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General Conditions and Specific Organisms Requiring Transmission Based Precautions |
| Prior to the identification of a specific causative agent, patients with the following general conditions should be placed on the indicated Transmission-based precautions for the specified duration. |
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| Organism/Syndrome | Precautions | Duration of Precautions | Comment |
| Abscess, draining, major | Contact | Duration of illness | "Major" defined as "No dressing or dressing does not contain drainage adequately" |
| Acquired immunodeficiency syndrome (AIDS), Human Immunodeficiency Virus (HIV) | Standard | ||
| Acinetobacter baumannii | |||
| Multi-drug resistant | Standard* | *Consult Infection Control -Contact Precautions may be appropriate. | |
| Antibiotic sensitive | Standard | ||
| Actinomycosis(Actinomyces sp.) | Standard | ||
| Adenovirus | |||
| Respiratory infection, in infants and young children | Duration of illness | ||
| Gastrointestinal infection | Contact | Duration of illness | |
| Amebiasis | Standard | ||
| Anthrax (Bacillus anthracis) | |||
| Cutaneous | Standard | ||
| Pulmonary | Standard | ||
| Ascariasis (Ascaris sp.) | Standard | ||
| Aspergillosis (Aspergillus sp.) | Standard | ||
| Avian influenza | Airborne, Contact and Droplet | If this condition is suspected, CONTACT THE ON-CALL INFECTION CONTROL PRACTITIONER AT (415) 443-2644 AND INFECTIOUS DISEASE IMMEDIATELY | |
| Babesiosis | Standard | ||
| Blastomycosis North American, cutaneous or pulmonary (Blastomyces sp) | Standard | ||
| Bronchiolitis | Droplet | Until upper respiratory symptoms resolve regardless of test result | |
| Brucellosis (Brucella sp.) (undulant, Malta, Mediterranean fever) |
Standard | ||
| Candidiasis (Candida sp.), all forms including mucocutaneous | Standard | ||
| Cat-scratch
fever (Bartonella henselae) (benign inoculation
lympohoreticulosis) |
Standard | ||
| Cellulitis, uncontrolled drainage | Contact | Duration of illness | |
| Chancroid (soft chancre) (Haemophilus ducreyi) | Standard | ||
| Chickenpox (varicella) | Airborne and Contact | Until ALL lesions are crusted over. Susceptible persons should NOT enter the room if other, immune caregivers are available | Additional Resource: See Infection Control Manual |
| Chlamydia trachomatis (Conjuctivitis, Genital, Respiratory) | Standard | ||
| Closed cavity infection | |||
| Draining, limited or minor | Standard | ||
| Not draining | Standard | ||
| Clostridium | |||
| C. botulinum | Standard | Hand Hygiene with soap and water (not alcohol gel) is indicated when patients are on Contact Precautions for C. difficile. Precautions may be discontinued when diarrhea has ceased. | |
| C. difficile gastroenteritis, enterocolitis | Contact | Duration of illness | |
| C. perfringens | |||
| Food poisoning | Standard | ||
| Gas gangrene | Standard | ||
| Coccidioidomycosis(valley fever) (Coccidioides immitis) | Notify the Microbiology laboratory when submitting specimens for culture from patients known or suspected to have this disease(353-1268) | ||
| Draining lesions | Standard | ||
| Pneumonia | Standard | ||
| Colorado tick fever | Standard | ||
| Conjunctivitis | |||
| Acute bacterial | Standard | Duration of illness | |
| Chlamydia | Standard | Duration of illness | |
| Gonococcal (including gonococcal opthalmia neonatorum) | Standard | Duration of illness | |
| Acute viral (acute hemorrhagic) | Contact | Duration of illness | |
| Congenital rubella (German measles)- See also Rubella | Contact | During ANY admission until infant is 1 year of age unless naso-pharyngeal and urine cultures are negative for virus after age 3 months. | Additional Resource: See Infection Control Manual |
| Creutzfeldt-Jakob disease (CJD) | Standard | "Infection Control Policies And Procedures For Patients With Suspected Or Confirmed Human Prion Disease" Infection Control Manual Section 4.11 | |
| Croup | Droplet | Until upper respiratory symptoms resolve regardless of test result | |
| Cryptococcosis (Cryptococcus neoformans) | Standard | ||
| Cysticercosis (tapeworm) (Taenia sp., tapeworm) | Standard | ||
| Cytomegalovirus (CMV) neonatal or immunosuppressed | Standard | ||
| Decubitus ulcer | |||
| Infected, major | Contact | Duration of illness | "Major" defined as "No dressing or dressing does not contain drainage adequately" |
| Minor or limited | Standard | "Minor" defined as "Dressing covers and contains drainage adequately" | |
| Dengue | Standard | ||
| Diarrhea, acute, of unknown etiology, infective etiology suspected | Contact | Duration of illness / While symptoms persist | Hand Hygiene with soap and water (not alcohol gel) is indicated until cause of diarrhea is determined. |
| Diphtheria (Corynebacterium diptheriae) | |||
| Cutaneous | Contact | Until off antibiotics and 2 cultures collected at least 24 hours apart are negative | |
| Pharyngeal | Droplet | ||
| Echinococcosis (hydatid disease) (Echinococcus sp.) | Standard | ||
| Encephalitis (or encephalomyelitis), | Examples: eastern, western, Venezuelan equine encephalomyelitis; St. Louis, California encephalitis | ||
| arthropodborne viral | Standard | ||
| other | Standard | ||
| Endometritis | Standard | ||
| Enterobiasis (Enterobius sp) (pinworm disease, oxyuriasis) | Standard | ||
| Enterococcus sp, vancomycin resistant (VRE) | Standard | ||
Enterovirus, (coxsackievirus disease, echovirus, hand foot and mouth disease, herpangina, pleurodynia)
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| Infants and young children | Contact | Duration of illness | |
| Adults | Standard | ||
| Epiglottitis, due to Haemophilus influenzae | Droplet | Until after 24 hours after initiation of effective therapy | |
| Epstein-Barr virus (including infectious mononucleosis) | Standard | ||
| Food poisoning | |||
| Botulism | Standard | ||
| Clostridium perfringens | Standard | ||
| Clostridium welchii | Standard | ||
| Staphylococcal (Staphylococcus aureus) | Standard | ||
| Furunculosis, staphylococcal, in infants and young children | Contact | Duration of illness | |
| Gangrene (gas gangrene) | Standard | ||
| Gastroenteritis | |||
| Campylobacter sp. | Standard* | *Use Contact Precautions for diapered or incontinent children <6 years of age for duration of illness | |
| Cholera | Standard* | *Use Contact Precautions for diapered or incontinent children <6 years of age for duration of illness | |
| C. difficile | Contact | Duration of illness (until diarrhea resolves) | Hand hygiene with alcohol gel is recommended EXCEPT use soap and water with suspected or confirmed C.difficile disease. |
| Cryotosporidiosis (Cryptosporidium sp.) | Standard* | ||
| Eschericia. Coli (Enterohemorrhagic O157:H7) | Standard* | ||
| If Diapered or incontinent patient, any age | Contact | Duration of illness | |
| Eschericia. Coli Other species | Standard* | ||
| Giardiasis (Giardia lamblia) | Standard* | ||
| Rotavirus | Contact | Duration of illness (until diarrhea resolves) AND one negative rotavirus test is obtained | |
| Salmonella (including S. typhi) | Standard* | ||
| Shigella species | |||
| IF diapered or incontinent | Standard* | Duration of illness | |
| Patient,any age | Contact | ||
| Vibrio parahaemolyticus | Standard | ||
| Viral (not otherwise mentioned, including Norwalk/Norovirus) | Standard* | ||
| Yersinia enterocolitica | Standard* | ||
| Gonorhea (Neisseria gonorrhea) | Standard | ||
| Granuloma inguinale (donovanosis, granuloma venereum) | Standard | ||
| Guillain-Barre syndrome | Standard | ||
| Hand, foot and mouth disease (See Enterovirus) | |||
| Hantavirus pulmonary syndrome | Standard | ||
| Helicobacter pylori | Standard | ||
| Hemorrhagic fevers or acute hemorrhagic conjunctivitis (Ebola, Lassa, Marburg, Crimean-Congo) | Contact and Droplet | Duration of illness | If this condition is suspected, CONTACT THE ON-CALL INFECTION CONTROL PRACTITIONER AT (415) 443-2644 AND INFECTIOUS DISEASE IMMEDIATELY. |
| Hepatitis, viral | |||
| Type A | Standard | ||
| Type A if diapered or incontinent patient | Contact (see comments) | Age < 3 year: Duration of hospitalization | |
| Type B (HBsAg positive) | Standard | Age 3-14 years: Until 2 weeks after onset of symptoms | |
| Type C and other unspecified non-A, non-B | Standard | All others: Until 1 week after onset of symptoms | |
| Type E | Standard | ||
| Herpangina (See Enterovirus) | |||
| Herpes simplex (herpesvirus hominis) | |||
| Neonatal | Contact | Duration of illness | Vaginal or C-section delivery if mother has active infection and membranes have been ruptured for more than 4 to 6 hours |
| If encephalitis ONLY | Standard | ||
| Mucocutaneous, disseminated or primary, severe | Contact | Duration of illness | |
| Mucocutaneous, recurrent (skin, oral, genital) | Standard | ||
| Herpes zoster ( See varicella zoster) | |||
| Histoplasmosis | Standard | ||
| Hookworm disease (ancylostomiasis, uncinariasis) (Ancylostoma duodenale, Necator americanus) | Standard | ||
| Impetigo | Contact | Until 24 hours after initiation of effective therapy | |
| Influenza (See also Avian Influenza) | Droplet | Until symptoms resolve regardless of test result | NOTE: Droplet Precautions (e.g. mask use/eye protection) required during suctioning of intubated patients; follow Standard Precautions for routine care. |
| Kawasaki syndrome | Standard | ||
| Legionnaires' disease (Legionella sp.) | Standard | ||
| Leprosy (Mycobacterium leprae) | Standard | ||
| Leptospirosis (Leptospira sp.) | Standard | ||
| Lice (pediculosis) | Contact | Until 24 hours after initiation of effective therapy | Gown and gloves required for all patient contact. Additional Resource: See Infection Control Manual |
| Listeriosis (Listeria monocytogenes) | Standard | ||
| Lyme disease (borreliosis, Borrelia burgdorferi) | Standard | ||
| Lymphocytic choriomeningitis | Standard | ||
| Lymphogranuloma venereum | Standard | ||
| Malaria | Standard | ||
| Measles (rubeola), all presentations | Airborne | Duration of illness | Additional resource: See Infection Control Manual |
| Meloidosis, all forms (Burkholderia,(Pseudomonas) | Standard | ||
| Meningitis | |||
| Asceptic (non-bacterial or viral meningitis; also see Enterovirus) | Standard | ||
| Bacterial, gram negative enteric, in neonates | Standard | ||
| Fungal* | Standard | *Alert the Microbiology
Laboratory (353-1268) prior to submitting specimens for culture from patients
with suspected or confirmed Coccidiodes meningitis |
|
| Haemophilus influenzae (known or suspected) | Droplet | Until 24 hrs after initiation of effective therapy | |
| Listeria monocytogenes | Standard | ||
| Neisseria meningitidis (known or suspected) | Droplet | Until 24 hrs after initiation of effective therapy | Additional Resource: See Infection Control Manual |
| Pneumococcal (Streptococcus pneumoniae) | Standard | ||
| Tuberculosis** | Standard | **Patient should be examined for evidence of current (active) pulmonary tuberculosis. If evidence exists, see Tuberculosis below for additional precautions. | |
| Other diagnosed bacterial | Standard | ||
| Molluscum contagiosum | Standard | ||
| Mucormycosis | Standard | ||
| Multidrug resistant (MDR) organisms | |||
| Enterococcus, vancomycin resistant (VRE) | Standard | ||
| Gram negative organisms, MDR (including MDR Acinetobacter baumannii) | Standard* | *Consult Infection Control - Contact Precautions may be appropriate | |
| Staphylococcus aureus, nafcillin / methicillin resistant | Standard | ||
| Mumps (infectious parotitis) | Droplet | For 9 days after onset of swelling | Mask not required if immune |
| Mycobacteria | |||
| Non-tuberculous (atypical), pulmonary or wound | Standard | ||
| Tuberculosis | Airborne/AFB | ||
| Mycoplasma pneumonia | Droplet | Duration of illness | |
| Necrotizing enterocolitis | Standard | ||
| Neisseria meningitidis, invasive (meningitis, pneumonia, sepsis, meningococcemia) | Droplet | Until 24 hrs after initiation of effective therapy | Additional Resource: See Infection Control Manual |
| Nocardiosis (Nocardia sp.), any presentation | Standard | ||
| Orf | Standard | ||
| Parainfluenza, infants and young children and immunocompromised adults | Droplet | Until symptoms resolve regardless of test result | NOTE: Droplet Precautions (e.g. mask use/eye protection) required during suctioning of intubated patients; follow Standard Precautions for routine care. |
| Parvovirus B19 (Fifth disease) | |||
| Erythema infectiosum | Standard | ||
| Immune deficient patient | Droplet | Duration of hospitalization when chronic disease occurs | |
| Patient with transient aplastic or red-cell crisis | Droplet | 7 days | |
| Pertussis (whooping cough) | Droplet | Until 5 days after patient is placed on effective therapy | Additional resource: See Infection Control Manual NOTE: Droplet Precautions (e.g. mask use/eye protection) required during suctioning of intubated patients; follow Standard Precautions for routine care. |
| Pinworm infection | Standard | ||
| Plague (Yersinia pestis) | |||
| bubonic | Standard | ||
| pneumonic | Droplet | Until 72 hrs after initiation of effective therapy | |
| Pleurodynia (see Enterovirus) | |||
| Pneumonia, due to | |||
| Adenovirus | Droplet and Contact | Duration of illness | |
| Bacterial, not listed elsewhere | Standard | ||
| Burkholderia (Pseudomonas) cepacia in cystic fibrosis patients, including respiratory tract colonization | Standard | ||
| Chlamydia | Standard | ||
| Fungal | Standard | ||
| H. influenzae | |||
| Adults | Standard | ||
| Infants and children (any age) | Droplet | Until 24 hours after initiation of effective therapy | |
| Legionella | Standard | ||
| Meningococcal (N.meningitidis) | Droplet | Until 24 hours after initiation of effective therapy | |
| Mycoplasma (primary atypical pneumonia) | Droplet | Duration of illness | |
| Pneumococcal (Streptococcus pneumoniae) | Standard | ||
| Pneumocystis carinii | Standard | ||
| Staphylococcus aureus (nafcillin/methicillin sensitive OR resistant) | Standard | ||
| Streptococcus pyogenes (group A strep) | |||
| Adults | Standard | ||
| Infants and young children | Droplet | Until 24 hours after initiation of effective therapy | |
| Viral | |||
| Adults | Standard | Until 24 hours after initiation of effective therapy | |
| Infants and young children | Droplet | Duration of illness | |
| Poliomyelitis | Standard | ||
| Psittacosis (Chlamydia psittaci) (ornithosis) | Standard | ||
| Q fever (Coxiella burnetii) | Standard | ||
| Rabies | Standard | ||
| Rat-bite fever (Streptobacillus moniliformis, Spirillum minus) | Standard | ||
| Relapsing fever | Standard | ||
Respiratory syncytial virus (RSV), infants, young children and immunocompromised adults
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Droplet and Contact | Until symptoms resolve regardless of test result. | Additional resource:See Infection Control Manual NOTE: Droplet Precautions (e.g. mask use/eye protection) required during suctioning of intubated patients. |
| Reye's syndrome | Standard | ||
| Rheumatic fever | Standard | ||
| Rickettsial fevers, tickborne (Rocky Mountain spotted fever, tickborne typhus fever) | Standard | ||
| Rickettsialpox(vescicular rickettsiosis) | Standard | ||
| Ringworm (dermatophytosis, dermatomycosis, tinea) | Standard | ||
| Ritter's disease (staphylococcal scalded skin syndrome) | Standard | ||
| Rocky Mountain Spotted fever | Standard | ||
| Roseola infantum (exanthema subitum) | |||
| Rotavirus | Contact | Duration of hospitalization | |
| Rubella (German measles) (See also Congenital Rubella) | Droplet | Until 7 days after onset rash. | Mask not required if immune. Additional resource:See Infection Control Manual |
| Salmonellosis (Salmonella sp.) See gastroenteritis | |||
| SARS (Severe Acute Respiratory Syndrome) | Airborne, Contact and Droplet | If this condition is suspected, CONTACT THE ON-CALL INFECTION CONTROL PRACTITIONER AT (415) 443-2644 AND INFECTIOUS DISEASE IMMEDIATELY. | |
| Scabies | Contact | Until 24 hours after initiation of effective therapy | Gown and glove for direct patient care x 24 hours after treatment. Additional resource: See Scabies Fact Sheet |
| Scalded skin syndrome, staphylococcal (Ritter's disease) | Standard | ||
| Schistosomiasis (bilharziasis) | Standard | ||
| Shigellosis (Shigella sp.) (See Gastroenteritis) | |||
| Shingles (See Varicella zoster) | |||
| Smallpox | Airborne, Contact and Droplet | If this condition is suspected, CONTACT THE ON-CALL INFECTION CONTROL PRACTITIONER AT (415) 443-2644 AND INFECTIOUS DISEASE IMMEDIATELY. | |
| Sporotrichosis (Sporothrix schenckii) | Standard | ||
| Staphylococcal disease (Staphylococcus aureus) | |||
| Skin wound or burn | |||
| Major | Contact | Duration of illness | "Major" defined as "No dressing or dressing does not contain drainage adequately" |
| Minor or limited | Standard | "Minor" defined as "Dressing covers and contains drainage adequately" | |
| Enterocolitis | Standard* | *Use Contact Precautions for diapered or incontinent children < 6 years of age for duration of illness | |
| Methicillin/Nafcillin resistant | Standard | ||
| Pneumonia | Standard | ||
| Scalded skin syndrome | Standard | ||
| Toxic shock syndrome | Standard | ||
| Streptobacillus moniliformis (rat-bite fever) | Standard | ||
| Streptococcal disease, (group A streptococcus, Streptococcus pyogenes) | |||
| Skin wound (including necrotizing fasciitis) or burn, | |||
| Major | Contact | Until 24 hours after initiation of effective therapy | "Major" defined as "No dressing or dressing does not contain drainage adequately" |
| Minor | Standard | "Minor" defined as "Dressing covers and contains drainage adequately" | |
| Endometritis (puerperal sepsis) | Standard | ||
| Pharyngitis in infants and young children | Droplet | Until 24 hours after initiation of effective therapy | |
| Pneumonia, in infants and young children | Droplet | Until 24 hours after initiation of effective therapy | |
| Scarlet Fever, in infants and young children | Droplet | Until 24 hours after initiation of effective therapy | |
| Streptococcal disease (group B strep, Streptococcus agalactiae), neonatal | Standard | ||
| Streptococcal disease (Streptococcus sp., not otherwise mentioned) | Standard | ||
| Strongyloidiasis (Strongyloides stercoralis) | Standard | ||
| Syphilis | |||
| Skin and mucous membrane, including congenital, primary, secondary | Standard | ||
| Latent (tertiary) and seropositivity without lesions | Standard | ||
| Tapeworm disease | |||
| Hymenolepis nana | Standard | ||
| Taenia solium (pork) | Standard | ||
| Other | Standard | ||
| Tetanus | Standard | ||
| Toxic shock syndrome (staphylococcal disease) | Standard | ||
| Trachoma, acute (Chlamydia trachomatis) | Standard | ||
| Trench mouth (Vincent's angina) | Standard | ||
| Trichinosis | Standard | ||
| Trichomoniasis (Trichomonas vaginalis) | Standard | ||
| Trichuriasis (whipworm) | Standard | ||
| Tuberculosis | |||
| Extrapulmonary, draining lesions (including scrofula) | Standard | Provided draining lesions can be adequately covered/contained | |
| Extrapulmonary, meningitis | Standard* | *Patient should be examined for evidence of current (active) pulmonary tuberculosis. If evidence exists, additional precautions are necessary | |
| Skin-test (PPD) positive with no evidence of current pulmonary disease | Standard | ||
| Pulmonary (suspected or confirmed) OR laryngeal disease | Airborne/AFB | Discontinue precautions only when TB patient is:
|
See also CDC Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities. Additional Resource: See Infection Control Manual
|
| Tularemia | |||
| Draining lesion | Standard | Provided draining lesions can be adequately covered/contained | |
| Pulmonary | Standard | ||
| Typhoid fever (Salmonella typhi) (See Gastroenteritis) | |||
| Typhus, (Rickettsia sp.)endemic and epidemic | Standard | ||
| Upper Respiratory Infection of unknown etiology | Droplet | Until upper respiratory symptoms resolve regardless of test result. | Isolation precautions should be initiated when DFA is ordered to rule out viral pathogens. NOTE: Droplet Precautions (e.g. mask use/eye protection) required during suctioning of intubated patients; follow Standard Precautions for routine care. |
| Urinary tract infection (including pyelonephritis), with or without urinary catheter | Standard | ||
| Varicella (chickenpox) | Airborne and Contact | Until ALL lesions are crusted over | Susceptible persons should NOT enter the room if other, immune caregivers are available. Additional Resource: See Infection Control Manual |
| Varicella zoster (herpes zoster, shingles) | Persons
susceptible to varicella are also at risk for developing varicella when
exposed to patients with herpes zoster lesions; therefore, susceptibles
should not enter the room if other immune caregivers are available. Additional
Resource: See Infection Control Manual |
||
| Localized in immunocompromised patient OR disseminated | Airborne and Contact | Until ALL lesions are crusted over | |
| Localized in normal patient | Standard | ||
| Vescicular rash | Airborne | Until all lesions are crusted over or when chickenpox,/varicella zoster (shingles) infection have been ruled out | |
| Vibrio parahaemolyticus (See Gastroenteritis) | |||
| Vincent's angina (trench mouth) | Standard | ||
| Viral Fevers, arthropodborne | Standard | Examples: dengue, yellow fever, Colorado tick fever | |
| Whooping cough(Bordatella pertussis) | Droplet | Until 5 days after patient is placed on effective therapy | Additional resource: See Infection Control Manual |
| Wound infection | |||
| Major | Contact | "Major" defined as "No dressing or dressing does not contain drainage adequately" | |
| Minor or limited | Standard | "Minor" defined as "Dressing covers and contains drainage adequately" | |
| Yersinia enterocolitica (See Gastroenteritis) | |||
| Zoster (See Varicella zoster) | |||
| Zygomycosis (phycomycosis, mucormycosis, Mucor sp., Rhizopus sp., Absidia sp.) | Standard | ||
| Policy reviewed by: | Date Approved: | ||
| Infection Control Committee | 12/05 | ||
| Quality Improvement Executive Committee | 1/06 | ||
| Revised: | 5/06 |
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