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ISOLATION PRECAUTIONS

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					                                            ISOLATION PRECAUTIONS
Purpose: To minimize transmission of infectious disease by:
      1.     providing standard precautions as a baseline in the care of patients in the hospital
             regardless of their presumed infection status.
      2.     providing isolation for selected infections and conditions.
Personnel: Precautions/isolation are to be used by all persons involved in patient care.
                                    TABLE OF CONTENTS
I.    Equipment & General Instructions ........................................................................... Page 1

II..     Overview Chart ......................................................................................................... Page 2

III.     Standard Precautions ................................................................................................. Page 3
         -Hand Hygiene …………………………………………………………………….. Page 4A
         -Respiratory Hygiene/cough etiquette ……………………………………………...Page 4B
IV.      Contact Isolation Precautions.................................................................................... Page 5

V.       Airborne Isolation Precautions.................................................................................. Page 7

VI.      STOP: Airborne Isolation Precautions (Tuberculosis). . . . . . . . . . . . . . . . . . . . . . . Page 9

VII.     Droplet Isolation Precaution.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Page 10

VIII.    Precautions for Selected Conditions Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 11

IX.      Clinical Syndromes or Conditions Warranting Empiric Precautions. . . . . . . . . . . . Page 21

X.       Negative Airflow Rooms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Page 22

XI.      Bioterrorism: Practices for Patient Management. . . . . . . . . . . . . . . . . . . . . . . . . . . Page 23

Equipment:
   Signs: Contact (Storeroom Ord. #078622), Droplet (#078623), STOP: Airborne (#078624) &
   Airborne (#078625)
   Personal Protective Equipment: gowns, gloves, eye protection, masks, respirators,
   Carts or Nurse Servers, Specimen bags, Labels

General Instructions:
Patients are placed in isolation precautions according to the following guidelines.
1. The physician orders isolation for suspected or diagnosed infections.
2. If an order has not been written, patients admitted with a provisional diagnosis or with a
     subsequent diagnosis of an isolatable disease are isolated on the advice of the charge nurse,
     administrative supervisor or Infection Control/Epidemiology until an appropriate order by the
     physician is obtained.
3. The patient and family are educated regarding isolation precautions.
4. Notify receiving department of isolation category on requisition.
5. There are no special precautions necessary with dishes and meal trays.
General Instructions: (Continued)

   6.    Double bagging is only used when the outside of a linen or trash bag becomes contaminated
         with infectious material.
   7.    The isolation cart remains outside the room.
   8.    At _________ call S.P.D. to have equipment removed and cleaned.
         At _________ call housekeeping to clean isolation cart if applicable.


                          ISOLATION PRECAUTIONS OVERVIEW

        Isolation                 Source                     Mode of
        Category                 Examples                  Transmission                      Action
      Airborne            Small particles generated    Small particles of            Negative pressure room
 (Detailed on page 7)     when patient coughs,         evaporated droplets that      Standard Precautions
                          sneezes or talks.            remain suspended in the       Limited transportation
                          Disease examples:            air for long periods of       & mask patient with
                          chickenpox,                  time can be inhaled.          surgical mask
                          disseminated herpes
                          zoster, or measles

       Contact            Draining wound that          Hands when turning,           Private room or cohort
 (Detailed on page 5)     cannot be covered,           bathing or other activities   patients
                          diarrhea, or resistant       that require physical         Standard Precautions
                          bacteria.                    contact. Contact with         Limited transportation
                          Disease examples:            soiled items.
                          respiratory syncytial
                          virus (RSV), Staph
                          aureus, Clostridium
                          difficle.

      Droplet             Droplets in the air that     Droplets contacting           Private room or cohort
  (Detailed on page       are generated during         conjunctiva or mucous         patients
                          coughing, sneezing,          membrane of nose or           Masks within 3' of
         10)              suctioning and               mouth (either directly        patient
                          bronchoscopy (generally      deposited or spread by        Standard Precautions
                          within a 3 foot distance).   contaminated hands.           Mask patient during
                          Disease examples:                                          transport
                          bacterial meningitis,
                          mumps, rubella,
                          whooping cough

    STOP: Airborne        Small particles generated    Small particles of            Negative pressure room.
      Precautions         when patient coughs,         evaporated droplets that       N95 or HEPA respirator
   (Detailed on page 9)   sneezes or talks.            remain suspended in the       must be worn.
                          Disease: pulmonary           air for long periods of       Limited transportation
                          tuberculosis                 time can be inhaled.          & mask patient with
                                                                                     surgeons mask
                                                                                     Standard precautions
                                  STANDARD PRECAUTIONS

Definition:

Standard precautions are a combination of Universal Precautions and Body Substance Isolation
(BSI). They are a single set of precautions used for the care of all patients in the hospital regardless
of their presumed infection status. These precautions apply to (1) blood; (2) all body fluids,
secretions and excretions except sweat, regardless of whether or not they contain visible blood; (3)
non-intact skin; and (4) mucous membranes.

Purpose:

Standard precautions are designed to reduce the risk of transmission of microorganisms from both
recognized and unrecognized sources of infection in hospitals.

Precautions include:

1.    Hand Hygiene:

Refer to Hand Hygiene Policy – See Page 4 A

2     Gloves:
      a.   disposable latex or non-latex
      b. wear when touching blood, body fluids, secretions, excretions and contaminated items.
      c.   wear clean gloves before touching mucous membranes and non-intact skin.
      d. change gloves between tasks and procedures on the same patient after contact with
           material that may contain a high concentration of microorganisms.
      e.   remove gloves
              Promptly after use
              Before touching non-contaminated items or environmental surfaces
              Before going to another patient
              Wash hands immediately to avoid transfer of microorganisms to other patients or
               environments if visibly contaminated with proteinaceous material or soiled with
               blood or body fluids. Otherwise hands may be decontaminated with alcohol based
               antiseptic.

     3.   Masks, eye protection, face shields:
     4.   Wear mask and eye protection or face shield to protect 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.




                                       3
                           STANDARD PRECAUTIONS - continued
4.   Gown:
     a.  Wear 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,
         excretions or from contact with soiled/contaminated equipment.
     b. Remove gown as promptly as possible, wash hands to avoid transfer of microorganisms
         to other patients or environments.

5.   Patient Placement:
     Place a patient who contaminates the environment or who does not (or cannot be expected to)
     assist in maintaining appropriate hygiene in a private room. If a private room is not available,
     consult with Infection Control/Epidemiology regarding patient placement or alternatives.

6.   Patient-Care Equipment:
     a.    Wear gloves and/or a gown if soiling likely when handling used equipment.
     b. Reusable equipment will be cleaned and disinfected/sterilized prior to use by another
           patient.
     c.    Single-use items will be discarded properly.

7.   Patient Environment:
     Routine cleaning and disinfection of environmental surfaces and equipment takes place at each
     patient discharge or transfer. When cleaning spills of blood and body fluids, visible material
     shall be first removed and then the area decontaminated with the EPA approved hospital
     disinfectant or 5.25% hypochlorite (household bleach) diluted fresh daily 1:10 parts water to
     1:100 (1/4 cup bleach to 1 gallon tap water) parts water 6/4/93 MMWR Vol. 42/No.2)

8.   Linen:
     Linen soiled with blood, body fluids, secretions, and excretions will be handled the same as
     other linen and placed in green plastic bags for reprocessing. Soiled linen is bagged at the
     location where it is used and not sorted or rinsed in patient care areas. Contract laundry
     employees recognize green plastic bags as hospital linen and wear appropriate PPE.

9.   Health Care Worker Safety:
     -Do not recap, bend or break needles or other sharp objects.
     -Place used sharps in puncture-resistant containers located as close as possible to the area of
      use.
     -During invasive procedures, if a glove is torn or other injury from a used sharp occurs, replace
     the glove with a new one as soon as possible. Remove the needle or instrument involved in the
     incident from the sterile field.
     -Place all blood and body fluid specimens in sturdy containers with a secure lid. Avoid
     contaminating the outside of the container.
     -Mouthpieces, resuscitation bags and other ventilation devices are available in areas where the
     need for resuscitation is predictable.
     Additional information is located in the Blood Borne Pathogen Exposure Control Plan.




                                      4
SUBJECT:           HAND HYGIENE POLICY – HOSPITAL-WIDE (INCLUDES TECHNIQUE)
POLICY:            Hand washing and hand antisepsis are important procedures for preventing the spread of infections.
                   Hands should be washed thoroughly with soap and water when visibly soiled. For general use a plain
                   nonantimicrobial soap is recommended. An antimicrobial soap or alcohol-based antiseptic is used
                   before the performance of invasive procedures, for isolation and in certain high-risk settings. Hand
                   lotion is also provided.
                   1.   Indications for hand washing and hand antisepsis
                             a.   When hands are visibly dirty or contaminated with proteinaceous material or are visibly
                                  soiled with blood or other body fluids, wash hands with either a nonantimicrobial soap
                                  and water or with an antimicrobial soap and water. Before eating and after using a
                                  restroom, wash hands with a nonantimicrobial soap and water or with an antimicrobial
                                  soap and water.
                             b.   If hands are not visibly soiled, use an alcohol-based hand rub for routinely
                                  decontaminating hands in all other clinical situations. Alternatively, wash hands with an
                                  antimicrobial soap and water in other clinical situations.

HAND WASHING TECHNIQUE:
                   1.   Wet hands with running water.
                   2.   Apply 1 ml of regular or 3 ml of antimicrobial soap and thoroughly distribute over hands.
                   3.   Vigorously rub hands together for 15 seconds, generating friction on all surfaces of the hands and
                        fingers. Clean beneath fingernails.
                   4.   Hands should be thoroughly rinsed to remove residual soap and then dried.
                   5.   When sink does not have foot controls or an automatic shut off, a paper towel may be used to shut
                        off faucet to avoid recontaminating the hands.
                   6.   In the interruption of water supply, alternative agents such as detergent-containing towelettes or
                        alcohol-based antiseptics are available.

ALCOHOL-BASED WATERLESS ANTISEPTIC TECHNIQUE:
                   1.   May use when hands are not visibly soiled (no blood or body fluids on hands).
                   2.   Use one pump from product for each time hands are decontaminated.
                   3.   Rub hands briskly until dry.
                   4.   No rinsing required.
                   5.  To avoid risk of fire let alcohol evaporate before touching metal or anything that would
                       cause static electricity.
                   Routine superficial contact with a source not suspected of being contaminated, such as touching an
                   object not visibly soiled or taking a blood pressure, does not require hand washing, but hands may be
                   decontaminated with alcohol-based waterless antiseptic.

                   Resources:
                      Guideline for Hand Washing & Environmental Control, 1985, Garner & Favero, CDC, Infect. Control 1986;
                       7:231-5.
                      “APIC Guidelines for Hand Washing & Hand Antisepsis in Health Care Settings”, Elaine L. Larson, AJIC
                       8/95, Vol 23, #4, pp 251-269.
                      Guidelines for Hand Hygiene in Health Care Settings – Recommendations of the Healthcare Infection
                       Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
APPROVED: Infection Control Executive Committee                  REVIEWED: 12/99, 11/04, 1/06




                                                  5
      _________ HEALTH SERVICES
      _________ MEDICAL CENTER
      _________ HOSPITAL & MEDICAL CENTER


SUBJECT:      Respiratory Hygiene/Cough Etiquette

      1.       To contain respiratory secretions, all persons with signs and symptoms of a
           respiratory infection, regardless of presumed cause, should be instructed to:

           a. Cover the nose/mouth when coughing or sneezing
           b. Use tissues to contain respiratory secretions
           c. Dispose of tissues in the nearest waste receptacle. Provide no-touch receptacles for
              used tissues disposal
           d. Providing patients with alcohol-based hand gels or handwashing facilities for hand
              hygiene. Patients are to perform hand hygiene after contact with respiratory
              secretions and contaminated objects.
           e. Surgical masks will be available for patients who are coughing. Encourage coughing
              persons to sit at least 3 feet away from others in common waiting rooms.
           f. Staff should practice Droplet Precautions (i.e. wear a surgical mask and eye
              protection for close contact) in addition to Standard Precautions, when examining a
              patient with symptoms of a respiratory infection while patient is in the Emergency
              Department.
           g. Droplet Precautions should be maintained if tests are ordered for diseases requiring
              droplet precautions under the isolation precautions policy.




Approved: Central Infection Control Committee 2003

Reviewed: 9/04, 1/06




                                     6
                          CONTACT ISOLATION PRECAUTIONS

Definition/Purpose:
Contact Isolation Precautions are designed to prevent transmission for skin-to-skin (direct) contact
from an infected or colonized patient to an employee and to prevent transmission from a
contaminated item (indirect contact) to an employee or another patient. Examples: draining wound
that cannot be covered, diarrhea, or resistant bacteria.

Contact Isolation Precautions apply to patients known or suspected to have serious illnesses easily
transmitted by direct patient care or by contact with items in the patient's environment.
Examples: respiratory syncytial virus (RSV), Staph aureus, or Clostridium difficle.

Placement:
Private room. If a private room is not available, patients may be placed together.
Example:
1. Patients who have an active infection with the same organism and no other infection.
2. When a private room is not available, and cohorting is not achievable or recommended, it is
    very important to consider the epidemiology of the infecting pathogen and the patient
    population being served in determining patient placement. Consultation with Infection
    Control/Epidemiology is advised before patient placement.

Gloves & Handwashing/Gowns/Linen/Patient Equipment & Worker Safety:
Refer to Standard Precautions. Wash hands with an antimicrobial soap immediately after glove
removal. After glove removal and handwashing, ensure that hands do not touch potentially
contaminated environmental surfaces or items in the patient's room to avoid transfer of
microorganisms to other patients or environments.

Patient Transport:
1. Limit transporting patient out of room for essential purposes only.
2. Drape vehicle with a clean sheet during transport if drainage cannot be contained.
3. If contact with infective material is anticipated, wear appropriate personal protective
    equipment.

Patient Care Equipment:
Dedicate use of non-critical items to a single patient to avoid sharing between patients. Non-critical
items are items that touch intact skin such as blood pressure cuffs, commodes, tables, IV poles, etc..

Duration of Precautions:
Refer to table "Precautions/Isolation for selected Infections & Conditions".

Resistant Organisms:
MRSA (Methicillin-resistant Staph. aureus) - See reference tables.
VRE ( Vancomycin-resistant Enterococcus) - See reference tables.


                                      7
             SIGN – LIGHT GREEN




               CONTACT PRECAUTIONS
               CONTACT PRECAUTIONS

       VISITORS: REPORT TO NURSE BEFORE ENTERING

  1.   Wear personal protective equipment when exposure anticipated (gloves,
       gowns, mask, and/or eye protection).

   2. Use antimicrobial soap for handwashing.

  3.   After glove removal and handwashing, ensure that hands do not touch
       potentially contaminated environmental surfaces or items in the patient’s
       room to avoid transfer of microorganisms to other patients or
       environments.

  4.   During patient transport drape vehicle with a clean sheet if drainage
       cannot be contained.

  5. Leave routine patient-care equipment in room (examples: BP cuff,
    stethoscope, thermometer, commode). Clean & disinfect patient-care
equipment before use with another patient.




               8
                         AIRBORNE ISOLATION PRECAUTIONS




Definition/Purpose:
Airborne Isolation Precautions are designed to reduce the risk of airborne transmission of infectious
agents. This isolation is used for patients known or suspected to be infected with microorganisms
transmitted by airborne droplet nuclei (small-particle residue [5m or smaller in size] of
evaporated droplets that may remain suspended for long periods of time) in the air or dust particles
containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by
air currents and may become inhaled by or deposited on a susceptible host within the same room or
over a longer distance. Examples of diseases requiring Airborne Isolation are: measles and
chickenpox.


Patient Placement
1.   Place the patient in a private room that has negative air pressure
     a.    monitor negative air pressure in relation to the surrounding areas daily
     b. hospital specific room number list attached
2.   Keep the room door closed and the patient in the room.
3.   When a private room is not available, place the patient in a room with a patient who has active
     infection with the same microorganism.
4.   When a private room is not available, and cohorting is not achievable or recommended, it is
     very important to consider the epidemiology of the infecting pathogen and the patient
     population being served in determining patient placement. Consultation with Infection
     Control/Epidemiology is advised before patient placement.

Respiratory Protection
1.   Susceptible persons should not enter the room of patients known or suspected to have
     measles (rubeola) or varicella (chickenpox).
2.   Persons immune to measles (rubeola) or varicella need not wear respiratory protection.

Patient Transport
Limit the movement and transport of the patient from the room to essential purposes only.
1.   If transport or movement is necessary, minimize patient dispersal of droplet nuclei by
     placing a surgical mask on the patient.
2.   If transport or movement is necessary and the patient is on a ventilator, minimize
     dispersal of droplet nuclei by placing HEPA bacterial filter on the exhalation tube.




                                     9
                            SIGN - LIGHT BLUE




       AIRBORNE ISOLATION PRECAUTIONS
            AIRBORNE ISOLATION PRECAUTIONS
VISITORS:   PERSONS NOT IMMUNE TO CHICKENPOX OR MEASLES
            REPORT TO NURSE

               1. Keep room door closed and patient in room.

               2. Persons not immune to chickenpox or measles should not
                enter room.

               3. Use surgical mask on patient during transport.




                           10
                       STOP: AIRBORNE ISOLATION (Tuberculosis)

Definition/Purpose:
STOP: Airborne isolation is designed to reduce the risk of airborne transmission of tuberculosis.
This isolation is used for patients known or suspected to be infected with tuberculosis which is
transmitted by airborne droplet nuclei (small-particle residue [5m or smaller in size] of
evaporated droplets that remain suspended in the air and that can be dispersed widely by air currents
within a room or over a long distance).

Patient Placement
1.   Place the patient in a private room that has negative air pressure and ultraviolet lamps.
     a.    monitor negative air pressure in relation to the surrounding areas,
     b. hospital specific room number list attached
2.   Keep the room door closed and the patient in the room.
3.   If a TB equipped room is unavailable, the patient must be transferred to another facility that
     can handle tuberculosis.

Respiratory Protection
A HEPA or N95 respirator must be worn in a TB room at all times. Only staff fitted and trained in
the use of these special respirators are permitted to use them and provide care to the patient.

Patient Transport
Limit the movement and transport of the patient from the room to essential purposes only.
1.   If transport or movement is necessary, minimize patient dispersal of droplet nuclei by
     placing a surgical mask on the patient.
2.   If transport or movement is necessary and the patient is on a ventilator, minimize
     dispersal of droplet nuclei by placing a HEPA filter on the exhalation tube.

                              SIGN - WHITE WITH RED LETTERS




                           STOP: AIRBORNE ISOLATION
                  VISITORS: REPORT TO NURSE BEFORE ENTERING

                         1. Keep room door closed and patient in room.

                         2. Respiratory Protection.
                            Employees wear respirator when entering the room.

                         3. Use surgical mask on patient during transport.



                                      11
                          DROPLET ISOLATION PRECAUTIONS

Definition:
Droplet isolation precautions are used for patients infected with known or suspected illness
transmitted by droplets. Droplets are primarily transmitted during coughing, sneezing, talking or
certain procedures such as suctioning or bronchoscopy. Examples of diseases requiring droplet
isolation include: invasive Haemophilus influenzae, type b disease such as meningitis, pneumonia
or epiglottitis; pertussis; Adenovirus infections in infants and young children; rubella, and; bacterial
meningitis.

Placement:
1.   When possible the patient is placed in a private room.
2.   If a private room is not available, an infected patient can be placed with another patient
     infected with the same organism who does not present risk of infection from another
     potentially transmitted organism and risk of reinfection with the same organism is not likely.
3.   Consult infection control if there are questions.

Personal Protective Equipment:
A surgical mask and eye protection is worn by hospital personnel to provide protection from
transmission and spread of droplets. Generally, these droplets travel only short distances (up to 3
feet) from infected patients.

Patient Transport:
1.   Patients should leave their room only for essential purposes.
2.   When transport is necessary the patient in droplet isolation should wear a mask to reduce the
     risk of transmission to other patients, visitors and hospital personnel during transport.
3.   Personnel in the area the infected patient will be taken should be notified in advance of the
     transfer that droplet isolation is in effect to further reduce the risk of transmission
                                        SIGN- LIGHT YELLOW




                                DROPLET PRECAUTIONS
                     VISITORS: REPORT TO NURSE BEFORE ENTERING

                          1. Wear surgical mask and eye protection
                             when working within 3 feet of patient.

                          2. Use surgical mask on patient during transport.




                                       12
PRECAUTIONS/ISOLATION NEEDED FOR SELECTED INFECTIONS AND
                         CONDITIONS
                     Infection/Condition                           Type Precautions                           Duration/Comments
Abscess
      Draining, major (no dressing or dressing does not contain         Contact         Duration of illness
      drainage adequately.)
      Drainage, minor or limited (Dressing covers and contains         Standard
      drainage adequately.)
Acquired immunodeficiency syndrome                                     Standard

Actinomycosis                                                          Standard

Adenovirus infection, in infants and young children                Droplet & Contact    Duration of illness

Amebiasis                                                              Standard
Anthrax
      Cutaneous                                                        Standard
      Gastrointestinal                                                 Standard
          (unless diapered or incontinent)                             Contact          Hand washing mechanically washes off the spores.
      Pulmonary                                                        Standard

Antibiotic-associated colitis see Clostridium difficile

Arthropodborne viral encephalitides (eastern, western Venezuelan       Standard
equine encephalomyelitis; St. Louis, California encephalitis)
Arthropodborne viral fevers (dengue, yellow fever, Colorado
tick fever)                                                            Standard
Ascariasis
                                                                       Standard
Aspergillosis
                                                                       Standard
Avian H5N1 Influenza A, same as SARS for 14 days after onset
of symptoms 2/04
Babesiosis                                                             Standard

Blastomycosis, North American, cutaneous or pulmonary                  Standard

Botulism                                                               Standard
Bronchiolitis (see respiratory infections in infants and young
children)

Brucellosis (undulant, Malta, Mediterranean fever)                     Standard

Campylobacter gastroenteritis (see gastroenteritis)

Candidiasis, all forms including mucocutaneous                         Standard

Cat-scratch fever (benign inoculation lymphoreticulosis)                Standard
Cellulitis, uncontrolled drainage                                       Contact         Duration of illness
Chancroid (soft chancre)                                                Standard
Chickenpox (varicella; see comments)                               Airborne & Contact   Maintain precautions until all lesions are crusted. The
                                                                                        average incubation period for varicella is 10-16 days, with a
                                                                                        range of 10-21 days. After exposure, use varicella zoster
                                                                                        immune globulin (VZIG) when appropriate, and discharge
                                                                                        susceptible patients if possible. Place exposed susceptible
                                                                                        patients on Airborne Precautions beginning 10 days after
                                                                                        exposure and continuing until 21 days after last exposure
                                                                                        (up to 28 days if VZIG has been given). Susceptible
                                                                                        persons should not enter the room of patients on precautions
                                                                                        if other immune caregivers are available
Chlamydia trachomatis
     Conjunctivitis                                                    Standard
     Genital                                                           Standard
     Respiratory                                                       Standard




                                                          13
                      Infection/Condition                              Type Precautions                             Duration/Comments
Cholera (see gastroenteritis)

Closed-cavity infection
      Draining, limited or minor                                            Standard
      Not draining                                                          Standard

Clostridium                                                                                   Hand washing mechanically washes off the spores.
       C. botulinum                                                         Standard
       C. difficile                                                         Contact           Duration of illness
       C. perfringens
               Food poisoning                                               Standard
               Gas gangrene                                                 Standard

Coccidioidomycosis (_________ fever)
      Draining lesions                                                      Standard
      Pneumonia                                                             Standard

Colorado tick fever                                                         Standard

Congenital rubella                                                           Contact          Place infant on precautions during any admission until 1
                                                                                              year of age, unless nasopharyngeal and urine cultures are
                                                                                              negative for virus after age 3 months)

Conjunctivitis
      Acute bacterial                                                       Standard
      Chlamydia                                                             Standard
      Gonococcal                                                            Standard
      Acute viral (acute hemorrhagic)                                       Contact           Duration of illness

Coxsackievirus disease (see enteroviral infection)

Cretzfeldt-Jakob disease                                                    Standard          Additional special precautions are necessary for handling
                                                                                              and decontamination of blood, body fluids and tissues, and
                                                                                              contaminated items from patients with confirmed or
                                                                                              suspected disease. See latest College of American
                                                                                              Pathologists (Northfield, Illinois) guidelines or other
                                                                                              references.

Croup (see respiratory infections in infants and young children)
Cryptococcosis                                                              Standard
Cryptosporidiosis (see gastroenteritis)

Cysticerosis                                                                Standard
Cytomegalovirus (CMV) infection, neonatal or                                Standard
immunosuppressed
Decubitus ulcer, infected
       Major (No dressing or dressing does not contain drainage              Contact          Duration of illness
       adequately.)
       Minor or limited (Dressing covers and contains drainage              Standard
       adequately.)

Dengue                                                                      Standard
Diarrhea, acute - infective etiology suspected (see gastroenteritis)

Diphtheria
      Cutaneous                                                              Contact          Continue precautions until off antibiotics and until 2
      Pharyngeal                                                             Droplet          cultures taken at least 24 hours apart are negative.
Ebola viral hemorrhagic fever                                                Contact          Duration of illness
 *Airborne if patient has cough, vomiting, diarrhea, or                         &             Call state health department and CDC for specific advice
hemorrhage.                                                                 *Airborne         about management of a suspected case. During the 1995
                                                                                              Ebola outbreak in Zaire interim recommendations were
                                                                       Surgical mask & eye    published. Pending a comprehensive review of the
                                                                        protection within 3   epidemiologic data from the outbreak and evaluation of the
                                                                                feet.         interim recommendations, the 1988 guidelines for the
                                                                                              management of patients with suspected viral hemorrhagic
                                                                                              infections will be reviewed and updated if indicated.



                                                         14
                     Infection/Condition                            Type Precautions                         Duration/Comments
Echinococcus (hydatidosis)
                                                                        Standard
Echovirus (see enteroviral infection)

Encephalitis or encephalomyelitis (see specific etiologic agents)

Endometritis                                                            Standard

Enterobiasis (pinworm disease, oxyuriasis)                              Standard

Enterococcus species (see multidrug-resistant organisms if
   epidemiologically significant or vancomycin resistant)

Enterocolitis, Clostridium difficile                                    Contact        Duration of illness
Enteroviral infections
       Adults                                                           Standard
       Infants and young children                                       Contact        Duration of illness
Epiglottitis, due to Haemophilus influenzae                             Droplet        Until 24 hours after initiation of effective therapy
Epstein-Barr virus infection, including infectious mononucleosis        Standard
Erythema infectiosum (also see Parvovirus B19)                          Standard
Escherichia coli gastroenteritis (see gastroenteritis)

Food poisoning
      Botulism                                                          Standard
      Clostridium perfringens or welchii                                Standard
      Staphylococcal                                                    Standard
Furunculosis - staphylococcal
      Infants and young children                                        Contact        Duration of illness

Gangrene (gas gangrene)                                                 Standard
Gastroenteritis                                                                        *Use contact precautions for diapered or incontinent
      Campylobacter species                                            Standard*       children<6 years of age for duration of illness.
      Cholera                                                          Standard*
      Clostridium difficile                                             Contact        Duration of illness
      Cryptosporidium species                                          Standard*
       Escherica coli
              Enterohemorrhagic 0157:H7                                Standard*
                Diapered or incontinent                                 Contact        Duration of illness
              Other species                                            Standard*
      Giardina lambia                                                  Standard*
      Rotavirus                                                        Standard*
              Diapered or incontinent                                   Contact        Duration of illness
      Salmonella species (including S. typhi)                          Standard*
      Shigella species                                                 Standard*
              Diapered or incontinent                                   Contact        Duration of illness
      Vibrio parahaemolyticus                                          Standard*
      Viral (if not covered elsewhere)                                 Standard*
      Yersinia enterocolitica                                          Standard*

German Measles (Rubella)                                                Droplet        Until 7 days after onset of rash

Giardiasis (see gastroenteritis)
Glanders (see Melioidosis)
Gonococcal ophthalmia neonatorum (gonorrheal ophthalmia,
      acute conjunctivitis of newborn)                                  Standard

Gonorrhea                                                               Standard

Granuloma inguinale (donovanosis, granuloma venereum)                   Standard

Guillain-Barré syndrome                                                 Standard

Hand, foot, and mouth disease (see enteroviral infection)
Hantavirus pulmonary syndrome                                           Standard




                                                       15
                     Infection/Condition                         Type Precautions                             Duration/Comments
Helicobacter pylori                                                  Standard
Hemorrhagic fevers (for example, Lassa and Ebola)                    Contact            Duration of illness
                                                                        &               Call state health department and CDC for specific advice
 *Airborne if patient has cough, vomiting, diarrhea, or             *Airborne           about management of a suspected case. During the 1995
hemorrhage.                                                                             Ebola outbreak in Zaire, interim recommendations were
                                                                 Surgical mask & eye    published. Pending a comprehensive review of the
                                                                  protection within 3   epidemiologic data from the outbreak and evaluation of the
                                                                          feet.         interim recommendations, the 1988 guidelines for
                                                                                        management of patients with suspected viral hemorrhagic
                                                                                        infections will be reviewed and updated if indicated.
Hepatitis, viral
      Type A                                                          Standard
               Diapered or incontinent patients                       Contact           Maintain precautions in infants and children <3 years of age
                                                                                        for duration of hospitalization; in children 3 to 14 years of
                                                                                        age, until 2 weeks after onset of symptoms; and in others,
                                                                                        until 1 week after onset of symptoms.
Type B--HBsAg positive                                                Standard
      Type C and other unspecified non-A, non-B                       Standard
      Type E                                                          Standard
Herpangina (see enteroviral infection)

Herpes simplex (Herpesvirus hominis)
      Encephalitis                                                    Standard
      Neonatal (For infants delivered vaginally or by                 Contact           Duration of Illness
      C-section and if mother has active infection and
      membranes have been ruptured for more than 4 to 6 hours.
      Mucocutaneous, disseminated or primary, severe                  Contact
      Mucocutaneous, recurrent (skin, oral, genital)                  Standard          Duration of Illness

Herpes zoster (varicella-zoster)
      Localized in immunocompromised patient, or disseminated    Airborne & Contact     Duration of illness
                                                                                        Persons susceptible to chickenpox are also at risk for
       Localized in normal patient                                                      developing chickenpox when exposed to patient's with
                                                                      Standard          herpes zoster lesions; therefore, susceptibles should not
                                                                                        enter the room if other immune caregivers are available.

Histoplasmosis                                                        Standard
HIV (see human immunodeficiency virus)                                Standard
Hookworm disease (anclyostomiasis, uncinariasis)                      Standard

Human immunodeficiency virus (HIV) infection                          Standard          (Also see syndromes or conditions listed on page 21)


Impetigo                                                               Contact          Until 24 hours after initiation of effective therapy.

Infectious mononucleosis                                              Standard
Influenza                                                             Droplet           Duration of illness
        (Avian H5N1 Influenza A, same as SARS for 14 days                               If sufficient private rooms are unavailable, consider
        after onset of symptoms 2/04)                                                   cohorting patients, or at the very least, avoid room sharing
                                                                                        with high-risk patients.

Kawasaki syndrome                                                     Standard

Lassa fever                                                            Contact          Duration of illness
                                                                          &             Call state health department and CDC for specific advice
 *Airborne if patient has cough, vomiting, diarrhea, or               *Airborne         about management of a suspected case. During the 1995
hemorrhage.                                                                             Ebola outbreak in Zaire, interim recommendations were
                                                                 Surgical mask & eye    published. Pending a comprehensive review of the
                                                                  protection within 3   epidemiologic data from the outbreak and evaluation of the
                                                                          feet.         interim recommendations, the 1988 guidelines for
                                                                                        management of patients with suspected viral hemorrhagic
                                                                                        infections will be reviewed and updated if indicated.


Legionnaires' disease                                                 Standard




                                                          16
                        Infection/Condition                         Type Precautions                       Duration/Comments
Leprosy                                                                 Standard

Leptospirosis                                                           Standard

Lice (pediculosis)                                                      Contact        Until 24 hours after initiation of effective therapy.

Listeriosis                                                             Standard

Lyme Disease                                                            Standard
Lymphocytic choriomeningitis                                            Standard
Lymphogranuloma venereum                                                Standard
Malaria                                                                 Standard

Marburg virus disease                                                   Contact        Duration of illness
                                                                                       Call state health department and CDC for specific advice
                                                                                       about management of a suspected case. During the 1995
                                                                                       Ebola outbreak in Zaire, interim recommendations were
                                                                                       published. Pending a comprehensive review of the
                                                                                       epidemiologic data from the outbreak and evaluation of the
                                                                                       interim recommendations, the 1988 guidelines for
                                                                                       management of patients with suspected viral hemorrhagic
                                                                                       infections will be reviewed and updated if indicated.

Measles (rubeola), all presentations                                    Airborne       Duration of illness
Melioidosis, all forms (Pseudomonas-pseudomallei)                       Standard       P. mallei causes Glanders a highly communicable disease
P. pseudomallei cannot be distinguished serologically from           Contact-if skin   in horses, mules & donkeys. Foci are thought to exist in
P. mallei                                                            involvement or    Asia & some eastern Mediterranean Countries.
                                                                        diapered.
Meningitis
     Aseptic (nonbacterial or viral meningitis [also see                Standard
     enteroviral infections])
     Bacterial, gram-negative enteric, in neonates                      Standard
     Fungal                                                             Standard
     Haemophilus influenzae, known or suspected                         Droplet*       *Until 24 hours after initiation of effective therapy.
     Listeria monocytogenes                                             Standard
     Neisseria meningitidis (meningococcal) known or                    Droplet*
     suspected
     Pneumococcal                                                       Standard
     Tuberculosis (Patient should be examined for evidence of           Standard
     current (active) pulmonary tuberculosis. If evidence exists,
     additional precautions are necessary (see tuberculosis).
     Other diagnosed bacterial
                                                                        Standard

Meningococcal pneumonia                                                 Droplet        Until 24 hours after initiation of effective therapy.

Meningococcemia (meningococcal sepsis)                                  Droplet        Until 24 hours after initiation of effective therapy.
MRSA (methicillin resistant Staph. aureus)                              Contact        Notify nursing home, other hospital or home-health agency
 (See multi drug-resistant organisms)                                                  of MRSA status before transfer.

Molluscum contagiosum                                                   Standard
                                                                        Contact        Use N95 respirator. Discontinuation of isolation determined
Monkey Pox                                                              Droplet        by health department.
                                                                        Airborne

Mucormycosis                                                            Standard
Multidrug-resistant organisms, infection or colonization
(Resistant bacteria judged by the infection control program,
based on current state, regional, or national recommendations,
to be of special clinical and epidemiologic significance.)
See MRSA & VRE.
               Gastrointestinal                                         Contact*       *Until off antibiotics and culture-negative.
               Respiratory                                              Contact*
                   Pneumococcal                                         Standard
               Skin, wound, or burn                                     Contact*




                                                      17
                     Infection/Condition                          Type Precautions                        Duration/Comments
Mumps (infectious parotitis)                                          Droplet         For 9 days after onset of swelling.

Mycobacteria, nontuberculosis (atypical)
      Pulmonary                                                       Standard
      Wound                                                           Standard
Mycoplasma pneumonia                                                  Droplet         Duration of illness.
Necrotizing enterocolitis                                             Standard
Nocardiosis, draining lesions or other presentations                  Standard

Norwalk agent gastroenteritis (see viral gastroenteritis)
Orf                                                                   Standard
Parainfluenza virus infection, respiratory in infants and young       Contact         Duration of illness.
children
Parvovirus B19                                                         Droplet        Maintain precautions for duration of hospitalization when
                                                                                      chronic disease occurs in an immunodeficient patient. For
                                                                                      patients with transient aplastic crisis or red-cell crisis,
                                                                                      maintain precautions for 7 days.
Pediculosis (lice)                                                    Contact         Until 24 hours after initiation of effective therapy.

Pertussis (whooping cough)                                             Droplet        Maintain precautions until 5 days after patient is placed on
                                                                                      effective therapy.

Pinworm infection                                                     Standard
Plague
       Bubonic                                                        Standard
                                                                   Contact-if skin
                                                                    involvement
       Pneumonic                                                      Droplet         Until 48 hours after initiation of effective therapy & clinical
                                                                                      improvement.
Pleurodynia (see enteroviral infection)

Pneumonia
     Adenovirus                                                   Droplet & Contact   Duration of illness.
     Bacterial not-listed elsewhere (including gram-negative
     bacterial)                                                       Standard
     Burkholderia cepacia in cystic fibrosis (CF)                     Standard        Avoid cohorting or placement in the same room with a CF
     patients,including respiratory tract colonization                                patient who is not infected or colonized with B cepacia.
                                                                                      Persons with CF who visit or provide care and are not
                                                                                      infected or colonized with B cepacia may elect to wear a
                                                                                      mask when within 3 ft of a colonized or infected patient.

       Chlamydia                                                      Standard

       Fungal                                                         Standard

       Hemophilus influenzae

                Adults                                                Standard

                Infants and children (any age)                         Droplet        Until 24 hours after initiation of effective therapy.

       Legionella                                                     Standard

       Meningococcal                                                   Droplet        Until 24 hours after initiation of effective therapy.

       Multidrug-resistant bacterial (see multidrug-resistant
       organisms)

       Mycoplasma (primary atypical pneumonia)                         Droplet        Duration of illness.

       Pneumococcal (Streptococcus pneumoniae)                        Standard

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




                                                        18
                    Infection/Condition                             Type Precautions                           Duration/Comments
Pneumonia (Continued)
     Pseudomonas cepacia (see Burkholderia cepacia)                     Standard        Avoid cohorting or placement in the same room with a CF
                                                                                        patient who is not infected or colonized with P cepacia.
                                                                                        Persons with CF who visit or provide care and are not
                                                                                        infected or colonized with P cepacia may elect to wear a
                                                                                        mask when within 3 ft of a colonized or infected patient.
       Staphylococcus aureus                                            Standard
       Streptococcus, Group A
               Adults                                                   Standard
               Infants and young children                               Droplet         Until 24 hours after initiation of effective therapy.
       Viral
               Adults                                                   Standard
               Infants and young children                               Contact
Poliomyelitis                                                           Standard
Psittacosis (ornithosis)                                                Standard
Q fever                                                                 Standard
Rabies                                                                  Standard
Rat-bite fever (Streptobacillus moniliformis disease, Spirillum         Standard
minus disease)

Relapsing fever                                                         Standard

Resistant bacterial infection or colonization (see multidrug-
resistant organisms)

Respiratory infectious disease, acute (if not covered elsewhere)
      Adults                                                            Standard
      Infants and young children (Also see syndromes or                 Contact         Duration of illness.
      conditions listed on Page 21)

Respiratory syncytial virus infection, in infants and young              Contact        Duration of illness.
children, and immunocompromised adults

Reye's syndrome                                                         Standard

Rheumatic fever                                                         Standard

Rickettsial fevers, tickborne (Rocky Mountain spotted fever,            Standard
tickborne typhus fever)

Rickettsialpox (vesicular rickettsiosis)                                Standard

Ringworm (dermatophytosis, dermatomycosis, tinea)                       Standard

Ritter's disease (staphylococcal scalded skin syndrome)                 Standard

Rocky Mountain spotted fever                                            Standard

Roseola infantum (exanthem subitum)                                     Standard

Rotavirus infection (see gastroenteritis)

Rubella (German measles; also see congenital rubella)                    Droplet        Until 7 days after onset of rash.

Salmonellosis (see gastroenteritis)
                                                                                        Until 10 days after afebrile and asymptomatic.
SARS Severe Acute Respiratory Syndrome                             Contact & Airborne   Use N95 respirator, (discard after every use) gown, gloves
                                                                                        & eye protection to enter room. Post log to record all
                                                                                        individuals entering room.

Scabies                                                                  Contact        Until 24 hours after initiation of effective therapy.

Scalded skin syndrome, staphlococcal (Ritter's disease)                 Standard
Schistosomiasis (bilharziasis)                                          Standard




                                                        19
                       Infection/Condition                        Type Precautions                          Duration/Comments
Shigellosis (see gastroenteritis)
Shingles (See Herpes Zoster)
Smallpox                                                         Contact & Airborne   Use N95 Respirator until disappearance of all scabs. Post
                                                                                      log to record all individuals entering room.

Sporotrichosis                                                        Standard


Spirillum minus disease (rat-bite fever)                              Standard

Staphylococcal disease (S aureus)
      Skin, wound, or burn
             Major (No dressing or dressing does not                   Contact        Duration of illness
             contain drainage adequately)
             Minor or limited (Dressing covers and                    Standard        Duration of illness
             contains drainage adequately)
      Enterocolitis                                                   Standard        Use Contact Precautions for diapered or incontinent children
                                                                                      <6 years of age for duration of illness.
       Multidrug-resistant (see multidrug-resistant organisms)
       Pneumonia                                                      Standard
       Scalded skin syndrome                                          Standard
       Toxic shock syndrome                                           Standard

Streptobacillus moniliformis disease (rat-bite fever)                 Standard

Streptococcal disease (group A streptococcus)
       Skin, wound, or burn
              Major (No dressing or dressing does not                 Contact*        *Until 24 hours after initiation of effective therapy.
              contain drainage adequately)
              Minor or limited (Dressing covers and                   Standard
              contains drainage adequately)
       Endometritis (puerperal sepsis)                                Standard
       Pharyngitis in infants and young children                      Droplet*
       Pneumonia in infants and young children                        Droplet*
       Scarlet fever in infants and young children                    Droplet*

Streptococcal disease (group B streptococcus), neonatal               Standard

Streptococcal disease (not group A or B) unless covered               Standard
elsewhere
       Multidrug-resistant (see multidrug-resistant organisms)

Strongyloidiasis                                                      Standard

Syphilis
       Skin and mucous membrane, including congenital,primary,        Standard
       secondary
       Latent (tertiary) and seropositivity without lesions           Standard

Tapeworm disease
     Hymenolepis nana                                                 Standard
     Taenia solium (pork)                                             Standard
     Other                                                            Standard

Tetanus                                                               Standard

Tinea (fungus infection dermatophytosis, dermatomycosis,              Standard
ringworm)


Toxoplasmosis                                                         Standard

Toxic shock syndrome (staphylococcal disease)                         Standard

Trachoma, acute                                                       Standard
Trench mouth (Vincent's angina)
                                                                      Standard



                                                        20
                       Infection/Condition                            Type Precautions                        Duration/Comments
Trichinosis                                                               Standard

Trichomoniasis                                                            Standard

Trichuriasis (whipworm disease)                                           Standard
Tuberculosis
      Extrapulmonary, draining lesion (including scrofula)                Standard
      Extrapulmonary, meningitis (Patient should be examined              Standard
      for evidence of current (active) pulmonary tuberculosis. If
      evidence exists, additional precautions are necessary (see
      pulmonary tuberculosis).
      Pulmonary, confirmed or suspected or laryngeal                        Stop           Discontinue precautions only when TB patient is on
      disease                                                             Airborne         effective therapy, is improving clinically, and has three
                                                                                           consecutive negative sputum smears collected on different
                                                                                           days, or TB is ruled out.
                                                                                           Also see special Tuberculosis policy
      Skin-test positive with no evidence of current                      Standard
      pulmonary disease
Tularemia
      Draining lesion                                                     Standard
      Pulmonary                                                           Standard
Typhoid (Salmonella typhi) fever (see gastroenteritis)

Typhus, endemic and epidemic                                              Standard
Urinary tract infection (including pyelonephritis), with or without       Standard
urinary catheter
Vaccinia Virus used in Smallpox vaccinations                              Standard         Dispose of dressing & scab in red or biohazard bag. Use
                                                                                           contact precautions if drainage is not able to be contained in
                                                                                           dressing.
Varicella (chickenpox)                                                Airborne & Contact   Maintain precautions until all lesions are crusted. The
                                                                                           average incubation period for varicella is 10 to 16 days, with
                                                                                           a range of 10 to 21 days. After exposure, use varicella
                                                                                           zoster immune globulin (VZIG) when appropriate, and
                                                                                           discharge susceptible patients if possible. Place exposed
                                                                                           susceptible patients on Airborne Precautions beginning 10
                                                                                           days after exposure and continuing until 21 days after last
                                                                                           exposure (up to 28 days if VZIG has been given).
                                                                                           Susceptible persons should not enter the room of patients on
                                                                                           precautions if other immune caregivers are available.
Vibrio parahaemolyticus (see gastroenteritis)

Vincent's angina (trench mount)                                           Standard
Viral diseases
       Respiratory (if not covered elsewhere)
               Adults                                                     Standard
               Infants and young children (see respiratory
               infectious disease, acute)
Viral Encephalitis                                                        Standard          Ven. Equine Encephalitis add Droplet precautions.
VRE (Vancomycin-resistant enterococcus)                                   Contact           Initiate the following precautions to prevent patient-to-
                                                                                            patient transmission of VRE.
                                                                                           1. Place VRE –infected or colonized patients in private
                                                                                                  rooms or in the same room as other patients who have
                                                                                                  VRE.
                                                                                           2. Wear gloves (clean, nonsterile gloves are adequate)
                                                                                                  when entering the room of a VRE-infected or
                                                                                                  colonized patient because VRE can extensively
                                                                                                  contaminate such an environment. When caring for
                                                                                                  patient, change of gloves might be necessary after
                                                                                                  contact with material that could contain high
                                                                                                  concentrations of VRE (e.g., stool).
                                                                                           3. Wear a gown (clean, nonsterile is adequate) when
                                                                                                  entering the room of a VRE-infected or colonized
                                                                                                  patient:
                                                                                                  a.    If substantial contact with the patient or with
                                                                                                        environmental surfaces in the patient’s room is
                                                                                                        anticipated.


                                                         21
                       Infection/Condition                      Type Precautions                       Duration/Comments
                                                                                        b.    If the patient is incontinent, or
                                                                                        c.    If the patient has had an ileostomy or colostomy,
                                                                                              has diarrhea, or has wound drainage not
                                                                                              contained by a dressing.

                                                                                   4.   Remove gloves and gown before leaving the patients
                                                                                        room and immediately wash hands with an antiseptic
                                                                                        soap. Hands can be contaminated via glove leaks or
                                                                                        during glove removal, and bland soap does not always
                                                                                        completely remove VRE from hands.
                                                                                   5.   Ensure that after glove and gown removal and
                                                                                        handwashing, clothing and hands do not contact
                                                                                        environmental surfaces in the patient’s room that are
                                                                                        potentially contaminated with VRE (e.g., a door knob
                                                                                        or curtain).
                                                                                   6.   Follow dilution and contact time recommended on
                                                                                        label of disinfectants.
                                                                                   7.   Dedicate the use of noncritical items (e.g., a
                                                                                        stethoscope, sphygmomanometer, or thermometer) to
                                                                                        a single patient or cohort of patients infected or
                                                                                        colonized with VRE.
                                                                                   8.   Because patients with VRE can remain colonized for
                                                                                        long periods after discharge from the hospital, Contact
                                                                                        Precautions should be instituted if the patient is
                                                                                        readmitted.
                                                                                   9.   Before discharge, notify the receiving nursing home,
                                                                                        other hospital or home health care agency of the
                                                                                        patient’s VRE status.

Whooping cough (pertussis)                                          Droplet        Maintain precautions until 5 days after patient is placed on
                                                                                   effective therapy.
Wound infections
   Major (No dressing or dressing does not contain drainage         Contact        For duration of illness
   Adequately)
   Minor or limited (Dressing covers and contains drainage          Standard
  adequately)
Yersinia enterocolitica gastroenteritis (see gastroenteritis)       Contact        Duration of illness
Zygomycosis (phycomycosis, mucormycosis)                            Standard
Zoster (See Herpes-zoster)




                                                         22
CLINICAL SYNDROMES OR CONDITIONS WARRANTING EMPIRIC PRECAUTIONS
Clinical Syndromes or Conditions Warranting Additional Empiric Precautions To Prevent Transmission Of Epidemiologically
Important Pathogens Pending Confirmation Of Diagnosis


Clinical Syndrome or Condition*                                                          Potential Pathogens+              Empiric Pr ecautions

Diarrhea
  Acute diarrhea with a likely infectious cause in an                                     Enteric pathogens\                           Contact
     incontinent or diapered patient
  Diarrhea in an adult with a history of recent antibiotic                                Clostridium difficle                         Contact
Meningitis                                                                                Neisseria Meningitidis                       Droplet
Rash or exanthems, generalized, etiology unknown
  Petechial/ecchymotic with fever                                                         Neisseria Meningitidis                    Droplet
                     Vesicular                                                            Varicella                         Airborne &Contact

  Maculopapular with coryza and fever                                    Rubeola (measles)                                             Airborne
Respiratory infections
  Cough/fever/upper lobe pulmonary infiltrate in an                       Mycobacterium tuberculosis                                   Airborne
     HIV-negative patient or a patient at low risk for HIV
     infection
  Cough/fever/ pulmonary infiltrate in any location in an                Mycobacterium tuberculosis                                    Airborne
     HIV-infected patient or a patient at high risk for HIV
     infection
  Paroxysmal or severe persistent cough during periods of                Bordella pertussis                                            Droplet
     pertussis activity
  Respiratory infections, particularly bronchiolitis and croup,          Respiratory syncytial or                                      Contact
     in infants and young children                                       parainfluenza virus
Risk of multidrug-resistant microorganisms
  History of infection or colonization with multidrug-resistant Resistant bacteria                Contact
     organisms
  Skin, wound, or urinary tract infection in a patient with a            Resistant bacteria                                            Contact
     recent hospital or nursing home stay in a facility where
     multidrug-resistant organisms are prevalent
Skin or Wound Infection
  Abscess or draining wound that cannot be covered                       Staphylococcus aureus,                                        Contact
                                                                         Group A streptococcus

    *Patients with the syndromes or conditions listed below may present with atypical signs or symptoms (eg. Pertussis in neonates and adults may not have
paroxysmal or severe cough). The clinicians index of suspicion should be guided by the prevalence of specific conditions in the community , as well as
clinical judgement.
+The organisms listed under the column Potential pathogens are not intended to represent the complete, or even most likely, diagnoses, but rather possible
etiologic agents that require additional precautions beyond Standard Precautions until they can be ruled out.
\These paythogens include enterohemorrhagic Escherichia coli 0157:H7, Shigella,Hepatitis A, and Rotavirus.




                                                        23
                                                NEGATIVE AIRFLOW ROOMS

Airborne Isolation patients should be placed in a negative air pressure room. Tuberculosis patients are admitted to a negative
air room with ultraviolet light. Oncology patients should be evaluated before being placed in negative air rooms. All patient
rooms designated as “Negative Air flow” rooms are labeled with a dark green ½” tall capital “N”. This “N” is located on the
lower right hand corner of the room number placard.

                                                    _________ MEDICAL CENTER


CICU                          305, Ultraviolet light

ICU                           200, 206 has Ultraviolet light

MOTHER/BABY                   2001, 2011

ACU-7 TOWER                   701, 702, 703, 730, 731 All have ultraviolet, 701 & 731 have anti rooms, 729 negative airflow

8 TOWER                       802, 803, 807, 826, 827, 801 & 827 both have ultraviolet light and anti room, 827 has a negative
                              airflow monitor

9 TOWER                       901, 902 has ultraviolet light, 930 & 931 both have ultraviolet, 931 has anti room

10 TOWER                      1001, 1031

11 TOWER                      1101, 1131 both have ultraviolet light and anti room

PACU                          472

SSU                           Room 4



                                         _________ HOSPITAL & MEDICAL CENTER

Negative Air Pressure Rooms Are:

Emergency Department Room 11 has anti room & >12 air exchanges

PEDS                          164 has anti room, 165 2-bed no anti room

Variable Volume Damper Rooms Which Allow Either Positive or Negative Pressure are:

PCU                           212 anti room

ICU                           1 & 10 ICU - 1 also has ultraviolet light and is used for TB with negative airflow setting.

MEDICAL                       312 anti room

SURGICAL                      323 anti room




Orig 5/97   Revised: 1/98, 2/99, 6/02, 2/03, 9/03, 5/04, 10/04, 2/05, 1/08   Reviewed: 10/00


                                                  24

				
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