CDC Guidelines for Isolation Precautions in Hospitals

Minnesota Dept. of Health

Yale New Haven Hospital Infection Control Manual
Use Airborne Precautions for patients known or suspected to have serious illnesses
transmitted ! airorne droplet nuclei. "hese include#
Measles $rueola%
&aricella $chicken po'% ( re)uires Contact Prec. as well
Herpes *oster $shin+les%, disseminated ( re)uires contact prec. as well
"-
.evere /cute 0epirator! .!ndrome $./0.%
/irorne Precautions include personal respirator! protection and special ventilation
and air handlin+. /irorne transmission occurs throu+h either# airorne droplet
nuclei $small particles, 1 micro+rams or smaller, of evaporated droplets containin+
microor+anisms that remain suspended in the air for lon+ periods of time% or dust
particles that contain an infectious a+ent.
Microor+anisms carried ! the airorne route can e widel! dispersed ! air currents
and ma! ecome inhaled ! a susceptile host in the same room or over a lon+
distance form the source patient ( dependin+ on environmental factors such as
temperature and ventilation.
/irorne precautions include .tandard Precautions plus personal respirator!
protection $N21 respirator% or powered air3purif!in+ respirator $P/P0% and airorne
infection isolation room $/II0%. "hese rooms must, at a minimum, provide ne+ative
pressure with a minimum of 4 air e'chan+es per hour, and e'haust directl! to the
outside or throu+h H5P/ filtration.
Droplet Precautions# droplets can e transmitted durin+ cou+hin+, snee6in+, talkin+, and
durin+ certain procedures such as suctionin+ or ronchoscop!. Droplets +enerall! travel
no further than 7 feet from patient. Droplet precautions include .tandard Precautions
plus sur+ical mask worn when workin+ within 7 feet of the patient.
In addition to .tandard Precautions, use Droplet Precautions for patients known or
suspected to have serious illnesses transmitted ! large particle droplets. "hese include#
Invasive Haemophilus influen6a $H.influen6a%, t!pe disease, includin+
menin+itis, pneumonia, epi+lottitis, and sepsis
Invasive Neisseria menin+itides disease, includin+ menin+itis, pneumonia, and
sepsis
8ther serious acterial respirator! infections spread ! droplet transmission, includin+#
Diptheria $phar!n+eal%
M!coplasma pneumonia
Pertussis
Pneumonic pla+ue
.trep $+roup /% phar!n+itis, pneumonia, or scarlet fever in infants and !oun+
children
.erious viral infections spread ! droplet transmission, includin+#
/denovirus
Influen6a
Mumps
Parvovirus -92
0uella $German Measles%
Contact Precautions
In addition to .tandard Precautions, use Contact Precautions for patients known or
suspected to have serious illnesses easil! transmitted ! direct patient contact or !
contact with items in the patient:s environment. 5'amples of such illnesses include#
Gastrointestinal, respirator!, skin, or wound infections or coloni6ation with
multidru+3resistant acteria ;ud+ed ! the infection control pro+ram, ased on
current state, re+ional, or national recommendations, to e of special clinical and
epidemiolo+ic si+nificance
5nteric infections with a low infectious dose or prolon+ed environmental survival,
includin+#
o Clostridium difficile
o <or diapered or incontinent patients# enterohemorrha+ic Escherichia coli
891=#H=, Shigella, hepatitis /, or rotavirus
0espirator! s!nc!tial virus, parainfluen6a virus, or enteroviral infections in
infants and !oun+ children
.kin infections that are hi+hl! conta+ious or that ma! occur on dr! skin,
includin+#
o Diphtheria $cutaneous%
o Herpes simple' virus $neonatal or mucocutaneous%
o Impeti+o
o Ma;or $noncontained% ascesses, cellulitis, or decuiti
o Pediculosis
o .caies
o .taph!lococcal furunculosis in infants and !oun+ children
o *oster $disseminated or in the immunocompromised host%>
&iral?hemorrha+ic con;unctivitis
&iral hemorrha+ic infections $5ola, @assa, or Marur+%
Measles (rubeola) re)uires .tandard Precautions and /irorne Precautions. *No mask
re)uired if immune to measles. *Note# /ll healthcare workers should have received A
doses of the measles vaccine if orn after 921=. If orn prior to 921=, one is considered
immune. @imit transport of patientB if transportin+ is necessar!, place N321 mask on
patient. Private3Ne+ative Pressure 0oom 0e)uired. Duration of Precautions: Duration of
illness
German Measles (Rubella ) requires Standard Precautions and Droplet Precautions.
Duration of Precautions: Until 7 days after onset of rash
Group A and Group B Strep in!asi!e# re)uires .tandard precautions.
"#trapulmonar$ %uberculosis (draining lesion including scro&ula) re)uires .tandard
Precautions.
%uberculous Meningitis re)uires .tandard Precautions.
Note: Patient should e evaluated for evidence of concurrent $active% pulmonar!
tuerculosis. If evidence e'ists for active pulmonar! tuerculosis /irorne Precautions
are re)uired.
Pulmonar$ %uberculosis con&irmed or suspected (including lar$ngeal disease)
re)uires .tandard Precautions and /irorne Precautions. Cear N321? H5P/ respirator
prior to enterin+ patient:s room. @imit transport of patientB if transportin+ is necessar!,
place N321 mask on patient. Private3Ne+ative Pressure 0oom 0e)uired. Duration of
Precautions: Duration of illness
C'ic(enpo# (Primar$ )aricella *oster in&ection) re)uires .tandard precautions,
/irorne Precautions and Contact Precautions. Ne+ative pressure room re)uired. DNo
mask re)uired if immune to &aricella. @imit transport of patientB if transportin+ is
necessar!, place a N321 mask on patientB all staff who have contact with patient durin+
transport must e immune. Contact Precautions# Don and remove +own and +loves upon
enterin+ and e'itin+ ptEs room. Dedicate non3critical pt care e)uipment. Duration of
Precautions# Maintain precautions until all lesions are crusted. "he avera+e incuation
period for varicella is 9F to 94 da!s, with a ran+e of 9F to A9 da!s. Place e'posed
susceptile patients on /irorne Precautions e+innin+ on the 9Fth da! after e'posure
and continuin+ until A9 da!s after last e'posure $up to AG da!s if &*IG has een +iven%.
Ant'ra# + Cutaneous and Ant'ra#,-n'alational re)uires .tandard Precautions.
Ant'ra# ma$ be a disease indicating possible bioterrorism.
Clostridium di&&icile colitis re)uires .tandard Precautions and Contact Precautions.
Bronc'iolitis (in&ants and $oung c'ildren) re)uires .tandard Precautions and Contact
Precautions.
Candidiasis: .tandard Precautions
C'lam$dia all t$pes# .tandard Precautions
Gastroenteritis, includin+ cholera, e.coli, rotavirus, +iardia, etc# re)uires .tandard
Precautions *but re)uires the use of Contact Precautions for diapered or incontinent
patients includin+ children under 4 !ears of a+e.
CM) $c!tome+alovirus% # .tandard Precautions
Croup re)uires .tandard Precautions and Contact Precautions.
Decubitis ulcer , ma/or re)uires .tandard Precautions and Contact Precautions. / ma;or
decuitus ulcer is one that is not contained ! a dressin+. Duration of Precautions: Until
wound heals over and stops drainin+. Minor re)uires .tandard Precautions onl!.
Dipt'eria + Cutaneous and Dipt'eria ,, P'ar$ngeal# .tandard and Contact. Duration
of Precautions: Until off all antiiotics and until two cultures otained AH hours apart are
ne+ative.
Art'ropod,borne )iral "ncep'alitis re)uires .tandard Precautions. 5'amples# Cest
Nile 5ncephalitis, 5astern 5)uine 5ncephalitis, Cestern 5)uine 5ncephalitis, .t. @ouis
5ncephalitis, California $@aCrosse% 5ncephalitis
-n!asi!e 0emop'ilus in&luen*ae disease: ie: 0. in&luen*a meningitis 0. in&luen*a
epiglottitis: .tandard and Droplet precautions. Duration of Precautions# until AH hours of
effective antimicroial therap! has een +iven.
"pstein,Barr )irus, includin+ mononucleosis# .tandard precautions
1i&t'2s Disease# .tandard and Droplet, Dut in an immunocompetent $normal% patient
with acute disease, it is not communicale after onset of rashB thus, Droplet Precautions
are not then necessar!. Duration of precautions for others# <or an immunocompromised
patient 3it' c'ronic disease,,duration of hospitali6ation. aplastic crisis or red cell
aplasia (e.g. sic( cell patients) ,,maintain Droplet Precautions for = da!s
4epros$ (0ansen2s Disease): standard precautions.
0epatitis A B C D "# standard precautions, e'cept for diapered?incontinent patients
and t!pe /.
-mpetigo# standard and contact. Duration of precautions# until AH hours after initiation of
effective therap!.
5a3asa(i S$ndrome# standard precautions
4egionnaire2s Disease# standard precautions
Meningococcal meningitis $due to Neisseria menin+itides%# standard and droplet
precautions.
Pneumococcal meningitis# standard precautions
Mumps# standard and droplet. Duration of precautions# for 2 da!s after onset of
swellin+.
Nor3al( !iral gastroenteritis# standard precautions *but re)uires the use of Contact
Precautions for diapered or incontinent patients includin+ children under 4 !ears of a+e.
Duration of precautions is duration of illness.
Respirator$ S$nc$tial )irus (RS)): standard and contact precautions. Can e roomed
with other 0.& pts as lon+ as there are no other si+nificant or+anisms present $ie M0./,
&05, etc%
Smallpo#: standard, airorne, and contact precautions. Smallpo# is a public 'ealt'
emergenc$ and ma$ be a disease indicating possible bioterrorism. 4inen: /ll laundr!
should e placed in ioha6ard a+s and autoclaved efore launderin+. Patient transport
re)uires approval of Hospital 5pidemiolo+ist or desi+nee. Duration of Isolation: "o e
determined ! Hospital 5pidemiolo+!.
Smallpo# !accination re)uires .tandard Precautions, /irorne Precautions and Contact
Precautions if an individual presents with an acute medical complaint and the sca has
not separated from the inoculation site $usuall! occurs ! da! 9H3A9 post3vaccination%.
%$p'oid 1e!er including Salmonellosis6all salmonella species# standard *but
re)uires the use of Contact Precautions for diapered or incontinent patients includin+
children under 4 !ears of a+e for duration of illness.
7'ooping Coug' is PertussisB re)uires standard and droplet precautions. Maintain
precautions until 1 da!s after patient is placed on effective therap!.