TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Precautions
Duration †
*
Type
Comments
Abscess
Draining, major
Draining, minor or limited
Acinetobacter baumannii (multiple drug resistant)
Acquired human immunodeficiency syndrome (AIDS)/HIV infection
Actinomycosis
Adenovirus infection, in infants and young children (also, see
gastroenteritis, adenovirus)
Amebiasis
Anthrax
C
S
C
S
S
D, C
S
Pulmonary
S
Antibiotic-associated colitis (see Clostridium difficile)
Arthropod-borne viral encephalitides (eastern, western, Venezuelan
equine encephalomyelitis; St Louis, California encephalitis; West Nile
Virus)
DH
A, C
S
Arthropod-borne viral fevers (dengue, yellow fever, Colorado tick fever)
S
Ascariasis
S
No dressing or containment of drainage; until drainage stops or can be
contained by dressing
Dressing covers and contains drainage
Contact Infection Prevention
Not transmitted person-to-person.
DI
S
Cutaneous
Aerosolizable spore-containing powder or other substance
DI
Person-to-person transmission is rare.
DE
Transmission through non-intact skin contact with draining lesions possible
therefore use Contact Precautions if large amount of uncontained drainage.
Hand hygiene with soap and water preferable. Alcohol gel/foams have no
sporicidal activity.
Not transmissible person-to-person.
Until decontamination of environment complete. Wear N-95 respirator,
protective clothing; decontaminate persons with powder on them.
Hand hygiene: Hand washing for 30-60 seconds with soap and water or 2%
chlorhexidine gluconate (CHG) after spore contact. Alcohol gel hand rubs are
ineffective.
Post-exposure prophylaxis following exposure: 60 days of antimicrobials
(either doxycycline, ciprofloxacin, or levofloxacin) and post-exposure
vaccine.
Not transmitted from person-to-person except rarely by transfusion, and for
West Nile virus by organ transplant, breast milk or transplacentally.
Not transmitted from person-to-person except by transfusion (rare)
Not transmitted from person-to-person
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
1
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Aspergillosis
Precautions
Duration †
*
Type
Contact Precautions and Airborne Precautions if massive soft tissue infection
with copious drainage and repeated irrigations required
S
Avian influenza (see influenza, avian below)
A, D, C
Babesiosis
Blastomycosis, cutaneous or pulmonary
Botulism
Bronchiolitis (see Respiratory infections in infants and young children)
S
S
S
C
Brucellosis
S
Campylobacter gastroenteritis (see Gastroenteritis)
Candidiasis, all forms
Cat-scratch fever
S
S
Cellulitis
S
Chancroid (soft chancre)
Chickenpox (see varicella)
Chlamydia trachomatis
Conjunctivitis
Genital
Pneumonia (infants <3 mos of age)
Chlamydia pneumoniae
Cholera (see gastroenteritis)
Closed-cavity infection
Open drain in place; limited or minor drainage
No drain or closed drainage system in place
Clostridium
C. botulinum
S
Comments
7 days after
onset of
symptoms
DI
Not transmitted from person-to-person except rarely by transfusion,
Not transmitted from person-to-person
Not transmitted from person-to-person
Use mask according to Standard Precautions
Not transmitted from person-to-person except rarely via banked
spermatozoa and sexual contact. Provide antimicrobial prophylaxis during
lab exposure. Notify Infection Prevention. Notify laboratory personnel
before sending specimens if disease is suspected.
Not transmitted from person-to-person
S
S
S
S
S
S
Contact Precautions if there is copious uncontained drainage
S
Not transmitted from person-to-person
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
2
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
C. difficile (see Gastroenteritis, C. difficile)
C. perfringens
Food poisoning
Gas gangrene
Coccidioidomycosis (valley fever)
Precautions
Duration †
*
Type
C
S
Pneumonia
S
Colorado tick fever
S
Congenital rubella
C
Conjunctivitis
Acute bacterial
Chlamydia
Gonococcal
S
S
S
Acute viral (acute hemorrhagic)
Coronavirus associated w/ SARS or MERS (see Severe Acute Respiratory
Syndrome or Middle Eastern Respiratory Syndrome)
Coxsackie virus disease (see enteroviral infection)
Creutzfeldt-Jakob disease (including variant CJD)
CJD, vCJD
See IP website
S
S
Draining lesions
C
S
Comments
Not transmitted from person-to-person
Not transmitted from person-to-person
Not transmitted from person-to-person except under extraordinary
circumstances because the infectious arthroconidial form of Coccidoides
immitus is not produced in humans. Notify laboratory personnel prior to
specimen submission if disease is suspected.
Not transmitted from person-to-person except under extraordinary
circumstances (e.g., inhalation of aerosolized tissue phase endospores
during necropsy, transplantation of infected lung) because the infectious
arthroconidial form of Coccidiodes immitus is not produced in humans.
Not transmitted from person-to-person
Until 1 yr. of Standard Precautions if nasopharyngeal and urine cultures repeatedly neg.
age
after 3 mos. of age
DI
Adenovirus most common; enterovirus 70, Coxsackie virus A24 also
associated with outbreaks in eye clinics, pediatric and neonatal settings,
institutional settings reported. Eye clinics follow Standard Precautions when
handling patients with conjunctivitis. Routine use of infection control
measures when handling instruments and equipment prevents occurrence
of outbreaks in this and other settings.
Use disposable instruments or special sterilization/disinfection for surfaces,
objects contaminated with neural tissue if CJD or vCJD suspected and has
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
3
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Precautions
Duration †
*
Type
Comments
not been R/O; No special burial procedures.
Croup (see respiratory infections in infants and young children)
Crimean-Congo Fever (see Viral Hemorrhagic Fever)
Cryptococcosis
Cryptosporidiosis (see gastroenteritis)
Cysticercosis
Cytomegalovirus infection, neonatal or immunosuppressed
Decubitus ulcer (see Pressure ulcer)
Dengue fever
Diarrhea, acute-infective etiology suspected (see gastroenteritis)
Diphtheria
Cutaneous
Pharyngeal
Ebola virus (see viral hemorrhagic fevers)
Echinococcosis (hydatidosis)
Echovirus (see enteroviral infection)
Encephalitis or encephalomyelitis (see specific etiologic agents)
Endometritis (endomyometritis)
Enterobiasis (pinworm disease, oxyuriasis)
Enterococcus species (see multidrug-resistant organisms if
epidemiologically significant or vancomycin resistant)
Enterocolitis, C. difficile (see C. difficile, gastroenteritis)
S
Not transmitted from person-to-person, except rarely via tissue and corneal
transplant.
S
S
Not transmitted from person-to-person
No additional precautions for pregnant HCWs
S
Not transmitted from person-to-person
C
D
CN
CN
S
Until 2 cultures taken 24 hrs. apart negative
Until 2 cultures taken 24 hrs. apart negative
Not transmitted from person-to-person
S
S
Enteroviral infections
S
Epiglottitis, due to Haemophilus influenzae type b
Epstein-Barr virus infection, including infectious mononucleosis
Erythema infectiosum (also see Parvovirus B19)
Escherichia coli gastroenteritis (see gastroenteritis)
Food poisoning
Botulism
D
S
S
S
U 24 hrs
Use Contact Precautions for diapered or incontinent children for duration of
illness and to control institutional outbreaks
See specific disease agents for epiglottitis due to other etiologies
Not transmitted from person-to-person
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
4
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
C. perfringens or welchii
Staphylococcal
Precautions
Duration †
*
Type
Comments
S
S
Not transmitted from person-to-person
Not transmitted from person-to-person
Furunculosis, staphylococcal
S
Contact if drainage not controlled or MRSA
Infants and young children
Gangrene (gas gangrene)
C
S
Gastroenteritis
S
Adenovirus
S
Campylobacter species
S
Cholera
S
C. difficile (suspected or confirmed)
C
Cryptosporidium species
S
E. coli
Enteropathogenic O157:H7 and other shiga toxin-producing
Strains
S
Other species
S
Giardia lamblia
S
Noroviruses
S
DI
DI
Not transmitted from person-to-person
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks for gastroenteritis
caused by all of the agents below
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Do not share electronic thermometers; ensure consistent environmental
cleaning and disinfection. Bleach solutions is required for cleaning. Hand
hygiene with soap and water preferred because of the absence of sporicidal
activity of alcohol in waterless antiseptic hand rubs.
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks. Persons who clean
areas heavily contaminated with feces or vomitus may benefit from wearing
masks since virus can be aerosolized from vomitus and feces; ensure
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
5
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Precautions
Duration †
*
Type
Rotavirus
C
Salmonella species (including S. typhi)
S
Shigella species
S
Vibrio parahaemolyticus
S
Viral (if not covered elsewhere)
S
Yersinia enterocolitica
S
German measles (see rubella; see congenital rubella)
Giardiasis (see gastroenteritis)
Gonococcal ophthalmia neonatorum (gonorrheal ophthalmia,
acute conjunctivitis of newborn)
Gonorrhea
Granuloma inguinale (Donovanosis, granuloma venereum)
Guillain-Barré’ syndrome
Hand, foot, and mouth disease (see enteroviral infection)
Hansen’s Disease (see Leprosy)
Hantavirus pulmonary syndrome
Helicobacter pylori
Hepatitis, viral
Type A
Diapered or incontinent patients
DI
Comments
consistent environmental cleaning and disinfection. Bleach solutions may be
required when continued transmission. Alcohol less active, but there is not
evidence that alcohol antiseptic hand rubs are not effective for hand
decontamination. Cohorting of affected patients to private rooms may
interrupt transmission.
Ensure consistent environmental cleaning and disinfection; prolonged
shedding may occur in the immunocompromised
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
Use Contact Precautions for diapered or incontinent persons for the
duration of illness or to control institutional outbreaks
S
S
S
S
S
S
Not transmitted from person-to-person
S
Provide hepatitis A vaccine post exposure as recommended
Maintain Contact Precautions in infants and children <3 years of age for
duration of hospitalization; for children 3-14 yrs. of age for 2 weeks after
C
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
6
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Precautions
Duration †
*
Type
Type B-HbsAg positive; acute or chronic
Type C and other unspecified non-A, non-B
Type D (seen only with hepatitis B)
S
S
S
Type E
S
Type G
Herpangina (see enteroviral infection)
Herpes simplex (Herpesvirus hominis)
Encephalitis
Use Contact Precautions for diapered or incontinent persons for the
duration of illness
S
C
Mucocutaneous, recurrent (skin, oral, genital)
S
C
Herpes zoster (varicella-zoster, shingles)
Disseminated disease in any patient
Localized disease in immunocompromised patient
Localized in patient with intact immune system with lesions that can
be contained/covered
Histoplasmosis
Human immunodeficiency virus (HIV)
onset of symptoms; >14 yrs. of age for 1 week after onset of symptoms.
Specific recommendations for care of patients in hemodialysis centers
Specific recommendations for care of patients in hemodialysis centers
S
Mucocutaneous, disseminated or primary, severe
Neonatal
Comments
Until lesions
dry and
crusted
Also, for asymptomatic, exposed infants delivered vaginally or by C-section
Until lesions
and if mother has active infection and membranes have been ruptured for
dry and
more than 4 to 6 hours until infant surface cultures obtained at 24-36 hrs. of
crusted
age negative after 48 hours incubation
A,C
DI
S
DI
S
S
Susceptible HCWs are reassigned if immune caregivers are available
Susceptible HCWs are reassigned if immune caregivers are available.
Not transmitted from person-to-person
Human metapneumovirus
C
DI
Impetigo
Infectious mononucleosis
C
U 24 hrs
Assumed to be Contact transmission as for RSV since the viruses are closely
related and have similar clinical manifestations and epidemiology.
S
Influenza
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
7
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Human (seasonal influenza)
Precautions
Duration †
*
Type
D
Avian (e.g., H5N1, H7, H9 strains) Consult Infection Prevention
Pandemic Influenza Consult Infection Prevention
Kawasaki syndrome
Lassa fever (see viral hemorrhagic fevers)
Legionnaires’ disease
Leprosy
Leptospirosis
Lice
Head (pediculosis)
D
S
Private room when available or cohort; avoid placement with high-risk
patients; mask patient when transported out of room;
7 days except chemoprophylaxis/vaccine to control/prevent outbreaks. Use gown and
DI in immuno gloves according to Standard Precautions especially in Pediatric settings.
compromised Duration of precautions for immunocompromised patients cannot be
defined; prolonged duration of viral shedding (i.e. for several weeks) has
persons
been reported. Use N95 respirator when performing aerosol-generating
procedures.
7 days from See (www.pandemicflu.gov ) for current pandemic influenza guidance
onset of
symptoms
Not an infectious condition
S
S
S
Not transmitted person-to-person
See http://www.cdc.gov/parasites/lice/index.html
C
Body
S
Pubic
S
Listeriosis
S
Lyme disease
Lymphocytic choriomeningitis
Lymphogranuloma venereum
S
S
S
Malaria
S
Marburg virus disease (see viral hemorrhagic fevers)
Comments
U 24 hrs
Transmitted person-to-person through infested clothing. Wear gown and
gloves when removing clothing; bag and wash clothes according to CDC
guidance above.
Transmitted person-to-person through sexual contact
Person-to-person transmission rare; Cross transmission in neonatal settings
reported
Not transmitted from person-to-person
Not transmitted from person-to-person
Not transmitted from person-to-person except through transfusion rarely
and through failure to follow Standard Precautions during patient care
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
8
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Precautions
Duration †
*
Type
Measles (rubeola)
A
Melioidosis, all forms
Meningitis
Aseptic (nonbacterial or viral; also see enteroviral infections)
Bacterial, gram-negative enteric, in neonates
Fungal
Haemophilus influenzae, type b known or suspected
Listeria monocytogenes
Neisseria meningitidis (meningococcal) known or suspected
Streptococcus pneumoniae
S
S
S
S
D
S
D
S
M. tuberculosis
S
Other diagnosed bacterial
S
Meningococcal disease: sepsis, pneumonia, meningitis
Middle Eastern Respiratory Syndrome (MERS) Coronavirus (MERS-CoV)
D
A, D, C
4 days after
onset of rash;
DI in immune
compromised
Comments
Susceptible HCWs are reassigned if immune care providers are available; For
exposed susceptible persons, post-exposure vaccine within 72 hrs. or
immune globulin within 6 days when available. Place exposed susceptible
patients on Airborne precautions and exclude susceptible HCW from duty
from day 5 after first exposure to day 21 after last exposure regardless of
post exposure vaccine.
Not transmitted from person-to-person
Contact for infants and young children
U 24 hrs
U 24 hrs
Not transmitted from person-to-person
See meningococcal disease below
Concurrent, active pulmonary disease or draining cutaneous lesions
necessitate addition of Airborne Precautions For children, Airborne
Precautions until active pulmonary tuberculosis in visiting family members
can be ruled out
Post exposure chemoprophylaxis for household contacts, HCWs exposed to
respiratory secretions. Contact Infection Prevention; post exposure vaccine
only if outbreak
DI plus 10 days Enhanced precautions with N95 or higher respiratory protection; surgical
after
mask if N95 unavailable; eye protection (goggles, face shield); gowns and
resolution of gloves; aerosol-generating procedures and “supershedders” highest risk for
transmission via small droplet nuclei and large droplets. Vigilant
fever,
provided environmental disinfection. Contact Infection Prevention.
respiratory sxs
are absent or
improving
U 24 hrs
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
9
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Molluscum contagiosum
Monkeypox
Precautions
Duration †
*
Type
S
A,C
Mucormycosis
Multidrug-resistant organisms (MDROs), infection or colonization (e.g.,
MRSA, VRE, VISA/VRSA, Resistant Acinetobacter baumannii, ESBLs)
Mumps (infectious parotitis)
Mycobacteria, nontuberculosis (atypical)
Pulmonary
Wound
Mycoplasma pneumonia
Necrotizing enterocolitis
Nocardiosis, draining lesions, or other presentations
Norovirus (see gastroenteritis)
Norwalk agent gastroenteritis (see gastroenteritis)
Orf
Comments
Until
See www.cdc.gov/ncidod/monkeypox for most current recommendations.
monkeypox Transmission in hospital settings unlikely
confirmed and Pre- and post-exposure smallpox vaccine recommended for exposed HCWs
smallpox
excluded,
lesions crusted
S
S/C
D
S
S
D
S
S
MDROs – see Isolation Policy for specific MDROs and Isolation type
After onset of swelling; susceptible HCWs are reassigned if immune
U 5 days after
caregivers are available. Contact Infection Prevention for advice on infected
parotitis onset
HCW or immunocompromised patients.
Not transmitted person-to-person
DI
Contact Precautions when cases temporally clustered
S
Parainfluenza virus infection, respiratory
C
Parvovirus B19
D
Pediculosis (lice)
C
DI
Viral shedding may be prolonged in immunosuppressed patients. Reliability
of antigen testing to determine when to remove patients with prolonged
hospitalizations from Contact Precautions is uncertain. Consult Infection
Prevention.
Maintain precautions for duration of hospitalization when chronic disease
occurs in an immunocompromised patient. For patients with transient
aplastic crisis or red-cell crisis, maintain precautions for 7 days. Duration of
precautions for immunosuppressed patients with persistently positive PCR
not defined, but transmission has occurred.
U 24 hrs of tx
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
10
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Precautions
Duration †
*
Type
U 5 days
Post-exposure chemoprophylaxis for household contacts and HCWs with
prolonged exposure to respiratory secretions.
S
D
U 48 hrs
Antimicrobial prophylaxis for exposed HCW.
D, C
DI
Pertussis (whooping cough)
D
Pinworm infection
Plague (Yersinia pestis)
Bubonic
Pneumonic
Pneumonia
S
Adenovirus
Bacterial not listed elsewhere (including gram-negative bacterial)
B. cepacia in patients with CF, including
respiratory tract colonization
B. cepacia in patients without CF(see
Multidrug-resistant organisms)
Chlamydia
Fungal
Haemophilus influenzae, type b
Adults
Infants and children
Legionella spp.
Meningococcal
Multidrug-resistant bacterial (see multidrug-resistant organisms)
Mycoplasma (primary atypical pneumonia)
Pneumococcal pneumonia
Pneumocystis jiroveci (Pneumocystis carinii )
Staphylococcus aureus
Streptococcus, group A
Adults
Infants and young children
Varicella-zoster (See Varicella-Zoster)
Comments
For immunocompromised patients, extend duration of isolation due to
prolonged viral shedding.
S
C
While
Avoid exposure to other persons with CF; private room preferred. Criteria
hospitalized for D/C precautions not established. See CF foundation guideline
S
S
S
D
S
D
U 24 hrs
U 24 hrs
D
S
S
S
DI
D
U 24 hrs
D
U 24 hrs
See meningococcal disease above
Avoid placement in the same room with an immunocompromised patient
For MRSA, see MDRO section.
See streptococcal disease (group A streptococcus) below
Contact precautions if skin lesions present
Contact Precautions if skin lesions present
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
11
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Viral
Adults
Infants and young children (see respiratory infectious disease,
acute)
Poliomyelitis
Pressure ulcer (decubitus ulcer, pressure sore) infected
Major
Minor or limited
Prion disease (See Creutzfeldt-Jacob Disease)
Psittacosis (ornithosis)
Q fever
Rabies
Precautions
Duration †
*
Type
S
C
DI
C
DI
S
S
S
S
Rat-bite fever (Streptobacillus moniliformis disease, Spirillum minus
disease)
Relapsing fever
Resistant bacterial infection or colonization (see multidrug-resistant
organisms)
Respiratory infectious disease, acute (if not covered elsewhere)
Adults
Infants and young children
Comments
If no dressing or containment of drainage; until drainage stops or can be
contained by dressing.
If dressing covers and contains drainage
Not transmitted from person-to-person
DI
Person-to-person transmission is rare; transmission via corneal, tissue, and
organ transplants has occurred. If patient has bitten another individual or
saliva has contaminated an open wound or mucous membrane, wash
exposed area thoroughly and administer post exposure prophylaxis.
S
S
S
C
Respiratory syncytial virus infection, in infants,
young children and immunocompromised adults
C
Reye's syndrome
Rheumatic fever
S
S
Rhinovirus
D
DI
DI
DI
In immunocompromised patients, extend the duration of Contact
Precautions due to prolonged shedding. Reliability of antigen testing to
determine when to remove patients with prolonged hospitalization from
Contact Precautions is uncertain. Contact Infection Prevention.
Not an infectious condition
Not an infectious condition
Add Contact Precautions if copious moist secretions and close contact likely
to occur (e.g., young infants.)
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
12
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Rickettsial fevers, tickborne (Rocky Mountain spotted fever, tickborne
typhus fever)
Rickettsialpox (vesicular rickettsiosis)
Precautions
Duration †
*
Type
S
S
Ritter's disease (staphylococcal scalded skin syndrome)
Rocky Mountain spotted fever
Roseola infantum (exanthem subitum; caused by HHV-6)
Rotavirus infection (see gastroenteritis)
C
S
S
Rubella (German measles, also see congenital rubella)
Salmonellosis (see gastroenteritis)
Scabies
Scalded skin syndrome, staphylococcal
Schistosomiasis (bilharziasis)
Shigellosis (see gastroenteritis)
Smallpox (variola; see vaccinia for management of vaccinated persons)
DI
Not transmitted person-to-person
Rarely outbreaks have occurred in healthcare settings, (e.g., NICU, rehab
hospitals). Use Contact Precautions for outbreaks.
See staphylococcal disease, scalded skin syndrome below
Not transmitted from person-to-person except through transfusion, rarely
D
Susceptible HCWs are reassigned if immune caregivers are available.
Pregnant women who are not immune are not assigned to these patients.
U 7 days after Administer vaccine within 3 days of exposure to non-pregnant susceptible
onset of rash persons. Place exposed susceptible patients on Droplet Precautions; exclude
exposed susceptible HCW from duty from day 5 after first exposure to day
21 after last exposure, regardless of post-exposure vaccine.
A, D,C
DI plus 10 days Enhanced precautions with N95 or higher respiratory protection; surgical
after
mask if N95 unavailable; eye protection (goggles, face shield); gowns and
resolution of gloves; aerosol-generating procedures and “supershedders” highest risk for
transmission via small droplet nuclei and large droplets. Vigilant
fever,
provided environmental disinfection. See http://www.cdc.gov/sars/index.html
respiratory
symptoms are
absent or
improving
Rubeola (see measles)
Severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV)
Not transmitted from person-to-person except through transfusion, rarely
S
Ringworm (dermatophytosis, dermatomycosis, tinea)
Comments
C
C
S
U 24
DI
A,C
DI
See staphylococcal disease, scalded skin syndrome below)
Until all scabs have crusted and separated (3-4 weeks). Non-vaccinated
HCWs do not provide care when immune HCWs are available; N95 or higher
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
13
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Sporotrichosis
Spirillum minus disease (rat-bite fever)
Staphylococcal disease (S aureus)
Skin, wound, or burn
a
Major
b
Minor or limited
Enterocolitis
Multidrug-resistant (see multidrug-resistant organisms)
Pneumonia
Scalded skin syndrome
Toxic shock syndrome
Streptobacillus moniliformis disease (rat-bite fever)
Streptococcal disease (group A streptococcus)
Skin, wound, or burn
Major
Minor or limited
Endometritis (puerperal sepsis)
Pharyngitis in infants and young children
Pneumonia
Scarlet fever in infants and young children
Serious invasive disease
Streptococcal disease (group B streptococcus), neonatal
Streptococcal disease (not group A or B) unless covered elsewhere
Multidrug-resistant (see multidrug-resistant organisms)
Strongyloidiasis
Precautions
Duration †
*
Type
Comments
respiratory protection required for susceptible and successfully vaccinated
individuals; postexposure vaccine within 4 days of exposure protective
S
S
C
S
DI
No dressing or dressing does not contain drainage adequately
Dressing covers and contains drainage adequately
Use Contact Precautions for diapered or incontinent children for duration of
illness
DI
Consider healthcare personnel as source of nursery, NICU outbreak
S
S
C
S
S
C,D
S
S
D
D
D
D
Not transmitted from person-to-person
U 24 hrs
No dressing or dressing does not contain drainage adequately
Dressing covers and contains drainage adequately
U 24 hrs
U 24 hrs
U 24 hrs
U24 hrs
Outbreaks of serious invasive disease have occurred secondary to
transmission among patients and healthcare personnel
Contact Precautions for draining wound as above; follow rec. for
antimicrobial prophylaxis in selected conditions
S
S
S
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
14
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Syphilis
Latent (tertiary) and seropositivity without lesions
Skin and mucous membrane, including congenital, primary,
Secondary
Tapeworm disease
Hymenolepis nana
Taenia solium (pork)
Other
Tetanus
Tinea (e.g., dermatophytosis, dermatomycosis, ringworm)
Precautions
Duration †
*
Type
S
S
S
S
S
S
S
Toxoplasmosis
S
Toxic shock syndrome (staphylococcal disease, streptococcal disease)
S
Trachoma, acute
Transmissible spongiform encephalopathy (see Creutzfeld-Jacob disease,
CJD, vCJD)
Trench mouth (Vincent's angina)
Trichinosis
Trichomoniasis
Trichuriasis (whipworm disease)
Tuberculosis (M. tuberculosis)
S
Extrapulmonary, draining lesion)
Comments
Not transmitted from person-to-person
Not transmitted from person-to-person
Vertical transmission from mother to child and through transplant organs
and blood transfusions.
Droplet Precautions for first 24 hours after implementation of antibiotic
therapy if Group A streptococcus is likely.
S
S
S
S
A,C
Extrapulmonary, no draining lesion, meningitis
S
Pulmonary or laryngeal disease, confirmed
Pulmonary or laryngeal disease, suspected
Skin-test positive with no evidence of current active disease
A
A
S
Discontinue precautions only when patient is improving clinically, and
drainage has ceased or there are three consecutive negative cultures of
continued drainage. Examine for evidence of active pulmonary tuberculosis.
Examine for evidence of pulmonary tuberculosis. For infants and children,
use Airborne Precautions until active pulmonary tuberculosis in visiting
family members ruled out.
Consult Infection Prevention to discontinue precautions.
Consult Infection Prevention to discontinue isolation precautions.
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
15
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Tularemia
Draining lesion
Pulmonary
Typhoid (Salmonella typhi) fever (see gastroenteritis)
Typhus, endemic and epidemic
Rickettsia prowazekii (Epidemic Louse-borne Typhus)
Rickettsia typhi
Urinary tract infection (including pyelonephritis), with or without urinary
catheter
Precautions
Duration †
*
Type
S
S
BSL 2 laboratory only for processing cultures
Not transmitted from person-to-person
Not transmitted from person-to-person
S
S
Transmitted person-to-person through close personal or clothing contact.
Not transmitted from person-to-person
S
Vaccinia (vaccination site, adverse events following vaccination) *
Vaccination site care (including autoinoculated areas)
Eczema vaccinatum
Fetal vaccinia
Generalized vaccinia
Progressive vaccinia
Postvaccinia encephalitis
Blepharitis or conjunctivitis
Iritis or keratitis
Vaccinia-associated erythema multiforme (Stevens Johnson
Syndrome)
Secondary bacterial infection (e.g., S. aureus, group A beta
hemolytic streptococcus
Comments
S
C
C
C
C
S
S/C
S
S
S/C
Until lesions
dry and
crusted, scabs
separated
Only vaccinated HCWs have contact with active vaccination sites and care
for persons with adverse vaccination events; if unvaccinated, only HCWs
without contraindications to vaccine may provide care.
Vaccination recommended for vaccinators; for newly vaccinated HCWs:
semi-permeable dressing over gauze until scab separates, with dressing
change as fluid accumulates, ~3-5 days; gloves, hand hygiene for dressing
change; vaccinated HCW or HCW without contraindication to vaccine for
dressing changes
For contact with virus-containing lesions and exudative material
Use Contact Precautions if there is copious drainage
Not an infectious condition
Follow organism-specific (strep, staph most frequent) recommendations and
consider magnitude of drainage
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
16
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Varicella
Precautions
Duration †
*
Type
A,C
Variola (see smallpox)
Vibrio parahaemolyticus (see gastroenteritis)
Vincent's angina (trench mouth)
Viral hemorrhagic fevers
due to Lassa, Ebola, Marburg, Crimean-Congo fever viruses
Viral respiratory diseases (not covered elsewhere)
Adults
Infants and young children (see respiratory infectious disease,
acute)
Whooping cough (see pertussis)
Wound infections
Major
Minor or limited
Yersinia enterocolitica gastroenteritis (see gastroenteritis)
Comments
In immunocompromised host with varicella pneumonia, prolong duration of
precautions for duration of illness. Post-exposure prophylaxis: provide postexposure vaccine ASAP but within 120 hours; for susceptible exposed
persons for whom the vaccine is contraindicated, (immune compromised
Until lesions
persons, pregnant women, newborns whose mother’s varicella onset is < 5
dry and
days before delivery or within 48 hours after delivery) provide VZIG when
crusted
available, within 96: if unavailable, use IVIG. Use Airborne Precautions for
exposed susceptible persons and exclude susceptible exposed HCW
beginning 8 days after the first exposure until 21 days after last exposure or
28 days if received VZIG regardless of post-exposure vaccine
S
S, A, C
DI
Private negative pressure room with anteroom. Emphasize: 1) use of sharps
safety devices and safe work practices, 2) hand hygiene; 3) barrier
protection against blood and body fluids upon room entry (double gloves
and fluid resistant or impervious gown, eye/face protection with masks,
goggles, or face shields); appropriate waste handling. Use Powered Air
Purifying Respirator (PAPR) when performing aerosol generating procedures.
Largest viral load in final stages of illness when hemorrhage may occur;
additional PPE, including double gloves, neck, leg, and shoe coverings
beneficial when extensive uncontrolled bleeding. Notify Infection Prevention
immediately if Ebola is suspected
S
C
S
DI
No dressing or dressing does not contain drainage adequately
Dressing covers and contains drainage adequately
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
17
TYPE AND DURATION OF TRANSMISSION-BASED PRECAUTIONS RECOMMENDED
FOR SELECTED INFECTIONS AND CONDITIONS (JUNE 4, 2015)
Infection/Condition
Zoster (varicella-zoster, see herpes zoster)
Zygomycosis (phycomycosis, mucormycosis)
Precautions
Duration †
*
Type
S
Comments
Not transmitted person-to-person
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf
*Precautions Type: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard
† Duration: DI, duration of illness; DE, until environment completely decontaminated; CN, until off antimicrobial treatment and culture-negative; U, until
time specified in hours (hrs) after initiation of effective therapy DH, duration of hospitalization.
18