Largest viral load in final stages of illness when hemorrhage may occur; additional PPE, including double gloves, leg and shoe coverings may be used, especially in resource-limited settings where options for cleaning and laundry are limited. Notify public health officials immediately if Ebola is suspected [, , , ].
Also see Table 3C for Ebola as a bioterrorism agent. Infants and young children see Respiratory infectious disease, acute. Diseases beginning with the letter W, precaution type, duration, and comments. Diseases beginning with the letter Y, precaution type, duration, and comments. Diseases beginning with the letter Z, precaution type, duration, and comments. Get Email Updates. To receive email updates about this page, enter your email address: Email Address. What's this?
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Anthrax Environmental: aerosolizable spore-containing powder or other substance. Antibiotic-associated colitis see Clostridium difficile. Arthropod-borne viral encephalitides eastern, western, Venezuelan equine encephalomyelitis; St Louis, California encephalitis; West Nile Virus and viral fevers dengue, yellow fever, Colorado tick fever.
Use DEET-containing mosquito repellants and clothing to cover extremities. Campylobacter gastroenteritis see Gastroenteritis. Chlamydia trachomatis Genital lymphogranuloma venereum. Closed-cavity infection Open drain in place; limited or minor drainage. Closed-cavity infection No drain or closed drainage system in place. Conjunctivitis Acute bacterial Chlamydia.
Conjunctivitis Acute bacterial Gonococcal. Coxsackie virus disease see enteroviral infection. Escherichia coli gastroenteritis see Gastroenteritis. Duration of illness with wound lesions, until wounds stop draining. Gastroenteritis C. Gastroenteritis E. Gastroenteritis Salmonella species including S. Gastroenteritis Shigella species Bacillary dysentery.
Gonococcal ophthalmia neonatorum gonorrheal ophthalmia, acute conjunctivitis of newborn. Hand, foot, and mouth disease see Enteroviral Infection. Herpes simplex Herpesvirus hominis Mucocutaneous, disseminated or primary, severe. Herpes simplex Herpesvirus hominis Mucocutaneous, recurrent skin, oral, genital. Herpes zoster varicella-zoster shingles Disseminated disease in any patient Localized disease in immunocompromised patient until disseminated infection ruled out.
Influenza Avian e. Marburg virus disease see Viral Hemorrhagic Fevers. Meningitis Aseptic nonbacterial or viral; also see Enteroviral infections. Meningitis Haemophilus Influenzae , type b known or suspected. Meningitis Listeria monocytogenes See Listeriosis. Meningitis Neisseria meningitidis meningococcal known or suspected. The below note has been superseded by the above recommendation update Note: Recent assessment of outbreaks in healthy year olds has indicated that salivary viral shedding occurred early in the course of illness and that 5 days of isolation after onset of parotitis may be appropriate in community settings; however the implications for healthcare personnel and high-risk patient populations remain to be clarified.
Until 24 hours after initiation of effective therapy after treatment. Pneumonia Bacterial not listed elsewhere including gram-negative bacterial. Pneumonia B. Pneumonia Haemophilus influenzae , type b Adults. Pneumonia Haemophilus influenzae , type b Infants and children. Pneumonia Multidrug-resistant bacterial see Multidrug-Resistant Organisms. Pneumonia Pneumocystis jiroveci Pneumocystis carinii. Pneumonia Streptococcus , group A Adults.
Pneumonia Streptococcus , group A Infants and young children. Pneumonia Viral Infants and young children see Respiratory Infectious Disease, acute , or specific viral agent. Pressure ulcer decubitus ulcer, pressure sore infected Major. Pressure ulcer decubitus ulcer, pressure sore infected Minor or limited. Respiratory infectious disease, acute if not covered elsewhere Adults. Respiratory infectious disease, acute if not covered elsewhere Infants and young children.
Respiratory syncytial virus infection, in infants, young children and immunocompromised adults. Rickettsial fevers, tickborne Rocky Mountain spotted fever, tickborne Typhus fever. Rubella German measles also see Congenital Rubella. See Staphylococcal Disease, scalded skin syndrome below. Some severely immunocompromised patients are nursed in protective isolation to decrease the risk of exposure to infectious diseases.
The success of transmission prevention in each institution relies on several keystones: written documents describing isolation procedures, successful implementation of the procedures, monitoring of the compliance with isolation procedures, and the collaboration between the different hospital departments during the stay and investigations of the patient.
Search for: Search. Skip to content. Topic Outline. KEY ISSUES The combination of standard precautions and isolation procedures represents an effective strategy in the fight against healthcare associated transmission of infectious agents.
KNOWN FACTS Isolation and barrier precautions aim to reduce or eliminate direct or indirect patient-to-patient transmission of healthcare associated infections that can occur through three mechanisms: Via contact, which involves skin or mucosa to skin contact and the direct physical transfer of microorganisms from one patient to another or via hands of an HCP, and indirect via a contaminated surface.
Besides patient-to-patient transmission, healthcare associated infections can be endogenous patient is the source of pathogen causing the infection or acquired exogenous from environmental sources like contaminated water supplies, medical equipment, IV solutions, etc.
These infections are not prevented by isolation precautions. The most cost-effective, simple, and feasible way to prevent transmission of pathogens, consists in a two-tier approach as described in the CDC-HICPAC guidelines 1 : Standard precautions represent a basic list of hygiene precautions designed to reduce the risk of healthcare-associated transmission of infectious agents.
These precautions are applied to every patient in a healthcare setting. In addition to standard precautions, extra barrier or isolation precautions are necessary during the care of patients suspected or known for colonization, or an infection with highly transmissible or epidemiologically important pathogens. Isolation and barrier precautions have also proven successful in limiting the epidemic spread of multidrug-resistant Gram-negative bacilli, methicillin resistant Staphylococcus aureus MRSA , and vancomycin resistant enterococci 4 VRE.
Standard Precautions Standard precautions are designed to reduce the risk of transmission from both recognized and unrecognized sources of infection.
Hand hygiene among HCPs constitutes the single most important prevention of nosocomially transmitted infections. These precautions combine the major features of universal precautions 7 and body substance isolation 8 , and are based on the principle that all blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes may contain transmissible infectious agents.
HCPs should wash hands when soiled, and disinfect hands, irrespective of whether gloves were worn. Gloves should be worn if there is contact with blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or when potentially contaminated objects are manipulated.
Gloves must be changed between patients and before touching clean sites on the same patient. Hand hygiene should be applied immediately after gloves are removed, before and between patient contacts. A mask and eye protection as well as a gown should be worn to protect mucous membranes, skin, and clothing during procedures that are likely to result in splashing of blood, body fluids, secretions, or excretions.
Immunize or provide the appropriate immune globulin to susceptible persons as soon as possible following unprotected contact i. Administer measles vaccine to exposed susceptible persons within 72 hours after the exposure or administer immune globulin within six days of the exposure event for high-risk persons in whom vaccine is contraindicated Administer varicella vaccine to exposed susceptible persons within hours after the exposure or administer varicella immune globulin VZIG or alternative product , when available, within 96 hours for high-risk persons in whom vaccine is contraindicated e.
Administer smallpox vaccine to exposed susceptible persons within 4 days after exposure. Protective Environment Table 4. Recommendation number, description, and category for protective environment Recommendation Category VI.
IB VI. No recommendation for placing patients with other medical conditions that are associated with increased risk for environmental fungal infections e. Filter incoming air using central or point-of-use high efficiency particulate HEPA filters capable of removing Direct room airflow with the air supply on one side of the room that moves air across the patient bed and out through an exhaust on the opposite side of the room IB VI. Monitor air pressure daily with visual indicators e.
Ensure well-sealed rooms that prevent infiltration of outside air IB VI. Ensure at least 12 air changes per hour IB. Lower dust levels by using smooth, nonporous surfaces and finishes that can be scrubbed, rather than textured material e. Wet dust horizontal surfaces whenever dust detected and routinely clean crevices and sprinkler heads where dust may accumulate II VI. Avoid carpeting in hallways and patient rooms in areas IB VI. Prohibit dried and fresh flowers and potted plants II VI.
Minimize the length of time that patients who require a Protective Environment are outside their rooms for diagnostic procedures and other activities IB VI. During periods of construction, to prevent inhalation of respirable particles that could contain infectious spores, provide respiratory protection e.
No recommendation for fit-testing of patients who are using respirators. No recommendation for use of particulate respirators when leaving the Protective Environment in the absence of construction. Unresolved issue. Use Standard Precautions as recommended for all patient interactions. IA VI. Barrier precautions, e. Implement Airborne Precautions for patients who require a Protective Environment room and who also have an airborne infectious disease e.
Use an anteroom to further support the appropriate air-balance relative to the corridor and the Protective Environment; provide independent exhaust of contaminated air to the outside or place a HEPA filter in the exhaust duct if the return air must be recirculated IB VI.
Get Email Updates. To receive email updates about this page, enter your email address: Email Address. What's this? Return to Guidelines Library. Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
You will be subject to the destination website's privacy policy when you follow the link. CDC is not responsible for Section compliance accessibility on other federal or private website. Cancel Continue. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies. Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale.
Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale. Provide administrative support, including fiscal and human resources for maintaining infection control programs. Assure that individuals with training in infection control are employed by or are available by contract to all healthcare facilities so that the infection control program is managed by one or more qualified individuals.
Determine the specific infection control full-time equivalents FTEs according to the scope of the infection control program, the complexity of the healthcare facility or system, the characteristics of the patient population, the unique or urgent needs of the facility and community, and proposed staffing levels based on survey results and recommendations from professional organizations.
Include prevention of healthcare-associated infections HAI as one determinant of bedside nurse staffing levels and composition, especially in high-risk units.
Involve infection control personnel in decisions on facility construction and design, determination of AIIR and Protective Environment capacity needs and environmental assessments. Provide ventilation systems required for a sufficient number of airborne infection isolation rooms AIIR s as determined by a risk assessment and Protective Environments in healthcare facilities that provide care to patients for whom such rooms are indicated, according to published recommendations.
Involve infection control personnel in the selection and post-implementation evaluation of medical equipment and supplies and changes in practice that could affect the risk of HAI. Identify resources for performing surveillance cultures, rapid diagnostic testing for viral and other selected pathogens, preparation of antimicrobial susceptibility summary reports, trend analysis, and molecular typing of clustered isolates performed either on-site or in a reference laboratory and use these resources according to facility-specific epidemiologic needs, in consultation with clinical microbiologists.
Develop and implement policies and procedures to ensure that reusable patient care equipment is cleaned and reprocessed appropriately before use on another patient. Develop and implement processes to ensure oversight of infection control activities appropriate to the healthcare setting and assign responsibility for oversight of infection control activities to an individual or group within the healthcare organization that is knowledgeable about infection control.
Include in education and training programs, information concerning use of vaccines as an adjunctive infection control measure. Enhance education and training by applying principles of adult learning, using reading level and language appropriate material for the target audience, and using online educational tools available to the institution.
Monitor the incidence of epidemiologically-important organisms and targeted HAIs that have substantial impact on outcome and for which effective preventive interventions are available; use information collected through surveillance of high-risk populations, procedures, devices and highly transmissible infectious agents to detect transmission of infectious agents in the healthcare facility.
When transmission of epidemiologically-important organisms continues despite implementation and documented adherence to infection prevention and control strategies, obtain consultation from persons knowledgeable in infection control and healthcare epidemiology to review the situation and recommend additional measures for control. During the delivery of healthcare, avoid unnecessary touching of surfaces in close proximity to the patient to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces.
When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water. After contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings. After contact with inanimate objects including medical equipment in the immediate vicinity of the patient. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.
Develop an organizational policy on the wearing of non-natural nails by healthcare personnel who have direct contact with patients outside of the groups specified above. Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed. Provide resources and instructions for performing hand hygiene in or near waiting areas in ambulatory and inpatient settings ; provide conveniently-located dispensers of alcohol-based hand rubs and, where sinks are available, supplies for handwashing.
Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces and persons. If laundry chutes are used, ensure that they are properly designed, maintained, and used in a manner to minimize dispersion of aerosols from contaminated laundry. Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient. Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use.
If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile. Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients. Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space i. Adhere to federal and state requirements for protection of healthcare personnel from exposure to bloodborne pathogens. In addition to Standard Precautions, use Transmission-Based Precautions for patients with documented or suspected infection or colonization with highly transmissible or epidemiologically-important pathogens for which additional precautions are needed to prevent transmission see Appendix A.
The additional precautions required include a disposable apron or a fluid-resistant disposable gown if an apron is insufficient for the task being undertaken.
A fluid-resistant surgical facemask with eye protection or full-face visor will also be required. As with droplet precautions, if airborne precautions are required, contact and droplet precautions will already be in place.
FFP3 masks are designed to fit closely to the face to prevent transmission of particulates via the airborne route. Before using FFP3 masks for the first time, each staff member should have the fit tested, and from then on undertake regular fit checks HPS, These masks should always be worn with full-face plastic visors or goggles to protect the eyes.
However, it is important to consult local guidelines and for infection prevention and control teams to check on PPE and RPE requirements.
In a systematic review by Abad et al , it was recognised that isolation has an adverse psychological consequence. It is important that staff recognise that the behaviours may be linked to isolation Wilson, Abad et al suggest one of the main reasons for anxiety and depression is feeling a loss of control. Isolation also has a potential effect on care. Patients can be at increased risk of falls and omissions in care, such as infrequent documentation and poor recording of vital signs Stelfox et al, Abad et al found evidence to suggest that health professionals may spend less time with patients in isolation than with other patients.
The act of putting on the PPE and other interventions linked to TBPs may be viewed as cumbersome and time-consuming and can detract from the time spent with the patient.
If a patient cannot be isolated in a single room with the door closed due to safeguarding issues, this will need careful consideration and discussions with the infection prevention and control team.
It is also important to note that it is the microorganism s that require isolating and not the person. Transmission-based precautions are a necessary part of reducing the risk of transmission of infective agents and diseases to patients and healthcare workers. It is vital that all staff involved in patient care are aware of SIPCs, the different routes of transmission and the appropriate TBPs to take.
The detrimental psychosocial impact of isolation should not be overlooked by staff caring for patients in these situations. Tagged with: Coronavirus zone: infection prevention and control.
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