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TABLE OF RECOMMENDED PRECAUTIONS: SELECTED INFECTIOUS DISEASES, CONDITIONS & MICROORGANISMS

DOCUMENT TYPE: REFERENCE TOOL

IC.05.02 TABLE OF RECOMMENDED PRECAUTIONS SELECTED INFECTIOUS DISEASES, CONDITIONS &/OR MICROORGANISMS REV. Mar 2020

Disease, Condition,

MicroorganismPresentation Type of

PrecautionsDuration of Precautions

Mother/Infant (MI) considerations

BF = breast feeding, RI = rooming-in

Comments

Reportable diseases reported by IPACS

Abscess Minor

Major (drainage not contained by dressing)

Routine

Contact Duration of drainage

MI contact and RI permitted if drainage adequately controlled.

Mother:- Breast abscess-consult

physician prior to breast feeding

Acquired Immune Deficiency Syndrome

Routine MI contact and RI permitted Assess mothers individually for possibility of other infections.

Reportable disease

Adenovirus Respiratory Droplet and Contact

Adult: Until symptom free

Pediatric: Minimum of eleven days from onset and child is symptom free

Mother ill:- Droplet and contact

precautions for mother- Routine practices for infant

Healthy term infant:- MI contact, BF and RI

permitted- Mother to wear mask when

within 2 metres of infant

Infant in NICU:- Mother should be

Strict attention to hand hygiene.

C-0506-14-60344 | IC05.02 Published Date: 18-Mar-2020 of 91 Review Date: 18-Mar-2023

This is a controlled document for BCCH& BCW internal use. Refer to online version. Print copy may not be current. See Disclaimer at the end of the document.



Disease, Condition,





Comments


Adenovirus (cont)

encouraged not to visit until symptom free*- BF permitted as expressed

milk

Infant ill:- Droplet and contact

precautions for infant- Routine practices for mother- MI contact and BF permitted

*If Mother must visit:o Place infant in private roomo Mother to limit visits and go

directly in and out of NICUo Mother to wear mask for

duration of visit in NICU

Diarrhea Contact* Until stool is formed or back to baseline for the patient for 48 hours

Consult IPACS if immune compromised

Mother ill:- Contact precautions for mother- Routine practices for infant

Healthy Term Infant:- MI contact, BF and RI

permitted.

Infant in NICU:- Mother should be encouraged

not to visit until stool is formed or back to baseline for the mother for 48 hours*

Infant ill:- Contact precautions for infant**- Routine practices for Mother- MI contact, BF and RI

o Strict attention to hand hygiene

*Prolonged fecal shedding may occur in immunocompromised patients after recovery. Contact precautions for duration of hospitalization may be justified.

If Mother must visit:o Place infant in private roomo Mother to limit visits and go

directly in and out of NICU

**Ensure immediate disposal of diapers into leak proof bag.





Disease, Condition,





Comments


Adenovirus (cont)

permittedConjunctivitis Contact Until symptom

freeMother ill:- Contact precautions for mother- Routine practices for infantHealthy Term infant:- MI contact, BF and RI

permitted

Baby in NICU:- Mother should be encouraged

not to visit until symptom free*- BF permitted as expressed

breast milkInfant ill:- Contact precautions for infant- Routine precautions for Mother

No sharing of towels, linens, etc.




Aeromonas Diarrhea, dysentery

Contact Until stool is formed or back to baseline for the patient


Reportable disease

Amoebiasis(Dysentery)(Entamoeba histolytica)

Asymptomatic, to severe diarrhea to grossly bloody dysentery

Contact Until stool is formed or back to baseline for the patient


Reportable disease

Anthrax Skin lesions, Routine Notify IPACS immediately.





Disease, Condition,





Comments


pneumonia

Contact precautions for patients with draining wounds

Duration of drainage

Notify Public Health immediately.

Notify Microbiology laboratory before sending specimens.

Does not spread from person to person.Acquired from infected animals or animal products.

Reportable diseaseAntibiotic Resistant Organisms (ARO)

Refer to: Extended-

Spectrum Beta-Lactamases (ESBL)

Carbapenemase-Producing

Infection or colonization of any body site

Contact* For duration of hospital stay

- Refer to the infection control manual for specific information on ARO’s.

*Refer to specific organism in table for further guidance on precautions required

Strict attention to hand hygiene





Disease, Condition,





Comments


Organisms (CPO)

Methicillin-Resistant Staphylococcus aureus (MRSA)

Multi-drug Resistant Organism (MDRO)

Vancomycin-Resistant Enterococci (VRE)

Arthropod-Borne Viral Infections(Arboviruses)

(West Nile virus, Dengue, Japanese Encephalitis, Yellow Fever, Zika virus etc.)

Encephalitis, fever, rash

Most infections are subclinical (asymptomatic)

Routine No person-to-person spread except by transfusion, organ transplantation, intrauterine transmission and possibly human milk.

Reportable disease





Disease, Condition,





Comments


*Several hundred different viruses, most limited to geographic areas.AscariasisAscaris lumbricoides, (roundworm)

Usually asymptomatic

Routine No person-to-person spread.

AspergillosisAspergillus species

Skin, lung, wound or central nervous system infection

Routine

Atypical Mycobacteria (Mycobacterium other than tuberculosis “MOTT”) e.g. Mycobacterium avium complex “MAC”

Lymphadenitis; pneumonia; disseminated disease in immune compromised host.

Mycobacterium abscessus in CF patients

Routine

Contact For duration of hospital stay

No person-to-person transmission, except for Mycobacterium abscessus in CF patients. Please refer to CF standard in section 6.

Acquired from soil, water, animal, reservoirs.

Babesiosis Often asymptomatic

Routine Tick-borne.No person-to-person spread except by transfusion, and





Disease, Condition,





Comments


congenital/perinatal routeBedbugsblood-sucking ectoparasites (external parasites)

Mild to severe allergic reaction to the bites

Routine Practices

Consider wearing a gown to protect clothing when providing direct bedside care to a heavily infested patient.

Contact Housekeeping Services who will arrange for Pest Control Services as required.For more information see BC Health File # 95 at http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=za1160

BlastomycosisBlastomyces dermatitdis

Asymptomatic, pulmonary, cutaneous or disseminated

Routine No person-to-person spread.

Notify Microbiology laboratory before sending specimens

BK Virus (BKV)Polyomavirus

Asymptomatic or cystitis in healthy people

Causes lower and upper renal tract disease in

Routine * Disease can include hemorrhagic cystitis, interstitial nephritis, renal allograph loss, nephropathy



http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=za1160

http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=za1160



Disease, Condition,





Comments


immunocompromised patients*-painful hematuria most common symptom

Bocavirus

See “Respiratory Viral Infections”

Droplet and Contact



Bornholms DiseasePleurodynia

See Enteroviral infection

Contact

NICU: Droplet and Contact

Until symptom free

Until discontinued by IPACS

BotulismClostridium botulinum

Descending flaccid Paralysis, cranial nerve palsies

Routine No person-to-person spread

Reportable disease

BronchiolitisSee “ Respiratory Viral

Droplet and Contact

Minimum of eleven days from onset





Disease, Condition,





Comments


Infections” and child is symptom free

Brucellosis(Undulant fever)

Manifestations are non-specific & include:fever, night sweats, weakness, malaise, and arthralgia

Routine

Contact precautions for patients with draining wounds


Person-to-person spread is rare. Congenital brucellosis has been reported.Infected mothers can transmit brucella species to their infants through breast feeding.


Reportable diseaseBurkholderia cepacia complex

Associated with severe pulmonary infections in patients with cystic fibrosis and Chronic Granulomatous Diseases (CGD)

Routine

For CF patientsContact*

*Refer to section 6 for specific information on Cystic Fibrosis

Campylobacter

See “Diarrhea”

Diarrhea Contact Until stool is formed or back to baseline for the patient.

Reportable disease

Candida auris Blood stream Contact Plus For duration Mother ill: Strict attention to hand hygiene





Disease, Condition,





Comments


Candida auris (cont)

infections, wound infections, otitis

Can be multi-drug resistant

of hospital stay

- Contact plus precautions for mother

- Contact plus precautions for all newborns of positive mothers.


permitted- Mother uses routine practices

for infant (Mother may choose to use contact plus precautions)

Baby in NICU:- Baby to be placed in single

room- MI contact and BF permitted- Mother uses routine practices

for infant (Mother may choose to use contact plus precautions)

- Mother to limit visits to her child only and go directly in and out of NICU.

Infant ill:- Contact plus precautions for

infant





Disease, Condition,





Comments


- Routine practices for Mother- MI Contact, BF and RI

permittedCandidiasis(Moniliasis)

Mucocutaneous infection in oropharynx (thrush) or vaginal candidiasis.

Can be disseminated or invasive

Routine MI contact, BF, and RI permitted

Carbapenemase-Producing Organisms (CPO)


Contact Plus

Add Droplet Precautions for any coughing or ventilated patient with CPO

For duration of hospital stay

Mother has CPO:- Contact plus precautions for

mother- Contact plus precautions for

newborns of positive mothers.


permitted- Mother uses routine

practices for infant (Mother may choose to use contact precautions)

Baby in NICU:

Refer to the infection control manual for specific information on CPO.

Notify IPACS immediately

Reportable Disease





Disease, Condition,





Comments


- Baby to be placed in single room- MI contact and BF permitted- Mother uses routine

practices for infant (Mother may choose to use contact precautions)- Mother to limit visits to her

child only and go directly in and out of NICU.

Infant has CPO:- Contact plus precautions for

infant- Contact plus precautions for

Mother- MI Contact, BF and RI

permittedCat Scratch FeverBartonella henselae

Lymphadenopathy (regional)


Cellulitis, with drainage

See “Abscess”

Minor

Major (drainage not contained by

Routine

Contact* Duration of drainage

*Implement Droplet precautions if H. influenzae type b is suspected in non-immune children < 5years old.





Disease, Condition,





Comments


dressing)

Cervical lymphadenitis

No drainage, intact skin

For draining, see abscess or specific organism

Routine

ChancroidHaemophilus ducreyi

Genital Ulcers Routine Sexually transmitted.

Reportable disease

ChickenpoxVaricella

Vesicular rash, mild fever and systemic symptoms.

Airborne and Contact

For a minimum of 5 days after onset of rash and until all lesions are crusted which can be a week or longer in immuno-compromised patients.

Mother with active lesions-Mother-airborne and contact precautions-Infant-needs to be assessed for VZIG and treated as a susceptible contact.

Healthy term infant:-Once infant has received VZIG, RI, BF and MI contact is allowed.-Will require isolation from day 8-21 (28 if VZIG given)

Notify IPACS of all cases of suspected or confirmed chickenpox.

Patients with active chickenpox should be placed in an airborne isolation room away from severely immuno-compromised patients (e.g., they should not be cared for on the oncology ward).

HCW should have their immune status validated with PHSA Workplace Health





Disease, Condition,





Comments


Chickenpox (cont)Varicella

Susceptible contacts of patients with chickenpox should be placed on airborne and contact isolation on day 8 from the first known contact and up to and including day 21 if they have not received VZIG, 28 days if they have received VZIG

Infant in NICU:-Mother may not go to NICU for a minimum of 5 days or until all lesions have crusted over.-MI contact not permitted-BF by expressed breast milk only

Infant has chickenpox:-Airborne and contact precautions-Only immune visitors/siblings may visit*-MI contact permitted if mother is immune-BF permitted

Infant is Chickenpox contact:Assess need for VZIGWill require isolation from day 8-21 (28 if VZIG given)

Non-immune HCW should not care for patients with active chickenpox *

*Immunity is defined as any of the following: Documentation of age

appropriate varicella vaccine. Laboratory evidence of

immunity or laboratory confirmation of disease.

Varicella diagnosed or a verification of history from family members by the physician or delegate.

History of herpes zoster diagnosed by physician or delegate

Visitors who have active chickenpox or shingles must not visit.

HCW with suspected chickenpox should not be at work and must report toPHSA Workplace Health.





Disease, Condition,





Comments


ChlamydiaChlamydia trachomatis(CT)

Chlamydophila pneumoniae(CPn)Chlamydophila psittaci(CPs)

Neonatal conjunctivitisPneumoniaTrachomaGenital tract infection and lymphogranuloma venereum (LGV),

Respiratory tract infectionPneumonia

Routine MI contact, BF, and RI permitted Chlamydia disease including Psittacosis is reportable.

Reportable disease

CholeraVibrio cholera

Voluminous watery diarrhea, dehydration and other serious complications

Contact Until stool is formed or back to baseline for the patient.

Consult IPACS Notify IPACS

Reportable disease

Clostridium botulinum

See “Botulism”

Routine

Reportable diseaseClostridium difficile

DiarrheaPseudo membranous colitis

Contact Plus Until diarrhea has subsided for 72 hours and stools are formed or

Mother ill and Healthy Term Infant:-MI contact, RI, and BF permitted-Mother: Contact precautions


Bacterial spores may persist in the environment; therefore, special attention must be paid to





Disease, Condition,





Comments


Clostridium difficile(cont)

back to baseline for the patient. Contact IPACS prior to discontinuation of precautions.

-Infant: Routine practices

Mother ill and Baby in NICU:-Baby to be placed in single room-Mother to limit visits and go directly in and out of NICU-MI contact and BF permitted; mother uses routine practices for infant

cleaning of the environment.

Note: Asymptomatic colonization is common in newborns and infants.

Clostridium perfringens

Gas Gangrene Routine No person-to-person spread

Coccidioido-mycosis(Valley Fever)

Pneumonia, cutaneous or soft tissue infection,



Cold, common

See “Respiratory Viral Infections”Cold, common(cont)

Droplet and Contact

Adult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom free

Congenital Rubella

Droplet and Contact for congenital

Continue precautions for at least 1

Reportable disease





Disease, Condition,





Comments


See “Rubella” rubella year, unless 2 urine and nasopharyngeal culture results after 3 months of age are negative

Conjunctivitis Eye discharge Contact Until viral etiology ruled out or for duration of symptoms*.

Mother ill:-Contact precautions for mother-Routine practices for infantHealthy Term infant:MI contact, RI, and BF permittedBaby in NICU:-Mother should be encouraged not to visit until symptom free**-BF permitted as expressed breast milk.Infant ill:-Contact precautions for infant-Routine practices for mother


*If viral etiology established, see specific organism.

**If Mother must visit Baby inNICU:o Place infant in private roomo Mother to limit visits and go


Coronavirus 229E/OC43/NL63/HKU1

See “Respiratory Viral infections”

Droplet and Contact


Pediatric: Minimum of eleven days





Disease, Condition,





Comments


from onset and child is symptom free

COVID-19(SARS-CoV-2, novel coronavirus 2019, nCoV2019)

Fever, new onset of (or exacerbation of chronic) cough, pneumonia, diarrhea, nausea.

Droplet and ContactAdd Airborne precautions if Aerosol-Generating Medical Procedures (AGMP) are likely to be required (e.g. nebulized therapy, CPR, CPAP, Endotracheal intubation & extubation, High frequency oscillatory ventilation, Bronchoscopy and bronchoalveolar lavage,

Consult IPAC Mother/Caregiver ill:Droplet and contact precautions for mother and infantMother/Caregiver to wear mask when within 2 metres of infant if contact occurs.

Risk of transmission via breast milk is unlikely but evidence is limited. No evidence of virus in breast milk in small studies; EBM likely safe. If BF occurs mask must be worn by mother and diligent hand hygiene practiced.

Healthy infant:Assess MI contact and RI on acase by case basis inconsultation with the clinicalteam(s).*

Infant in NICU:Caregivers with COVID-19 may

Family members and visitors with an acute respiratory infection or those under quarantine should not participate in care or enter the hospital with the exception of child's parent/primary caregiver. The parent/primary caregiver should continue to follow BCCDC recommendations for self-isolation while in hospital.


If Mother/caregiver mustparticipate in care:

- Place infant in private room- Mother/caregiver to limit

visits and go directly in and out of NICU.

- Mother/caregiver to wear mask for duration of time in NICU

Reportable disease





Disease, Condition,





Comments


Laryngoscopy, Positive pressure ventilation (BiPAP & CPAP), sputum induction).

not enter the NICU until at least symptom free.* Consult IPAC as required

Family members and visitors must be approved by NICU staff on a case by case basis prior to entering NICU

CoxsackievirusSee “ Enterovirus infections”

Contact


Until symptom free for 48 hours


Creutzfeldt-Jakob Disease(CJD)

Encephalopathy Routine* Notify IPACS immediately if CJD is suspected.

Tissues associated with high levels of infectivity include brain, eyes, spinal cord

*Please follow Public Health Agency of Canada guidelines for CJD



http://www.phac-aspc.gc.ca/nois-sinp/pdf/cjd-eng.pdf





Disease, Condition,





Comments


Reportable diseaseCroup


Droplet and Contact

Minimum of eleven days from onset and child is symptom free

CryptococcosisCryptococcus neoformans, Cryptococcus gatti

Pneumonia, dissemination, meningitis.


Reportable disease

Cryptosporidiosis


Reportable disease

Cysticercosis Cysts in various organs including brain (neurocysticercosis


Cytomegalovirus(CMV)

Usually asymptomatic; Infectious Mononucleosis, Congenital infection,

RoutineCongenital CMV disease is reportable





Disease, Condition,





Comments


Retinitis, colitis, disseminated infection in immunocompromised host

Decubitus Ulcer Minor


Routine


MI contact, RI permitted if drainage adequately controlled

Dengue FeverSee “Arthopod-borne viral infections”

Routine

Dermatitis

Many causes (bacteria, virus, fungus).

Minor


Routine

Contact

If compatible with scabies, see scabies.

Dermatophyte infectionSee “Tinea” Ringworm

Routine

DiarrheaSeveral bacteria, viruses, parasites which

Acute diarrhea, sometimes accompanied by vomiting,

Contact

Add Droplet if vomiting

Until infectious cause ruled out or until

Mother ill:-Contact precautions for Mother-Routine practices for infantHealthy Term Infant:

Emphasize hand hygiene with mother as shedding may be prolonged.





Disease, Condition,





Comments


may include: norovirus, rotavirus, enteric adenovirus, Salmonella, Shigella, Campylobacter, E. coli, Yersinia

See specific organism for more details

abdominal cramps specific etiology established and then refer to specific organism for appropriate precautions.

If no organism identified, continue precautions until stool is formed or back to baseline for the patient.

-MI contact, RI, and BF permittedInfant in NICU:-Mother should be encouraged not to visit until stool is formed or back to baseline for the mother *Infant ill:-Contact precautions for infant**-Routine practices for Mother-MI contact, RI and breastfeeding permitted


directly in and out of NICUo Strict attention to hand

hygiene**Ensure immediate disposal of diapers into leak proof bagReinforce hand hygiene

Consult IPACS if you suspect an outbreak.

Reportable disease-depending on etiology

DiphtheriaCorynebacterium diphtheria

Cutaneous (characteristic ulcerative lesion)

Contact Until 2 cultures of skin lesions taken 24 hours apart and 24 hours after completing antimicrobial treatment are

Contact IPACS Close contacts should be given antibiotic prophylaxis:-carriers-cases

Reportable disease





Disease, Condition,





Comments


Diphtheria (cont)Corynebacterium diphtheriae

negative for C. diphtheriae

Pharyngeal (adherent grayish membrane)

Droplet Until 2 cultures from both the nose and throat taken 24 hours apart and 24 hours after completing antimicrobial treatment are negative for C. diphtheria

Ebola virus

See “Hemorrhagic fevers”

Airborne + goggles and Contact

Until hemorrhagic fever virus ruled out or until discontinued by IPACS

Notify IPACS immediately.


Echinococcosis “Hydatid Disease”Echinococcus

Cysts in various organs, including liver

Routine No person to person spread





Disease, Condition,





Comments


granulosus and Echinococcus multilocularisEchovirus DiseaseSee Enterovirus infection

Contact


Until symptom free


Empyema (draining)

Common organisms include Staph aureus (including MRSA), GAS

Contact Duration of Drainage.

Consult IPACS as needed

Encephalitis or encephalomyelitis

Adult: Routine

Pediatric: Contact


Until specific etiology established and then refer to specific diseases for appropriate precautions

May be associated with HSV, Enterovirus, arbovirus. measles, mumps, varicella, Mycoplasma pneumonie, Epstein-Barr virus (EBV).

Reportable Disease

Endometritis Routine MI contact, RI and BF permitted. If infection is due to Group A Streptococcus, see “Streptococcal Disease– Group A”.

Enterobiasis Routine





Disease, Condition,





Comments


See “Pinworms”Enterovirus Enterovirus (nonpolio):Coxsackieviruses- Echoviruses- Enteroviruses

Enterovirus (cont)

Acute febrile respiratory illness, e.g., cough, fever

Acute febrile illness, aseptic meningitis, encephalitis, pharyngitis, herpangina, rash, pleurodynia, hand foot and mouth disease

Gastroenteritis may occur but is not common.

Droplet and Contact

Contact


Until symptom free

Until symptom free

Until

Mother ill:-Additional precautions as indicated for mother-Routine practices for infant

Healthy term infant:- MI contact, RI and BF permitted

Infant in NICU:-MI contact NOT permitted in the NICU until mother asymptomatic*-BF as expressed milkInfant ill:-Additional precautions as indicated for infant.-Routine practices for mother-MI contact, RI and BF permittedInfant ill and in NICU:-Droplet and contact precautions for infant.-Mother uses routine practices for infant (Mother may choose to use droplet and contact precautions)


Shedding of Enterovirus can occur in stool.

*If Mother must visit infant in NICU, consult IPACS.





Disease, Condition,





Comments


discontinued by IPACS

-Mother to limit visits to her child only and go directly in and out of NICU.

Epiglottitis Haemophilus influenzae type b;Streptococcus group A, Staphylococcus aureus

Adult: Routine

Pediatric: Droplet until H. influenzae is ruled out

If H. influenzae:Until 24 hours of appropriate antimicrobial therapy received

Epstein-Barr virus

Epstein-Barr virus(cont)

Infectious Mononucleosis,X-linked lymphoproliferative syndrome, post-transplantation lymphoproliferative disorder, Burkitts lymphoma, nasopharyngeal carcinoma

Routine Spread via intimate contact with oral secretions or from articles contaminated with oral secretions.

Erysipelas

See “Streptococcus group A”

Acute, cutaneous inflammatory disease

Droplet and Contact

Until 24 hours of appropriate antimicrobial therapy received

Erythema Rash, anemia, Routine





Disease, Condition,





Comments


InfectiosumFifth DiseaseParvovirus B19”

aplastic crisis. In pregnancy: hydrops foetalis

Droplet for the following patients:-Aplastic crisis-Immuno-compromised-Papulopurpuric gloves-socks (PGS) syndromeTransient aplastic or erthyrocyte crisis

For duration of hospitalization (aplastic crisis, immuno-compromised, PGS)

For 7 days for patients with transient aplastic crisis (TAC)

Escherichia coli(E coli O157 and other shiga-toxin producing strains)

See “Diarrhea” and “HUS”

Diarrhea, abdominal cramps, hemolytic-uremic syndrome (HUS), thrombotic thrombocytopenic purpura

Contact Until stool is formed or back to baseline for the patient and the results of two stool cultures are negative for E. coli 0157

Reportable disease

Extended Infection or Contact* For duration Mother has an ESBL: *Patients who are only colonized





Disease, Condition,





Comments


Spectrum Beta-Lactamases (ESBL)

See also “Multi-drug Resistant Organism”

colonization of any body site

of hospital stay

- Contact precautions for mother- Contact precautions for






room- MI contact and BF permitted- Mother uses routine



Infant has an ESBL:- Contact precautions for infant- Contact precautions for Mother- MI Contact, BF and RI

may only require routine practices. Consult IPACS.





Disease, Condition,





Comments


permittedFifth Disease

See “Erythema Infectiosum”

Routine

Droplet for the following patients:-Aplastic crisis-Immuno-compromised-Papulopurpuric gloves-socks (PGS) syndrome

Transient aplastic or erthyrocyte crisis

For duration of hospitalization (aplastic crisis, immunocompromised, PGS)


Food Poisoning/Food-Borne Illness

E.g. Bacillus cereus, Clostridium

Diarrhea, vomiting and abdominal cramps

Contact


Until specific etiology established and then refer to specific organism for

Mother ill:-Contact precautions for mother-Routine practices for infant

Healthy Term Infant:-MI contact, RI, and BF permitted







Disease, Condition,





Comments


perfringens, Staphylococcus aureus, Salmonella, vibrio parahaemolyticus, Escherichia coli 0157 and others


appropriate precautions.


Infant in NICU:-Mother should be encouraged not to visit until stool is formed or back to baseline for the mother *

Infant ill:-Contact precautions for infant**-Routine practices for mother-MI contact, RI and BF permitted

directly in and out of NICUo Strict attention to hand

hygiene

**Ensure immediate disposal of diapers into leak proof bagReinforce hand hygiene


Reportable disease

FurunculosisStaphylococcus aureus, including MRSA

See “Abscess”

Minor


Routine


GastroenteritisSeveral bacteria, viruses, parasites which may include: norovirus, rotavirus, enteric adenovirus,

Acute diarrhea, vomiting, abdominal cramps

Contact


Until infectious cause ruled out or until specific etiology established and then refer

Mother ill:-Contact precautions for mother-Routine practices for infant


permitted



directly in and out of NICUC-0506-14-60344 | IC05.02 Published Date: 18-Mar-2020 of 91 Review Date: 18-Mar-2023




Disease, Condition,





Comments


Salmonella, Shigella, Campylobacter, E. coli, Yersinia


to specific organism for appropriate precautions.


Infant in NICU:-Mother should be encouraged not to visit until stool is formed or back to baseline for the mother *

Infant ill:-Contact precautions for infant**-Routine practices for mother-MI contact, RI and breastfeeding permitted


**Ensure immediate disposal of diapers into leak proof bagReinforce hand hygiene


Reportable disease-depending on etiology

German Measles

See “Rubella”

Droplet

Droplet and Contact for congenital rubella

Until 7 days after onset of rash

Continue precautions for at least 1 year, unless 2 urine and nasopharyngeal culture results after 3 months of age

Reportable disease





Disease, Condition,





Comments


are negativeGiardiasisGiardia lamblia


Reportable disease

GonococcalInfectionsNeisseria gonorrhoeae

Ophthalmia neonatorum, gonorrhea, arthritis, pelvic inflammatory disease

Routine Mother ill:-routine practices for Mother and infant-MI contact, BF and RI permitted.

Infant ill (conjunctivitis, scalp abscess, sepsis):-MI contact, BF and RI permitted.

Reportable disease

Granuloma inguinale/Donovanosis

Klebsiella granulomatis

Painless genital ulcers, inguinal ulcers, nodules

Routine Sexual transmission

Haemophilus influenzae type b

Invasive disease:Pneumonia, meningitis, epiglottis, septic arthritis, cellulitis, otitis media,

Adult: Droplet

Pediatric: Droplet

Until 24 hours of appropriate antimicrobial therapy

Invasive Haemophilus influenzae type b is a reportable disease





Disease, Condition,





Comments


endocarditis, periorbital cellulitis in non-immune child < 5 years old, etc.

Haemophilus influenzae non b

Routine All invasive Haemophilus influenza are a reportable disease by type

Hand, Foot & Mouth Disease

See “Enterovirus infection”

Contact


Until symptom free


Hansen’s Disease

See “Leprosy”

RoutineReportable disease

Hantavirus Hemorrhagic fever, pulmonary syndrome, renal syndrome

Routine Infection acquired from rodents.

Reportable disease

Helicobacter pylori

Gastritis, ulcer Routine

Hemolytic A prodromal illness Contact Until E.coli C-0506-14-60344 | IC05.02 Published Date: 18-Mar-2020 of 91 Review Date: 18-Mar-2023




Disease, Condition,





Comments


Uremic Syndrome(HUS)

Shiga toxin-producing Enterohemorrhagic E. coli (EHEC) or Shigella

with abdominal pain, vomiting, and diarrhea that immediately precedes the development of HUS: (Hemolytic anemia, Thrombocytopenia, Acute renal injury)


0157 or other infectious cause ruled out and then refer to specific organism for appropriate precautions.

Reportable disease

Hemorrhagic Fevers

Lassa, Ebola, Marburg, and others

Severe Febrile diseases with bleeding, shock and multisystem involvement





Hepatitis of unknown etiology

Hepatitis, jaundice Contact For 7 days after onset of jaundice or until hepatitis A and E ruled out

Hepatitis A and E

Hepatitis, jaundice, acute febrile illness.

Contact Duration of symptoms or at least one

MI contact, BF and RI are permitted

If mother has Hepatitis A or E infection, notify the infant’s physician.





Disease, Condition,





Comments


week from onset of symptoms, whichever is longer

Asymptomatic HAV infection in infants can occur: Excretion of virus in stool can be prolonged.

Reportable diseaseHepatitis B Hepatitis, jaundice,

acute and chronic oftenasymptomatic

Routine -MI contact and RI permitted-BF permitted if infant of an HBsAg positive Mother has received HBIG and Hepatitis B vaccine-consult physician

Reportable diseaseHerpangina

See “Enterovirus”

Contact


Until symptom free


Herpes Simplex

Genital,Mucocutaneous, oral,Herpetic Whitlow, Eczema Herpeticum,encephalitis and meningitis

Routine practices for:o Patients

with localized recurrent lesions

o Patients with CNS

Mother has lesions:-MI contact permitted*-Total rooming in preferred-Observe strict hand hygiene-Mother may choose to wear a gown when caring for infant-Mothers with herpes labialis should wear a disposable surgical mask when touching

* For mothers with mucotaneous HSV lesions: instruct the Mother on hand hygiene, to wear a mask or cover lesion when around her infant, not kiss the infant while lesion is present and to avoid touching affected areas.

HCW with active herpes lesions





Disease, Condition,





Comments


Herpes Simplex (cont)

Neonatal HSV infections can be severe, can involve multiple organs.

Children, Adolescents and Adults are often asymptomatic.

Symptoms may include: gingivostomatitis,vesicular lesions, genital herpes, conjunctivitis, keratitis,encephalitis.

After primary infection HSV persists for life.

infection infant until lesions are crusted over and dried.-BF permitted if no herpetic lesions on the breast-For mothers with herpetic whitlow-gloves should be worn

(cold sores, herpetic whitlow) should consult PHSA Workplace Health for direction.

Herpes genitalis and congenital Herpes Simplex infection are reportable diseases

Contact precautions for:

Neonates with Until lesions are crusted





Disease, Condition,





Comments


mucacutaneous lesions

Neonates exposed to active HSV lesions during birth

Women in labor and postpartum women with active HSV lesions

Patients with severe mucocutaneous disease

over and dried

Birth to 6 weeks of age or until neonatal HSV infection has been ruled out.

Until lesions are crusted over and dried

Until lesions are crusted over and dried

Herpes zoster(Shingles, Zoster, Varicella Zoster)

See “Shingles”

Immunocompetent patient:- Localized and

can be covered

o Extensive or localized that

Contact


Until lesions have crusted over and dried.





Disease, Condition,





Comments


cannot be covered

Immunocompromised host or disseminated disease


HistoplasmosisHistoplasma capsulatumHistoplasmosis (cont)

Asymptomatic, pulmonary or disseminated

Routine No person-to-person spread.Notify Microbiology laboratory before sending specimens

HIVHuman Immunodeficiency Virus

A wide range of clinical manifestations

Routine - MI contact and RI permitted Assess mothers individually for possibility of other infections.

Reportable disease

Human Astrovirus

Acute gastroenteritis

Contact* Until stool is formed or back tobaseline for thepatient for 48hoursConsult IPACS ifimmune

Mother ill:- Contact precautions formother- Routine practices forinfantHealthy Term Infant:- MI contact, BF and RI permitted.Infant in NICU:- Mother should be

o Strict attention to hygiene*Prolonged fecal sheddingmay occur in immunocompromised patients after recovery.Contact precautions for duration of hospitalization may be justified.If Mother must visit:o Place infant in privateroom





Disease, Condition,





Comments


compromised encouraged not to visituntil stool is formed orback to baseline for themother for 48 hours*Infant ill:- Contact precautions forinfant**- Routine practices for Mother- MI contact, BF and RI permitted

o Mother to limit visitsand go directly in andout of NICU**Ensure immediatedisposal of diapers into leakproof bag.

Reportable Disease

HumanHerpesvirus 6

See “Roseola

Fever followed by rash

Routine

Human Metapneumovirus


Droplet and Contact



Human Papillomaviruses

Skin warts, anogenital warts (condylomata acuminate)

Routine

Human T-Cell Asymptomatic Routine -MI contact and RI permitted





Disease, Condition,





Comments


Lymphotropic Virus I/II (HTLV I/II)Impetigoe.g. Staphylococcus aureus, and Group A Streptococcus

Variants of impetigo include: bullous, non-bullous or ecthyma

Minor


Routine

Contact Duration of drainage or can be contained by a dressing

MI contact, RI permitted if drainage adequately controlled.

Mother: If impetigo on breast-consult physician prior to breast feeding.

Instruct the Mother on hand hygiene, to cover lesion when around her infant, not kiss the infant while peri-oral lesion is present and to avoid touching affected areas.

Influenza Acute febrile respiratory illness, e.g., cough, fever, muscle and joint pain, headache, etc

Droplet and Contact

Continue precautions for 5 days after onset of illness or until symptoms resolve, whichever is longer.

Mother ill:-Contact and droplet precautions for mother-Routine practices for infant

Healthy term infant:- MI contact, BF and RI

permitted-Mother to wear mask when within 2 metres of infant.

Infant in NICU:-Mother should be encouraged

Family members and visitors with an acute respiratory infection should not visit or enter the hospital.

Pregnant women and infants are at high risk of complications of influenza.

Women who are or will be pregnant or who will deliver during influenza season are a high priority group for receiving





Disease, Condition,





Comments


Influenza (cont)

not to visit until symptom free.*-BF permitted as expressed milk.-Consult IPACS as required

Infant ill:-Droplet and contact precautions for infant-Routine practices for mother- MI contact, BF and RI permitted

influenza vaccine.


*If ill Mother must visit infant in NICU:o Place infant in private roomo Mother to limit visits and go

directly in and out of NICU.o Mother to wear mask for


All HCW should receive annual influenza vaccine.Consult IPACS if you suspect an outbreak.Refer to Section 6 for specific information on Influenza

Reportable diseaseInfluenza Vaccine (Live Attenuated Influenza Vaccine – LAIV) intranasal spray

e.g FluMist®

Patients, staff and visitors who have received LAIV

Routine(see comments)

Patients, staff, visitors and family members who have received LAIV should not have direct contact with severely immunocompromised patients for 14 days post immunization.

Severely immunocompromised C-0506-14-60344 | IC05.02 Published Date: 18-Mar-2020 of 91 Review Date: 18-Mar-2023




Disease, Condition,





Comments


patients include those in the Bone Marrow Transplant Unit and other patients on Protective Isolation.

NICU:Children visiting, who have received FluMist, must wear a mask before entering NICU for 7 days following the vaccine.

Consult IPACS as needed

Kawasaki Acute febrile, self-limited, systemic vasculitis of early childhood

Routine

Lassa Fever

See “Hemorrhagic Fevers”



Legionella pneumophila Infections

Legionnaires disease: Varies in severity from mild


Notify IPACSC-0506-14-60344 | IC05.02 Published Date: 18-Mar-2020 of 91 Review Date: 18-Mar-2023




Disease, Condition,





Comments


to severe pneumonia, fever, cough and progressive respiratory distress

Pontiac Fever:Mild febrile illness without pneumonia

Reportable disease

Leprosy(Hansen’s disease)Mycobacterium leprae

Infection involving skin, peripheral nerves, mucosa of the upper respiratory tract, and testes

Routine Transmission between persons only with very prolonged extensive close personal contact.Household contacts should be given prophylaxis

Reportable diseaseLeptospirosisLeptospira species

Acute febrile disease with varied manifestations characterized by vasculitis

Routine Reportable disease

Lice (Pediculosis)

Pediculus capitis: Head lice-lice and eggs in hair,

ItchingSome children with head lice may be asymptomatic

Secondary

Contact Until 24 hours after treatment is complete

Mother symptomaticContact for motherHealthy term Infant:-MI contact, RI, BF permitted

Infant in NICU:

Treatment should be applied as soon as possible.Repeat the treatment in 7-10 days to ensure that head lice which hatch after the first treatment will be killed. No approved





Disease, Condition,





Comments


behind ears and nape of neck

Pediculus corporis: Body lice

Pthirius pubis: Pubic lice/Crab Lice

bacterial infection -MI contact and BF permitted once mother has been treated

pediculicide is completely ovicidal.After each treatment, checking the hair and combing with a nit comb to remove nits and lice every 2-3 days may decrease the chance of self-re-infestation. Continue to check for 2-3 weeks to be sure all lice and nits are gone.

Refer to Section 6 for more specific information on lice.

Listeriosis

Listeria monocytogenes

Primarily food borne

Influenza like illness, malaise, headache, and gastrointestinal symptoms. More severe in neonates (early and late onset disease). Central nervous system infections.

Routine - MI contact , RI and BF permitted Reportable disease

Lyme diseaseBorrelia

3 stages:Early localized,

RoutineReportable disease





Disease, Condition,





Comments


burgdorferi early disseminated, and late disease.

Lymphadenitis No drainage, intact skin

For draining, see abscess or specific organism

Routine

Lymphogranuloma Venereum (LGV)

See “Chlamydia trachomatis”

Routine

MalariaPlasmodium species

Febrile illness with a history of travel

Routine Malaria in pregnancy carries significant risks of morbidity and mortality for both the mother and fetus

Reportable diseaseMastitisSee “Staphylococcus aureus”

Minor

Major (drainage not contained by dressing

Routine

Contact


Measles Fever, cough, Airborne Until 4 days Mother has measles: Refer to Section 6 for specific





Disease, Condition,





Comments


“Red Measles”(Rubeola)

Measles

coryza, conjunctivitis, an erythematous maculopapular rash, and a pathognomonic enanthema (Koplik’s spots)

after start of rash.For duration of illness if illness in immune compromised patients.

Susceptible contacts of known measles cases should be placed on airborne precautions from 5 days after their first exposure to 21 days after their last exposure, or 28 days if they have received Immune

-Mother: airborne-Infant: should receive Immune Globulin (IG) and remain on airborne precautions until 28 days from last exposureHealthy term infant:-MI contact, RI permitted-BF permitted if RIInfant in NICU: -Mother not permitted in NICU until 4 days after appearance of the rash, or if immune compromised for duration of illness -BF permitted as expressed breast milkInfant has measles-Mother immune – permitted to see infant and BF permitted-Mother susceptible – consult IPACS-Infant on Airborne Precautions until 4 days after start of rash

Infant is measles contact: Airborne precautions 5 days after first exposure to 21 days after last exposure, or 28 days if

information on measlesNotify IPACS as soon as you suspect measles

HCW:- HCW should have their immune status validated with PHSA Workplace Health - - Non-immune HCW should not care for patients with measles.- HCW with suspected measles should not be at work and report to PHSA Workplace Health

Only immune family and visitors to visit

Immunity is defined as a previous history of measles or having received 2 doses of measles vaccine or born before 1957

Reportable disease





Disease, Condition,





Comments


“Red Measles”(Rubeola) (cont)

Globulin. they have received IG.

Meningitis Symptoms include headache, neck stiffness, fever, petechiae, etc. Severity of symptoms depends on causative organism.

Etiology unknown:Droplet and contact

Until etiology determined or infectious cause ruled out.

Notify IPACS of all cases of meningitis

Meningitis is a reportable disease – all causes.

Fungal MenigitisRoutine

Haemophilius influenzae type bDroplet


Lysteria monocytogenesRoutineMeningococcal(Neisseria meningitidis)Droplet


Streptococcus C-0506-14-60344 | IC05.02 Published Date: 18-Mar-2020 of 91 Review Date: 18-Mar-2023




Disease, Condition,





Comments


Meningitis (cont)

pneumoniaeRoutineOther bacterial: Routine PracticesTuberculosis:Airborne

If TB is causative organism the patient should be placed on airborne precautions until pulmonary TB is ruled out in patient and family members.If TB confirmed: See “Tuberculosis”

Viral:Adult - Routine

Pediatric - Continue for 7





Disease, Condition,





Comments


Contact

NICU – Droplet and Contact


days after onset of illness unless a non-enteroviral diagnosis is established

Meningococcal Disease(Neisseria meningitidis)

Meningococcemia meningitis, pneumonia, sepsis

Droplet Until 24 hours of appropriate antimicrobial therapy

Close contacts may require chemoprophylaxis.

Reportable disease

Methicillin-resistant Staphylococcus aureus (MRSA)


Contact

Add Droplet Precautions for any coughing patient with MRSA

For duration of hospital stay

Mother has MRSA:- Contact precautions for mother- Contact precautions for





Baby in NICU:

Refer to the infection control manual for specific information on MRSA





Disease, Condition,





Comments


- Baby to be placed in single room- MI contact and BF permitted- Mother uses routine


child only and go directly in and out of NICU, if she has an infection.

Infant has MRSA:- Contact precautions for infant- Contact precautions for Mother- MI Contact, BF and RI

permittedMiddle East Respiratory Syndrome Coronavirus (MERS-CoV)

Severe acute respiratory illness and fever

Airborne, Droplet and Contact

Until MERS-CoV is ruled out or until discontinued by IPACS



Molluscum Contagiosum

Infection of the skin with no systemic manifestations; characterized by umbilicated

Routine Requires intimate direct personal contact for transmission.





Disease, Condition,





Comments


papulesMononucleosis,

See “Epstein-barr virus” and “Cytomegalovirus”

Routine

Mucormycosis (Zygomycosis-Rhizopus, Mucor, Rhizomucor, Absidia species)

Fungal Disease

Rhinocerebral, pulmonary, skin, or disseminated.Disease in Immunosuppression (e.g. malignancy, Diabetes, Renal Failure)

Routine

Multi-drug Resistant Organism

See also “Extended Spectrum Beta-Lactamases (ESBL)”


Contact* For duration of hospital stay

Mother has an MDRO:- Contact precautions for mother- Contact precautions for





*Patients who are only colonized may only require routine precautions. Consult IPACS.





Disease, Condition,





Comments






Infant has an MDRO:- Contact precautions for infant- Contact precautions for Mother- MI Contact, BF and RI

permittedMumpsParotitis

Swelling of one or more of the salivary glands (usually the parotid glands), orchitis, meningitis

Droplet Continue precautions for 5 days after onset of parotid swelling.

Susceptible contacts of

Mother has mumps:Mother – Droplet precautions

Term Infant:-MI contact, BF, and RI permitted

Infant in NICU:-Mother not to go to NICU until 5 days after the onset of the parotid swelling

Notify IPACS as soon as you suspect mumps.

HCW:- HCW should have their immune status validated with PHSA Workplace Health- Non-immune HCW should not care for patients with mumps.- HCW with suspected mumps should not be at work and report





Disease, Condition,





Comments


Mumps (cont)Parotitis

known mumps cases should be placed on droplet precautions from 10 days after their first exposure to 26 days after their last exposure.

-BF as expressed milk until 5 days after onset of parotid swelling

Infant has mumpsMother immune:permitted to see infantMother susceptible:Consult IPACS. BF as expressed breast milk

Infant is mumps contactDroplet precautions from 10 days to 26 days from last exposure

to PHSA Workplace Health.


Immunity is defined as a previous history of mumps or having receivedmumps vaccine or born before 1957- One dose is recommended for individuals born between 1957 and 1969.- Two doses are recommended for all individuals born on or after 1970Reference: BCCDC Immunization manual.

Reportable diseaseMycobacteria, other than tuberculosis

See “Atypical mycobacteria”

Mycobacterium abscessus in CF patients

Routine


No person-to-person transmission, except for Mycobacterium abscessus in CF patients. Please refer to CF standard in section 6.





Disease, Condition,





Comments


Mycobacterium tuberculosis,See “Tuberculosis”

Airborne Reportable disease

Mycoplasma pneumoniae

Upper respiratory tract infections, acute bronchitis, pneumonia

Unusual manifestations: CNS disease, myocarditis, hemolytic anemia.

Droplet Until symptom free

Necrotizing Enterocolitis (NEC)

Routine Contact Precautions may be indicated for clusters/outbreaks-Consult IPACSUnknown if transmissible.

Neisseria Meningitidis

See “Meningococcal Disease”

Droplet Until 24 hours of appropriate antimicrobial therapy

Reportable disease

Nipah virus Encephalitis Droplet and Contact

Until symptoms resolve

Reportable disease





Disease, Condition,





Comments


NocardiosisNocardia species

Fever, pulmonary or CNS infection

Routine No person-to-person transmission.

Norovirus Gastroenteritis Droplet and Contact

Until stool is formed or back to baseline for the patient for 48 hoursIf ongoing GI symptoms (e.g. immunocompromised, chronic GI disease):-Continue contact precautions until 2 PCR negative results are obtained or until stool is formed or back to baseline for



permitted.




permitted






Reportable Disease





Disease, Condition,





Comments


the patient for 48 hours.-Test stool every 2 weeks if results continue to be positive- If previous result was negative, repeat stool test in 1 week. Discontinue precautions if a second negative result is obtained

Ophthalmia Neonatorum

See “Conjunctivitis”

Contact Until symptom free

Osteomyelitis May result from contiguous spread from adjacent soft

Routine





Disease, Condition,





Comments


Osteomyelitis (cont)

tissues and joints, hematogenous seeding, or direct inoculation into the bone as a result of trauma or surgery

Parainfluenza Virus

See “Respiratory Viral infections”

Droplet and Contact



Paratyphoid FeverSalmonella paratyphi

See “Salmonellosis”

Contact Adults:Until stool is formed or back to baseline for the patient.

Pediatrics:Continue precautions until culture Reportable disease





Disease, Condition,





Comments


results for 3 consecutive stool specimens obtained at least 48 hours after cessation of antimicrobial therapy are negative

Parechovirus Acute febrile respiratory illness, e.g., cough, fever

Acute febrile illness, meningitis, encephalitis

Gastroenteritis

Droplet and Contact

Contact

Until symptom free

Until symptom free

Mother ill:-Additional precautions as indicated for mother-Routine practices for infant

Healthy term infant:- MI contact, RI and BF permitted

Infant in NICU:-MI contact NOT permitted in the NICU until mother asymptomatic*-BF as expressed milkInfant ill:-Additional precautions as


Shedding of Parechovirus can occur in stool.

*If Mother must visit infant in NICU, consult IPACS.





Disease, Condition,





Comments


may occur but is not common.



indicated for infant.-Routine practices for mother-MI contact, RI and BF permittedInfant ill and in NICU:-Droplet and contact precautions for infant.-Mother uses routine practices for infant (Mother may choose to use droplet and contact precautions)-Mother to limit visits to her child only and go directly in and out of NICU.

Parvovirus B19Fifth Disease,

See “Erythema Infectiosum”

Routine

Droplet for the following patients:-Aplastic crisis-Immuno-compromised-Papulopurpuric gloves-socks (PGS) syndrome

For duration of hospitalization (aplastic crisis, immuno-compromised, PGS)





Disease, Condition,





Comments


Transient aplastic or erthyrocyte crisis


Pediculosis

See “Lice”

Contact Until 24 hours after treatment is complete

Refer to Section 6 for specific information on Lice.

Pertussis(Whooping cough)Bordetella pertussis

Whooping cough, non specific respiratory tract infection

Droplet Until 5 days of appropriate antimicrobial treatment has been completed.

If appropriate antimicrobial therapy is not given, until 3 weeks after the onset of cough

Mother ill:Mother - droplet

Healthy Term Infant:-MI contact not permitted until 5 days of effective therapy or infant is on chemoprophylaxis-BF permitted if infant on chemoprophylaxis or as expressed breast milk if not on prophylaxis

Infant in NICU:-MI contact not permitted in NICU until 5 days of appropriate antimicrobial treatment has

Notify IPACS of all confirmed or suspected cases of Pertussis.

Reportable disease as prompt use of chemoprophylaxis in household contacts is effective in limiting secondary transmission.

No HCW, family members or visitors are to enter hospital with an acute respiratory infection.

HCW should have their immune status validated with PHSA Workplace Health





Disease, Condition,





Comments


been completed-BF permitted as expressed breast milk

Infant ill:-MI contact permitted-BF permitted

Reportable disease

PinwormsEnterobius vermicularis

Perianal itching Routine Close household contacts may need treatment.

Plague(Yersinia pestis)

BubonicFever, chills, headache, lymphadenitis,

Routine Notify IPACS immediately.



If left untreated, plague often will progress to sepsis with renal failure, acute respiratory distress syndrome, and death.

Reportable disease

Pneumonic -cough, fever, dyspnea, hemoptysis

Droplet Until 48 hours after appropriate antimicrobial treatment

Plesiomonas Secretory or dysenteric diarrhea, vomiting

Contact


Until stool is formed or back to baseline for


Reportable disease





Disease, Condition,





Comments


the patient

Pneumococcal DiseaseSee “Streptococcal Disease”

Droplet Until 24 hours after appropriate antimicrobial therapy

Reportable disease if invasive.

Pneumocystis jirovecii (carinii)

Pneumonia in immunocompromised host

Routine Ensure room mates not immunocompromised.

PneumoniaEtiology unknown

See “Respiratory Viral Infections”“ or specific organism

Fever, cough Droplet and contact

Continue precautions until etiology established or infectious cause ruled out

May be reportable depending on the organism.

Poliomyelitis Asymmetric acute flaccid paralysis

Contact For duration of hospitalization or in consultation with IPACS

Reportable disease

Pseudo-membranous Colitis

Contact Plus Until diarrhea has subsided for 72 hours and stools are

Mother ill and Healthy Term Infant:-MI contact, RI, and BF permitted


Bacterial spores may persist in the environment; therefore,





Disease, Condition,





Comments


See “Clostridium difficile”

Pseudo-membranous Colitis (cont)

formed or back to baseline for patient.

Contact IPACS prior to discontinuation of precautions.

-Mother: Contact precautions-Infant: Routine practices

Mother ill and Baby in NICU:-Baby to be placed in single room-Mother to limit visits and go directly in and out of NICU-MI contact and BF permitted; mother uses routine practices for infant

special attention must be paid to cleaning of the environment.

Note: Asymptomatic colonization is common in newborns and infants.

Psittacosis

See “Chlamydia”

Routine

Q feverCoxiella burnetii

Acute: fever, pneumonia, hepatitisChronic: endocarditis

Routine No person to person transmission.

Reportable disease

Rabies Acute illness with rapidly progressive central nervous system manifestations

RoutineNotify IPACS

Reportable disease

Rat-bite fever Fever, rash, Routine No person to person spreadC-0506-14-60344 | IC05.02 Published Date: 18-Mar-2020 of 91 Review Date: 18-Mar-2023




Disease, Condition,





Comments


Streptobacillus moniliformis disease, Spirillum minus disease

arthralgia

Resistant organism

See “ARO”


Respiratory Viral Infections,Parainfluenza, RSV, Human Metapneumovirus,Rhinovirus, Coronavirus 229E/OC43/NL63/HKU1

See influenza and adenovirus for specific information

Acute cough, fever, pneumonia. Symptoms may vary in infants and small children, e.g., lethargy, change in respirations, etc.

Droplet and Contact



Mother ill:-Droplet and contact precautions for mother-Routine practices for infant

Healthy term infant:-MI contact, BF and RI permitted-Mother to wear mask when within 2 metres of infant

Infant in NICU:-Mother should be encouraged not to visit until symptom free.* BF permitted as expressed breast milk. Consult IPACS as required

Infant ill:

Family members and visitors with an acute respiratory infection should not visit or enter the hospital.



directly in and out of NICU.o Mother to wear mask for


During outbreak situations, additional precautions may be required.





Disease, Condition,





Comments


-Infant - droplet and contact-Routine practices for mother-MI contact, RI and BF permitted


Reye’s Syndrome

Not an infectious condition

Routine May be associated with viral infection, (influenza, varicella) and aspirin.

Reportable diseaseRheumatic Fever

May include arthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules.

Routine

Rhinovirus

See Respiratory Viral Infections

Droplet and Contact



RingwormSee tinea

Routine Rarely, have outbreaks occurred in healthcare settings. Use Contact Precautions for outbreak.

Roseola Infantum

Fever followed by rash

Routine





Disease, Condition,





Comments


(Exanthem Subitum, Sixth disease, HHV-6)Rotavirus

See “Diarrhea”

Acute diarrhea, sometimes accompanied by vomiting, abdominal cramps

Contact*


Until stool is formed or back to baseline for the patient for 48 hours

Consult IPACS if immune compromised



permitted.




permitted






Reportable Disease

Rotavirus Vaccinee.g.

Infants who receive rotavirus vaccine while in

Contact Until 14 days from date of immunization.

Mother infant contact, breast feeding and rooming in is permitted.

Parents are not required to use contact precautions but must be instructed on the need for strict





Disease, Condition,





Comments


RotaTeq®Rotarix™

hospital. hand hygiene and the proper disposal of diapers. They should go directly in and out of NICU/PICU and visit their infant only.

Siblings who have received Rotavirus vaccine must wait 2 weeks post vaccine to visit. Visitation may be reviewed with IPACS on a case-by-case basis

Rubella(German Measles)

Most cases are subclinical

Clinical disease is usually mild, characterized by fever, rash, lymphadenopathy and polyarthralgia

Congenital (baby born with rubella)**

Droplet

Droplet and Contact for congenital rubella

Until 7 days after onset of rash

Congenital - continue precautions for at least 1 year, unless 2 urine and nasopharyngeal culture results after 3 months of age are negative

Mother has rubella:-Droplet precautions for mother.-Routine practices for infant

Healthy term infant:-MI contact, RI and BF permitted

Infant in NICU:-Mother cannot go to NICU until 7 days after onset of rash-Expressed breast milk allowed

Infant has congenital rubella:-MI contact, BF permitted-Total rooming in preferred

HCW:- HCW should have their immune status validated with PHSA Workplace Health - Only immune HCW can care for patients with rubella.


Immunity is defined as:- Being born before 1957- Having received 1 dose of

rubella vaccine if born on or after Jan 1, 1957

- Laboratory evidence of





Disease, Condition,





Comments


Susceptible contacts of known rubella cases should be placed on droplet precautions from 7 days after their first exposure to 21 days after their last exposure.

disease. (BCCDC Immunization manual)

**Congenitally infected infants may shed virus for up to 3 years.

Reportable disease

Rubeola

See “Measles”

Airborne Until 4 days after start of rash.For duration of illness in immune compromised patients

Reportable disease

Salmonellosis(Salmonella species)

Diarrhea, enteric fever, typhoid fever

Contact Non-typhoid:Contact precautions until stool is formed or back to

Notify IPACS

Reportable disease





Disease, Condition,





Comments


baseline for the patient.

Typhoid:Contact precautions should be continued until culture results for 3 consecutive stool specimens obtained at least 48 hours after cessation of antimicrobial therapy are negative

Sapovirus Acute gastroenteritis

Contact* Until stool is formed or back to baseline for the patient for 48 hours

Consult

Mother ill:- Contact precautions formother- Routine practices forinfant


o Strict attention to hygiene*Prolonged fecal sheddingmay occur in immunocompromised patients after recovery.Contact precautions for duration of hospitalization may be justified.If Mother must visit:





Disease, Condition,





Comments


IPACS ifImmune compromised

permitted.

Infant in NICU:- Mother should beencouraged not to visituntil stool is formed orback to baseline for themother for 48 hours*Infant ill:- Contact precautions forinfant**- Routine practices forMother- MI contact, BF and RIpermitted

o Place infant in privateroomo Mother to limit visitsand go directly in andout of NICU

**Ensure immediatedisposal of diapers into leakproof bag.

Reportable Disease

ScabiesSarcoptes scabiei

Limited or typical -papular rash, intense itching,

Crusted (Norwegian) or Atypical -severe and highly infectious due to large number of mites

Contact Until 24 hours after the treatment is complete

For crusted or atypical, please consult IPACS before discontinuing precautions

Mother symptomatic:-Contact precautions-Routine Practices for infant

Healthy Term Infant:-MI contact permitted 24 hours after treatment is complete-If MI contact necessary before treatment mother should use contact precautions when holding baby-BF permitted once mother has been appropriately treated or

*For optimum control, all contacts suspected of having substantial contact with a symptomatic patient should be treated at the same time. Eg: household contacts, playmates.

See Section 6 for further details on Scabies.





Disease, Condition,





Comments


may be provided as expressed breast milk

Infant in NICU:-MI contact permitted 24 hours after treatment is complete-BF permitted once Mother treatment complete or may be provided as expressed breast milk

Severe Acute Respiratory Syndrome (SARS)

Fever, pneumonia, acute respiratory distress syndrome

Airborne and Contact + goggles


Notify Public Health immediately

Notify IPACS

Reportable diseaseScalded Skin Syndrome

See “Abscess major” if drainage not contained by dressing


Scarlet Fever

See Streptococcal

Occurs in association with pharyngitis

Droplet Until 24 hours after appropriate antimicrobial





Disease, Condition,





Comments


Disease, Group A Streptococcus

Characteristic confluent erythematous sandpaper like rash

therapy

ShigellosisShigella species

See “Diarrhea”


Reportable disease

ShinglesHerpes zoster, Zoster, Varicella Zoster

Vesicular skin lesions in dermatomal distribution


can be covered

- Extensive or localized that cannot be covered

Contact



Mother with localized shingles-MI contact and RI permitted-Total rooming in preferred-Mother may not go to nursery/NICU until lesions are crusted-BF allowed if lesions not on breast

Mother has extensive or localized lesions that cannot be covered-Mother on airborne and contact-Infant-rooming in on routine precautions

Notify IPCAS of all cases of suspected or confirmed shingles.

Visitors who have active chickenpox or shinglesmust not visit.

Note: Non-immune individuals who are a shingles contact may develop chickenpox.

Only chickenpox immune visitors/siblings to visit.





Disease, Condition,





Comments


Shingles (cont)Herpes zoster, Zoster, Varicella Zoster

-Total rooming in preferred-Mother may not go to nursery until lesions are crusted-BF permitted if lesions not on breast

HCW should have their immune status validatedwith PHSA Workplace Health*.

Non-immune HCW should not care for patients with active chickenpox or shingles.

*Immunity is defined as any of the following: Documentation of age

appropriate varicella vaccine. Laboratory evidence of

immunity or laboratory confirmation of disease.

Varicella diagnosed or a verification of history from family members by the physician or delegate.

History of herpes zoster diagnosed by physician or delegate

HCW with suspected shingles should report to PHSA Workplace Health before commencing work.



Continue until all lesions have crusted over

Chickenpox susceptible contacts of patients with shingles should be placed on airborne (and contact precautions if lesions develop) from day 8 from the first known contact and up to and including day

Mother is immunocompromised:-Mother on airborne and contact-Infant-rooming in -on routine precautions and contact precautions if lesions develop-Total rooming in preferred-Mother may not go to nursery until lesions are crusted-BF permitted if lesions not on breast

Infant in NICU:-Mother may not visit NICU until lesions are crusted

Infant who is a contact in NICU:-Airborne precautions from day 8 from first exposure up to and including day 21 of last exposure (if infant has been





Disease, Condition,





Comments


21 if they have not received VZIG, 28 days if they have received VZIG

given VZIG up to day 28)-BF by expressed breast milk until lesions are crusted over

Smallpox“Variola”

Declared eradicated world-wide by WHO in 1979

Severe prodromal illness (high fever, malaise, severe headache), mucous lesions of the moth or pharynx, rash




Notify IPACS

Reportable disease

Staphylococcal DiseaseStaphylococcus aureus

See ARO for more information on MRSA

Food poisoningSee “Food poisoning”

Skin, wound or burn infection, impetigo

See “Abscess” or “Impetigo”

Contact

Minor-routine

Major: contact -drainage not contained by dressing

Until symptom free for 48 hours


-MI contact, RI and BF allowed

Mother has draining wound:-Mother-contact precautions-Infant-routine practices

Healthy Term Infant:-MI contact, RI allowed.-BF allowed if lesion not on breast*-Mother –change dressing, and gown and have mother perform hand hygiene prior to contact with infant

*It may be advisable to withhold milk from breast with mastitis until 24 hours of effective treatment.

During outbreak situations, additional precautions and cohorting of infants may be required.





Disease, Condition,





Comments


Staphylococcal Disease (cont)Staphylococcus aureus

See ARO for

Infant in NICU:-MI contact permitted as long as drainage is contained-BF allowed or by expressed milk-mother-change dressing and gown, and have mother perform hand hygiene prior to leaving unit and prior to contact with infant.Infant has draining wound:Infant-contact precautionsMother- routine-MI contact, RI, and BF preferredInfant in NICU:- private room if drainage not contained

Pneumonia Droplet Until 24 hours after appropriate antimicrobial therapy

-MI contact, RI and BF allowedInfant in NICU has pneumonia:-Droplet precautions and private room-MI contact, BF permitted

Tracheitis with a tracheostomy tube in place

Droplet For the duration of illness





Disease, Condition,





Comments


more information on MRSA Toxic Shock

SyndromeRoutine -MI contact, RI and BF allowed

as tolerated by Mother

Staphylococcus epidermidis and other coagulase negative staphylococcal infections

Health-care associated infections (related to catheters, shunts, grafts, prosthesis, etc.)Late-onset bacteremia among preterm infants

Routine -MI contact, RI and BF permitted

Streptococcal Disease

Group A Streptococcus

Necrotizing fasciitis

Droplet and Contact

Until 24 hours after appropriate antimicrobial therapy

Mother ill:-Mother contact and droplet until 24 hours after appropriate antimicrobial therapy-Infant -routine practices-MI contact, RI and BF permitted*

*It may be advisable to withhold milk frombreast with mastitis until 24 hours of effective treatment.

If mother has invasive GAS, notify infants’ physician.

Notify IPACS

Reportable disease if invasive

Skin, wound or burn infection

Contact

Toxic shock like syndrome (TSLS)

Droplet and Contact

Mother ill:-Mother- contact and droplet until 24 hours after appropriate antimicrobial therapy





Disease, Condition,





Comments


Streptococcal Disease (cont)

Group A Streptococcus

-Infant-routine practices-MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapy

Pneumonia Droplet Mother ill:-Mother contact and droplet, until 24 hours after appropriate antimicrobial therapy-Infant-routine practices-MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapy

Pharyngitis/scarlet fever

Droplet Mother ill:-Mother contact and droplet until 24 hours after appropriate antimicrobial therapy-Infant-routine practices-MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapy

Endometritis(Puerperal Sepsis)

Routine Mother ill:-Mother -contact until 24 hours after appropriate antimicrobial therapy-Infant-routine practices





Disease, Condition,





Comments


-MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapy

Streptococcal disease

Group B Streptococcus

Colonization in Mother or infection in Mother and/or infant

Routine -MI contact, RI and BF permitted If mother has invasive disease, notify the infant’s physician.

Notify IPACS

Neonatal invasive GBS disease is reportable

Streptococcus pneumoniae

See “Meningitis”

Routine Invasive Streptococcus pneumoniae infection is reportable.

StrongyloidiasesStrongyloides stercoralis

AsymptomaticEosinophiliaSeveral manifestations due to larvae migration

Dissemination (hyper infection) in immunocompromised patients

Routine Infective larvae in soil

Syphilis Acquired : Mucocutaneou Until 24 hours Mother has lesions: As moist open lesions, secretions





Disease, Condition,





Comments


Treponema pallidum

Genital, skin or mucous lesions, systemic symptoms, gummatous changes of the skin, bone, or viscera, CVS or CNS involvement

s lesions: Contact

after appropriate antimicrobial therapy

-Mother contact-Infant routine precautions-MI contact, RI and BF permitted after 24 hours of appropriate antimicrobial treatment

and possiblyblood are contagious in all patients with syphilis,contact precautions should be used when caringfor patients with congenital, primary andsecondary syphilis with skin and mucousmembrane lesions until 24 hours after appropriate antimicrobial therapy

*If mother has syphilis, notify the infant’s physician.

Reportable disease

Congenital :Range from stillbirth to being symptom free at birth.

Contact* Until 24 hours after appropriate antimicrobial therapy

Infant has congenital:Mother: routineInfant :contact until 24 hours after appropriate antimicrobial therapy

-MI contact, RI and BF permittedTapeworm DiseaseDiphyllobothrium latum (fish)Hymenolepis nana, Taenia saginata (beef)Taenia solium (pork)

See

Usually asymptomatic or mild GI symptoms

CNS involvement in Taenia solium “neurocysticercosis”

Routine





Disease, Condition,





Comments


”Echinococcosis”TetanusClostridium tetani

Trismus and severe muscular spasms


Reportable disease

ThrushSee “Candidiasis”

Routine

Tinea “Ringworm”

Dermatophytes:-Epidermophyton,-Trichophyton, and-Microsporum) or Malassezia furfur

Fungal infection of the skin or nails e.g. tinea capitis, athlete’s foot, pityriasis versicolor

Routine

ToxoplasmosisToxoplasma gondii

Asymptomatic or fever, lymphadenopathy, retinitis, encephalitis in immune compromised host.

Congenital

Routine Mother and/or Infant ill:-MI contact, BF and RI permitted

No person-to-person spread

Congenital toxoplasmosis is reportable





Disease, Condition,





Comments


infectionTrench mouth

See ‘Vincent’s angina”

Routine

TrichinellosisTrichinella spiralis

Asymptomatic, GI upset, periorbital edema, rash, muscle calcification, myocarditis, neurologic involvement and pneumonitis


TrichomoniasisTrichomonas vaginalis

Asymptomatic, vaginal discharge, vulvovaginal pruritis and irritationMales: Urithritis, but most are asymptomatic

Routine Sexual transmission.

Trichuriasis “Whipworm”Trichuris trichiura

Asymptomatic, abdominal pain, diarrhea, rectal prolapse

Routine

Tuberculosis“TB”

Extrapulmonary, no draining

Routine MI contact, RI, and BF permitted *Assess for concurrent pulmonary tuberculosis.





Disease, Condition,





Comments


Mycobacterium tuberculosis

Tuberculosis (cont)“TB” Mycobacterium tuberculosis

lesions*Notify IPACS of all suspected or confirmed TB patients

Tuberculosis in young children is rarely infectious; assess visiting family members forcough.

**Usually considered no longer infectious after 2 weeks of effective therapy, is improving and has three consecutive sputum smears negative forAFB, collected 24 hours apartIf multidrug-resistant TB, until culture negative

Refer to Section 6 for specific information onTuberculosis

Reportable disease

Extrapulmonary, draining lesions*

Airborne Continue precautions until drainage ceased or three consecutive negative AFB smears.

Consult IPACS

Pulmonary-confirmed or suspected or laryngeal disease

Airborne Continue precautions until TB ruled out.If confirmed, until no longer considered infectious by IPACS **

Mother has TB-MI contact is not permitted until mother is no longer infectious**-Mother may provide expressed breast milk

Infant has TB (mother source)-Infant on airborne precautions with mother-MI contact, RI and BF permitted

Skin test positive with no evidence of active disease

Routine MI contact, RI and BF permitted

TularemiaFrancisella tularensis

Fever, ulcerative lesion, lymphadenopathy,

Routine No person to person spread

Notify Microbiology laboratory C-0506-14-60344 | IC05.02 Published Date: 18-Mar-2020 of 91 Review Date: 18-Mar-2023




Disease, Condition,





Comments


conjunctivitis, GI symptoms, pneumonia

before sending specimens

Reportable diseaseTyphoid Fever

See “Salmonellosis”

Typhoid Fever(cont)

Contact Adults:Until stool is formed or back to baseline for the patient.Pediatrics:Continue precautions until culture results for 3 consecutive stool specimens obtained at least 48 hours after cessation of antimicrobial therapy are negative

Reportable disease

Vancomycin-Resistant Enterococci (VRE)



Mother has VRE:- Contact precautions for mother- Contact precautions for


Refer to the infection control manual for specific information on VRE





Disease, Condition,





Comments









Infant has VRE:- Contact precautions for infant- Contact precautions for Mother- MI Contact, BF and RI

permittedVancomycin-Intermediate

Infection or colonization of any

Contact For duration of hospital

Mother has VISA/VRSA:- Contact precautions for mother





Disease, Condition,





Comments


Staphlyococcus aureus (VISA) orVancomycin-Resistant Staphylococcus aureus(VRSA)

body site - Contact precautions for newborns of positive mothers.








Infant has VISA/VRSA:- Contact precautions for infant- Contact precautions for Mother- MI Contact, BF and RI

permitted





Disease, Condition,





Comments


Varicella(Chickenpox)

See “Chickenpox”

Airborne and contact

For a minimum of 5 days after onset of rash and until all lesions are crusted which can be a week or longer in immunocompromised patient

Notify IPACS of all confirmed or suspected cases of chickenpox

Varicella Zoster(Shingles, Herpes Zoster, Zoster)

See “Shingles”


can be covered- Extensive or

localized that can not be covered

- Immunocompromised host or disseminated disease

Contact




Notify IPACS of all confirmed or suspected cases of Shingles and Herpes Zoster.

Variola Airborne and Contact

Until discontinued






Disease, Condition,





Comments


See “Smallpox” by IPACSNotify IPACS

Reportable diseaseVibrio cholerae

See “Cholera”

Contact Until discontinued by IPACS

Notify IPACS

Reportable disease

VibrioNon CholeraVibrio parahaemolyticus, Vibrio vulnificus

Gastroenteritis, wound infections and bacteriemia


Vincent’s angina(Trench mouth or acute necrotizing ulcerative gingivitis)

Acute onset of fetid breath, pain, blunting of the interdental papilla, and an ulcerative necrotic slough of the gingiva

Routine

Viral Hemorrhagic Fevers

See “Hemorrhagic Fevers” (Lassa,



Reportable disease





Disease, Condition,





Comments


Ebola, Marburg, Crimean-Congo fever viruses)

Viral warts

See “Human papilloma virus”

Routine

Whooping Cough

See “Pertussis”

Droplet and contact

Until 5 days of appropriate antimicrobial treatment has been completed.

If appropriate antimicrobial therapy is not given, until 3 weeks after the onset of cough

Reportable disease

Wound infections

See “Abscess”

Minor


Routine






Disease, Condition,





Comments


Yellow fever

See “Arthropod-borne viral fevers”

Routine Reportable disease

Yersinia enterocolitia

See “Diarrhea”


Reportable disease

Yersinia pestis

See “Plague”

BubonicFever, chills, headache, lymphadenitis,

Routine Practices

Reportable disease

Pneumonic -cough, fever, dyspneia, hemoptysis

Droplet Until 48 hours after appropriate antimicrobial treatment

Zoster

See “Herpes Zoster”


can be covered

- Extensive or localized that cannot be

Contact



Refer to Section 6 for specific information onShingles, Herpes Zoster.





Disease, Condition,





Comments


covered



Developed ByC&W Infection Control – Medical Microbiologist

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN22-Aug-2019

C-0506-14-60344 Table Of Recommended Precautions: Selected Infectious Diseases, Conditions & Microorganisms

Approved at: CW Infection Control Committee

11-Mar-2020 “ Action: C&W Infection Control added information re: COVID-1918-Mar-2020 “ Updated by C&W IPAC; Approved by Professional Practice Director





DISCLAIMERThis document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.



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