© 2013 UPMC All Rights Reserved
UPMC
POLICY AND PROCEDURE MANUAL
POLICY: HS-IC0609 *
INDEX TITLE: Infection Prevention
and Control
SUBJECT: Isolation/Standard Precautions Policy
DATE: November 8, 2013
TABLE OF CONTENTS I. POLICY STATEMENT……………………………………………………………………………….3
II. STANDARD PRECAUTIONS………………………………………………………………………..3
1. Scope………………………………………………………………………………….……….3
2. Procedure…………………………………………………………………………….………..4
Hand Hygiene…………………………………………………………………………….4
Personal Protection Equipment PPE
o Gloves………………………………………………………….……………….4
o Eye/Face Protection………………………………….…………………………4
o Gowns…………………………………………………….…………………….5
Patient Care Equipment…………………………………………………………………..5
Environmental control……………………………………………………………………5
Textiles and Laundry …………………………………………………………………….5
Eating Utensils……………………………………………………………………………6
Needles and other sharps …………………………………………………………………6
Patient Resuscitation……………………………………………………………………...6
Respiratory hygiene/cough etiquette……………………………………………………..6
Protective Environment…………………………………………………………………..7
III. TRANSMISSION BASED PRECAUTIONS………………………………………………………...7
1. Scope…………………………………………………………………………………………...7
2. Definition………………………………………………………………………………………7
3. Procedure………………………………………..……………………………………………..7
4. Types of Precautions……………………………………………………………………..…….8
A. Airborne Precautions…………………………………………………………………8
B. Droplet Precautions…………………………………………………………………..9
C. Contact Precautions…………………………………………………………………..9
D. Airborne/Contact Precautions……………………………………………………….11
E. Droplet/Contact Precautions………………………………………………………...11
5. Education for HCW”S patients and families ………………………………………………………11
IV. POLICIES REFERENCED WITHIN THIS POLICY…………………………………………….11
Attachment I – Procedure for Donning and Removing Personal Protective
Equipment……………………………………………………………………………………………………….13
Attachment II – Miscellaneous………………..……………………………………………………………….14
Disinfecting Equipment…………………………………………………..………………….14
Water Pitchers……………………………………………………………..…………………14
POLICY HS-IC0609
PAGE 2
© 2013 UPMC All Rights Reserved
Dietary Trays………………………………………………………………..……………….14
Admitting/Consent Forms……………………………………..…………………………….14
Reusable Items…………………………………………………………..…………………..14
Attachment III – Adaptations to Transmission Based
Precautions for Behavioral Health………………………………………………………………………………15
Attachment IV- Adaptations for Rehabilitation Units…………………………………………………………18
Attachment V - Procedures to Follow for Patients with Newly Emerging Organisms that Require Additional
Preventive Measures such as VISA/VERSA……………………………………………………………………20
Observer/Personnel Log ………………………………………………………………………………………..25
Attachment VI – Disease Specific Reference List
Type and duration of precautions needed for selected infections and
conditions……………………………………………………………………………….……………………….26
Attachment VII – Respiratory hygiene/cough etiquette……………………………………………………….51
Attachment VIII - Components of a Protective Environment…………………………………………………52
Attachment IX - Isolation Signs………………………………………………………………………………..53
Attachment X - Guidelines for Transporting Patients in
Isolation…………………………………………………………………………………………………………61
POLICY HS-IC0609
PAGE 3
© 2013 UPMC All Rights Reserved
UPMC
POLICY AND PROCEDURE MANUAL
POLICY: HS-IC0609 *
INDEX TITLE: Infection Prevention
and Control
SUBJECT: Isolation/Standard Precautions Policy
DATE: November 8, 2013
I. POLICY STATEMENT
It is the policy of UPMC to reduce the risk of transmission of pathogens by implementing
Standard Precautions and Transmission Based Precautions. To achieve this goal, two
tiers of precautions will be utilized. The first and most important tier is those precautions
designed for the care of all patients in the hospital regardless of their diagnosis or
presumed infection status. Implementation of these “Standard Precautions” is the primary
strategy for successful healthcare-associated infection control as well as employee safety.
The second tier, “Transmission-based Precautions” reflects infection control measures, in
addition to standard precautions that are needed to prevent transmission with patients
known or suspected to be infected or colonized with pathogens that can be transmitted by
a well defined route.
Links are provided to policies referenced within this policy and a list can also be found in
Section IV.
II. STANDARD PRECAUTIONS
1. SCOPE
Standard Precautions apply to all United States based UPMC patients receiving
care regardless of their diagnosis or presumed infection status.
Standard Precautions apply to:
Blood
All body fluids, secretions and excretions except sweat, regardless of
whether they contain visible blood
Non-intact skin
Mucous membranes
Standard Precautions are designed to reduce the risk of transmission of all
microorganisms from both recognized and unrecognized sources of infections in
hospitals.
POLICY HS-IC0609
PAGE 4
© 2013 UPMC All Rights Reserved
Standard Precautions merges the major feature of Universal Precautions (designed
to reduce the risk of transmission of Bloodborne Pathogens (BBP) and Body
Substance Isolation (BSI - designed to reduce the risk of transmission of all
pathogens from moist body substances).
2. PROCEDURE
Hand hygiene
Decontaminate hands using soap and water or an alcohol based hand rub utilizing
the World Health Organization (WHO) 5 Moments of Hand Hygiene as defined
by the System Hand Hygiene Policy HS-IC0615.
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Gloves
Wear gloves (clean nonsterile, non-vinyl gloves are adequate) when touching
blood, body fluids, secretions, excretions, contaminated items, mucous
membranes and nonintact skin or potentially colonized intact skin (e.g. patient
with diarrhea).
Do not use torn or discolored gloves.
Change gloves between tasks and procedures on the same patient after contact
with material that may contain a high concentration of microorganisms.
In patient care areas, gloves should not be used for non-patient care activities
such as answering the telephone, using a computer, or pushing elevator
buttons.
Do not wear the same pair of gloves for care of more than one patient.
Remove gloves after contact with blood/body fluids, secretions/excretions
Remove gloves after contact with contaminated items and environmental
surfaces
Do not wash gloves
Decontaminate hands immediately after glove removal to avoid transfer of
microorganisms to other patients or environments
Mask/Eye Protection/Face Shield
Use personal protective equipment (PPE) to protect the mucous membranes of
the eyes, nose and mouth during procedures and patient-care activities that are
likely to generate splashes or sprays of blood, body fluids, secretions and
excretions. Masks, goggles, face shields, and combinations of each should be
selected according to the task performed.
During procedures that generate sprays of respiratory secretions
(e.g./bronchoscopy, suctioning and intubations) wear gloves, gown, and either
a face shield that fully covers the front and sides of the face, or a mask and
goggles. Use a NIOSH approved N95 respirator or Powered Air Purifying
POLICY HS-IC0609
PAGE 5
© 2013 UPMC All Rights Reserved
Respirator (PAPR) instead of a surgical mask if the patient has a suspected or
proven infection that is likely to be transmitted by the airborne route.
Gowns
Wear a fluid resistant/impervious nonsterile gown to protect skin and prevent
soiling of clothing during procedures and patient care activities that are likely
to generate splashes or sprays of blood, body fluids, secretions or excretions
or cause soiling of clothing.
Select a gown that is appropriate for activity and amount of fluid likely to be
encountered.
Promptly remove a soiled gown and decontaminate hands to avoid transfer of
microorganisms to other patients or environment. PPE grossly contaminated
with blood or body fluids is discarded in the biohazard waste receptacle.
Patient Care Equipment
Handle used patient care equipment soiled with blood, body fluids, secretions and
excretions in a manner that prevents skin and mucous membrane exposures,
contamination of clothing and transfer of microorganisms to other patients and
environments. Reusable equipment should not be used for the care of another
patient until it has been appropriately cleaned, disinfected and/or reprocessed.
Single-use items are discarded in the appropriate container.
Environment Control
Hospital approved procedures for the routine care, cleaning and disinfection of
environmental surfaces, beds, bedrails, bedside equipment and other frequently
touched surfaces will be followed.
All spills of blood or body fluids are to be disinfected with a 10% solution (9 parts
water: 1 part bleach) of 5.25% sodium hypochlorite (bleach) or other approved
disinfectant wearing gloves and gowns and protective face wear as needed. All
patient specimens may be contaminated on the outside of the container and must
be handled with gloves. All patient specimens are to be transported in leak-proof
containers and bags that are labeled with the biohazardous symbol.
All trash that is contaminated with blood and body fluids must be treated as
infectious and disposed of in biohazardous bags.
Textiles and Laundry
Laundry visibly soiled with blood or body fluids must be handled with gloves.
All laundry must be placed in a fluid resistant bag. If linen hamper is used inside
the patient room, it should be as close to the door as possible. Do not place
laundry in a biohazardous bag. If the outside of the bag is visibly soiled with
POLICY HS-IC0609
PAGE 6
© 2013 UPMC All Rights Reserved
blood or body fluids, the bag must be placed inside another bag. All used laundry
must be considered contaminated. If personal clothing becomes contaminated
with blood or other potentially infectious material, it cannot be taken home until it
is laundered or disinfected.
Handle used laundry with minimum shaking to avoid contamination of air,
surfaces, and persons.
When handling used linen, always hold it away from your body.
If laundry chutes are used, ensure that they are properly designed, maintained,
and used in a manner to minimize dispersion of aerosols from contaminated
laundry.
Eating Utensils
No special precautions are needed for dishes, glasses, cups or eating utensils. The
combination of hot water and detergents used in hospital dishwashers is sufficient
to decontaminate dishware and eating utensils.
The hospital dietary tray should not be used as a means to dispose of any medical
devices or contaminated objects.
Dishes and/or food trays from any patient’s rooms, which are visibly
contaminated by blood or body fluids, should be cleaned by nursing personnel
prior to being returned to the food cart.
Needles and other sharps
Do not recap, bend, break, or hand—manipulate used needles; if recapping is
required, use a one-handed scoop technique only; use safety features when
available; place used sharps in puncture-resistant container. For additional
information refer to UPMC Policy HS-IC0616, Guidelines for Handling Sharps.
For additional information refer to UPMC Policy HS-IC0604, OSHA Bloodborne
Pathogen Standard Exposure Control Plan.
Patient Resuscitation – Use Mouthpiece, resuscitation bag, other ventilation
devices to prevent contact with mouth and oral secretions.
Respiratory hygiene/cough etiquette – instruct symptomatic persons to cover
mouth/nose when sneezing, coughing; use tissues and dispose in no-touch
receptacle and perform hand hygiene after soiling of hands with respiratory
secretions; wear surgical mask if tolerated or maintain spatial separation, > 3 feet
if possible. (See Respiratory Hygiene/Cough Etiquette guidelines,
Attachment VII).
POLICY HS-IC0609
PAGE 7
© 2013 UPMC All Rights Reserved
Protective Environment – refer to Attachment VIII “Components of a Protective
Environment” for specified patient populations.
III. TRANSMISSION BASED PRECAUTIONS
1. SCOPE
Transmission-based Precautions are used for patients known or suspected to be
infected or colonized with epidemiologically important pathogens spread by
airborne or droplet transmission, or by direct contact with patients or surfaces
potentially contaminated by the patient. Transmission-based Precautions are to be
strictly adhered to within the hospital. Modifications of Transmission-based
Precautions cannot be made without the consent of the Medical Director of
Infection Control and/or Hospital Infection Committee Chairperson of that
facility.
2. DEFINITION
Transmission-based Precautions are designed for patients documented or
suspected to be infected with highly transmissible or epidemiologically important
pathogens for which additional precautions beyond Standard Precautions are
needed to interrupt transmission in Health Care Facilities.
Transmission-based Precautions include:
1. Airborne Precautions
2. Droplet Precautions
3. Contact Precautions
Or a combination of the above may be used:
Airborne/Contact Precautions
Droplet/Contact Precautions
3. PROCEDURE
It is the responsibility of the healthcare provider to implement isolation for
patients under his or her care. When a physician or nurse is in doubt regarding the
need and type of isolation or precaution, they should consult the Infection
Prevention Policies on line. An Infection Prevention Practitioner should be
consulted for specific questions or recommendations not found in the manual.
The Medical Director of Infection Prevention, Infection Committee Chairperson,
or designee may initiate isolation or special precautions as deemed necessary.
Refer to Attachment IX - System Isolation Signage
POLICY HS-IC0609
PAGE 8
© 2013 UPMC All Rights Reserved
4. TYPES OF PRECAUTIONS
A. AIRBORNE PRECAUTIONS
In addition to Standard Precautions, Airborne Precautions are used for patients
known or suspected to be infected with microorganisms transmitted by airborne
droplet nuclei (small-residue [5 microns or smaller in size] (e.g. Tuberculosis
(TB) or Measles (Rubeola).
Non-immune HCWs should not care for patients with vaccine preventable
airborne diseases (if immune caregivers are available.) All HCW’s entering room
should wear a NIOSH approved N95 respirator or Powered Air Purifying
Respirator (PAPR).
Patient Placement
Place the patient in a private room that has:
Monitored negative air pressure in relation to the surrounding areas.
Six to twelve air changes per hour.
Appropriate discharge of air outdoors or monitored high-efficiency filtration
of room air before the air is circulated to other areas in the hospital.
Keep doors closed and the patient in the room.
When a private room is not available the patient will be placed in a room with
a patient(s) who has been infected with the same microorganism, but with no
other communicable infection (cohorting) Cohorting patients in a negative
pressure room is permitted if necessary(private room is not available and the
patient is infected with same microorganism)
Respiratory Protection
Wear approved respiratory protection a NIOSH approved N95 respirator or
Powered Air Purifying Respirator (PAPR) when entering the room.
Patient Transport (See Attachment X)
Limit the movement and transport of the patient from the room for essential
purposes only. If transport or movement is necessary place a mask
(regular/procedure/surgical) on the patient (do not use the N95 respirator for the
patient). For patients with skin lesions associated with varicella (chickenpox)
smallpox or draining skin lesions caused by M. tuberculosis, cover the patient to
prevent aerosolization or contact with the infectious agent present in skin lesions.
The receiving areas must be informed about the patient’s isolation status. No PPE
is worn by the HCW during transportation unless special
circumstances/conditions warrant additional procedures.
POLICY HS-IC0609
PAGE 9
© 2013 UPMC All Rights Reserved
For additional precautions for preventing transmission of tuberculosis, refer to the
UPMC Policy HS-IC0611, TB Exposure Control Plan.
B. DROPLET PRECAUTIONS
In addition to Standard Precautions, Droplet Precautions are used for patients
known or suspected to be infected with microorganisms transmitted by droplets
[particles larger than 5 microns in size] that can be generated by the patient during
coughing, sneezing, talking or the performance of cough inducing procedures
(e.g. Neisseria meningitis, and influenza).
Patient Placement
Place the patient in a private room. If a private room is not available, place the
patient in a room with a patient(s) who has active infection with the same
microorganism, but with no other communicable infection (cohorting).
When a private room is not available and cohorting is not easily achievable,
consult with Infection Prevention professionals before patient placement.
Respiratory Protection
A mask (regular/procedure/surgical) should be worn when within three feet of the
isolated patient
Patient Transport (See Attachment X)
Limit the movement and transport of the patient from the room for essential
purposes only. If transport or movement is necessary, minimize patient dispersal
of droplets by placing a mask (regular/procedure/surgical) on the patient. The
receiving areas must be informed about the patient’s isolation status. No PPE is
worn by the HCW during transportation unless special circumstances/conditions
warrant additional procedures.
C. CONTACT PRECAUTIONS
In addition to Standard Precautions, use Contact Precautions for specified patients
known or suspected to be infected or colonized with epidemiologically important
microorganisms including Multidrug-resistant organisms (MDROs) that can be
transmitted by direct contact with the patient (hand or skin-to-skin), or indirect
contact (touching) with environmental surfaces or patient-care items in the
patient’s environment.
*Enhanced signage is utilized for patients on Contact Precautions which require soap
and water for hand hygiene after contact with the patient and/or environment; such as
C.difficile or Norovirus. Refer to facility specific guidelines.
POLICY HS-IC0609
PAGE 10
© 2013 UPMC All Rights Reserved
Patient Placement
Place the patient in a private room. When a private room is not available, the
patient can be placed in a room with a patient(s) who has been identified with the
same microorganism, but with no other communicable infection (cohorting).
When a private room is not available and cohorting is not easily achievable,
consult with Infection Prevention professionals before patient placement.
Gloves and Hand Hygiene
In addition to Standard Precautions, wear clean, non-sterile non-vinyl procedure
gloves for contact with the patient and or environment. During the course of
providing care for a patient, change gloves after contact with infective material.
Remove gloves and immediately decontaminate hands with an antimicrobial
agent or an alcohol based hand rub.
Gowns
In addition to Standard Precautions, wear a clean non-sterile gown for contact
with the patient and or the environment. Remove gown before you leave the
patients environment and decontaminate hands with an antimicrobial agent or an
alcohol based hand rub. See Attachment I for the procedure for donning and
removing isolation garb.
Patient Transport (See Attachment X)
Limit the movement and transport of the patient from the room to essential
purposes only. Generally, patients in Contact Precautions should not go to
common areas on the nursing unit or within the facility. If the patient is
transported out of the room, ensure that precautions are maintained to minimize
the risk of transmission of microorganisms to other patients and contamination of
environmental surfaces or equipment. The receiving areas must be informed
about the patient’s isolation status. No PPE is worn by the HCW during
transportation unless special circumstances/ conditions warrant additional
procedures.
Patient Care Equipment
When possible, dedicate the use of noncritical patient-care equipment to a single
patient (or cohort of patients infected or colonized with the pathogen requiring
precautions). If use of common equipment or items is unavoidable, then
adequately clean and disinfect them before use for another patient.
POLICY HS-IC0609
PAGE 11
© 2013 UPMC All Rights Reserved
D. AIRBORNE/CONTACT PRECAUTIONS
Patients requiring both Airborne Precautions and Contact Precautions should be
placed into this category (e.g. chickenpox, disseminated herpes zoster, or
smallpox).
Non-immune HCW’s should not care for patients with vaccine preventable
airborne diseases (e.g. chickenpox, smallpox) if immune caregivers are available.
All HCW’s entering room should wear a NIOSH approved N95 respirator or
Powered Air Purifying Respirator (PAPR) .
Emerging Infectious Diseases may require eye protection in addition to Airborne
Precautions (e.g. SARS, Avian Influenza).
E. DROPLET/CONTACT PRECAUTIONS
Patients requiring both Droplet Precautions and Contact Precautions such as
Vancomycin Resistant Staph Aureus (VRSA) should be placed into this category.
All precautions listed for each category must be maintained.
Emerging Infectious Diseases may require eye protection in addition to Droplet
Precautions (e.g. SARS, Avian Influenza).
5. EDUCATION OF HCW’S, PATIENTS AND FAMILIES
Healthcare workers will receive training on Standard and Transmission based
Precautions during orientation and annually thereafter.
It is the responsibility of Healthcare providers to educate patients and visitors
about the use of precautions and their responsibility for adherence to them.
Adherence to precautions may be monitored and findings used to direct
improvements. Document all education in the patient record.
IV. POLICIES REFERENCED WITHIN THIS POLICY
HS-IC0615 Hand Hygiene
HS-IC0604 OSHA Bloodborne Pathogen Exposure Control Plan
HS-IC0611 TB Exposure Control Plan
HS-IC0605 CJD/Prion Transmission Prevention
HS-IC0612 Respiratory Pathogens-Emerging Viruses (RPEV)
HS-IC0608 Infection Control Bioterrorism Readiness Guidelines
POLICY HS-IC0609
PAGE 12
© 2013 UPMC All Rights Reserved
SIGNED: Tami Minnier
Chief Quality Officer
ORIGINAL: August 8, 2003
APPROVALS:
Policy Review Subcommittee: October 10, 2013
Executive Staff: November 8, 2013
PRECEDE: July 8, 2013
SPONSOR: System Infection Prevention and Control Committee
Attachments
* With respect to UPMC business units described in the Scope section, this policy is intended to replace
individual business unit policies covering the same subject matter. In-Scope business unit policies covering
the same subject matter should be pulled from all manuals.
POLICY HS-IC0609
PAGE 13
© 2013 UPMC All Rights Reserved
Attachment I
Procedure for Donning and Removing Personal Protective Equipment
Donning Personal Protective Equipment:
Obtain gown, gloves and/or mask as required.
Put on the gown with the opening in the back and tie at the neck and waist.
Don mask per specific isolation requirement.
Place mask over nose and mouth and adjust for close fit.
Change mask when it becomes moist.
Never wear the mask lowered or hung around the neck.
Mask with eye shield is used when splashing is possible.
N95 respirator may be reused.
If PAPR is used, follow specific hospital procedure.
Practice hand hygiene with soap and water or hand sanitizer
Put on non-sterile non-vinyl procedure gloves. Examine gloves for possible tears, cracks, or
tiny holes. Replace damaged gloves as soon as possible.
Removing Personal Protective Equipment
Untie gown at waist.
Remove gloves by:
Grasp glove near the cuff and pull glove down with the inside out.
Cup the glove in the palm of the gloved hand.
Insert two fingers of the bare hand inside the cuff of the gloved hand.
Pull down on this glove so that it comes off with the inside out and with the first glove
tucked into the center.
Decontaminate hands.
Remove mask.
*Note that for Airborne Precautions, N95 Respirator or PAPR should remain on until exiting the
room.
Remove gown:
Untie gown at the neck.
Roll the gown over the forearms and hands so that the gown is also inside out. Do not touch
the outside surface of the gown.
Roll the gown into a compact bundle for disposal.
Gowns, gloves and masks must be removed before exiting the room and placed in the
appropriate waste container.
Decontaminate hands.
POLICY HS-IC0609
PAGE 14
© 2013 UPMC All Rights Reserved
Attachment II: Miscellaneous
Disinfecting Equipment Used for Isolation
Dedicated equipment is used for isolation patients (e.g. thermometers, stethoscopes,
tourniquets.)
If reusable equipment must be used, it must be disinfected between patients (e.g. pulse ox,
glucometers, bed scales) with a hospital approved disinfectant.
Isolation Related Issues
Water pitchers
Water pitchers cannot leave the isolated patient’s room to be refilled.
Dietary trays
Dietary trays for patients must be delivered by personnel wearing appropriate garb if contact
with the environment is anticipated.
After patient or environmental contact the tray must be placed directly in the dietary cart or
designated area.
Trays removed from patient rooms should not be placed on counter tops outside of patient
rooms.
Admitting/Consent Forms
If a patient known to be colonized with resistant organisms is being admitted, forms should
be placed on a clipboard and held away from the patient or environment as the patient signs
the form to help avoid contamination.
Forms can then be placed in the chart as usual.
Reusable items
Community non health care related items (i.e. magazines, books, etc.) should be discarded
when patient is discharged.
POLICY HS-IC0609
PAGE 15
© 2013 UPMC All Rights Reserved
Attachment III
Adaptations to Transmission-based Precautions for
Behavioral Health Facilities
Modifications/adaptations of Transmission-based Precautions may be made on a case-by-case
basis for the care and special needs of special population (e.g. behavioral health) with the
approval of the Director of Infection Prevention and Control or his/her designee. Modifications
cannot be made for conditions requiring Airborne Precautions (i.e. Tuberculosis), or
Airborne/Contact precautions. Modifications/adaptations may include but are not limited to:
CONTACT PRECAUTIONS
Private Room - A private room is indicated, however patients infected with the same
organism may share a room if necessary.
The patient may come out of their room to attend group activities in the therapeutic
milieu. If the patient is incontinent, they must wear an adult incontinence brief, wear
double barriers (e.g. in street clothes, or gown with robe) and only sit on community
furniture covered with a plastic pad. Continent patient must wear double barriers
(e.g. street clothes or gown with robe.)
In addition, patient must clean hands under staff observation before coming into the
milieu.
Gloves - Wear non-sterile, non-vinyl procedure gloves for contact with the patient and/or
environment. Change gloves after contact with infective material. Remove gloves
immediately.
Gowns – Wear gowns if you anticipate that your clothes will have contact with the patient,
environmental surfaces, or items in the patient’s room. Remove gown before you leave the
patients environment.
Hand Hygiene- Decontaminate hands using soap and water or an alcohol based hand rub.
Transport – Limit the movement transport of patients to essential purposes only. During
transport, ensure that all precautions are maintained at all times.
Equipment – Delegate the use of patient care equipment to a single patient. If common
equipment is used, disinfect between patients with a hospital approved disinfectant.
EXAMPLES (FOR CONTACT PRECAUTIONS):
Acute diarrhea with a likely infectious cause in an incontinent or diapered patient
Drainage, uncontrolled (cannot be contained in a dressing)
Gastroenteritis, if caused by E. coli 0157:H7, Shigella, or
Hepatitis A (in a patient incontinent of stool)
Multiple-resistant bacteria, infection or colonization (any site) with any of the following:
POLICY HS-IC0609
PAGE 16
© 2013 UPMC All Rights Reserved
1. Gram negative bacilli resistant to all aminoglycosides or to multiple advanced generation
beta-lactams.
2. Enterococcus – Resistant to vancomycin
3. Other resistant bacteria may be included in this isolation category if they are judged by
the Infection Control team to be of special clinical and epidemiological significance
Clostridium difficile
Pediculosis (lice)
Scabies
Staphylococcal disease, in a major wound or burn
Herpes simplex, disseminated mucocutaneous or severe primary
DROPLET PRECAUTIONS
Private Room – A private room is indicated, however patients with the same organism may
share a room.
The door to the patient’s room may be left ajar.
Gloves and gowns should be worn as per standard precautions.
A mask should be worn when entering the room or when within three feet of the isolated
patient.
If necessary, patient may enter the therapeutic milieu if wearing a mask at all times. The
patient cannot come to milieu without a mask until they are completely asymptomatic.
Transport – Limit the movement/transport of patients to essential purposes only. During
transport, place mask on patient.
EXAMPLES (FOR DROPLET PRECAUTIONS):
Diphtheria, pharyngeal
Meningitis (known or suspected Meningococcal, or H. Influenza)
Meningococcal pneumonia
Streptococcal (Group A)-Pneumonia or Pharyngitis
Parvovirus – B-19
Meningococcemia (meningococcal sepsis)
Influenza
Mumps (infectious parotitis)
Pertussis (whooping cough)
Plague, pneumonic
Rubella (German Measles)
Pneumonia-known or suspected mycoplasma
DROPLET/CONTACT PRECAUTIONS:
All precautions used for Droplet and Contact Precautions must be observed as above.
POLICY HS-IC0609
PAGE 17
© 2013 UPMC All Rights Reserved
EXAMPLES FOR CONTACT/DROPLET PRECAUTIONS:
Adenovirus
Norovirus
Diphtheria, cutaneous
Streptococcal disease (group A), pneumonia or in major wound or burn
Multiply-resistant bacteria, infection or colonization (any site) with any of the following:
1. Pneumococcus resistant to penicillin.
2. Haemophilus influenzae resistant to ampicillin (beta-lactamase positive) and
chloramphenicol.
Other resistant bacteria may be included in this isolation category if they are judged by the
Infection Prevention and Control Department to be of special clinical and epidemiologic
significance.
POLICY HS-IC0609
PAGE 18
© 2013 UPMC All Rights Reserved
Attachment IV
Adaptations to Transmission-based Precautions for Rehabilitation Units
Modifications/adaptations of Transmission-based Precautions may be made on a case-by-case
basis for the care and special needs of special population (e.g. Rehabilitation Units) with the
approval of the Director of Infection Prevention and Control or his/her designee. Modifications
cannot be made for conditions requiring Airborne Precautions (i.e. Tuberculosis), or
Airborne/Contact precautions. Modifications/adaptations may include but are not limited to:
CONTACT PRECAUTIONS
Modification in multi-patient therapeutic treatment area:
1. Therapeutic staff having direct contact with the patient will complete hand hygiene and
don gloves during therapy.
2. Upon completion of therapy staff will remove gloves and complete hand hygiene.
3. If patient cannot wear isolation gown the therapist treating must wear both gown and
gloves.
Community Outings:
1. Patients in contact isolation that require community interactions for rehabilitation
purposes should be evaluated and assessed by the Rehabilitation Nursing Staff for the
appropriateness of the outing with input from the Infection Prevention and Control
department as needed.
2. Criteria considered during the evaluation process:
a. From what body site(s) has organism been cultured?
b. Is the drainage or body substance containable?
c. What invasive devices, if any, are present?
d. What is the mental competence and personal hygiene of the individual and how
do these factors relate to the patient’s potential to transmit resistant organisms?
e. What kind of direct patient care is being provided to the patient?
POLICY HS-IC0609
PAGE 19
© 2013 UPMC All Rights Reserved
Common Areas:
1. Patients in contact isolation are permitted to eat in the dining area, sit in common
hallways, and practice mobility within the unit/department.
2. Patients should wear an isolation gown and complete hand hygiene before exiting the
room.
3. Patients are permitted to participate in therapies off of the unit in designated therapy
areas with supervision.
4. Areas of restriction include the gift shop, cafeteria and lobby area.
POLICY HS-IC0609
PAGE 20
© 2013 UPMC All Rights Reserved
Attachment V
Procedures to Follow for Patients with Newly Emerging Organisms that Require
Additional Preventive Measures
Additional measures may be required for patients that are identified with newly emerging
organisms in order to prevent healthcare-associated transmission. These organisms are often
times untreatable or difficult-to-treat multidrug-resistant organisms that are emerging in the
United States or other parts of the world.
VISA & VRSA:
Vancomycin -intermediate Staphylococcus aureus (VISA) and Vancomycin-resistant
Staphylococcus aureus (VRSA) are specific types of antimicrobial-resistant bacteria. Persons
who develop this type of staph infection may have underlying health conditions (such as diabetes
and kidney disease), tubes going into their bodies (such as catheters), previous infections with
methicillin-resistant Staphylococcus aureus (MRSA), and recent exposure to vancomycin and
other antimicrobial agents.
Staphylococcus aureus in general is an important cause of healthcare and community associated
infections. The diseases associated with this organism range from mild skin and soft-tissue
infections to potentially fatal systemic illnesses such as endocarditis and toxic-shock syndrome.
S. aureus is a common pathogen that affects individuals across the age spectrum.
CRE-NDM:
Enterobacteriaceae is a large family of Gram-negative bacteria that includes both normal and
pathogenic enteric bacteria such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Serratia,
Salmonella and Shigella. CRE are those Enterobacteriacea that have developed high levels of
resistance to antibiotics, including last-resort antibiotics called carbapenems. CRE infections
most commonly occur among patients who are receiving antibiotics and significant medical
treatment for other conditions.
Carbapenem-resistant Enterobacteriaceae (CRE) New Delhi metallo-β-lactamase (NDM) is a
specific type of antimicrobial-resistant bacteria associated with a high mortality rate and the
potential to spread widely. This organism is more common in other areas of the world and in the
United States has generally been found among patients who received medical care in countries
where these organisms are known to be present.
POLICY HS-IC0609
PAGE 21
© 2013 UPMC All Rights Reserved
A. IDENTIFICATION AND NOTIFICATION
Once the microbiology laboratory suspects the presence of VISA, VRSA, CRE-NDM or any
newly identified organism of epidemiologic concern the laboratory should immediately notify
Infection Prevention and Control personnel, the clinical unit and the attending physician.
Infection Prevention and Control will notify the Medical Director of Infection Prevention and
Control and/or Chairperson of the Infection Prevention and Control Committee, the State and/or
Local Health Department, Administration and the Centers for Disease Control and Prevention
(CDC). The Medical Director of Infection Prevention and Control and/or Chairperson of the
Infection Prevention and Control Committee will be responsible for informing medical
leadership.
B. ISOLATION
The patient will be placed in Contact precautions (gown and gloves required when
entering room). Mask and/or face shield should be worn to protect the mucous
membranes of the eyes, nose and mouth during procedures and patient-care activities
that are likely to generate splashes or sprays of blood, body fluids, secretions and
excretions.
Performing hand hygiene according to policy HS-IC0615 Hand Hygiene is
imperative.
The patient’s current room will be closed to admissions until terminally cleaned. The
patient will be moved as soon as possible to a private room preferably one that has an
anteroom. This room should have dialysis capability if the patient requires it, as the
patient will not be able to leave the room unless absolutely necessary. If this room is
not immediately available, transfers must be made expeditiously to make one
available. If the anteroom serves two rooms, the other room must be blocked or used
as cohort room for another isolation patient with the same organism.
HCW having contact with the patient will be limited. (One nurse should care for the
patient per shift if possible).
Isolation precautions will be utilized through the patient’s entire hospitalization.
A long-term isolation code will be applied in the electronic health record indicating
the patient will be isolated upon readmission until the code is removed according to
current CDC recommendations and/or per the recommendation of Infection
Prevention and Control Department.
If a newly identified organism, isolation type may be changed per Infection
Prevention and Control recommendations.
POLICY HS-IC0609
PAGE 22
© 2013 UPMC All Rights Reserved
C. OBSERVER/CONTROLLER
The function of this person will be to restrict access to the room, maintain personnel
log, and enforce HH and PPE precautions. Traffic into the room will be controlled
twenty-four hours per day. These individuals will be oriented by Infection Prevention
and Control and given a copy of the policy and procedure.
A log of all personnel will be completed by the observer for HH and PPE compliance
and maintained by Infection Prevention and Control as a reference for potential
outbreak surveillance.
The information will be documented on the Personnel Log (See Attachment A).
D. TRANSPORT
Any non-critical diagnostic or therapeutic procedure should be postponed. Others
will be done portable in the isolation room, such as dialysis.
If the patient must be transported, the observer/controller will accompany the patient,
providing information and direction as needed, and be responsible for transporting the
patients chart. The chart should not be placed on top of the patient bed/stretcher or
wheelchair.
Those having contact with the patient must wear gowns and gloves. Persons having
direct contact with the patient during transport or during a medical procedure must be
added to the personnel log as described above.
The patient will:
1. be given a fresh grown to decrease the bioburden.
2. be placed on a stretcher and/or wheelchair layered with clean sheets.
3. be covered as much as possible so that very little skin is exposed and an isolation
gown should be placed atop the sheets as a visual cue for those in contact with the
patient during transfer.
Linen should be carefully placed in a linen bag and laundered as usual.
Any item or equipment (including stretcher or wheelchair) coming in direct contact
with the patient must be cleaned thoroughly with a hospital approved disinfectant
before being used on the next patient.
E. SIGNAGE/COMMUNICATION
Contact signage will be displayed according to hospital policy.
Isolation will be prominently marked on registration forms and in the medical record.
The banner bar in the electronic health record will display the appropriate isolation
code.
POLICY HS-IC0609
PAGE 23
© 2013 UPMC All Rights Reserved
Staff should hand off the appropriate information during shift change and when the
patient is being transported or transferred to a different department or being
discharged to an outside facility.
Consultation with an Infectious Disease physician is strongly recommended.
F. EQUIPMENT AND SUPPLIES
There will be dedicated equipment. When possible, use disposable patient care items.
Sharing of general supplies (tape, 4 x 4s, betadine) and equipment (I.V. poles, BP
cuff, stethoscope, and thermometer) is not permitted.
Any equipment that cannot be dedicated to the patient, which enters the room, must
be thoroughly cleaned with hospital approved disinfectant before leaving.
All supplies other than reusable equipment are discarded after discharge.
G. ENVIRONMENTAL SERVICES
The room will be cleaned daily by Environmental Services using sodium hypochlorite
(bleach) and/or a hospital-approved disinfectant. Close attention is necessary in
cleaning high-touch surfaces.
The mop head must not be used in other rooms.
A laundry hamper for linen will be kept in the isolation room.
Once the linen is bagged, it can be handled per routine.
Terminal isolation cleaning procedures should be used for all areas (patient room,
procedure areas etc.) and include changing of cubicle curtains.
H. SPECIMENS
Specimens are collected in the room and placed in a leak-proof container affixed with
a patient label/identifier.
The container is wiped with an alcohol wipe before being placed in a sealable
specimen bag.
The specimen is placed in a bag (being held opened by an assistant) avoiding
contamination of the outside of the bag.
I. DIETARY
Trays/dishes must be removed from patient room following procedure for patients in
isolation.
POLICY HS-IC0609
PAGE 24
© 2013 UPMC All Rights Reserved
J. EDUCATION
Infection Prevention and Control will provide in-service education for the staff as
needed.
Infection Preventionist and/or nursing staff will provide education and counseling for
the patient and family.
Discharge instructions will be in conjunction with the CDC recommendations.
K. VISITORS/FAMILY MEMBERS
Visitors and/or family members will be encouraged to maintain limited visitation.
Visitors in appropriate barrier attire will be permitted as per guidelines.
L. OUTBREAK SURVEILLANCE
If a contact investigation is warranted, the Infection Prevention and Control
department will follow guidelines to determine whether transmission has occurred.
This may include the collection of baseline cultures from the anterior nares and hands
of all healthcare workers, roommates and others with direct patient contact.
Contacts (healthcare workers, visitors, volunteers, etc.) who are potentially exposed
will be categorized based on their level of interaction (i.e., extensive, moderate, or
minimal) with the colonized or infected patient during an outbreak investigation.
CDC guidelines will be reviewed but ultimate decisions regarding interaction
category will be made by Infection Prevention and Control.
If there was a roommate involved in a potential exposure, he/she should be placed in
a private room in contact precautions and the attending physician must be notified.
If there are additional cases, the unit may be closed to new admissions per review by
Infection Prevention and Control and hospital Administration.
POLICY HS-IC0609
PAGE 25
© 2013 UPMC All Rights Reserved
Attachment A
PERSONNEL LOG
Please print
(Include observer/control name per shift)
Dates/Shift
Name
Job Title
Department
Phone #
Comments
POLICY HS-IC0609
PAGE 26
© 2013 UPMC All Rights Reserved
Attachment VI:
DISEASE-SPECIFIC REFERENCE LIST
The Disease-Specific Reference List lists most of the common infectious agents and diseases
that are likely to be found in U.S. hospitals and the specific isolation precautions indicated for
each. Diseases are listed alphabetically in several ways: by anatomical site of syndrome
(abscess, burn wound, cellulitis, etc.), by etiologic agent (Chlamydia trachomatis, Clostridium
perfringens, Escherichia coli, etc.) and sometimes by a combination of a syndrome and etiologic
agent (endometritis, group A Streptococcus; pneumonia, Staphylococcus aureus, etc.). In an
attempt to make the table useful to all hospital personnel, including those from nonclinical areas
(admitting, dietary, housekeeping, laundry, etc.), common terminology and jargon (such as
gangrene and “TORCH” syndrome) are also used in the alphabetical listing of diseases.
For some diseases or conditions listed, we recommend more stringent isolation precautions for
infants and young children than for adults since the risk of spread and the consequences of
infection are greater in infants and young children. We use the term “young children” rather
than an age breakpoint because children mature at such different rates. Thus, the interpretation
of the term “young children” will differ in various pediatric settings according to the patient
population.
The Disease-Specific Reference List specifies the Type of Isolation, Duration of Precautions
and Comments. Symbols used in the Disease Specific Reference list include the following:
Type of Isolation A Airborne
C Contact
D Droplet
S Standard
*When A, C, and D are specified, also use S
In general, patients infected with the same organism may share a room. For some diseases or
conditions a private room is indicated if patient hygiene is poor. A patient with poor hygiene
does not wash hands after touching infective material (feces, purulent drainage, or secretions),
contaminates the environment with infective material, or shares contaminated articles with other
patients. Likewise, for some diseases a mask is indicated only for those who get close (about 3
feet) to the patient. Hand Hygiene is not listed in the table because it is important for all patient
care, whether or not the patient is infected, and is always necessary to prevent transmission of
infection.
Duration of Isolation
CN Until off antimicrobial treatment and culture negative.
DI Duration of illness (with wounds, DI means until wounds stop draining)
DE Until environment completely decontaminated
U Until time specified in hours (hrs.) after initiation of effective therapy
POLICY HS-IC0609
PAGE 27
© 2013 UPMC All Rights Reserved
In addition to including the specific precautions indicated for each disease, the Disease-Specific
Reference List identifies which secretions, excretions, discharges, body fluids, and tissues are
infective or might be infective. Again, common terms such as feces and pus are used to describe
infective material. In the table the term “pus” refers to grossly purulent as well as serous
drainage that is likely to be infective. In the table, we also tell how long to apply the precautions
and other considerations that personnel should be aware of when taking care of an infected or
colonized patient for whom isolation precautions are indicated.
It is imperative that all employees utilize STANDARD PRECAUTIONS when in contact with
all blood and body fluids.
These Precautions are based upon published literature and CDC guidelines. Individual
facilities may have additional precautions applied based upon their facility specific standard.
POLICY HS-IC0609
PAGE 28
28
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Abscess
Draining, major C DI No dressing or containment of drainage; until drainage stops or can be contained by dressing
Draining, minor or limited S Dressing covers and contains drainage
Acquired human immunodeficiency syndrome (H IV) S Post-exposure chemoprophylaxis for some blood exposures 866.
Actinomycosis S Not transmitted from person to person
Adenovirus infection ( see agent-specific guidance under gastroenteritis, conjuctivitis, pneumonia)
Amebiasis S
Person to person transmission is rare. Transmission in settings for the mentally challenged and in a family group has been reported 1045. Use care when handling diapered infants and mentally challenged persons 1046.
Anthrax S Infected patients do not generally pose a transmission risk.
Cutaneous S
Transmission through non-intact skin contact with draining lesions possible, therefore use Contact Precautions if large amount of uncontained drainage. Handwashing with soap and water preferable to use of waterless alcohol based antiseptics since alcohol does not
1 Type of Precautions: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard; when A, C, and D are specified, also use S.
† Duration of precautions: CN, until off antimicrobial treatment and culture-negative; DI, duration of illness (with wound lesions, DI means until wounds stop draining); DE, until environment completely decontaminated; U, until time specified in hours (hrs) after initiation of effective therapy; Unknown: criteria for establishing eradication of pathogen has not been determined
POLICY HS-IC0609
PAGE 29
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
have sporicidal activity 983.
Pulmonary S Not transmitted from person to person
Environmental: aerosolizable spore-containing powder or other substance
DE
Until decontamination of environment complete 203 . Wear respirator (N95 mask or PAPRs), protective clothing; decontaminate persons with powder on them (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5135a3.htm) Hand hygiene: Handwashing for 30-60 seconds with soap and water or 2% chlorhexidene gluconate after spore contact (alcohol handrubs inactive against spores 983. Post-exposure prophylaxis following environmental exposure: 60 days of antimicrobials (either doxycycline, ciprofloxacin, or levofloxacin) and post-exposure vaccine under IND
Antibiotic-associated colitis (see Clostridium difficile)
Arthropod-borne viral encephalitides (eastern, western, Venezuelan equine encephalomyelitis; St Louis, California encephalitis; West Nile Virus) and viral fevers (dengue, yellow fever, Colorado tick fever)
S
Not transmitted from person to person except rarely by transfusion, and for West Nile virus by organ transplant, breastmilk or transplacentally 530, 1047 . Install screens in windows and doors in endemic areas Use DEET-containing mosquito repellants and clothing to cover extremities
Ascariasis S Not transmitted from person to person
Aspergillosis S Contact Precautions and Airborne Precautions if massive soft tissue infection with copious drainage and
repeated irrigations required 154.
Avian influenza (see influenza, avian below)
Babesiosis S Not transmitted from person to person except rarely by transfusion,
Blastomycosis, North American, cutaneous or pulmonary S Not transmitted from person to person
Botulism S Not transmitted from person to person
Bronchiolitis (see respiratory infections in infants and young children) C DI Use mask according to Standard Precautions.
POLICY HS-IC0609
PAGE 30
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Brucellosis (undulant, Malta, Mediterranean fever) S
Not transmitted from person to person except rarely via banked spermatozoa and sexual contact 1048, 1049 . Provide antimicrobial prophylaxis following laboratory exposure 1050.
Campylobacter gastroenteritis (see gastroenteritis)
Candidiasis, all forms including mucocutaneous S
Cat-scratch fever (benign inoculation lymphoreticulosis) S Not transmitted from person to person
Cellulitis S
Chancroid (soft chancre) (H. ducreyi) S Transmitted sexually from person to person
Chickenpox (see varicella)
Chlamydia trachomatis
Conjunctivitis S
Genital (lymphogranuloma venereum) S
Pneumonia (infants < 3 mos. of age)) S
Chlamydia pneumoniae S Outbreaks in institutionalized populations reported, rarely 1051, 1052
Cholera (see gastroenteritis)
Closed-cavity infection
Open drain in place; limited or minor drainage S Contact Precautions if there is copious uncontained drainage
No drain or closed drainage system in place S
Clostridium
C. botulinum S Not transmitted from person to person
C. difficile (see Gastroenteritis, C. difficile) C Length of
Stay
C. perfringens
Food poisoning S Not transmitted from person to person
Gas gangrene S Transmission from person to person rare; one outbreak in a surgical setting reported
1053. Use Contact
Precautions if wound drainage is extensive.
POLICY HS-IC0609
PAGE 31
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Coccidioidomycosis (valley fever)
Draining lesions S
Not transmitted from person to person except under extraordinary circumstances because the infectious arthroconidial form of Coccidioides immitis is not produced in humans 1054 .
Pneumonia S
Not transmitted from person to person except under extraordinary circumstances, (e.g., inhalation of aerosolized tissue phase endospores during necropsy, transplantation of infected lung) because the infectious arthroconidial form of Coccidioides immitis is not produced in humans 1054, 1055.
Colorado tick fever S Not transmitted from person to person
Congenital rubella C
Until 1 yr of age
Standard Precautions if nasopharyngeal and urine cultures repeatedly neg. after 3 mos. of age
Conjunctivitis
Acute bacterial S
Chlamydia S
Gonococcal S
Acute viral (acute hemorrhagic) C DI
Adenovirus most common; enterovirus 70 1056,
Coxsackie virus A24 1057) also associated with community outbreaks. Highly contagious; outbreaks in eye clinics, pediatric and neonatal settings, institutional settings reported. Eye clinics should follow Standard Precautions when handling patients with conjunctivitis. Routine use of infection control measures in the handling of instruments and equipment will prevent the occurrence of outbreaks in this and other settings. 460, 814,
1058, 1059 461, 1060 .
Corona virus associated with SARS (SARS-CoV) (see severe acute respiratory syndrome)
POLICY HS-IC0609
PAGE 32
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Coxsackie virus disease (see enteroviral infection)
CRE (Carbapenem-resistant Enterobacteriaceae) C
CRE-NDM (New Delhi metallo-β-lactamase) C See Attachment (V ) for Additional measure that must be followed.
Creutzfeldt-Jakob disease CJD, vCJD
S
Use disposable instruments or special sterilization/disinfection for surfaces, objects contaminated with neural tissue if CJD or vCJD suspected and has not been R/O; No special burial procedures 1061
Croup (see respiratory infections in infants and young children)
Crimean-Congo Fever (see Viral Hemorrhagic Fever) S
Cryptococcosis S Not transmitted from person to person, except rarely via tissue and
corneal transplant 1062, 1063
Cryptosporidiosis (see gastroenteritis)
Cysticercosis S Not transmitted from person to person
Cytomegalovirus infection, including in neonates and immunosuppressed patients
S No additional precautions for pregnant HCWs
Decubitus ulcer (see Pressure ulcer)
Dengue fever S Not transmitted from person to person
Diarrhea, acute-infective etiology suspected (see gastroenteritis)
Diphtheria
Cutaneous C CN Until 2 cultures taken 24 hrs. apart negative
Pharyngeal D CN Until 2 cultures taken 24 hrs. apart negative Ebola virus (see viral hemorrhagic fevers) Echinococcosis (hydatidosis) S Not transmitted from person to person Echovirus (see enteroviral infection) Encephalitis or encephalomyelitis (see specific etiologic agents) Endometritis (endomyometritis) S Enterobiasis (pinworm disease, oxyuriasis) S Enterococcus species (see multidrug-resistant organisms if
POLICY HS-IC0609
PAGE 33
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
epidemiologically significant or vancomycin resistant)
Enterocolitis, C. difficile (see C. difficile, gastroenteritis)
Enteroviral infections (i.e., Group A and B Coxsackie viruses and Echo viruses) (excludes polio virus) S
Use Contact Precautions for diapered or incontinent children for duration of illness and to control institutional outbreaks
Epiglottitis, due to Haemophilus influenzae type b D U 24 hrs See specific disease agents for epiglottitis due to other etiologies)
Epstein-Barr virus infection, including infectious mononucleosis S
Erythema infectiosum (also see Parvovirus B19)
ESBL (extended spectrum beta lactamase organism) C
Escherichia coli gastroenteritis (see gastroenteritis)
Food poisoning
Botulism S Not transmitted from person to person
C. perfringens or welchii S Not transmitted from person to person
Staphylococcal S Not transmitted from person to person
Furunculosis, staphylococcal S Contact if drainage not controlled. Follow institutional policies if MRSA
Infants and young children C DI
Gangrene (gas gangrene) S Not transmitted from person to person
Gastroenteritis S
Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks for gastroenteritis caused by all of the agents below
Adenovirus
S Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control
institutional outbreaks
Campylobacter species S
Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks
Cholera (Vibrio cholerae) S
Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks
C. difficile C Length of
Stay Discontinue antibiotics if appropriate. Do not share electronic thermometers 853, 854; ensure consistent environmental cleaning and
POLICY HS-IC0609
PAGE 34
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
disinfection. Hypochlorite solutions may be required for cleaning if transmission continues
847.
Handwashing with soap and water preferred because of the absence of sporicidal activity of alcohol in waterless antiseptic handrubs 983.
Cryptosporidium species S
Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks
E. coli
o Enteropathogenic O157:H7 and other shiga toxin-producing Strains
S Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control
institutional outbreaks
o Other species S Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control
institutional outbreaks
Giardia lamblia S Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control
institutional outbreaks
Noroviruses D/C
Ensure consistent environmental cleaning and disinfection with focus on restrooms even when apparently unsoiled 273, 1064 ). Hypochlorite solutions may be required when there is continued transmission 290-292. Hand Hygiene should be performed using soap and water. Cohorting of affected patients to separate airspaces and toilet facilities may help interrupt transmission during outbreaks.
Rotavirus C DI Ensure consistent environmental cleaning and disinfection and frequent removal of soiled diapers. Prolonged shedding may occur in both immunocompetent and immunocompromised children and the elderly 932, 933.
POLICY HS-IC0609
PAGE 35
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Salmonella species (including S. typhi) S
Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks
Shigella species (Bacillary dysentery) S
Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks
Vibrio parahaemolyticus S
Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks
Viral (if not covered elsewhere) S
Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks
Yersinia enterocolitica S Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control
institutional outbreaks
German measles (see rubella; see congenital rubella)
Giardiasis (see gastroenteritis)
Gonococcal ophthalmia neonatorum (gonorrheal ophthalmia, acute conjunctivitis of newborn)
S
Gonorrhea S
Granuloma inguinale (Donovanosis, granuloma venereum) S
Guillain-Barré’ syndrome S Not an infectious condition
Haemophilus influenzae (see disease-specific recommendations)
Hand, foot, and mouth disease (see enteroviral infection)
Hansen’s Disease (see Leprosy)
Hantavirus pulmonary syndrome S Not transmitted from person to person
Helicobacter pylori S
Hepatitis, viral
Type A S Provide hepatitis A vaccine post-exposure as recommended 1065
Diapered or incontinent patients
C Maintain Contact Precautions in infants and children <3 years of age
POLICY HS-IC0609
PAGE 36
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
for duration of hospitalization; for children 3-14 yrs. of age for 2 weeks after onset of symptoms; >14 yrs. of age for 1 week after onset of symptoms 833, 1066, 1067.
Type B-HBsAg positive; acute or chronic S
See specific recommendations for care of patients in hemodialysis centers 778
Type C and other unspecified non-A, non-B S
See specific recommendations for care of patients in hemodialysis centers 778
Type D (seen only with hepatitis B) S
Type E S
Use Contact Precautions for diapered or incontinent individuals for the duration of illness 1068
Type G S
Herpangina (see enteroviral infection)
Hookworm S
Herpes simplex (Herpesvirus hominis)
Encephalitis S
Mucocutaneous, disseminated or primary, severe C Until lesions
dry and crusted
Mucocutaneous, recurrent (skin, oral, genital) S
Neonatal C Until lesions
dry and crusted
Also, for asymptomatic, exposed infants delivered vaginally or by Csection and if mother has active infection and membranes have been ruptured for more than 4 to 6 hrs until infant surface cultures obtained at 24-36 hrs. of age negative after 48 hrs incubation 1069, 1070
Herpes zoster (varicella-zoster) (shingles)
Disseminated disease in any patient
Localized disease in immunocompromised patient until disseminated infection ruled out
A,C DI Susceptible HCWs should not enter room if immune caregivers are available.
POLICY HS-IC0609
PAGE 37
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Localized in patient with intact immune system with lesions that can be contained/covered
S DI
Susceptible HCWs should not provide direct patient care when other immune caregivers are available.
Histoplasmosis S Not transmitted from person to person
Human immunodeficiency virus (H IV) S Post-exposure chemoprophylaxis for some blood exposures 866.
Human metapneumovirus C DI HAI reported
1071, but route of transmission not established 823 . Assumed to be Contact transmission
as for RSV since the viruses are closely related and have similar clinical manifestations and epidemiology. Wear masks according to Standard Precautions..
Impetigo C U 24 hrs
Infectious mononucleosis S
Influenza
Human (seasonal influenza) D
5 days except DI in
immuno compromised
persons
Single patient room when available or cohort; avoid placement with high-risk patients; mask patient when transported out of room; chemoprophylaxis/vaccine to control/prevent outbreaks 611 . Use gown and gloves according to Standard Precautions may be especially important in pediatric settings. Duration of precautions for immunocompromised patients cannot be defined; prolonged duration of viral shedding (i.e. for several weeks) has been observed; implications for transmission are unknown 930.
Avian (e.g., H5N1, H7, H9 strains)) See www.cdc.gov/flu/avian/professional/infect-control.htm for current
avian influenza guidance.
Pandemic influenza (also a human influenza virus)
D 5 days from
onset of sympto
ms
See http://www.pandemicflu.gov for current pandemic influenza guidance.
Kawasaki syndrome S Not an infectious condition
Lassa fever (see viral hemorrhagic fevers)
POLICY HS-IC0609
PAGE 38
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Legionnaires’ disease S Not transmitted from person to person
Leprosy S
Leptospirosis S Not transmitted from person to person
Lice http://www.cdc.gov/ncidod/dpd/parasites/lice/default.htm
Head (pediculosis) C U 24 hrs
Body S
Transmitted person to person through infested clothing. Wear gown and gloves when removing clothing; bag and wash clothes according to CDC guidance above
Pubic S Transmitted person to person through sexual contact
Listeriosis (listeria monocytogenes) S
Person-to-person transmission rare; cross-transmission in neonatal settings reported 1072, 1073 1074, 1075
Lyme disease S Not transmitted from person to person
Lymphocytic choriomeningitis S Not transmitted from person to person
Lymphogranuloma venereum S
Malaria S
Not transmitted from person to person except through transfusion rarely and through a failure to follow Standard Precautions during patient care 1076-1079 . Install screens in windows and doors in endemic areas. Use DEET-containing mosquito repellants and clothing to cover extremities
Marburg virus disease (see viral hemorrhagic fevers)
Measles (rubeola) A 4 days after
onset of rash; DI in immune
compromised
Susceptible HCWs should not enter room if immune care providers are available; no recommendation for face protection for immune HCW; no recommendation for type of face protection for susceptible HCWs, i.e., mask or respirator 1027, 1028 . For exposed susceptibles, post- exposure vaccine within 72 hrs. or immune globulin within 6 days when available 17, 1032, 1034 . Place exposed susceptible patients on Airborne Precautions and exclude susceptible healthcare personnel
POLICY HS-IC0609
PAGE 39
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine 17.
Melioidosis, all forms S Not transmitted from person to person
Meningitis
Aseptic (nonbacterial or viral; also see enteroviral infections) S Contact for infants and young children
Bacterial, gram-negative enteric, in neonates S
Fungal S
Haemophilus influenzae, type b known or suspected D U 24 hrs
Listeria monocytogenes (See Listeriosis) S
Neisseria meningitidis (meningococcal) known or suspected D U 24 hrs See meningococcal disease below
Streptococcus pneumoniae S
M. tuberculosis S
Concurrent, active pulmonary disease or draining cutaneous lesions may necessitate addition of Contact and/or Airborne Precautions; For children, airborne precautions until active tuberculosis ruled out in visiting family members (see tuberculosis below)
42
Other diagnosed bacterial S
Meningococcal disease: sepsis, pneumonia, meningitis D U 24 hrs Postexposure chemoprophylaxis for household contacts, HCWs exposed to respiratory secretions; postexposure vaccine only to control outbreaks 15, 17.
Molluscum contagiosum S
Monkeypox A,C
A-Until monkeypox confirmed
and smallpox excluded C-Until lesions crusted
Use See www.cdc.gov/ncidod/monkeypox for most current recommendations. Transmission in hospital settings unlikely
269. Pre- and post-exposure smallpox vaccine recommended for exposed
HCWs
POLICY HS-IC0609
PAGE 40
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type *
Duration †
Comments
MRSA C
Cohorting of infected and colonized patients may be indicated if private rooms are not available.
Mucormycosis S
Multidrug-resistant organisms (MDROs), infection or colonization (e.g., MRSA, VRE, VISA/VRSA, ESBLs, resistant S. pneumoniae)
S/C See specific organism listing in this document.
Mumps (infectious parotitis) D
U 9 days
After onset of swelling; susceptible HCWs should not provide care if immune caregivers are available. Note: (Recent assessment of outbreaks in healthy '8-24 year olds has indicated that salivary viral shedding occurred early in the course of illness and that 5 days of isolation after onset of parotitis may be appropriate in community settings; however the implications for healthcare personnel and high-risk patient populations remain to be clarified.)
Mycobacteria, nontuberculosis (atypical) Not transmitted person-to-person
Pulmonary S
Wound S
Mycoplasma pneumonia D DI
Necrotizing enterocolitis S Contact Precautions when cases clustered temporally '°8°-'°83 .
Nocardiosis, draining lesions, or other presentations S Not transmitted person-to-person
Norovirus (see gastroenteritis)
Norwalk agent gastroenteritis (see gastroenteritis)
Orf S
POLICY HS-IC0609
PAGE 41
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Parainfluenza virus infection, respiratory in infants and young children C DI Viral shedding may be prolonged in immunosuppressed patients 1009, 1010 Reliability of antigen testing to
determine when to remove patients with prolonged hospitalizations from Contact Precautions uncertain.
Parvovirus B19 (Erythema infectiosum) D Maintain precautions for duration of hospitalization when chronic disease occurs in an immunocompromised patient. For patients with transient aplastic crisis or red-cell crisis, maintain precautions for 7 days. Duration of precautions for immunosuppressed patients with persistently positive PCR not defined, but transmission has occurred 929.
Pediculosis (lice) C
U 24 hrs after
treatment
Pertussis (whooping cough) D U 5 days Single patient room preferred. Cohorting an option. Post-exposure chemoprophylaxis for household contacts and HCWs with prolonged exposure to respiratory secretions 863 . Recommendations for Tdap vaccine in adults under development.
Pinworm infection (Enterobiasis) S
Plague (Yersinia pestis)
Bubonic S
Pneumonic D U 48 hrs Antimicrobial prophylaxis for exposed HCW 207.
Pneumonia
Adenovirus D, C DI Outbreaks in pediatric and institutional settings reported 376, 1084-1086 . In immunocompromised hosts, extend duration of Droplet and Contact Precautions due to prolonged shedding of virus 931
Bacterial not listed elsewhere (including gram-negative bacterial)
S
B. cepacia in patients with CF, including respiratory tract colonization
C Unknown Avoid exposure to other persons with CF; private room preferred. Criteria for D/C precautions not established. See CF Foundation guideline 20
POLICY HS-IC0609
PAGE 42
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
B. cepacia in patients without CF(see Multidrug-resistant organisms)
Chlamydia S
Fungal S
Haemophilus influenzae, type b
o Adults S
o Infants and children D U 24 hrs
Legionella spp. S
Meningococcal D U 24 hrs See meningococcal disease above
Multidrug-resistant bacterial (see multidrug-resistant organisms)
Mycoplasma (primary atypical pneumonia) D DI
Pneumococcal pneumonia S Use Droplet Precautions if evidence of transmission within a patient
care unit or facility 196-198, 1087
Pneumocystis jiroveci (Pneumocystis carinii ) S
Avoid placement in the same room with an immunocompromised patient.
Staphylococcus aureus S For MRSA, see MDROs
Streptococcus, group A
Adults D U 24 hrs See streptococcal disease (group A streptococcus) below Contact precautions if skin lesions present
Infants and young children D U 24 hrs Contact Precautions if skin lesions present
Varicella-zoster (See Varicella-Zoster)
Viral
Adults S
Infants and young children (see respiratory infectious disease, acute, or specific viral agent)
Poliomyelitis C DI
Pressure ulcer (decubitus ulcer, pressure sore) infected
POLICY HS-IC0609
PAGE 43
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Major C DI If no dressing or containment of drainage; until drainage stops or can be contained by dressing
Minor or limited S If dressing covers and contains drainage
Prion disease (See Creutzfeld-Jacob Disease)
Psittacosis (ornithosis) (Chlamydia psittaci) S Not transmitted from person to person
Q fever S
Rabies S
Person to person transmission rare; transmission via corneal, tissue and organ transplants has been reported 539, 1088 . If patient has bitten another individual or saliva has contaminated an open wound or mucous membrane, wash exposed area thoroughly and administer postexposure prophylaxis. 1089
Rat-bite fever (Streptobacillus moniliformis disease, Spirillum minus disease)
S Not transmitted from person to person
Relapsing fever S Not transmitted from person to person
Resistant bacterial infection or colonization (see multidrug-resistant organisms)
Respiratory infectious disease, acute (if not covered elsewhere)
Adults S
Infants and young children C DI Also see syndromes or conditions listed in Table 2
Respiratory syncytial virus infection, in infants, young children and immunocompromised adults
C DI
Wear mask according to Standard Precautions 24
CB 116, 117 . In immunocompromised patients, extend the duration of Contact Precautions due to prolonged shedding
928) . Reliability of antigen testing to
determine when to remove patients with prolonged hospitalizations from Contact Precautions uncertain.
Reye's syndrome S Not an infectious condition
Rheumatic fever S Not an infectious condition
Rhinovirus D DI Droplet most important route of transmission 104 1090 . Outbreaks have
POLICY HS-IC0609
PAGE 44
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
occurred in NICUs and LTCFs 413, 1091, 1092. Add Contact Precautions if copious moist secretions and close contact likely to occur (e.g., young infants) 111, 833.
Rickettsial fevers, tickborne (Rocky Mountain spotted fever, tickborne typhus fever)
S
Not transmitted from person to person except through transfusion, rarely
Rickettsialpox (vesicular rickettsiosis) S Not transmitted from person to person
Ringworm (dermatophytosis, dermatomycosis, tinea) S
Rarely, outbreaks have occurred in healthcare settings, (e.g., NICU 1093 , rehabilitation hospital 1094 . Use Contact Precautions for outbreak.
Ritter's disease (staphylococcal scalded skin syndrome) C DI See staphylococcal disease, scalded skin syndrome below
Rocky Mountain spotted fever S
Not transmitted from person to person except through transfusion, rarely
Roseola infantum (exanthem subitum; caused by HHV-6) S
Rotavirus infection (see gastroenteritis)
Rubella (German measles) ( also see congenital rubella) D U 7 days
after onset of rash
Susceptible HCWs should not enter room if immune caregivers are available. No recommendation for wearing face protection (e.g., a surgical mask) if immune. Pregnant women who are not immune should not care for these patients 17, 33. Administer vaccine within three days of exposure to non-pregnant susceptible individuals. Place exposed susceptible patients on Droplet Precautions; exclude susceptible healthcare personnel from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine.
Rubeola (see measles)
Salmonellosis (see gastroenteritis)
Scabies C U 24
Scalded skin syndrome, staphylococcal C DI See staphylococcal disease, scalded skin syndrome below)
Schistosomiasis (bilharziasis) S
POLICY HS-IC0609
PAGE 45
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Severe acute respiratory syndrome (SARS) A, D,C
DI plus 10 days after resolution of fever, provided respiratory symptoms are absent or improving
Airborne Precautions preferred; D if AIIR unavailable. N95 or higher respiratory protection; surgical mask if N95 unavailable; eye protection (goggles, face shield); aerosol-generating procedures and “supershedders” highest risk for transmission via small droplet nuclei and large droplets 93, 94,
96.Vigilant environmental
disinfection (see www.cdc.gov/ncidod/sars)
Shigellosis (see gastroenteritis)
Smallpox (variola; see vaccinia for management of vaccinated persons)
A,C DI Until all scabs have crusted and separated (3-4 weeks). Non-vaccinated HCWs should not provide care when immune HCWs are available; N95 or higher respiratory protection for susceptible and successfully vaccinated individuals; postexposure vaccine within 4 days of exposure protective 108, 129, 1038-1040.
Sporotrichosis S
Spirilum minor disease (rat-bite fever) S Not transmitted from person to person
Staphylococcal disease (S aureus)
Skin, wound, or burn
o Major C DI No dressing or dressing does not contain drainage adequately
o Minor or limited S Dressing covers and contains drainage adequately
Enterocolitis S
Use Contact Precautions for diapered or incontinent children for duration of illness
Multidrug-resistant (see multidrug-resistant organisms)
Pneumonia S
Scalded skin syndrome C DI Consider healthcare personnel as potential source of nursery, NICU outbreak 1095.
Toxic shock syndrome S
Streptobacillus moniiformis disease (rat-bite fever) S Not transmitted from person to person
POLICY HS-IC0609
PAGE 46
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Streptococcal disease (group A streptococcus)
Skin, wound, or burn
o Major C,D U 24 hrs No dressing or dressing does not contain drainage adequately
o Minor or limited S Dressing covers and contains drainage adequately
Endometritis (puerperal sepsis) S
Pharyngitis in infants and young children D U 24 hrs
Pneumonia D U 24 hrs
Scarlet fever in infants and young children D U 24 hrs
Serious invasive disease D U24 hrs
Outbreaks of serious invasive disease have occurred secondary to transmission among patients and healthcare personnel 162, 972, 1096-1098
Contact Precautions for draining wound as above; follow rec. for antimicrobial prophylaxis in selected conditions 160.
Streptococcal disease (group B streptococcus), neonatal S
Streptococcal disease (not group A or B) unless covered elsewhere S
Multidrug-resistant (see multidrug-resistant organisms)
Strongyloidiasis S
Syphilis
Latent (tertiary) and seropositivity without lesions S
Skin and mucous membrane, including congenital, primary, Secondary
S
Tapeworm disease
Hymenolepis nana S Not transmitted from person to person
Taenia solium (pork) S
Other S
Tetanus S Not transmitted from person to person
Tinea (e.g., dermatophytosis, dermatomycosis, ringworm) S Rare episodes of person-to-person transmission
POLICY HS-IC0609
PAGE 47
ATTACHMENT VI1
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
Toxoplasmosis S
Transmission from person to person is rare; vertical transmission from mother to child, transmission through organs and blood transfusion rare
Toxic shock syndrome (staphylococcal disease, streptococcal disease)
S Droplet Precautions for the first 24 hours after implementation of antibiotic therapy if Group A
streptococcus is a likely etiology
Trachoma, acute S
Transmissible spongiform encephalopathy (see Creutzfeld-Jacob disease, CJD, vCJD)
Trench mouth (Vincent's angina) S
Trichinosis S
Trichomoniasis S
Trichuriasis (whipworm disease) S
Tuberculosis (M. tuberculosis)
Extrapulmonary, draining lesion) A,C
Discontinue precautions only when patient is improving clinically, and drainage has ceased or there are three consecutive negative cultures of continued drainage 1025, 1026. Examine for evidence of active pulmonary tuberculosis.
Extrapulmonary, no draining lesion, meningitis S
Examine for evidence of pulmonary tuberculosis. For infants and children, use Airborne Precautions until active pulmonary tuberculosis in visiting family members ruled out
42
Pulmonary or laryngeal disease, confirmed A
Discontinue precautions only when patient on effective therapy is improving clinically and has three consecutive sputum smears negative for acid-fast bacilli collected on separate days(MMWR 2005; 54: RR-17 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s
Pulmonary or laryngeal disease, suspected A
Discontinue precautions only when the likelihood of infectious TB disease is deemed negligible,
POLICY HS-IC0609
PAGE 48
ATTACHMENT VI1
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
and either 1) there is another diagnosis that explains the clinical syndrome or 2) the results of three sputum smears for AFB are negative. Each of the three sputum specimens should be collected 8-24 hours apart, and at least one should be an early morning specimen
Skin-test positive with no evidence of current active disease S
Tularemia
Draining lesion S Not transmitted from person to person
Pulmonary S Not transmitted from person to person
Typhoid (Salmonella typhi) fever (see gastroenteritis)
Typhus
Rickettsia pro wazekii (Epidemic or Louse-borne typhus) S
Transmitted from person to person through close personal or clothing contact
Rickettsia typhi S Not transmitted from person to person
Urinary tract infection (including pyelonephritis), with or without urinary catheter
S
Vaccinia (vaccination site, adverse events following vaccination) *
Only vaccinated HCWs have contact with active vaccination sites and care for persons with adverse vaccinia events; if unvaccinated, only HCWs without contraindications to vaccine may provide care.
Vaccination site care (including autoinoculated areas) S
Vaccination recommended for vaccinators; for newly vaccinated HCWs: semi-permeable dressing over gauze until scab separates, with dressing change as fluid accumulates, ~3-5 days; gloves, hand hygiene for dressing change; vaccinated HCW or HCW without contraindication to vaccine for dressing changes 205, 221, 225.
o Eczema vaccinatum C Until lesions dry and crusted, scabs separated
For contact with virus-containing lesions and exudative material
o Fetal vaccinia C
o Generalized vaccinia C
POLICY HS-IC0609
PAGE 49
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type
* Duration
† Comments
o Progressive vaccinia C
o Postvaccinia encephalitis S
o Blepharitis or conjunctivitis S/C Use Contact Precautions if there is copious drainage
o Iritis or keratitis S
o Vaccinia-associated erythema multiforme (Stevens Johnson Syndrome)
S Not an infectious condition
Secondary bacterial infection (e.g., S. aureus, group A beta hemolytic streptococcus
S/C
Follow organism-specific (strep, staph most frequent) recommendations and consider magnitude of drainage
Varicella Zoster A,C Until lesions
dry and
crusted
Susceptible HCWs should not enter room if immune caregivers are available. In immunocompromised host with varicella pneumonia, prolong duration of precautions for duration of illness. Post-exposure prophylaxis: provide post-exposure vaccine ASAP but within 120 hours; for susceptible exposed persons for whom vaccine is contraindicated (immunocompromised persons, pregnant women, newborns whose mother’s varicella onset is <5days before delivery or within 48 hrs after delivery) provide VZIG, when available, within 96 hours; if unavailable, use IVIG, Use Airborne Precautions for exposed susceptible persons and exclude exposed susceptible healthcare workers beginning 8 days after first exposure until 21 days after last exposure or 28 if received VZIG, regardless of postexposure
Variola (see smallpox)
VRSA (Vancomycin Resistant Staphylococcus aureus) C See attachment (V) for additional measures that must be followed
Vibrio parahaemolyticus (see gastroenteritis)
Vincent's angina (trench mouth) S
Viral hemorrhagic fevers S, D, C
DI Single-patient room preferred. Emphasize: 1) use of sharps safety
POLICY HS-IC0609
PAGE 50
ATTACHMENT VI
TYPE AND DURATION OF PRECAUTIONS RECOMMENDED FOR SELECTED INFECTIONS AND CONDITIONS
Infection/Condition Precautions
Type * Duration † Comments
due to Lassa, Ebola, Marburg, Crimean-Congo fever viruses
devices and safe work practices, 2) hand hygiene; 3) barrier protection against blood and body fluids upon entry into room (single gloves and fluid-resistant or impermeable gown, face/eye protection with masks, goggles or face shields); and 4) appropriate waste handling. Use N95 or higher respirators when performing aerosol-generating procedures. Largest viral load in final stages of illness when hemorrhage may occur; additional PPE, including double gloves, leg and shoe coverings may be used, especially in resource-limited settings where options for cleaning and laundry are limited. Notify public health officials immediately if Ebola is suspected 212, 314, 740,
772Also see Table 3 for Ebola as a
bioterrorism agent
Viral respiratory diseases (not covered elsewhere)
Adult S
Infants and young children (see respiratory infectious disease, acute)
VISA (Vancomycin Intermediate Staphylococcus aureus) C See attachment (V) for additional measures that must be followed.
VRE (Vancomycin Resistant Enterococcus) C Cohorting of infected and colonized patients may be indicated if private rooms
are not available. Whooping cough (see pertussis)
Wound infections
Major C DI No dressing or dressing does not contain drainage adequately
Minor or limited S Dressing covers and contains drainage adequately
Yersinia enterocolitica gastroenteritis (see gastroenteritis)
Zoster (varicella-zoster) (see herpes zoster)
Zygomycosis (phycomycosis, mucormycosis) S Not transmitted person-to-person
POLICY HS-IC0609
PAGE 51
Attachment: VII Respiratory Hygiene/Cough Etiquette
POLICY HS-IC0609
PAGE 52
Attachment: VIII Components of a Protective Environment
POLICY HS-IC0609
PAGE 53
Attachment: IX Isolation Signs
POLICY HS-IC0609
PAGE 54
POLICY HS-IC0609
PAGE 55
POLICY HS-IC0609
PAGE 56
POLICY HS-IC0609
PAGE 57
POLICY HS-IC0609
PAGE 58
POLICY HS-IC0609
PAGE 59
POLICY HS-IC0609
PAGE 60
POLICY HS-IC0609
PAGE 61
Attachment: X - Guidelines for Transporting Patients on Isolation Precautions.