, serum, and other

potentially infectious fluid or tissue must be labeled “suspect Brucella” and handled appropriately in the laboratory. Due to possible aerosolization, procedures on suspect cases require airborne precautions. May contact ID for treatment.

Burkholderia species Standard for non-CF patients; Contact for CF patients

Transmitted person to person contact; contact with contaminated environmental surfaces, patient care supplies, and environmental exposure (soil, water). If

patient has cystic fibrosis, see provisions for the Cystic

Fibrosis.


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Burn Wound Infection

Staphylococcus aureus, major

Contact Pus and wound drainage

Duration of illness

Consult with Hospital Epidemiology. Major wound is > 10% of body surface area; no dressing or dressing does not contain drainage adequately.

Staphylococcus aureus,

minor

Standard Pus and wound drainage

Consult with Hospital Epidemiology. Minor wound is < 10% of body surface area or wound is covered and adequately contains drainage.

Streptococcus pyogenes (GAS, major

Contact; Droplet

Pus and wound drainage

For 24 hours after start of effective therapy

Consult with Hospital Epidemiology. Major wound is > 10% of body surface area; no dressing or dressing does not contain drainage adequately.

Streptococcus pyogenes (GAS, minor

Standard Consult with Hospital Epidemiology. Minor wound is < 10% of body surface area or wound is covered and adequately contains drainage.

For other burns (not group A strep) of less than 10% body surface area

Other bacteria Standard See Abscess.

Campylobacter Gastroenteritis (See Gastroenteritis)

Candidiasis, All Forms, Including Mucocutaneous

Standard

Cat-Scratch Disease (Benign Lymphoreticulosis)

Standard Infectious agent is a gram negative bacilli. Not transmitted from person to person.

Cellulitis If specific organism isolated, see specific listing for further precautions.

Draining, major Contact Drainage Duration of drainage

Major = large open area or inadequately contained.


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Draining, minor or limited Standard Drainage

Minor or limited = dressing covers and adequately contains the drainage or infected area is very small.

Intact skin Standard

Chancroid (Soft Chancre) Standard See Notifiable Diseases.

Chikungunya Virus Standard Not transmitted from person to person except by transfusion, which rarely occurs. Transmitted rarely from mother to newborn around the time of birth.

Chickenpox (See Varicella)

Chlamydia trachomatis Infection

Conjunctivitis Standard Purulent exudate

Duration of drainage

Genital Standard Genital discharge


Respiratory Standard Respiratory secretions

Duration of illness

Cholera (See Gastroenteritis)

Closed Cavity Infection If specific organism isolated, see specific listing for further precautions.

Draining, major Contact Drainage Duration of drainage

Major = open wound inadequately contained or without a drain/closed drainage system.

Draining, minor or limited; not draining

Standard Drainage Minor or limited = dressing covers and adequately contains the drainage, closed drainage system adequately contains the drainage, or infected area is very small.

Clostridium botulinum (See Food Poisoning)


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Clostridium clostridioforme

Standard

Clostridium difficile (See Gastroenteritis)

Clostridium Perfringens

Food poisoning Standard Not transmitted from person to person.

Gas gangrene Standard Drainage Rarely transmitted from person to person. Contact Precautions preferred if draining wound.

Other syndromes Standard Drainage Not transmitted from person to person.

CMV (See Cytomegalovirus Infection)

Coccidioidomycosis (Valley Fever)

Draining lesions Standard Not transmitted from person to person.

Pneumonia Standard Not transmitted from person to person.

Colorado Tick Fever Standard Blood

Common Cold

Adults Standard Respiratory secretions (potentially)

Infants and young children

Standard Respiratory secretions

Rhinoviruses, most often associated with the common cold, may cause severe infection in an infant or child. During epidemics patients with colds may be placed in the same room. Consult with Hospital Epidemiology at such times.

Congenital Rubella (See Rubella)


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Conjunctivitis

Adenovirus (associated with/in infants and young children

Contact; Droplet Respiratory secretions and feces

Duration of illness

Acute bacterial (sore eye, pink eye)

Standard Purulent exudate

Chlamydial Standard Purulent exudate

Gonococcal, adults and newborns

Contact Purulent exudate

For 24 hours after start of effective therapy; duration of drainage

Place a barrier, such as a diaper or blanket, over the shoulder prior to lifting an infant to the shoulder. See

Notifiable Diseases.

Viral (acute hemorrhagic) Contact Purulent exudate

Duration of illness

Place a barrier, such as a diaper or blanket, over the shoulder prior to lifting an infant to the shoulder.

Corona virus Infection, Lower Respiratory

Non-SARS Standard Respiratory secretions (potentially)

SARS-Associated (See SARS)

Coxsackie Virus Disease (See Enteroviral Infections)

Creutzfeldt-Jakob Disease (CJD) or Variant CJD

Standard Infected tissue

Additional special precautions are necessary for handling and decontaminating items soiled with blood, body substances, and tissues from patients with confirmed or suspected disease. Consult with Hospital Epidemiology.


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No special burial procedures. See Creutzfeldt-Jakob

Disease: Infection Control Guidelines for Confirmed/

Suspected.

Crimean-Congo Fever (See Viral Hemorrhagic Fever)

Croup (See respiratory infections)

Cryptococcosis Standard Not transmitted from person to person

Cryptosporidiosis (See Gastroenteritis)

Cysticercosis Standard Not transmitted from person to person

Cytomegalovirus Infection, Neonatal or Immunosuppressed

Standard Urine and respiratory secretions (potentially)

No additional Precautions for pregnant HCWs.

Decubitus Ulcer, Infected (Pressure Ulcer/Sore)

If specific organism isolated, see specific listing for further precautions.

Major Contact Drainage Duration of drainage or until can be contained by a dressing

Major = no dressing or dressing does not adequately contain drainage.

Minor or limited Standard Drainage Minor or limited = dressing covers and adequately contains the drainage or infected area is very small.

Dengue Standard Blood Not transmitted from person to person.

Diarrhea, Acute - Infective Etiology Suspected (See Gastroenteritis)


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Diphtheria

Cutaneous Contact Drainage from lesions

Until 2 cultures from skin lesions, taken at least 24 hours apart after cessation of antimicrobial therapy are negative for Corynebacterium

diphtheriae


Pharyngeal Droplet Respiratory secretions

Until 2 cultures from both nose and throat, taken at least 24 hours apart after cessation of antimicrobial therapy, are negative for Corynebacterium

diphtheriae

A private room is required. Consult with Hospital

Epidemiology. See Notifiable Diseases.

Ebola Virus (See Viral Hemorrhagic Fever)

Echinococcosis (Hydatidosis)

Standard Not transmitted from person to person

Echovirus Disease (See Enteroviral Infection)

Eczema Herpeticum (See Herpes Simplex)


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Encephalitis, Encephalomyelitis, Etiology Unknown, but Infection Suspected (See also Specific Etiologic Agents; Likely Ones include Enterovirus and Arthropod-Borne Virus Infection)

Standard Feces Although specific etiologic agents can include enteroviruses, arthropod-borne viruses, and herpes simplex, Precautions for enteroviruses are generally indicated until a definitive diagnosis can be made. See


Endometritis Standard, unless caused by

Streptococcus

pyogenes (see

Streptococcal Disease; Group A Streptococcus)

Enterobiasis (Pinworm Disease, Oxyuriasis)

Standard

Enterobacter aerogenes

Standard, unless multiply-resistant

If multiply resistant, see Multi Drug Resistant Organisms, MDROs, gram negative bacilli; also see provisions for the

Prevention and Control of Multiply-Resistant and Other

Epidemiologically-Significant Bacteria.

Enterobacter cloacae Standard, unless multiply-resistant

If multiply resistant, see Multi Drug Resistant Organisms, MDROs, gram negative bacilli; also see provisions for the

Prevention and Control of Multiply-Resistant and Other

Epidemiologically-Significant Bacteria.

Enterococcus Species Standard, unless vancomycin resistant

If vancomycin resistant, see Multi Drug Resistant Organisms, MDROs.

Enteroviral Infection (Coxsackie Virus Disease or

Standard; Contact for

Respiratory secretions;

Duration of illness

Most common during summer and early fall, but seasonal patterns less evident in tropical climates. Viral shedding


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Echovirus; nonpolio virus) Includes Hand, Foot and Mouth Disease

diapered or incontinent patients

feces can occur without signs of clinical illness. Respiratory shedding is limited to a week or less, but fecal shedding can continue for several weeks after onset of infection. Hand hygiene is essential, especially after diaper changing.

Epiglottitis, Due to Haemophilus influenzae, type B

Droplet Respiratory secretions


Epstein-Barr Virus (EBV) Infection, Any Including Infectious Mononucleosis

Standard Patients with recent EBV infection or illness similar to infectious mononucleosis should not donate blood or solid organs.

Erythema Infectiosum (See Parvovirus B19)

Escherichia coli Gastroenteritis (See Gastroenteritis)

Extended Spectrum Beta Lactamase (ESBL) Producing Organism (See Multi-drug Resistant Organisms)

Fever of Unknown Origin (FUO)

Standard Patients with FUO do not need Transmission-Based Precautions unless they have signs and symptoms compatible with (and likely to be) a disease that requires Transmission-Based Precautions. If so, see the appropriate listing.

Fifth Disease (See Parvovirus B19)


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Food Poisoning

Botulism Standard Not transmitted from person to person. See Notifiable

Diseases.

Clostridium perfringens or

Clostridium welchii

Standard Not transmitted from person to person. See Notifiable

Diseases.

Salmonellosis (See Gastroenteritis)

Standard; Contact for diapered or incontinent patients

Feces Duration of illness


Staphylococcal

Staphylococcus aureus)

Standard Not transmitted from person to person.

Furunculosis, Staphylococcal

Standard; Contact for infants and young children

Duration of illness

Not transmitted from person to person. See Staphylococcal Disease for further guidance; or Multi-Drug Resistant Organisms if resistant to methicillin.

Gangrene If specific organism isolated, see specific listing for further precautions.

Gas gangrene (due to any bacteria)

Standard Drainage

Other (diabetic, wet, dry gangrene due to any bacteria)

Standard, unless multiply-resistant

Gastroenteritis

Unknown etiology, but infectious cause suspected



If etiology identified, see specific listing.


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Adenovirus Standard; Contact for diapered or incontinent patients

Respiratory secretions and feces

Duration of illness

Aeromonas species Standard; Contact for diapered or incontinent patients

Feces

Campylobacter species Standard; Contact for diapered or incontinent patients



Cholera Standard; Contact for diapered or incontinent patients

Feces/Vomitus Duration of illness


Clostridium difficile Enteric Feces Duration of illness

Avoid the use of stored electronic thermometers; assess need to discontinue antibiotics; ensure consistent environmental cleaning and disinfection. Please note: Alcohol-based foam may not be effective against C. difficile – hand hygiene with soap and water is required when caring for a patient with C. difficile.

Cryptosporidium parvum

(Cryptosporidiosis)





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Cyclosporiasis Standard; Contact for diapered or incontinent patients



Escherichia coli

(enteropathogenic, enterotoxigenic, enterohemorrhagic 0157:H7, or enteroinvasive)



Invasive Escherichia coli 0157:H7 is a reportable disease

(see Notifiable Diseases). Invasive is defined as bacteria

isolated from blood, bone, cerebrospinal fluid, joint, pericardial fluid, peritoneal fluid, or pleural fluid.

Giardia lamblia (Giardiasis)




Isosporiasis Standard; Contact for diapered or incontinent patients

Feces Duration of illness.

Microsporidia Standard; Contact for diapered or incontinent patients


Noroviruses (including Norwalk)

Enteric Feces/Vomitus Duration of illness

Special procedures required. Notify Epidemiology (1-2224). Ensure consistent environmental cleaning and disinfection; persons who clean areas contaminated with feces and vomitus should wear masks. Alcohol-based sanitizers may be less effective; hand hygiene with soap and water is required.


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Rotavirus Contact Feces Duration of illness

Prolonged viral shedding may occur in both the immunocompetent and immunocompromised and the elderly. For an infant in NICU, repeat stool cultures in 3 weeks if still an inpatient. If the results are positive at 3 weeks, continue Contact Precautions and repeat the rotazyme test every week or two until it is negative. Ensure consistent environmental cleaning and disinfection and frequent removal of soiled diapers.

Salmonella species (including

S. typhi) (See Typhoid Fever for additional precautions)




Shigella species Standard; Contact for diapered or incontinent patients

Feces

Duration of illness

Alcohol based sanitizers may be less effective; hand hygiene wit sap and water is recommended. See


Vibrio parahaemolyticus Standard; Contact for diapered or incontinent patients


See Notifiable Diseases

Viral Standard; Contact for diapered or incontinent patients


Yersinia enterocolitica Standard; Contact for diapered or


In infants, consider contamination (direct or indirect) of pacifiers, bottles and/or formula with raw pork. See

Notifiable Diseases


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incontinent patients

German Measles (See Rubella)

Giardiasis (See Gastroenteritis)

Gonococcal Ophthalmia Neonatorium (Gonorrheal Ophthalmia, Acute Conjunctivitis of the Newborn)

Standard Purulent exudate

Place a barrier, such as a diaper or blanket, over the shoulder prior to lifting an infant to the shoulder. See


Gonorrhea Standard

Discharge (potentially)


Granulocytopenia Standard Private room is required. Use Compromised Host/Neutropenic Precautions.

Granuloma Inguinale (Donovaniasis, Granuloma Venereum; Due to Calymmatobacterium)

Standard

Drainage (potentially)

Guillian-Barré Syndrome Standard Not an infectious condition

Hand, Foot and Mouth Disease (See Enteroviral Infection)

Hantavirus Pulmonary Syndrome

Standard

Not transmitted from person to person. See Notifiable

Diseases.

Helicobacter pylori Standard

Hemorrhagic Fevers (See Viral Hemorrhagic Fever)


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Hepatitis, Viral See Notifiable Diseases and related Employee Health

policies.

Type A (infectious hepatitis)


Feces See comments Hepatitis A is most contagious before hepatitis symptoms and jaundice appears. Maintain Precautions for infants < 3 years of age for the duration of hospitalization; in children 3 to 14 years of age, until 2 weeks after onset of symptoms; and in others, for one week after onset of

symptoms. See Notifiable Diseases.

Type B (serum hepatitis), hepatitis B surface antigen (HbsAg) positive; acute or chronic

Standard

Blood and body substances

See Notifiable Diseases and related Employee Health

policies.

Type C; Acute (and other unspecified non-A, non-B

Standard


See Notifiable Diseases and related Employee Health

policies.

Type D (seen only with hepatitis B)

Standard Blood and body substances

Type E Standard; Contact for diapered or incontinent patients


Type G Standard

Herpangina (See enteroviral infections)

Herpes Simplex (Herpesvirus hominis)


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Eczema herpeticum Contact Drainage from lesions

Duration of illness

Encephalitis Standard

Mucocutaneous, disseminated or primary, severe primary skin, oral, and genital)

Contact Drainage from lesions

Until lesions are dry and crusted

Mucocutaneous, recurrent (skin, oral, and genital)

Standard Drainage from lesions

Neonatal Contact Drainage from lesions

Duration of illness

Included are infants born with active disease or those who are delivered to women with active genital herpes at the time of delivery (vaginal deliveries and Cesarean sections done within 4 to 6 hours after membranes rupture) until surface cultures obtained at 24-36 hours after birth and remain negative after 48 hours of incubation.

Pneumonia

Contact Respiratory secretions

Duration of therapy

Herpes Zoster (Shingles; Varicella zoster)

Localized in immunocompromised patient until dissemination ruled out, or disseminated in all patients


Lesion and respiratory secretions

Duration of illness

A private, negative pressure room is required. If a negative pressure room is not available, consult Hospital Epidemiology. The door to the room remains closed at all times. Restrict susceptible persons from entering the room. An N-95 mask is donned before entering the room and removed after leaving the room regardless of immunity. Susceptible HCWs should not enter the room if other HCWs are available (including non-immune pregnant HCWs). Exposed susceptible patients are placed on Airborne and


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Contact Precautions beginning 8 days after the first day of exposure and continuing for 21 days after the last day of exposure; 28 days if varicella-specific immunoglobulins is

given. See Preadmission Communicable Diseases Screening

of Children. Consult with Hospital Epidemiology (1-2224). See Varicella zoster for information on exposed HCWs.

Localized in other, nonimmunocompromised patients with lesions that can be contained/covered

Standard

Lesion secretions

Duration of illness

Roommates should not be susceptible; Susceptible HCWs should not provide direct patient care when other immune caregivers are available.

Hidradenitis Suppurativa Standard See “Abscess, major, draining”.

Histoplasmosis Standard Not transmitted from person to person

HIV (See Human Immunodeficiency Virus)

Hookworm Disease (Ancylostomiasis, Uncinariasis)


Feces Not transmitted from person to person.

Human Herpes 6 and 7 (including Roseola, exanthema subitum, sixth disease)

Standard Respiratory secretions (potentially)

Human Immunodeficiency Virus (HIV) Infection

Standard Blood and body substances

Use caution when handling articles contaminated with blood and body substances. Take special care to avoid being injured by a needle or other sharp or being splashed by body substances to conjunctivae or mucous

membranes. See Standards for Employee and Student

Health. If a patient’s hygiene is poor, a private room is

indicated. If the patient is critically ill, hemorrhaging, or having multiple invasive bedside procedures, a private


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room or adequate distance (at least 7 feet) between patients is required. All HIV-infected patients who are > 12 years of age with an undiagnosed pneumonia require Airborne Precautions until tuberculosis is diagnosed and treated or is ruled-out. Post exposure chemoprophylaxis

for high risk blood exposures. See Notifiable Diseases.

Human Metapneumovirus Contact Respiratory secretions

Duration of illness

Wear masks according to Standard Precautions. Private room is preferred or cohort patients as necessary.

Impetigo Contact Drainage from lesions


Infectious Mononucleosis Standard Respiratory secretions (potentially)

Influenza

Seasonal Droplet Respiratory secretions (potentially)

5 days from onset of symptoms except for the immuno-compromised patient, which will be duration of illness

Private room is preferred when available or cohort

patients as necessary (See Grouping Patients with the

Same Infections). Avoid placement with high-risk

patients. Mask patient when transporting out of room. Duration of precautions for immunocompromised patients cannot be defined; prolonged duration of viral shedding has been observed. See Respiratory Infectious Disease, infants and young children for additional precautions.

Avian (H5N1, H7, H9 Strains)


Respiratory secretions (potentially

14 days from onset of symptoms or until alternate diagnosis is established or

Private room is preferred when available or cohort patients

as necessary (See Grouping Patients with the Same

Infections). HEPA filter may be used if negative pressure

room is not available. N-95 mask (surgical mask if N-95 is not available) is required. Eye protection (goggles) is required when within 3 feet of the patient. Human-to-


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until diagnostic test results indicate that the patient is not infected H5N1, H7, or H9 strains

human transmission is inefficient and rare, but the risk of reassortment with human influenza strains and the emergence of a pandemic strain is of serious concern. See www.cdc.gov/flu/avian/professional/infect-control.htm for current avian influenza guidance.

Pandemic Droplet Respiratory secretions (potentially

5 days from onset of symptoms and duration of illness for the immuno-compromised patients

Private room is preferred when available or cohort

patients as necessary (See Grouping Patients with the

Same Infections). See www.pandemicflu.gov for current

pandemic influenza guidance.

Isosporiasis (See Gastroenteritis)

Kawasaki Syndrome Standard Not an infectious condition.

Keratoconjunctivitis, Infective

Contact Purulent exudate


Lassa Fever (See Viral Hemorrhagic Fever)

Legionnaire’s Disease (Legionellosis)

Standard Not transmitted from person to person. See Notifiable

Diseases.

Leprosy Standard Nasal secretions and drainage from lesions

Leptospirosis Standard Blood and urine


Diseases.

http://www.cdc.gov/flu/avian/professional/infect-control.htm

http://www.pandemicflu.gov/


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Lice (Head [Pediculosis] Body, and Pubic)

Contact Infected areas (head/hair, body, pubic area)

For 24 hours after start of effective therapy and complete nit removal with nit comb

Lice infest others by direct and indirect hair to hair contact; lice do not fly. Avoid direct contact such as hugging children. Usual hygiene and housekeeping practices remove adult lice. Plasticized mattresses and pillows prevent bed infestation in the hospital. A private room is desirable before and during therapy.

Listeriosis Standard Person to person transmission. See Notifiable Diseases.

Lower Respiratory Tract Disease, Acute (See Respiratory Infectious Disease)

Lyme Disease Standard Not transmitted from person to person. See Notifiable

Diseases.

Lymphocytic Choriomeningitis

Standard Not transmitted from person to person. Pet rodents or wild mice in patient’s home should be considered likely sources of infection.

Lymphogranuloma Venereum

Standard Drainage (potentially)


Malaria Standard Blood Not transmitted from person to person except rarely through transfusion. Instruct travelers to endemic areas to use DEET-containing mosquito repellent and clothing

to cover extremities. See Notifiable Diseases.

Marburg Virus Disease (See Viral Hemorrhagic Fever)

Measles, All Presentations (See Rubeola)

Melioidosis, All Forms Standard Respiratory secretions and drainage from a

Not transmitted from person to person


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sinus tract (potentially)

Meningitis

Etiology unknown, but bacterial cause suspected



If etiology identified, see specific listing. See Notifiable

Diseases.

Aseptic (nonbacterial or viral meningitis) (See also specific etiologies)

Standard; Contact for infants and young children


Enteroviruses are the most common cause of aseptic

meningitis. See Notifiable Diseases.

Gram negative enteric rods in neonates

Standard

During a nursery outbreak, cluster or cohort infected or colonized infants, use gown if soiling with feces is likely, and use gloves if touching feces. Hospital Epidemiology

coordinates the cohorting plan. See Notifiable Diseases.

Fungal Standard See Notifiable Diseases.

Haemophilus influenzae,

type B known or suspected




Listeria monocytogenes Standard Not transmitted from person to person. See Notifiable

Diseases.

Neisseria meningitidis

(meningococcal), known or suspected



See Standards for Employee and Student Health and


Pneumococcal, penicillin-

susceptible (Streptococcus

Standard Penicillin resistance may be “relative” or “absolute”. Consider resistant if minimal inhibitory concentration

(MIC) for penicillin is > 0.1 mcg/ml. See Notifiable


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pneumoniae) Diseases.

Pneumococcal, penicillin-

resistant (Streptococcus

pneumoniae)




Tuberculosis

Standard Concurrent active pulmonary disease or draining cutaneous lesions necessitate Airborne Precautions. If pulmonary tuberculosis is present, see listing for

Mycobacteria, tuberculosis. See Notifiable Diseases.

Other diagnosed bacterial causes

Standard See Notifiable Diseases.

Meningococcal Disease (sepsis, pneumonia, meningitis)





Methicillin-Resistant Staphylococcus aureus (MRSA) (See Multi-Drug Resistant Organisms-MDROs)

Microspordia (See Gastroenteritis)

Molluscum Contagiosum Standard Contact Precautions may be implemented during outbreak situations.

Monkeypox Airborne and Contact

Lesions possibly respiratory secretions

Until lesions are crusted and until smallpox is excluded

Pre and post-exposure smallpox vaccine recommended for exposed HCWs. Consult with Hospital Epidemiology (1-2224). See www.cdc.gov/ncidod/monkeypox for most current guidelines.

Mononucleosis, Infectious (See Epstein-Barr Virus)

http://www.cdc.gov/ncidod/monkeypox


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Mucormycosis Standard In outbreaks, clustering or cohorting of infected and colonized patients may be indicated. Such efforts are coordinated by Hospital Epidemiology.

Multi-Drug Resistant Organisms (MDROs)

See Prevention and Control of Multiply-Resistant,

Epidemiologically-Significant Bacteria for all of the

following MDROs.

Carbapenem Resistant

Enterobacteriaceae (CRE) (KPC Producing Organisms)

Expanded Contact

Infected areas (blood, urine, respiratory secretions, and wound drainage). Colonized persons shed from lower intestinal tract.

Duration of hospitalization, and all subsequent encounters

Carbapenem-resistant Enterobacteriaceae (CRE) are usually resistant to all β-lactam agents as well as most other classes of antimicrobial agents. Outbreaks of CRE have been reported; patients colonized with CRE are thought to be a source of transmission in the healthcare setting. When identified, patients are coded “CRE” in the hospital’s information system.

Extended Spectrum Beta Lactamase (ESBL) producing Organisms

Contact Infected areas (blood, urine, respiratory secretions, and wound drainage)

Duration of hospitalization and all subsequent encounters

ESBLs are enzymes that mediate resistance to extended-spectrum (third generation) cephalosporins (e.g., ceftazidime, cefotaxime, and ceftriaxone) and monobactams (aztreonam) but do not affect cephamycins (cefoxitin and cefotetan) or carbapenems (meropenem or imipenem). When identified, patients are coded “ESB” in the hospital’s information system.

Gram Negative Bacilli (GNB), multiply resistant

Contact Infected areas (blood, urine, respiratory secretions, and wound drainage)

Duration of illness


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Methicillin-Resistant

Staphylococcus aureus

(MRSA)

Contact; Droplet for tracheitis and pneumonia

Infected areas (blood, urine, respiratory secretions, wound drainage, and skin lesions/ infections). Colonized persons shed from nares, axilla, groin, and skin.

Duration of hospitalization and subsequent encounters

In outbreaks, clustering or cohorting of infected and colonized patients may be indicated. Such efforts are coordinated by Hospital Epidemiology. When MRSA infected or colonized patients are identified, these patients are coded in the hospitals information system. The code "SI" represents methicillin-resistant

coagulase positive Staphylococcal Infections/colonizations.

This code is reflected on the patient’s label and appropriate computer fields. Inpatients, outpatients, HCWs, faculty, and students are coded in the same manner.

Vancomycin Intermediate and Resistant Staphylococcus aureus (VISA/VRSA)

Contact Infected areas (blood, urine, respiratory secretions, wound drainage, and skin lesions/ infections). Colonized persons shed from nares, axilla, groin, and skin.

Until culture is negative of the original site and 3 negative stool or rectal cultures each one week apart

Private room is required. In outbreaks, clustering or cohorting of infected and colonized patients may be indicated. Such efforts are coordinated by Hospital Epidemiology. The number of HCWs entering the room should be limited. Nursing assignment should be limited to this patient only. The nurse and/or the physician should perform all phlebotomy, vital signs, and distribution of meal trays, and other similar tasks. See

the provision: Guidelines for Vancomycin-Intermediate

Staphylococcus aureus (VISA) and Vancomycin-Resistant

Staphylococcus aureus (VRSA). When identified, patients

are coded “VIS” or “VRS” in the hospital’s information system.

Vancomycin-Resistant

Enterococcus - VRE (See

Enterococcus Species)

Contact Infected areas (blood, urine, respiratory secretions, and wound drainage).

Until culture is negative of the original site and 3 negative stool or rectal cultures each

In outbreaks, clustering or cohorting of infected and colonized patients may be indicated. Such efforts are coordinated by Hospital Epidemiology. When VRE infected or colonized patients are identified, these patients are coded in the hospitals information


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Colonized persons shed from lower intestinal tract.

one week apart system. The code "VRE" represents Vancomycin-Resistant Enterococcus infections/colonizations. This code is reflected on the patient’s label and appropriate computer fields. Inpatients, outpatients, HCWs, faculty, and students are coded in the same manner.

Mumps (Infectious Parotitis)


For 9 days after onset of swelling

Susceptible HCWs should not provide care if immune caregivers are available. Exposed susceptible patients require Droplet Precautions beginning 10 days after the first day of exposure and continuing for 25 days after the

last day of exposure. See Preadmission Communicable

Diseases Screening of Children and Notifiable Diseases.

Mycobacteria, Nontuberculosis; Atypical

Pulmonary/Blood Standard Not transmitted person to person.

Wound Standard

Mycobacteria, Tuberculosis (TB)

For infants and children, use Airborne Precautions until active pulmonary tuberculosis in visiting household contacts/family members has been ruled out.

Extrapulmonary, draining lesion (including scrofula and Pott's disease, if draining)


Drainage When patient is improving clinically and drainage has ceased or there are 3 consecutive negative cultures of continued drainage

Examine for evidence of active pulmonary tuberculosis.

Extrapulmonary, no draining lesions, meningitis

Standard Examine for evidence of active pulmonary tuberculosis.



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Extrapulmonary, urinary Standard Examine for evidence of active pulmonary tuberculosis.


Laryngeal, miliary, pulmonary, confirmed or suspected (sputum smear positive for acid fast bacilli (AFB) or chest x-ray suggestive of current, active disease, such as when a cavitary lesion is found)

Airborne Airborne nuclei Discontinue only when patient is on effective therapy and is clinically improving and has 3 consecutive sputum smears negative for AFB collected on separate days

A negative pressure room is required. The door to the room remains closed at all times. N-95 masks are required to enter the room; a mask is donned before entering the room and removed after leaving the room.



Skin test positive with no evidence of current laryngeal, miliary, or pulmonary disease

Standard


Mycoplasma Pneumonia Droplet Respiratory secretions

Duration of illness

A private room is preferred for children.

Necrotizing Enterocolitis (NEC)

Standard Feces (potentially)

See specific listing for infectious etiologies. For possible epidemics, clustering or cohorting of infected infants along with Contact Precautions may be necessary. Such efforts are coordinated by Hospital Epidemiology.

Staphylococcus aureus (See Staphylococcal Disease; enterocolitis)

Neisseria meningitidis


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(See Meningococcal Disease)

Neutropenia Standard Private, positive-pressure room is required. Use Compromised Host/Neutropenic Precautions.

Nocardiosis (draining lesions or other presentations)

Standard Not transmitted person to person.

Norwalk Agent; Norovirus (See Gastroenteritis)

Orf Standard Drainage (potentially)

Pappillomavins Standard

Paracoccidoidonmycosis Standard

Paragonimiasis Standard

Parainfluenza Virus Infection, Lower Respiratory in Infants and Young Children

Droplet and Contact


Duration of illness

Parainfluenza may cause colds. During epidemics, patients believed to have parainfluenzae infections may be placed in the same room. Consult with Hospital Epidemiology at such times.

Parotitis, Infectious (See Mumps)

Parvovirus B19

Erythema Infectiosum Fifth Disease)


Duration of illness

Transmitted through contact with infected persons, fomites, and large droplets. Infectious before the appearance of a rash. For pregnant HCWs, please see Employee Health policies.

Aplastic/Erythrocyte Crisis (In patient with hemolytic anemia)


For 7 days after onset of crisis

For pregnant HCWs, please see Employee Health policies.


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Immunocompromised Host who are known or suspected to be chronically infected



Duration of precautions for immunosuppressed patients with persistently positive PCR not defined by the CDC

Pediculosis (See Lice)

Pelvic Inflammatory Disease

Standard

Pertussis, Bordatella (Whooping Cough)


For 5 days after start effective therapy or until 3 weeks after onset of paroxysms in older patients who did not receive appropriate therapy

Place patient in a private room; cohorting is acceptable f private room is unavailable. Post-exposure chemoprophylaxis for household contacts and HCWs with prolonged exposure to respiratory secretions is recommended. Report all exposures immediately to

Hospital Epidemiology (1-2224). See Notifiable Diseases.

Pharyngitis, Etiology Unknown

Adults Standard Respiratory secretions (potentially)

Infants and young children



During epidemics, patients believed to have pharyngitis due to adenoviruses, influenza viruses, and parainfluenza viruses may share the same room. Consult with Hospital Epidemiology at such times.

Suspected streptococcal, group A, any age




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Pinworm Infection (Enterobiasis)

Standard Handle bed linen and under clothing carefully without shaking; laundry promptly.

Plague (Yersinia pestis)

Bubonic Standard Drainage Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification. See Hospital Emerging Infections Policy.

Pneumonic Droplet Respiratory secretions


Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification. See Hospital Emerging Infections Policy. Antimicrobial prophylaxis for exposed HCWs.

Pleurodynia Contact Feces For 7 days after onset

Enteroviruses frequently cause infection.

Pneumonia All HIV-infected patients who are > 12 years of age with an undiagnosed pneumonia require Airborne Precautions until tuberculosis is diagnosed and treated or ruled-out.

Adenovirus Droplet and Contact


Duration of illness

Extend duration of droplet and contact precautions in immunocompromised patients due to prolonged shedding of the virus.

Bacterial not listed elsewhere (including gram negative bacteria)


When cross infection in an intensive care unit occurs, clustering or cohorting and Contact Precautions may be indicated. Such efforts are coordinated by Hospital Epidemiology.

Burkholderia cepacia

Standard for non-CF patients; Contact for CF patients, including respiratory tract colonizations



Transmitted person to person contact; contact with contaminated environmental surfaces, patient care supplies, and environmental exposure (soil, water). If

patient has cystic fibrosis, see provisions for the Cystic

Fibrosis. Avoid clustering, cohorting, or placing a patient

in the same room with a cystic fibrosis patient.

Chlamydial Standard Respiratory Duration of


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secretions illness

Cytomegalovirus (CMV) Standard

Etiology unknown Maintain Precautions indicated for the etiology that is most likely.

Fungal Standard

Haemophilus influenzae ,

type B pneumonia in adults

Standard Respiratory secretions

Haemophilus influenzae

pneumonia in infants and children of any age



Herpes Contact Respiratory secretions

Duration of therapy

Influenza (See Influenza)

Legionella pneumophila Standard See Notifiable Diseases.

Mycoplasma (primary

atypical pneumonia, Eaton agent pneumonia)

Droplet Respiratory secretions (potentially)

Duration of illness

Neiserria meningitidis

(See Meningococcal Disease)

Pneumococcal Standard Use Droplet Precautions if evidence of transmission within a patient care unit or facility.

Pneumocystis carinii Standard Avoid placement in the same room with an immunocompromised patient.

Staphylococcal aureus ,

methicillin susceptible



Droplet Precautions should be maintained throughout illness for MSSA tracheitis with a tracheostomy tube in place.


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Staphylococcal aureus ,

methicillin resistant

Droplet and Contact


Duration of illness (to include colonization)

Droplet Precautions should be maintained throughout illness for MRSA tracheitis with a tracheostomy tube in place. See chapter six of the Infection Control Manual

(MDRO’s),

Streptococcus, β- hemolytic, group A

(Streptococcus pyogenes)



Contact Precautions are required if skin lesions are present.

Streptococcus pneumoniae,

penicillin-resistant (known or suspected)

Droplet Respiratory secretions (potentially)


Penicillin resistance may be “relative” or “absolute”. Consider resistant if minimal inhibitory concentration

(MIC) for penicillin is > 0.1 mcg/ml. See Notifiable

Diseases.

Varicella (See Varicella)

Viral pneumonia, adults (See also specific etiologic agents)

Standard

Respiratory secretions (potentially)

Viral pneumonia, infants and children (See also specific etiologic agents)

Droplet and Contact


Duration of illness

Viral pneumonia may be caused by various viruses such as parainfluenza, influenza, and respiratory syncytial virus, in children < 5 years of age. Viral pneumonia can result in significant lower respiratory disease. Precautions to prevent spread of these viruses are indicated.

Poliomyelitis Contact Duration of illness


Pseudomonas aeruginosa Standard, unless multiply-resistant

See chapter six of the Infection Control Manual (MDRO’s),

and if patient has cystic fibrosis, see provisions for the

Cystic Fibrosis.

Psittacosis (Ornithosis)



Diseases.


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Q Fever Standard Respiratory secretions (potentially)

Potential bioterrorism agent. Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification.

Rabies Standard Respiratory secretions (potentially)

Duration of illness

If has bitten another individual or saliva has contaminated an open wound or mucous membranes, wash exposed area thoroughly and administer post-exposure prophylaxis. Special procedures are required for specimen collection and transport. Consult with Hospital

Epidemiology (1-2224). See Notifiable Diseases.

Rat-Bite Fever (Streptobacillus moniliformis Disease, Spirillum minus Disease)

Standard Blood

Relapsing Fever (Borrela Infections)

Standard; Contact if louse infestation

Blood

Resistant Bacteria (See Multi Drug Resistant Organisms, MDROs)

Examples: Gram Negative Bacilli (Acinetobacter,

Pseudomonas, Serratia, Enterobacter), ESBL, MRSA, VRE.

Respiratory Infectious Disease, Acute

If specific organism isolated, see specific listing for further precautions.

Adult Standard Respiratory secretions (potentially)

Infants and young children Droplet and Contact


Duration of illness

Including croup.

Respiratory Syncytial Virus (RSV) Infection, in Infants and Young Children, and Immunocompromised

Contact and Droplet


Duration of illness

RSV may cause colds. During epidemics, patients believed to have RSV infection may share the same room. Consult with Hospital Epidemiology at such times. Extend duration of precautions for immunocompromised


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Adults

patients due to prolonged viral shedding. Discontinuing Contact Precautions: 1) If a patient is on ribovarin, after 5 days of therapy and one negative antigen test, Precautions can be discontinued; 2) if a patient is not on ribavirin, one negative antigen test is required to discontinue the Precautions; 3) the length of time between the initiation of the Precautions and the need to discontinue the Precautions does not matter; one negative antigen test is still required; a patient can shed the virus for a very long time; and 4) the age of the child is not significant.

Reye's Syndrome Standard Not an infectious condition.

Rheumatic Fever

Standard Not an infectious condition.

Rhinovirus Infection, Lower Respiratory

Adults Droplet Respiratory secretions

Duration of illness

Outbreaks have occurred in LTCFs. Add Contact Precautions if copious moist secretions and close contact likely to occur.

Infants and young children Droplet and Contact


Duration of illness

Outbreaks have occurred in NICUs.

Rickettsial Fever, Tickborne (Rocky Mountain Spotted Fever, Tickborne Typhus Fever)

Standard Not transmitted from person to person except rarely

through transfusion. See Notifiable Diseases.

Rickettsialpox (Vesicular Rickettsiosis)

Standard Not transmitted person to person.

Ringworm (See Tinea)


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Ritter’s Disease (See Staphylococcal Disease, Scalded Skin Syndrome)

Rocky Mountain Spotted Fever (See Rickettsial Fever)

Roseola Infantum (See Human Herpes 6 & 7)

Rotavirus Infection (See Gastroenteritis)

RSV (See Respiratory Syncytial Virus)

Rubella

German Measles Droplet Naso-pharyngeal/ Respiratory secretions

For 7 days after onset of rash

Susceptible HCWs should not enter the room if immune caregivers are available. Masks should be worn regardless of immune status. See related polices for employee/ student health for information on the rubella titer and immunization. All exposures should be reported to Hospital Epidemiology (1-2224). Exposed susceptible patients require Droplet Precautions beginning 5 days after the first day of exposure and continuing until 21

days after the last day of exposure. See Preadmission

Communicable Diseases Screening of Children and


Congenital Contact Naso-pharyngeal/ Respiratory secretions and urine

During any admission for first year after birth unless nasopharyngeal and urine

Susceptible HCWs should not enter the room if immune caregivers are available. All PPE should be worn according to Standard and Contact Precautions. See related polices for employee/student health. Also, see



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cultures after 3 months of age are negative for rubella

Rubeola, All Presentations (including Red Measles)

Airborne Respiratory secretions

4 days after the onset of rash and duration of illness in immuno-compromised patients

Wear N-95 masks regardless of immune status. Restrict susceptible persons from entering room of known or suspected patients if other HCWs are available. Exposed susceptible patients require Airborne Precautions beginning 5 days after the first day of exposure and continuing until 21 days after the last day of exposure. Post exposure vaccine may be given within 72 hours of exposure or immune globulin within 6 days after

exposure. See Preadmission Communicable Diseases

Screening of Children and Notifiable Diseases. Consult

with Hospital Epidemiology (1-2224).

Salmonellosis (See Gastroenteritis)

Scabies Contact Infected area For 24 hours after start of effective therapy

Mites burrow under the patient's skin and are not visible. Mites infest others by direct body to body contact. Use gloves to touch infested areas. Usual hygiene and housekeeping practices kill mites that may emerge. Plasticized mattresses and pillows prevent bed infestation in the hospital. A private room is desirable for ambulatory pediatrics before and during therapy.

Scalded Skin Syndrome, Staphylococcal; Ritter's Disease (See Staphylococcal Disease)

Scarlet Fever (See Streptococcal Disease)


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Schistosomiasis (Bilharziasis)

Standard

Serratia marcescens Standard, unless multiply-resistant

If multiply resistant, see Multi Drug Resistant Organisms, MDROs, gram negative bacilli; also see chapter six (MDRO’s) of the infection control manual

Severe Acute Respiratory Syndrome (SARS) (including associated Corona virus)

Airborne and Contact; Droplet under certain conditions-see comments


Duration of illness plus 10 days after resolution of fever, provided respiratory symptoms are absent or improving

Airborne Precautions preferred; droplet if negative pressure room not available. N-95 or higher respiratory protection; surgical mask if N-9t not available due to overwhelming surge capacity. Eye protection (goggles) is required. Aerosol generating procedures and “super shedders” highest risk for transmission via small droplet nuclei and large droplets. Environmental disinfection is extremely important in limiting transmission. Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification.

Shigellosis, Including Bacillary Dysentery (See Gastroenteritis)

Shingles (See Herpes Zoster)

Smallpox (Variola) Airborne and Contact

Respiratory secretions and drainage from lesions

Duration of illness (until all scabs have crusted and separated, typically 3-4 weeks)

Potential bioterrorism agent. Since the virus has not been eradicated and is quarantined in certain research laboratories, the potential exists for cases to occur. Non-vaccinated HCWs should not provide care when immune HCWs are available. A negative pressure room is required. An N-95 mask or higher respiratory protection is required for all HCWs. Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification. Post exposure vaccine may be given within 4 days of exposure.

Spirillum minus Disease Standard Blood Not transmitted person to person.


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(Rat-Bite Fever)

Sporotrichosis Standard

Staphylococcal Disease (Staphylococcus aureus)

Staphylococcus aureus is reported as coagulase positive

staphylococcus. Staphylococcus epidermidis, or coagulase

negative staphylococcus (CNS), does not require Transmission-Based Precautions, even if methicillin-resistant.

Skin, wound, or burn - major

Contact Pus Duration of illness

No dressing or the dressing does not contain drainage adequately.

Skin, wound, or burn - minor, limited, or not draining

Standard Dressing adequately covers and contains drainage

Enterocolitis Standard; Contact for diapered or incontinent patients


Multi-Drug Resistant (See Multi Drug Resistant Organism, MDROs)

Pneumonia Droplet Droplet and Contact if methicillin resistant (MRSA)


For 24 hours after start of effective therapy Duration of illness (to include colonization)

Droplet Precautions should be maintained throughout illness for MSSA/MRSA tracheitis with a tracheostomy tube in place. See Chapter 6 MDRO in the Infection Control Manual


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Scalded skin syndrome (Ritters Disease)

Contact Drainage from lesions

Duration of illness

HCWs are potential sources in nursery and NICU outbreaks.

Toxic shock syndrome Standard; Contact if drainage present

Discharge and/or purulent drainage



Staphylococcus epidermidis, methicillin-resistant (MRSE)

Standard Staphylococcus epidermidis is reported as staphylococcus coagulase negative (SCN). Further precautions may be deemed necessary by Hospital Epidemiology if presents in a high risk population in an outbreak or if there is increasing vancomycin resistance.

Stenotrophomonas maltophilia

Contact for cystic fibrosis patients

If multiply resistant, see Multi Drug Resistant Organisms, MDROs, gram negative bacilli; also see chapter six of the Infection Control Manual

Streptobacillus moniliformis Disease (Rat-Bite Fever)

Standard Blood Not transmitted from person to person

Streptococcus pneumoniae Invasive Streptococcus pneumoniae (penicillin susceptible

or resistant) is a reportable disease; see Notifiable

Diseases. Invasive is defined as bacteria isolated from a

normally sterile site, such as blood, bone, cerebrospinal fluid, joint, pericardial fluid, peritoneal fluid, pleural fluid, protected bronchial sampling, lung aspirate/biopsy, or other biopsy.

Penicillin Susceptible Standard

Penicillin Resistant Droplet For 24 hours after start of effective therapy

Streptococcal Disease Reportable disease if invasive. Invasive is defined as


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(Group A Streptococcus) bacteria isolated from a normally sterile site, such as blood, bone, cerebrospinal fluid, joint, pericardial fluid, peritoneal fluid, pleural fluid, protected bronchial sampling, lung aspirate/biopsy, or other biopsy. See


Endometritis (puerperal sepsis)

Contact Vaginal discharge


Pharyngitis Droplet Droplet and Contact for infants and young children



Pneumonia Droplet Droplet and Contact for infants and young children



Scarlet fever Droplet Droplet and Contact for infants and young children



Skin infection, wound, or burn, major

Droplet and Contact

Drainage For 24 hours after start of effective therapy



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Skin infection, wound, or burn, minor or limited infection

Standard Minor or limited = dressing covers and adequately contains the drainage, closed drainage system adequately contains the pus, or infected area is very small

Serious invasive disease (e.g., necrotizing fascitis, toxic shock syndrome)

Droplet For 24 hours after start of effective therapy

Contact Precautions for draining wound as above. Follow recommendations for antimicrobial prophylaxis (Consult with Hospital Epidemiology (1-2224).

Streptococcal Disease (Group B Streptococcus), Neonatal

Standard Skin; drainage from lesions; umbilicus; and feces

During a nursery outbreak, clustering or cohorting of infected and colonized infants, as well as Contact Precautions, may be indicated. Such efforts are coordinated by Hospital Epidemiology. If invasive, infection is a reportable disease Reportable disease if invasive. Invasive is defined as bacteria isolated from a normally sterile site, such as blood, bone, cerebrospinal fluid, joint, pericardial fluid, peritoneal fluid, pleural fluid, protected bronchial sampling, lung aspirate/biopsy, or

other biopsy. See Notifiable Diseases.

Streptococcal Disease (not Group A or B) Unless Covered Elsewhere

Standard

Strongyloidiasis Standard

Syphilis See Notifiable Diseases.

Skin and mucous membrane, including congenital, primary and secondary

Contact Drainage from lesions and blood


Skin lesions of primary and secondary syphilis may be highly infective. The rapid plasma reagin (RPR) test, Veneral Disease Research Laboratories (VDRL) test, or

microhemagglutinatin for Treponema pallidum (MHA-TP)

test is positive.

Latent (tertiary) and

seropositivity without lesions

Standard RPR, VDRL, or MHA-TP may be positive.


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Tapeworm Disease

Hymenolepis nana Standard Not transmitted from person to person.

Taenia saginata (beef) Standard Not transmitted from person to person.

Taenia solium (pork) Standard Not transmitted from person to person.

Other Standard Not transmitted from person to person.

TB (See Mycobacteria, Tuberculosis)

Tetanus Standard See Notifiable Diseases.

Tinea (Fungus Infection, Dermatophytosis, Dermatomycosis, Ringworm)

Standard Rare episodes of person to person transmission of ringworm. Outbreaks in healthcare setting rare; but use Contact Precautions should an outbreak occur.

Torch Syndrome For congenital forms of the following diseases, see separate listing For each: Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex Virus.

Possible Torch Syndrome, no lesions, no presenting clinical indications

Standard Urine and feces (potentially)

Adequate distance (at least 7 feet) between patients is helpful.

Toxic Shock Syndrome (See Staphylococcal Disease and Streptococcal Disease)

Toxicariasis Standard

Toxoplasmosis Standard

Trachoma, Acute Standard Purulent exudate



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Trench Mouth (Vincent's Angina)

Standard

Trichinosis Standard

Trichomoniasis Standard

Trichuriasis (Whipworm Disease)

Standard Feces

Trypanosomiasis Standard

Tuberculosis; TB (See Mycobacteria, Tuberculosis)

Tularemia Potential bioterrorism agent. See Notifiable Diseases.

Draining lesions Standard

Pulmonary Standard

Typhoid Fever, Salmonella typhii (See Gastroenteritis)

Contact Feces Until diarrhea has ceased and 3 consecutive fecal cultures are negative for the infecting strain; these cultures must be obtained 3 to 5 days after ending the antimicrobial therapy


Typhus Fever

Rickettsia prowazekii (epidemic and louse-borne)

Standard Transmitted from person to person through close personal or clothing contact.


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Rickettsia typhi Not transmitted from person to person.

Ulcer (See Decubitus Ulcer or Wound Infection)

Urinary Tract Infection (Including Pyelonephritis), With or Without Urinary Catheter

Standard, unless caused by multiply-resistant organism

If specific organism isolated, see specific listing for further precautions; and see Multi-Drug Resistant Organisms

(MDROs) and provisions for the Prevention and Control of

Multiply-Resistant and Other Epidemiologically-Significant

Bacteria.

Vaccinia – Vaccination site, adverse events following vaccination)

Contact Contact Hospital Epidemiology (1-2224) should a case be indentified. May contact CDC Smallpox Vaccine Adverse Events Clinical Information Line at (877) 554-4625.

Vancomycin-Resistant Enterococcus; VRE (See Multi Drug Resistant Organism, MDROs)

Varicella zoster (Chickenpox) (See Herpes zoster for shingles)

Airborne and Contact if skin lesions are present

Respiratory secretions and drainage from lesions

Until all lesions are crusted; duration of illness for immunocompromised patient with Varicella pneumonia

A private, negative pressure room is required. If a negative pressure room is not available, consult Hospital Epidemiology. The door to the room remains closed at all times. Restrict susceptible persons from entering the room. An N-95 mask is donned before entering the room and removed after leaving the room regardless of immunity. Susceptible HCWs should not enter the room if other HCWs are available (including non-immune pregnant HCWs). Exposed susceptible patients are placed on Airborne and Contact Precautions beginning 8 days after the first day of exposure and continuing for 21 days after the last day of exposure; 28 days if varicella-specific

immunoglobulins is given. See Preadmission

Communicable Diseases Screening of Children.

Exposed HCWs will be offered Acyclovir within 96 hours


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post-exposure unless you are pregnant or immunocompromised. If pregnant or immunocompromised, then VZIG will be offered. Exposed susceptible HCWs are excluded from duties beginning 8 days after first exposure until 21 days after last exposure or 28 days if received VZIG regardless of post exposure vaccination. Please see related Employee Health policies. Notify Hospital Epidemiology for all exposures (1-2224).

Variola (See Smallpox)

Vibrio parahemolyticus (See Gastroenteritis)

Vincent's Angina (See Trench Mouth)

Viral Diseases

See individual syndromes: gastroenteritis, conjunctivitis, pneumonia, meningitis, and encephalitis, for example.

Lower respiratory, adults if not covered elsewhere)


Lower respiratory, infants and children (if not covered elsewhere)

Droplet and Contact


Duration of illness

Various etiologic agents, such as respiratory syncytial virus, parainfluenza viruses, adenoviruses, and influenza viruses, can cause significant lower respiratory disease; thus, precautions to prevent their spread are generally indicated.

Pericarditis, myocarditis, or meningitis

Contact Feces For 7 days after onset

Enteroviruses frequently cause these infections. See


Viral Hemorrhagic Fever

Crimean-Congo Standard

Ebola Airborne; Contact;


Duration of illness

Follow hemorrhagic fever specific barrier precautions: 1) use of sharps safety devices and safe work practices, 2)


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Additional Precautions

hand hygiene, 3) barrier protection against blood and body fluids upon entry into room (single gloves, fluid –resistant or impermeable gown, N-95 masks, face/eye protection with goggles or face shields, leg and shoe covering), and 4) appropriate waste handling. Limit blood draws to those essential to care. Hospital Epidemiology and Public Health officials should be notified immediately if VHF is suspected/known. See Emerging Infections Policy.

Lassa Airborne; Contact; Additional Precautions


Follow hemorrhagic fever specific barrier precautions: 1) use of sharps safety devices and safe work practices, 2) hand hygiene, 3) barrier protection against blood and body fluids upon entry into room (single gloves, fluid –resistant or impermeable gown, N-95 masks, face/eye protection with goggles or face shields, leg and shoe covering), and 4) appropriate waste handling. Limit blood draws to those essential to care. Hospital Epidemiology and Public Health officials should be notified immediately if VHF is suspected/known. See Emerging Infections Policy.

Marburg Airborne; Contact; Additional Precautions


Follow hemorrhagic fever specific barrier precautions: 1) use of sharps safety devices and safe work practices, 2) hand hygiene, 3) barrier protection against blood and body fluids upon entry into room (single gloves, fluid –resistant or impermeable gown, N-95 masks, face/eye protection with goggles or face shields, leg and shoe covering), and 4) appropriate waste handling. Limit blood draws to those essential to care. Hospital Epidemiology and Public Health officials should be notified immediately if VHF is suspected/known. See Emerging Infections Policy.

Whooping Cough


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(See Pertussis, Bordatella)

Wound Infections If specific organism isolated, see specific listing for further precautions.

Major Contact Drainage Duration of drainage


Minor or limited Standard

Minor or limited = dressing covers and adequately contains the drainage, closed drainage system adequately contains the pus, or infected area is small, such as a stitch abscess.

Xanthomonas maltophilia (See Stenotrophomonas maltophilia)

Yersinia enterocolitica (See Gastroenteritis)

Zika Standard Blood and body fluids

Duration of illness

Most people infected with Zika virus are asymptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache. Clinical illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. However, there have been cases of Guillain-Barre syndrome reported in patients following suspected Zika virus infection. Recently, CDC concluded that Zika virus infection during pregnancy is a cause of microcephaly and other severe fetal brain defects. Due to concerns of microcephaly caused by maternal Zika virus infection, fetuses and infants of women infected with Zika virus during pregnancy should be evaluated for possible


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congenital infection and neurologic abnormalities.

Zycomycosis (Phycomycosis, Mucormycosis)

Standard

Responsibility Hospital Epidemiology is responsible for communicating current recommendations by the Centers for Disease Control. This listing will be updated as needed. All healthcare workers are responsible for following and implementing the proper Transmission-based Precautions.

transmission based precautions: initiation and ... · transmission based precautions: ... hand...

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