Transmission Based Precautions: Initiation and Discontinuance (1101) Addenda VI, Alphabetical Disease/Organism Listing for Transmission-Based Precautions Page 1 of 46
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: May 2016
Transmission Based Precautions (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 1 of 50
Use the table below as a guide for applying the appropriate transmission-based precautions; additional measures may be required and assessed on a case by case basis. Upper respiratory viral infections in young pediatric patients (infants through 5 years of age) require contact and droplet precautions for the duration of illness.
DISEASE/ORGANISM CATEGORY OF PRECAUTIONS
INFECTIVE MATERIAL
DURATION OF PRECAUTIONS
COMMENTS
Abscess If specific organism isolated, see specific listing for further precautions.
Draining, major Contact Drainage Duration of drainage or until contained by dressing
Major = no dressing or dressing does not adequately contain the drainage.
Draining, minor or limited; not draining
Standard Drainage Minor or limited = dressing covers the wound and adequately contains the drainage, closed drainage system adequately contains the drainage, or infected area is small such as a stitch abscess.
Acquired Immunodeficiency Syndrome (AIDS) (See Human Immunodeficiency Virus)
Actinomycosis Standard No person to person transmission.
Adenovirus Infection (See agent specific guidance under conjunctivitis, gastroenteritis, respiratory infection, pneumonia)
Droplet and Contact
Respiratory secretions and feces
Duration of hospitalization
In infants and immunocompromised patients, see Respiratory Syncytical Virus (RSV). During epidemics patients believed to have adenovirus infection may share the same room. Consult with Hospital Epidemiology at such times.
AIDS (See Human Immunodeficiency Virus Infection)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 2 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Amebiasis
Dysentery/colitis Contact Cysts in the feces
See Notifiable Diseases.
Liver abscess Standard If patient has concurrent colitis, initiate Contact
Precautions. See Notifiable Diseases.
Anthrax Bioterrorism Agent; Post-exposure prophylaxis; Consider post-exposure vaccine.
Cutaneous (skin lesions) Standard See comments
Drainage Contact Precautions if large amount of drainage that cannot be contained. Contaminated dressings and bed clothes should be incinerated or steam sterilized to destroy spores. Hand hygiene with soap and water is
preferred to alcohol-based sanitizers. See Notifiable
Diseases.
Pulmonary Standard See comments
Respiratory secretions (potentially)
See cutaneous anthrax; if patient has concurrent skin lesions. Autopsies performed on patients with systemic anthrax require special precautions. Consult with Hospital Epidemiology (1-2224) when autopsies are
necessary. See Notifiable Diseases.
Aerosolizable Spore-Containing Powder
Airborne and Contact
Spores Until environment is completely decontaminated
Wear N-95 mask or higher respiratory protection, protective clothing; decontaminate persons with powder on them. Hand hygiene for 30-60 seconds with sap and water or 2% chlorhexidine gluconate after spore contact.
See Notifiable Diseases.
Antibiotic-Associated Colitis (See Clostridium difficile)
Arthropod-borne Viral Encephalitides
Standard; Droplet for
CSF Blood
Not transmitted from person to person except rarely by transfusion and for West Nile Virus by organ transplant,
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 3 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
(Eastern, Western, and Venezuelan Equine Encephalitis; St. Louis and California Encephalitis)
Venezuelan equine encephalitis (VEE)
Throat (VEE) by breast milk or transplacentally. Instruct those living in endemic areas to install screens in windows and doors. Instruct those living in/visiting endemic areas to use DEET-containing mosquito repellents and clothing to
cover extremities. See Notifiable Diseases.
Arthropod-borne Viral Fevers (Dengue, Yellow Fever, and Colorado Tick Fever)
Standard Not transmitted from person to person except by transfusion, which rarely occurs.
Ascariasis Standard Feces Not transmitted from person to person.
Aspergillosis Standard See comments
Contact and Airborne if massive soft tissue infection with drainage and/or requiring repeated irrigations.
Avian Influenza (See Influenza)
Babesiosis Standard Blood Not transmitted from person to person except rarely by transfusion.
Bacteremia, Primary and Secondary
Standard The presence of bacteremia is not, by itself, an indication for Precautions. If a specific organism is isolated, see specific listing for further precautions. Secondary bacteremia results from infection with the same organism at another body site. See the appropriate listing by site (for example, pneumonia). Some bacteremias are
reportable; see Notifiable Diseases
Bedbugs (cimex lectularius) Contact Patient and all belongings
Duration of hospitalization
Bed bugs (Cimex lectularius) are small, flat, parasitic
insects that feed solely on the blood of people and animals while they sleep. Bedbugs are transmitted from person to person; they travel in the seams and folds of luggage and overnight bags, folded clothes, bedding, furniture, even carpeting, and anywhere else where they can hide; subsequently they infect areas as they travel. Every effort must be made to identify and isolate suspect
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 4 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
bedbug activity, and treat accordingly once confirmed. Please see the Bedbug Prevention and Response Policy #1091 in Policy Tech for more specific guidance.
Blastomycosis, North American, Cutaneous or Pulmonary
Standard Not transmitted from person to person
Botulism Standard Stool, gastric secretions, blood
Not transmitted from person to person; food borne;
potential bioterrorism agent. See Notifiable Diseases.
Bronchiolitis, Etiology Unknown in Infants and Young Children
Contact and Droplet(until etiologic agent is identified)
Respiratory secretions
Duration of illness
Various etiologic agents, such as respiratory syncytial virus, parainfluenza viruses, adenoviruses, and influenza virus, have been associated with this syndrome; therefore, Precautions to prevent the spread of these agents are generally indicated. If etiology identified, see specific listing.
Bronchitis Standard Not transmitted from person to person
Brucellosis (Undulant Fever, Malta Fever, Mediterranean Fever)
Standard; Contact if draining skin lesions or drainage devices
Pus and wound drainage
Consult Hospital Epidemiology
Typically zoonotic, but a potential bioterrorism agent; see
Notifiable Diseases. All blood, serum, and other
potentially infectious fluid or tissue must be labeled “suspect Brucella” and handled appropriately in the laboratory. Due to possible aerosolization, procedures on suspect cases require airborne precautions. May contact ID for treatment.
Burkholderia species Standard for non-CF patients; Contact for CF patients
Transmitted person to person contact; contact with contaminated environmental surfaces, patient care supplies, and environmental exposure (soil, water). If
patient has cystic fibrosis, see provisions for the Cystic
Fibrosis.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 5 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Burn Wound Infection
Staphylococcus aureus, major
Contact Pus and wound drainage
Duration of illness
Consult with Hospital Epidemiology. Major wound is > 10% of body surface area; no dressing or dressing does not contain drainage adequately.
Staphylococcus aureus,
minor
Standard Pus and wound drainage
Consult with Hospital Epidemiology. Minor wound is < 10% of body surface area or wound is covered and adequately contains drainage.
Streptococcus pyogenes (GAS, major
Contact; Droplet
Pus and wound drainage
For 24 hours after start of effective therapy
Consult with Hospital Epidemiology. Major wound is > 10% of body surface area; no dressing or dressing does not contain drainage adequately.
Streptococcus pyogenes (GAS, minor
Standard Consult with Hospital Epidemiology. Minor wound is < 10% of body surface area or wound is covered and adequately contains drainage.
For other burns (not group A strep) of less than 10% body surface area
Other bacteria Standard See Abscess.
Campylobacter Gastroenteritis (See Gastroenteritis)
Candidiasis, All Forms, Including Mucocutaneous
Standard
Cat-Scratch Disease (Benign Lymphoreticulosis)
Standard Infectious agent is a gram negative bacilli. Not transmitted from person to person.
Cellulitis If specific organism isolated, see specific listing for further precautions.
Draining, major Contact Drainage Duration of drainage
Major = large open area or inadequately contained.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 6 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Draining, minor or limited Standard Drainage
Minor or limited = dressing covers and adequately contains the drainage or infected area is very small.
Intact skin Standard
Chancroid (Soft Chancre) Standard See Notifiable Diseases.
Chikungunya Virus Standard Not transmitted from person to person except by transfusion, which rarely occurs. Transmitted rarely from mother to newborn around the time of birth.
Chickenpox (See Varicella)
Chlamydia trachomatis Infection
Conjunctivitis Standard Purulent exudate
Duration of drainage
Genital Standard Genital discharge
See Notifiable Diseases.
Respiratory Standard Respiratory secretions
Duration of illness
Cholera (See Gastroenteritis)
Closed Cavity Infection If specific organism isolated, see specific listing for further precautions.
Draining, major Contact Drainage Duration of drainage
Major = open wound inadequately contained or without a drain/closed drainage system.
Draining, minor or limited; not draining
Standard Drainage Minor or limited = dressing covers and adequately contains the drainage, closed drainage system adequately contains the drainage, or infected area is very small.
Clostridium botulinum (See Food Poisoning)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 7 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Clostridium clostridioforme
Standard
Clostridium difficile (See Gastroenteritis)
Clostridium Perfringens
Food poisoning Standard Not transmitted from person to person.
Gas gangrene Standard Drainage Rarely transmitted from person to person. Contact Precautions preferred if draining wound.
Other syndromes Standard Drainage Not transmitted from person to person.
CMV (See Cytomegalovirus Infection)
Coccidioidomycosis (Valley Fever)
Draining lesions Standard Not transmitted from person to person.
Pneumonia Standard Not transmitted from person to person.
Colorado Tick Fever Standard Blood
Common Cold
Adults Standard Respiratory secretions (potentially)
Infants and young children
Standard Respiratory secretions
Rhinoviruses, most often associated with the common cold, may cause severe infection in an infant or child. During epidemics patients with colds may be placed in the same room. Consult with Hospital Epidemiology at such times.
Congenital Rubella (See Rubella)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 8 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Conjunctivitis
Adenovirus (associated with/in infants and young children
Contact; Droplet Respiratory secretions and feces
Duration of illness
Acute bacterial (sore eye, pink eye)
Standard Purulent exudate
Chlamydial Standard Purulent exudate
Gonococcal, adults and newborns
Contact Purulent exudate
For 24 hours after start of effective therapy; duration of drainage
Place a barrier, such as a diaper or blanket, over the shoulder prior to lifting an infant to the shoulder. See
Notifiable Diseases.
Viral (acute hemorrhagic) Contact Purulent exudate
Duration of illness
Place a barrier, such as a diaper or blanket, over the shoulder prior to lifting an infant to the shoulder.
Corona virus Infection, Lower Respiratory
Non-SARS Standard Respiratory secretions (potentially)
SARS-Associated (See SARS)
Coxsackie Virus Disease (See Enteroviral Infections)
Creutzfeldt-Jakob Disease (CJD) or Variant CJD
Standard Infected tissue
Additional special precautions are necessary for handling and decontaminating items soiled with blood, body substances, and tissues from patients with confirmed or suspected disease. Consult with Hospital Epidemiology.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 9 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
No special burial procedures. See Creutzfeldt-Jakob
Disease: Infection Control Guidelines for Confirmed/
Suspected.
Crimean-Congo Fever (See Viral Hemorrhagic Fever)
Croup (See respiratory infections)
Cryptococcosis Standard Not transmitted from person to person
Cryptosporidiosis (See Gastroenteritis)
Cysticercosis Standard Not transmitted from person to person
Cytomegalovirus Infection, Neonatal or Immunosuppressed
Standard Urine and respiratory secretions (potentially)
No additional Precautions for pregnant HCWs.
Decubitus Ulcer, Infected (Pressure Ulcer/Sore)
If specific organism isolated, see specific listing for further precautions.
Major Contact Drainage Duration of drainage or until can be contained by a dressing
Major = no dressing or dressing does not adequately contain drainage.
Minor or limited Standard Drainage Minor or limited = dressing covers and adequately contains the drainage or infected area is very small.
Dengue Standard Blood Not transmitted from person to person.
Diarrhea, Acute - Infective Etiology Suspected (See Gastroenteritis)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 10 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Diphtheria
Cutaneous Contact Drainage from lesions
Until 2 cultures from skin lesions, taken at least 24 hours apart after cessation of antimicrobial therapy are negative for Corynebacterium
diphtheriae
See Notifiable Diseases.
Pharyngeal Droplet Respiratory secretions
Until 2 cultures from both nose and throat, taken at least 24 hours apart after cessation of antimicrobial therapy, are negative for Corynebacterium
diphtheriae
A private room is required. Consult with Hospital
Epidemiology. See Notifiable Diseases.
Ebola Virus (See Viral Hemorrhagic Fever)
Echinococcosis (Hydatidosis)
Standard Not transmitted from person to person
Echovirus Disease (See Enteroviral Infection)
Eczema Herpeticum (See Herpes Simplex)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 11 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Encephalitis, Encephalomyelitis, Etiology Unknown, but Infection Suspected (See also Specific Etiologic Agents; Likely Ones include Enterovirus and Arthropod-Borne Virus Infection)
Standard Feces Although specific etiologic agents can include enteroviruses, arthropod-borne viruses, and herpes simplex, Precautions for enteroviruses are generally indicated until a definitive diagnosis can be made. See
Notifiable Diseases.
Endometritis Standard, unless caused by
Streptococcus
pyogenes (see
Streptococcal Disease; Group A Streptococcus)
Enterobiasis (Pinworm Disease, Oxyuriasis)
Standard
Enterobacter aerogenes
Standard, unless multiply-resistant
If multiply resistant, see Multi Drug Resistant Organisms, MDROs, gram negative bacilli; also see provisions for the
Prevention and Control of Multiply-Resistant and Other
Epidemiologically-Significant Bacteria.
Enterobacter cloacae Standard, unless multiply-resistant
If multiply resistant, see Multi Drug Resistant Organisms, MDROs, gram negative bacilli; also see provisions for the
Prevention and Control of Multiply-Resistant and Other
Epidemiologically-Significant Bacteria.
Enterococcus Species Standard, unless vancomycin resistant
If vancomycin resistant, see Multi Drug Resistant Organisms, MDROs.
Enteroviral Infection (Coxsackie Virus Disease or
Standard; Contact for
Respiratory secretions;
Duration of illness
Most common during summer and early fall, but seasonal patterns less evident in tropical climates. Viral shedding
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 12 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Echovirus; nonpolio virus) Includes Hand, Foot and Mouth Disease
diapered or incontinent patients
feces can occur without signs of clinical illness. Respiratory shedding is limited to a week or less, but fecal shedding can continue for several weeks after onset of infection. Hand hygiene is essential, especially after diaper changing.
Epiglottitis, Due to Haemophilus influenzae, type B
Droplet Respiratory secretions
For 24 hours after start of effective therapy
Epstein-Barr Virus (EBV) Infection, Any Including Infectious Mononucleosis
Standard Patients with recent EBV infection or illness similar to infectious mononucleosis should not donate blood or solid organs.
Erythema Infectiosum (See Parvovirus B19)
Escherichia coli Gastroenteritis (See Gastroenteritis)
Extended Spectrum Beta Lactamase (ESBL) Producing Organism (See Multi-drug Resistant Organisms)
Fever of Unknown Origin (FUO)
Standard Patients with FUO do not need Transmission-Based Precautions unless they have signs and symptoms compatible with (and likely to be) a disease that requires Transmission-Based Precautions. If so, see the appropriate listing.
Fifth Disease (See Parvovirus B19)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 13 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Food Poisoning
Botulism Standard Not transmitted from person to person. See Notifiable
Diseases.
Clostridium perfringens or
Clostridium welchii
Standard Not transmitted from person to person. See Notifiable
Diseases.
Salmonellosis (See Gastroenteritis)
Standard; Contact for diapered or incontinent patients
Feces Duration of illness
See Notifiable Diseases.
Staphylococcal
Staphylococcus aureus)
Standard Not transmitted from person to person.
Furunculosis, Staphylococcal
Standard; Contact for infants and young children
Duration of illness
Not transmitted from person to person. See Staphylococcal Disease for further guidance; or Multi-Drug Resistant Organisms if resistant to methicillin.
Gangrene If specific organism isolated, see specific listing for further precautions.
Gas gangrene (due to any bacteria)
Standard Drainage
Other (diabetic, wet, dry gangrene due to any bacteria)
Standard, unless multiply-resistant
Gastroenteritis
Unknown etiology, but infectious cause suspected
Standard; Contact for diapered or incontinent patients
Feces Duration of illness
If etiology identified, see specific listing.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 14 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Adenovirus Standard; Contact for diapered or incontinent patients
Respiratory secretions and feces
Duration of illness
Aeromonas species Standard; Contact for diapered or incontinent patients
Feces
Campylobacter species Standard; Contact for diapered or incontinent patients
Feces Duration of illness
See Notifiable Diseases.
Cholera Standard; Contact for diapered or incontinent patients
Feces/Vomitus Duration of illness
See Notifiable Diseases.
Clostridium difficile Enteric Feces Duration of illness
Avoid the use of stored electronic thermometers; assess need to discontinue antibiotics; ensure consistent environmental cleaning and disinfection. Please note: Alcohol-based foam may not be effective against C. difficile – hand hygiene with soap and water is required when caring for a patient with C. difficile.
Cryptosporidium parvum
(Cryptosporidiosis)
Standard; Contact for diapered or incontinent patients
Feces Duration of illness
See Notifiable Diseases.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 15 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Cyclosporiasis Standard; Contact for diapered or incontinent patients
Feces Duration of illness
See Notifiable Diseases.
Escherichia coli
(enteropathogenic, enterotoxigenic, enterohemorrhagic 0157:H7, or enteroinvasive)
Standard; Contact for diapered or incontinent patients
Feces Duration of illness
Invasive Escherichia coli 0157:H7 is a reportable disease
(see Notifiable Diseases). Invasive is defined as bacteria
isolated from blood, bone, cerebrospinal fluid, joint, pericardial fluid, peritoneal fluid, or pleural fluid.
Giardia lamblia (Giardiasis)
Standard; Contact for diapered or incontinent patients
Feces Duration of illness
See Notifiable Diseases.
Isosporiasis Standard; Contact for diapered or incontinent patients
Feces Duration of illness.
Microsporidia Standard; Contact for diapered or incontinent patients
Feces Duration of illness
Noroviruses (including Norwalk)
Enteric Feces/Vomitus Duration of illness
Special procedures required. Notify Epidemiology (1-2224). Ensure consistent environmental cleaning and disinfection; persons who clean areas contaminated with feces and vomitus should wear masks. Alcohol-based sanitizers may be less effective; hand hygiene with soap and water is required.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 16 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Rotavirus Contact Feces Duration of illness
Prolonged viral shedding may occur in both the immunocompetent and immunocompromised and the elderly. For an infant in NICU, repeat stool cultures in 3 weeks if still an inpatient. If the results are positive at 3 weeks, continue Contact Precautions and repeat the rotazyme test every week or two until it is negative. Ensure consistent environmental cleaning and disinfection and frequent removal of soiled diapers.
Salmonella species (including
S. typhi) (See Typhoid Fever for additional precautions)
Standard; Contact for diapered or incontinent patients
Feces Duration of illness
See Notifiable Diseases.
Shigella species Standard; Contact for diapered or incontinent patients
Feces
Duration of illness
Alcohol based sanitizers may be less effective; hand hygiene wit sap and water is recommended. See
Notifiable Diseases.
Vibrio parahaemolyticus Standard; Contact for diapered or incontinent patients
Feces Duration of illness
See Notifiable Diseases
Viral Standard; Contact for diapered or incontinent patients
Feces Duration of illness
Yersinia enterocolitica Standard; Contact for diapered or
Feces Duration of illness
In infants, consider contamination (direct or indirect) of pacifiers, bottles and/or formula with raw pork. See
Notifiable Diseases
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 17 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
incontinent patients
German Measles (See Rubella)
Giardiasis (See Gastroenteritis)
Gonococcal Ophthalmia Neonatorium (Gonorrheal Ophthalmia, Acute Conjunctivitis of the Newborn)
Standard Purulent exudate
Place a barrier, such as a diaper or blanket, over the shoulder prior to lifting an infant to the shoulder. See
Notifiable Diseases.
Gonorrhea Standard
Discharge (potentially)
See Notifiable Diseases.
Granulocytopenia Standard Private room is required. Use Compromised Host/Neutropenic Precautions.
Granuloma Inguinale (Donovaniasis, Granuloma Venereum; Due to Calymmatobacterium)
Standard
Drainage (potentially)
Guillian-Barré Syndrome Standard Not an infectious condition
Hand, Foot and Mouth Disease (See Enteroviral Infection)
Hantavirus Pulmonary Syndrome
Standard
Not transmitted from person to person. See Notifiable
Diseases.
Helicobacter pylori Standard
Hemorrhagic Fevers (See Viral Hemorrhagic Fever)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 18 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Hepatitis, Viral See Notifiable Diseases and related Employee Health
policies.
Type A (infectious hepatitis)
Standard; Contact for diapered or incontinent patients
Feces See comments Hepatitis A is most contagious before hepatitis symptoms and jaundice appears. Maintain Precautions for infants < 3 years of age for the duration of hospitalization; in children 3 to 14 years of age, until 2 weeks after onset of symptoms; and in others, for one week after onset of
symptoms. See Notifiable Diseases.
Type B (serum hepatitis), hepatitis B surface antigen (HbsAg) positive; acute or chronic
Standard
Blood and body substances
See Notifiable Diseases and related Employee Health
policies.
Type C; Acute (and other unspecified non-A, non-B
Standard
Blood and body substances
See Notifiable Diseases and related Employee Health
policies.
Type D (seen only with hepatitis B)
Standard Blood and body substances
Type E Standard; Contact for diapered or incontinent patients
Feces Duration of illness
Type G Standard
Herpangina (See enteroviral infections)
Herpes Simplex (Herpesvirus hominis)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 19 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Eczema herpeticum Contact Drainage from lesions
Duration of illness
Encephalitis Standard
Mucocutaneous, disseminated or primary, severe primary skin, oral, and genital)
Contact Drainage from lesions
Until lesions are dry and crusted
Mucocutaneous, recurrent (skin, oral, and genital)
Standard Drainage from lesions
Neonatal Contact Drainage from lesions
Duration of illness
Included are infants born with active disease or those who are delivered to women with active genital herpes at the time of delivery (vaginal deliveries and Cesarean sections done within 4 to 6 hours after membranes rupture) until surface cultures obtained at 24-36 hours after birth and remain negative after 48 hours of incubation.
Pneumonia
Contact Respiratory secretions
Duration of therapy
Herpes Zoster (Shingles; Varicella zoster)
Localized in immunocompromised patient until dissemination ruled out, or disseminated in all patients
Airborne and Contact
Lesion and respiratory secretions
Duration of illness
A private, negative pressure room is required. If a negative pressure room is not available, consult Hospital Epidemiology. The door to the room remains closed at all times. Restrict susceptible persons from entering the room. An N-95 mask is donned before entering the room and removed after leaving the room regardless of immunity. Susceptible HCWs should not enter the room if other HCWs are available (including non-immune pregnant HCWs). Exposed susceptible patients are placed on Airborne and
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 20 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Contact Precautions beginning 8 days after the first day of exposure and continuing for 21 days after the last day of exposure; 28 days if varicella-specific immunoglobulins is
given. See Preadmission Communicable Diseases Screening
of Children. Consult with Hospital Epidemiology (1-2224). See Varicella zoster for information on exposed HCWs.
Localized in other, nonimmunocompromised patients with lesions that can be contained/covered
Standard
Lesion secretions
Duration of illness
Roommates should not be susceptible; Susceptible HCWs should not provide direct patient care when other immune caregivers are available.
Hidradenitis Suppurativa Standard See “Abscess, major, draining”.
Histoplasmosis Standard Not transmitted from person to person
HIV (See Human Immunodeficiency Virus)
Hookworm Disease (Ancylostomiasis, Uncinariasis)
Standard; Contact for diapered or incontinent patients
Feces Not transmitted from person to person.
Human Herpes 6 and 7 (including Roseola, exanthema subitum, sixth disease)
Standard Respiratory secretions (potentially)
Human Immunodeficiency Virus (HIV) Infection
Standard Blood and body substances
Use caution when handling articles contaminated with blood and body substances. Take special care to avoid being injured by a needle or other sharp or being splashed by body substances to conjunctivae or mucous
membranes. See Standards for Employee and Student
Health. If a patient’s hygiene is poor, a private room is
indicated. If the patient is critically ill, hemorrhaging, or having multiple invasive bedside procedures, a private
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 21 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
room or adequate distance (at least 7 feet) between patients is required. All HIV-infected patients who are > 12 years of age with an undiagnosed pneumonia require Airborne Precautions until tuberculosis is diagnosed and treated or is ruled-out. Post exposure chemoprophylaxis
for high risk blood exposures. See Notifiable Diseases.
Human Metapneumovirus Contact Respiratory secretions
Duration of illness
Wear masks according to Standard Precautions. Private room is preferred or cohort patients as necessary.
Impetigo Contact Drainage from lesions
For 24 hours after start of effective therapy
Infectious Mononucleosis Standard Respiratory secretions (potentially)
Influenza
Seasonal Droplet Respiratory secretions (potentially)
5 days from onset of symptoms except for the immuno-compromised patient, which will be duration of illness
Private room is preferred when available or cohort
patients as necessary (See Grouping Patients with the
Same Infections). Avoid placement with high-risk
patients. Mask patient when transporting out of room. Duration of precautions for immunocompromised patients cannot be defined; prolonged duration of viral shedding has been observed. See Respiratory Infectious Disease, infants and young children for additional precautions.
Avian (H5N1, H7, H9 Strains)
Airborne and Contact
Respiratory secretions (potentially
14 days from onset of symptoms or until alternate diagnosis is established or
Private room is preferred when available or cohort patients
as necessary (See Grouping Patients with the Same
Infections). HEPA filter may be used if negative pressure
room is not available. N-95 mask (surgical mask if N-95 is not available) is required. Eye protection (goggles) is required when within 3 feet of the patient. Human-to-
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 22 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
until diagnostic test results indicate that the patient is not infected H5N1, H7, or H9 strains
human transmission is inefficient and rare, but the risk of reassortment with human influenza strains and the emergence of a pandemic strain is of serious concern. See www.cdc.gov/flu/avian/professional/infect-control.htm for current avian influenza guidance.
Pandemic Droplet Respiratory secretions (potentially
5 days from onset of symptoms and duration of illness for the immuno-compromised patients
Private room is preferred when available or cohort
patients as necessary (See Grouping Patients with the
Same Infections). See www.pandemicflu.gov for current
pandemic influenza guidance.
Isosporiasis (See Gastroenteritis)
Kawasaki Syndrome Standard Not an infectious condition.
Keratoconjunctivitis, Infective
Contact Purulent exudate
Duration of drainage
Lassa Fever (See Viral Hemorrhagic Fever)
Legionnaire’s Disease (Legionellosis)
Standard Not transmitted from person to person. See Notifiable
Diseases.
Leprosy Standard Nasal secretions and drainage from lesions
Leptospirosis Standard Blood and urine
Not transmitted from person to person. See Notifiable
Diseases.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 23 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Lice (Head [Pediculosis] Body, and Pubic)
Contact Infected areas (head/hair, body, pubic area)
For 24 hours after start of effective therapy and complete nit removal with nit comb
Lice infest others by direct and indirect hair to hair contact; lice do not fly. Avoid direct contact such as hugging children. Usual hygiene and housekeeping practices remove adult lice. Plasticized mattresses and pillows prevent bed infestation in the hospital. A private room is desirable before and during therapy.
Listeriosis Standard Person to person transmission. See Notifiable Diseases.
Lower Respiratory Tract Disease, Acute (See Respiratory Infectious Disease)
Lyme Disease Standard Not transmitted from person to person. See Notifiable
Diseases.
Lymphocytic Choriomeningitis
Standard Not transmitted from person to person. Pet rodents or wild mice in patient’s home should be considered likely sources of infection.
Lymphogranuloma Venereum
Standard Drainage (potentially)
See Notifiable Diseases.
Malaria Standard Blood Not transmitted from person to person except rarely through transfusion. Instruct travelers to endemic areas to use DEET-containing mosquito repellent and clothing
to cover extremities. See Notifiable Diseases.
Marburg Virus Disease (See Viral Hemorrhagic Fever)
Measles, All Presentations (See Rubeola)
Melioidosis, All Forms Standard Respiratory secretions and drainage from a
Not transmitted from person to person
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 24 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
sinus tract (potentially)
Meningitis
Etiology unknown, but bacterial cause suspected
Droplet Respiratory secretions
For 24 hours after start of effective therapy
If etiology identified, see specific listing. See Notifiable
Diseases.
Aseptic (nonbacterial or viral meningitis) (See also specific etiologies)
Standard; Contact for infants and young children
Feces Duration of illness
Enteroviruses are the most common cause of aseptic
meningitis. See Notifiable Diseases.
Gram negative enteric rods in neonates
Standard
During a nursery outbreak, cluster or cohort infected or colonized infants, use gown if soiling with feces is likely, and use gloves if touching feces. Hospital Epidemiology
coordinates the cohorting plan. See Notifiable Diseases.
Fungal Standard See Notifiable Diseases.
Haemophilus influenzae,
type B known or suspected
Droplet Respiratory secretions
For 24 hours after start of effective therapy
See Notifiable Diseases.
Listeria monocytogenes Standard Not transmitted from person to person. See Notifiable
Diseases.
Neisseria meningitidis
(meningococcal), known or suspected
Droplet Respiratory secretions
For 24 hours after start of effective therapy
See Standards for Employee and Student Health and
Notifiable Diseases.
Pneumococcal, penicillin-
susceptible (Streptococcus
Standard Penicillin resistance may be “relative” or “absolute”. Consider resistant if minimal inhibitory concentration
(MIC) for penicillin is > 0.1 mcg/ml. See Notifiable
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 25 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
pneumoniae) Diseases.
Pneumococcal, penicillin-
resistant (Streptococcus
pneumoniae)
Droplet Respiratory secretions
For 24 hours after start of effective therapy
See Notifiable Diseases.
Tuberculosis
Standard Concurrent active pulmonary disease or draining cutaneous lesions necessitate Airborne Precautions. If pulmonary tuberculosis is present, see listing for
Mycobacteria, tuberculosis. See Notifiable Diseases.
Other diagnosed bacterial causes
Standard See Notifiable Diseases.
Meningococcal Disease (sepsis, pneumonia, meningitis)
Droplet Respiratory secretions
For 24 hours after start of effective therapy
See Standards for Employee and Student Health and
Notifiable Diseases.
Methicillin-Resistant Staphylococcus aureus (MRSA) (See Multi-Drug Resistant Organisms-MDROs)
Microspordia (See Gastroenteritis)
Molluscum Contagiosum Standard Contact Precautions may be implemented during outbreak situations.
Monkeypox Airborne and Contact
Lesions possibly respiratory secretions
Until lesions are crusted and until smallpox is excluded
Pre and post-exposure smallpox vaccine recommended for exposed HCWs. Consult with Hospital Epidemiology (1-2224). See www.cdc.gov/ncidod/monkeypox for most current guidelines.
Mononucleosis, Infectious (See Epstein-Barr Virus)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 26 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Mucormycosis Standard In outbreaks, clustering or cohorting of infected and colonized patients may be indicated. Such efforts are coordinated by Hospital Epidemiology.
Multi-Drug Resistant Organisms (MDROs)
See Prevention and Control of Multiply-Resistant,
Epidemiologically-Significant Bacteria for all of the
following MDROs.
Carbapenem Resistant
Enterobacteriaceae (CRE) (KPC Producing Organisms)
Expanded Contact
Infected areas (blood, urine, respiratory secretions, and wound drainage). Colonized persons shed from lower intestinal tract.
Duration of hospitalization, and all subsequent encounters
Carbapenem-resistant Enterobacteriaceae (CRE) are usually resistant to all β-lactam agents as well as most other classes of antimicrobial agents. Outbreaks of CRE have been reported; patients colonized with CRE are thought to be a source of transmission in the healthcare setting. When identified, patients are coded “CRE” in the hospital’s information system.
Extended Spectrum Beta Lactamase (ESBL) producing Organisms
Contact Infected areas (blood, urine, respiratory secretions, and wound drainage)
Duration of hospitalization and all subsequent encounters
ESBLs are enzymes that mediate resistance to extended-spectrum (third generation) cephalosporins (e.g., ceftazidime, cefotaxime, and ceftriaxone) and monobactams (aztreonam) but do not affect cephamycins (cefoxitin and cefotetan) or carbapenems (meropenem or imipenem). When identified, patients are coded “ESB” in the hospital’s information system.
Gram Negative Bacilli (GNB), multiply resistant
Contact Infected areas (blood, urine, respiratory secretions, and wound drainage)
Duration of illness
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 27 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Methicillin-Resistant
Staphylococcus aureus
(MRSA)
Contact; Droplet for tracheitis and pneumonia
Infected areas (blood, urine, respiratory secretions, wound drainage, and skin lesions/ infections). Colonized persons shed from nares, axilla, groin, and skin.
Duration of hospitalization and subsequent encounters
In outbreaks, clustering or cohorting of infected and colonized patients may be indicated. Such efforts are coordinated by Hospital Epidemiology. When MRSA infected or colonized patients are identified, these patients are coded in the hospitals information system. The code "SI" represents methicillin-resistant
coagulase positive Staphylococcal Infections/colonizations.
This code is reflected on the patient’s label and appropriate computer fields. Inpatients, outpatients, HCWs, faculty, and students are coded in the same manner.
Vancomycin Intermediate and Resistant Staphylococcus aureus (VISA/VRSA)
Contact Infected areas (blood, urine, respiratory secretions, wound drainage, and skin lesions/ infections). Colonized persons shed from nares, axilla, groin, and skin.
Until culture is negative of the original site and 3 negative stool or rectal cultures each one week apart
Private room is required. In outbreaks, clustering or cohorting of infected and colonized patients may be indicated. Such efforts are coordinated by Hospital Epidemiology. The number of HCWs entering the room should be limited. Nursing assignment should be limited to this patient only. The nurse and/or the physician should perform all phlebotomy, vital signs, and distribution of meal trays, and other similar tasks. See
the provision: Guidelines for Vancomycin-Intermediate
Staphylococcus aureus (VISA) and Vancomycin-Resistant
Staphylococcus aureus (VRSA). When identified, patients
are coded “VIS” or “VRS” in the hospital’s information system.
Vancomycin-Resistant
Enterococcus - VRE (See
Enterococcus Species)
Contact Infected areas (blood, urine, respiratory secretions, and wound drainage).
Until culture is negative of the original site and 3 negative stool or rectal cultures each
In outbreaks, clustering or cohorting of infected and colonized patients may be indicated. Such efforts are coordinated by Hospital Epidemiology. When VRE infected or colonized patients are identified, these patients are coded in the hospitals information
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 28 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Colonized persons shed from lower intestinal tract.
one week apart system. The code "VRE" represents Vancomycin-Resistant Enterococcus infections/colonizations. This code is reflected on the patient’s label and appropriate computer fields. Inpatients, outpatients, HCWs, faculty, and students are coded in the same manner.
Mumps (Infectious Parotitis)
Droplet Respiratory secretions
For 9 days after onset of swelling
Susceptible HCWs should not provide care if immune caregivers are available. Exposed susceptible patients require Droplet Precautions beginning 10 days after the first day of exposure and continuing for 25 days after the
last day of exposure. See Preadmission Communicable
Diseases Screening of Children and Notifiable Diseases.
Mycobacteria, Nontuberculosis; Atypical
Pulmonary/Blood Standard Not transmitted person to person.
Wound Standard
Mycobacteria, Tuberculosis (TB)
For infants and children, use Airborne Precautions until active pulmonary tuberculosis in visiting household contacts/family members has been ruled out.
Extrapulmonary, draining lesion (including scrofula and Pott's disease, if draining)
Airborne and Contact
Drainage When patient is improving clinically and drainage has ceased or there are 3 consecutive negative cultures of continued drainage
Examine for evidence of active pulmonary tuberculosis.
Extrapulmonary, no draining lesions, meningitis
Standard Examine for evidence of active pulmonary tuberculosis.
See Notifiable Diseases.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 29 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Extrapulmonary, urinary Standard Examine for evidence of active pulmonary tuberculosis.
See Notifiable Diseases.
Laryngeal, miliary, pulmonary, confirmed or suspected (sputum smear positive for acid fast bacilli (AFB) or chest x-ray suggestive of current, active disease, such as when a cavitary lesion is found)
Airborne Airborne nuclei Discontinue only when patient is on effective therapy and is clinically improving and has 3 consecutive sputum smears negative for AFB collected on separate days
A negative pressure room is required. The door to the room remains closed at all times. N-95 masks are required to enter the room; a mask is donned before entering the room and removed after leaving the room.
See Standards for Employee and Student Health and
Notifiable Diseases.
Skin test positive with no evidence of current laryngeal, miliary, or pulmonary disease
Standard
See Notifiable Diseases.
Mycoplasma Pneumonia Droplet Respiratory secretions
Duration of illness
A private room is preferred for children.
Necrotizing Enterocolitis (NEC)
Standard Feces (potentially)
See specific listing for infectious etiologies. For possible epidemics, clustering or cohorting of infected infants along with Contact Precautions may be necessary. Such efforts are coordinated by Hospital Epidemiology.
Staphylococcus aureus (See Staphylococcal Disease; enterocolitis)
Neisseria meningitidis
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 30 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
(See Meningococcal Disease)
Neutropenia Standard Private, positive-pressure room is required. Use Compromised Host/Neutropenic Precautions.
Nocardiosis (draining lesions or other presentations)
Standard Not transmitted person to person.
Norwalk Agent; Norovirus (See Gastroenteritis)
Orf Standard Drainage (potentially)
Pappillomavins Standard
Paracoccidoidonmycosis Standard
Paragonimiasis Standard
Parainfluenza Virus Infection, Lower Respiratory in Infants and Young Children
Droplet and Contact
Respiratory secretions
Duration of illness
Parainfluenza may cause colds. During epidemics, patients believed to have parainfluenzae infections may be placed in the same room. Consult with Hospital Epidemiology at such times.
Parotitis, Infectious (See Mumps)
Parvovirus B19
Erythema Infectiosum Fifth Disease)
Droplet Respiratory secretions
Duration of illness
Transmitted through contact with infected persons, fomites, and large droplets. Infectious before the appearance of a rash. For pregnant HCWs, please see Employee Health policies.
Aplastic/Erythrocyte Crisis (In patient with hemolytic anemia)
Droplet Respiratory secretions
For 7 days after onset of crisis
For pregnant HCWs, please see Employee Health policies.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 31 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Immunocompromised Host who are known or suspected to be chronically infected
Droplet Respiratory secretions
Duration of hospitalization
Duration of precautions for immunosuppressed patients with persistently positive PCR not defined by the CDC
Pediculosis (See Lice)
Pelvic Inflammatory Disease
Standard
Pertussis, Bordatella (Whooping Cough)
Droplet Respiratory secretions
For 5 days after start effective therapy or until 3 weeks after onset of paroxysms in older patients who did not receive appropriate therapy
Place patient in a private room; cohorting is acceptable f private room is unavailable. Post-exposure chemoprophylaxis for household contacts and HCWs with prolonged exposure to respiratory secretions is recommended. Report all exposures immediately to
Hospital Epidemiology (1-2224). See Notifiable Diseases.
Pharyngitis, Etiology Unknown
Adults Standard Respiratory secretions (potentially)
Infants and young children
Droplet Respiratory secretions
For 24 hours after start of effective therapy
During epidemics, patients believed to have pharyngitis due to adenoviruses, influenza viruses, and parainfluenza viruses may share the same room. Consult with Hospital Epidemiology at such times.
Suspected streptococcal, group A, any age
Droplet Respiratory secretions
For 24 hours after start of effective therapy
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 32 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Pinworm Infection (Enterobiasis)
Standard Handle bed linen and under clothing carefully without shaking; laundry promptly.
Plague (Yersinia pestis)
Bubonic Standard Drainage Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification. See Hospital Emerging Infections Policy.
Pneumonic Droplet Respiratory secretions
For 48 hours after start of effective therapy
Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification. See Hospital Emerging Infections Policy. Antimicrobial prophylaxis for exposed HCWs.
Pleurodynia Contact Feces For 7 days after onset
Enteroviruses frequently cause infection.
Pneumonia All HIV-infected patients who are > 12 years of age with an undiagnosed pneumonia require Airborne Precautions until tuberculosis is diagnosed and treated or ruled-out.
Adenovirus Droplet and Contact
Respiratory secretions
Duration of illness
Extend duration of droplet and contact precautions in immunocompromised patients due to prolonged shedding of the virus.
Bacterial not listed elsewhere (including gram negative bacteria)
Standard Respiratory secretions (potentially)
When cross infection in an intensive care unit occurs, clustering or cohorting and Contact Precautions may be indicated. Such efforts are coordinated by Hospital Epidemiology.
Burkholderia cepacia
Standard for non-CF patients; Contact for CF patients, including respiratory tract colonizations
Respiratory secretions
Duration of hospitalization
Transmitted person to person contact; contact with contaminated environmental surfaces, patient care supplies, and environmental exposure (soil, water). If
patient has cystic fibrosis, see provisions for the Cystic
Fibrosis. Avoid clustering, cohorting, or placing a patient
in the same room with a cystic fibrosis patient.
Chlamydial Standard Respiratory Duration of
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 33 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
secretions illness
Cytomegalovirus (CMV) Standard
Etiology unknown Maintain Precautions indicated for the etiology that is most likely.
Fungal Standard
Haemophilus influenzae ,
type B pneumonia in adults
Standard Respiratory secretions
Haemophilus influenzae
pneumonia in infants and children of any age
Droplet Respiratory secretions
For 24 hours after start of effective therapy
Herpes Contact Respiratory secretions
Duration of therapy
Influenza (See Influenza)
Legionella pneumophila Standard See Notifiable Diseases.
Mycoplasma (primary
atypical pneumonia, Eaton agent pneumonia)
Droplet Respiratory secretions (potentially)
Duration of illness
Neiserria meningitidis
(See Meningococcal Disease)
Pneumococcal Standard Use Droplet Precautions if evidence of transmission within a patient care unit or facility.
Pneumocystis carinii Standard Avoid placement in the same room with an immunocompromised patient.
Staphylococcal aureus ,
methicillin susceptible
Droplet Respiratory secretions
For 24 hours after start of effective therapy
Droplet Precautions should be maintained throughout illness for MSSA tracheitis with a tracheostomy tube in place.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 34 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Staphylococcal aureus ,
methicillin resistant
Droplet and Contact
Respiratory secretions
Duration of illness (to include colonization)
Droplet Precautions should be maintained throughout illness for MRSA tracheitis with a tracheostomy tube in place. See chapter six of the Infection Control Manual
(MDRO’s),
Streptococcus, β- hemolytic, group A
(Streptococcus pyogenes)
Droplet Respiratory secretions
For 24 hours after start of effective therapy
Contact Precautions are required if skin lesions are present.
Streptococcus pneumoniae,
penicillin-resistant (known or suspected)
Droplet Respiratory secretions (potentially)
For 24 hours after start of effective therapy
Penicillin resistance may be “relative” or “absolute”. Consider resistant if minimal inhibitory concentration
(MIC) for penicillin is > 0.1 mcg/ml. See Notifiable
Diseases.
Varicella (See Varicella)
Viral pneumonia, adults (See also specific etiologic agents)
Standard
Respiratory secretions (potentially)
Viral pneumonia, infants and children (See also specific etiologic agents)
Droplet and Contact
Respiratory secretions
Duration of illness
Viral pneumonia may be caused by various viruses such as parainfluenza, influenza, and respiratory syncytial virus, in children < 5 years of age. Viral pneumonia can result in significant lower respiratory disease. Precautions to prevent spread of these viruses are indicated.
Poliomyelitis Contact Duration of illness
See Notifiable Diseases.
Pseudomonas aeruginosa Standard, unless multiply-resistant
See chapter six of the Infection Control Manual (MDRO’s),
and if patient has cystic fibrosis, see provisions for the
Cystic Fibrosis.
Psittacosis (Ornithosis)
Standard Respiratory secretions (potentially)
Not transmitted from person to person. See Notifiable
Diseases.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 35 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Q Fever Standard Respiratory secretions (potentially)
Potential bioterrorism agent. Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification.
Rabies Standard Respiratory secretions (potentially)
Duration of illness
If has bitten another individual or saliva has contaminated an open wound or mucous membranes, wash exposed area thoroughly and administer post-exposure prophylaxis. Special procedures are required for specimen collection and transport. Consult with Hospital
Epidemiology (1-2224). See Notifiable Diseases.
Rat-Bite Fever (Streptobacillus moniliformis Disease, Spirillum minus Disease)
Standard Blood
Relapsing Fever (Borrela Infections)
Standard; Contact if louse infestation
Blood
Resistant Bacteria (See Multi Drug Resistant Organisms, MDROs)
Examples: Gram Negative Bacilli (Acinetobacter,
Pseudomonas, Serratia, Enterobacter), ESBL, MRSA, VRE.
Respiratory Infectious Disease, Acute
If specific organism isolated, see specific listing for further precautions.
Adult Standard Respiratory secretions (potentially)
Infants and young children Droplet and Contact
Respiratory secretions
Duration of illness
Including croup.
Respiratory Syncytial Virus (RSV) Infection, in Infants and Young Children, and Immunocompromised
Contact and Droplet
Respiratory secretions
Duration of illness
RSV may cause colds. During epidemics, patients believed to have RSV infection may share the same room. Consult with Hospital Epidemiology at such times. Extend duration of precautions for immunocompromised
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 36 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Adults
patients due to prolonged viral shedding. Discontinuing Contact Precautions: 1) If a patient is on ribovarin, after 5 days of therapy and one negative antigen test, Precautions can be discontinued; 2) if a patient is not on ribavirin, one negative antigen test is required to discontinue the Precautions; 3) the length of time between the initiation of the Precautions and the need to discontinue the Precautions does not matter; one negative antigen test is still required; a patient can shed the virus for a very long time; and 4) the age of the child is not significant.
Reye's Syndrome Standard Not an infectious condition.
Rheumatic Fever
Standard Not an infectious condition.
Rhinovirus Infection, Lower Respiratory
Adults Droplet Respiratory secretions
Duration of illness
Outbreaks have occurred in LTCFs. Add Contact Precautions if copious moist secretions and close contact likely to occur.
Infants and young children Droplet and Contact
Respiratory secretions
Duration of illness
Outbreaks have occurred in NICUs.
Rickettsial Fever, Tickborne (Rocky Mountain Spotted Fever, Tickborne Typhus Fever)
Standard Not transmitted from person to person except rarely
through transfusion. See Notifiable Diseases.
Rickettsialpox (Vesicular Rickettsiosis)
Standard Not transmitted person to person.
Ringworm (See Tinea)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 37 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Ritter’s Disease (See Staphylococcal Disease, Scalded Skin Syndrome)
Rocky Mountain Spotted Fever (See Rickettsial Fever)
Roseola Infantum (See Human Herpes 6 & 7)
Rotavirus Infection (See Gastroenteritis)
RSV (See Respiratory Syncytial Virus)
Rubella
German Measles Droplet Naso-pharyngeal/ Respiratory secretions
For 7 days after onset of rash
Susceptible HCWs should not enter the room if immune caregivers are available. Masks should be worn regardless of immune status. See related polices for employee/ student health for information on the rubella titer and immunization. All exposures should be reported to Hospital Epidemiology (1-2224). Exposed susceptible patients require Droplet Precautions beginning 5 days after the first day of exposure and continuing until 21
days after the last day of exposure. See Preadmission
Communicable Diseases Screening of Children and
Notifiable Diseases.
Congenital Contact Naso-pharyngeal/ Respiratory secretions and urine
During any admission for first year after birth unless nasopharyngeal and urine
Susceptible HCWs should not enter the room if immune caregivers are available. All PPE should be worn according to Standard and Contact Precautions. See related polices for employee/student health. Also, see
Notifiable Diseases.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 38 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
cultures after 3 months of age are negative for rubella
Rubeola, All Presentations (including Red Measles)
Airborne Respiratory secretions
4 days after the onset of rash and duration of illness in immuno-compromised patients
Wear N-95 masks regardless of immune status. Restrict susceptible persons from entering room of known or suspected patients if other HCWs are available. Exposed susceptible patients require Airborne Precautions beginning 5 days after the first day of exposure and continuing until 21 days after the last day of exposure. Post exposure vaccine may be given within 72 hours of exposure or immune globulin within 6 days after
exposure. See Preadmission Communicable Diseases
Screening of Children and Notifiable Diseases. Consult
with Hospital Epidemiology (1-2224).
Salmonellosis (See Gastroenteritis)
Scabies Contact Infected area For 24 hours after start of effective therapy
Mites burrow under the patient's skin and are not visible. Mites infest others by direct body to body contact. Use gloves to touch infested areas. Usual hygiene and housekeeping practices kill mites that may emerge. Plasticized mattresses and pillows prevent bed infestation in the hospital. A private room is desirable for ambulatory pediatrics before and during therapy.
Scalded Skin Syndrome, Staphylococcal; Ritter's Disease (See Staphylococcal Disease)
Scarlet Fever (See Streptococcal Disease)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 39 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Schistosomiasis (Bilharziasis)
Standard
Serratia marcescens Standard, unless multiply-resistant
If multiply resistant, see Multi Drug Resistant Organisms, MDROs, gram negative bacilli; also see chapter six (MDRO’s) of the infection control manual
Severe Acute Respiratory Syndrome (SARS) (including associated Corona virus)
Airborne and Contact; Droplet under certain conditions-see comments
Respiratory secretions
Duration of illness plus 10 days after resolution of fever, provided respiratory symptoms are absent or improving
Airborne Precautions preferred; droplet if negative pressure room not available. N-95 or higher respiratory protection; surgical mask if N-9t not available due to overwhelming surge capacity. Eye protection (goggles) is required. Aerosol generating procedures and “super shedders” highest risk for transmission via small droplet nuclei and large droplets. Environmental disinfection is extremely important in limiting transmission. Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification.
Shigellosis, Including Bacillary Dysentery (See Gastroenteritis)
Shingles (See Herpes Zoster)
Smallpox (Variola) Airborne and Contact
Respiratory secretions and drainage from lesions
Duration of illness (until all scabs have crusted and separated, typically 3-4 weeks)
Potential bioterrorism agent. Since the virus has not been eradicated and is quarantined in certain research laboratories, the potential exists for cases to occur. Non-vaccinated HCWs should not provide care when immune HCWs are available. A negative pressure room is required. An N-95 mask or higher respiratory protection is required for all HCWs. Potential bioterrorism agent. Notify Hospital Epidemiology as requires immediate public health notification. Post exposure vaccine may be given within 4 days of exposure.
Spirillum minus Disease Standard Blood Not transmitted person to person.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 40 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
(Rat-Bite Fever)
Sporotrichosis Standard
Staphylococcal Disease (Staphylococcus aureus)
Staphylococcus aureus is reported as coagulase positive
staphylococcus. Staphylococcus epidermidis, or coagulase
negative staphylococcus (CNS), does not require Transmission-Based Precautions, even if methicillin-resistant.
Skin, wound, or burn - major
Contact Pus Duration of illness
No dressing or the dressing does not contain drainage adequately.
Skin, wound, or burn - minor, limited, or not draining
Standard Dressing adequately covers and contains drainage
Enterocolitis Standard; Contact for diapered or incontinent patients
Feces Duration of illness
Multi-Drug Resistant (See Multi Drug Resistant Organism, MDROs)
Pneumonia Droplet Droplet and Contact if methicillin resistant (MRSA)
Respiratory secretions
For 24 hours after start of effective therapy Duration of illness (to include colonization)
Droplet Precautions should be maintained throughout illness for MSSA/MRSA tracheitis with a tracheostomy tube in place. See Chapter 6 MDRO in the Infection Control Manual
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 41 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Scalded skin syndrome (Ritters Disease)
Contact Drainage from lesions
Duration of illness
HCWs are potential sources in nursery and NICU outbreaks.
Toxic shock syndrome Standard; Contact if drainage present
Discharge and/or purulent drainage
Duration of drainage
See Notifiable Diseases.
Staphylococcus epidermidis, methicillin-resistant (MRSE)
Standard Staphylococcus epidermidis is reported as staphylococcus coagulase negative (SCN). Further precautions may be deemed necessary by Hospital Epidemiology if presents in a high risk population in an outbreak or if there is increasing vancomycin resistance.
Stenotrophomonas maltophilia
Contact for cystic fibrosis patients
If multiply resistant, see Multi Drug Resistant Organisms, MDROs, gram negative bacilli; also see chapter six of the Infection Control Manual
Streptobacillus moniliformis Disease (Rat-Bite Fever)
Standard Blood Not transmitted from person to person
Streptococcus pneumoniae Invasive Streptococcus pneumoniae (penicillin susceptible
or resistant) is a reportable disease; see Notifiable
Diseases. Invasive is defined as bacteria isolated from a
normally sterile site, such as blood, bone, cerebrospinal fluid, joint, pericardial fluid, peritoneal fluid, pleural fluid, protected bronchial sampling, lung aspirate/biopsy, or other biopsy.
Penicillin Susceptible Standard
Penicillin Resistant Droplet For 24 hours after start of effective therapy
Streptococcal Disease Reportable disease if invasive. Invasive is defined as
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 42 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
(Group A Streptococcus) bacteria isolated from a normally sterile site, such as blood, bone, cerebrospinal fluid, joint, pericardial fluid, peritoneal fluid, pleural fluid, protected bronchial sampling, lung aspirate/biopsy, or other biopsy. See
Notifiable Diseases.
Endometritis (puerperal sepsis)
Contact Vaginal discharge
For 24 hours after start of effective therapy
Pharyngitis Droplet Droplet and Contact for infants and young children
Respiratory secretions
For 24 hours after start of effective therapy
Pneumonia Droplet Droplet and Contact for infants and young children
Respiratory secretions
For 24 hours after start of effective therapy
Scarlet fever Droplet Droplet and Contact for infants and young children
Respiratory secretions
For 24 hours after start of effective therapy
Skin infection, wound, or burn, major
Droplet and Contact
Drainage For 24 hours after start of effective therapy
Major = no dressing or dressing does not adequately contain the drainage.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 43 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Skin infection, wound, or burn, minor or limited infection
Standard Minor or limited = dressing covers and adequately contains the drainage, closed drainage system adequately contains the pus, or infected area is very small
Serious invasive disease (e.g., necrotizing fascitis, toxic shock syndrome)
Droplet For 24 hours after start of effective therapy
Contact Precautions for draining wound as above. Follow recommendations for antimicrobial prophylaxis (Consult with Hospital Epidemiology (1-2224).
Streptococcal Disease (Group B Streptococcus), Neonatal
Standard Skin; drainage from lesions; umbilicus; and feces
During a nursery outbreak, clustering or cohorting of infected and colonized infants, as well as Contact Precautions, may be indicated. Such efforts are coordinated by Hospital Epidemiology. If invasive, infection is a reportable disease Reportable disease if invasive. Invasive is defined as bacteria isolated from a normally sterile site, such as blood, bone, cerebrospinal fluid, joint, pericardial fluid, peritoneal fluid, pleural fluid, protected bronchial sampling, lung aspirate/biopsy, or
other biopsy. See Notifiable Diseases.
Streptococcal Disease (not Group A or B) Unless Covered Elsewhere
Standard
Strongyloidiasis Standard
Syphilis See Notifiable Diseases.
Skin and mucous membrane, including congenital, primary and secondary
Contact Drainage from lesions and blood
For 24 hours after start of effective therapy
Skin lesions of primary and secondary syphilis may be highly infective. The rapid plasma reagin (RPR) test, Veneral Disease Research Laboratories (VDRL) test, or
microhemagglutinatin for Treponema pallidum (MHA-TP)
test is positive.
Latent (tertiary) and
seropositivity without lesions
Standard RPR, VDRL, or MHA-TP may be positive.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 44 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Tapeworm Disease
Hymenolepis nana Standard Not transmitted from person to person.
Taenia saginata (beef) Standard Not transmitted from person to person.
Taenia solium (pork) Standard Not transmitted from person to person.
Other Standard Not transmitted from person to person.
TB (See Mycobacteria, Tuberculosis)
Tetanus Standard See Notifiable Diseases.
Tinea (Fungus Infection, Dermatophytosis, Dermatomycosis, Ringworm)
Standard Rare episodes of person to person transmission of ringworm. Outbreaks in healthcare setting rare; but use Contact Precautions should an outbreak occur.
Torch Syndrome For congenital forms of the following diseases, see separate listing For each: Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex Virus.
Possible Torch Syndrome, no lesions, no presenting clinical indications
Standard Urine and feces (potentially)
Adequate distance (at least 7 feet) between patients is helpful.
Toxic Shock Syndrome (See Staphylococcal Disease and Streptococcal Disease)
Toxicariasis Standard
Toxoplasmosis Standard
Trachoma, Acute Standard Purulent exudate
Duration of drainage
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 45 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Trench Mouth (Vincent's Angina)
Standard
Trichinosis Standard
Trichomoniasis Standard
Trichuriasis (Whipworm Disease)
Standard Feces
Trypanosomiasis Standard
Tuberculosis; TB (See Mycobacteria, Tuberculosis)
Tularemia Potential bioterrorism agent. See Notifiable Diseases.
Draining lesions Standard
Pulmonary Standard
Typhoid Fever, Salmonella typhii (See Gastroenteritis)
Contact Feces Until diarrhea has ceased and 3 consecutive fecal cultures are negative for the infecting strain; these cultures must be obtained 3 to 5 days after ending the antimicrobial therapy
See Notifiable Diseases.
Typhus Fever
Rickettsia prowazekii (epidemic and louse-borne)
Standard Transmitted from person to person through close personal or clothing contact.
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 46 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Rickettsia typhi Not transmitted from person to person.
Ulcer (See Decubitus Ulcer or Wound Infection)
Urinary Tract Infection (Including Pyelonephritis), With or Without Urinary Catheter
Standard, unless caused by multiply-resistant organism
If specific organism isolated, see specific listing for further precautions; and see Multi-Drug Resistant Organisms
(MDROs) and provisions for the Prevention and Control of
Multiply-Resistant and Other Epidemiologically-Significant
Bacteria.
Vaccinia – Vaccination site, adverse events following vaccination)
Contact Contact Hospital Epidemiology (1-2224) should a case be indentified. May contact CDC Smallpox Vaccine Adverse Events Clinical Information Line at (877) 554-4625.
Vancomycin-Resistant Enterococcus; VRE (See Multi Drug Resistant Organism, MDROs)
Varicella zoster (Chickenpox) (See Herpes zoster for shingles)
Airborne and Contact if skin lesions are present
Respiratory secretions and drainage from lesions
Until all lesions are crusted; duration of illness for immunocompromised patient with Varicella pneumonia
A private, negative pressure room is required. If a negative pressure room is not available, consult Hospital Epidemiology. The door to the room remains closed at all times. Restrict susceptible persons from entering the room. An N-95 mask is donned before entering the room and removed after leaving the room regardless of immunity. Susceptible HCWs should not enter the room if other HCWs are available (including non-immune pregnant HCWs). Exposed susceptible patients are placed on Airborne and Contact Precautions beginning 8 days after the first day of exposure and continuing for 21 days after the last day of exposure; 28 days if varicella-specific
immunoglobulins is given. See Preadmission
Communicable Diseases Screening of Children.
Exposed HCWs will be offered Acyclovir within 96 hours
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 47 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
post-exposure unless you are pregnant or immunocompromised. If pregnant or immunocompromised, then VZIG will be offered. Exposed susceptible HCWs are excluded from duties beginning 8 days after first exposure until 21 days after last exposure or 28 days if received VZIG regardless of post exposure vaccination. Please see related Employee Health policies. Notify Hospital Epidemiology for all exposures (1-2224).
Variola (See Smallpox)
Vibrio parahemolyticus (See Gastroenteritis)
Vincent's Angina (See Trench Mouth)
Viral Diseases
See individual syndromes: gastroenteritis, conjunctivitis, pneumonia, meningitis, and encephalitis, for example.
Lower respiratory, adults if not covered elsewhere)
Standard Respiratory secretions (potentially)
Lower respiratory, infants and children (if not covered elsewhere)
Droplet and Contact
Respiratory secretions
Duration of illness
Various etiologic agents, such as respiratory syncytial virus, parainfluenza viruses, adenoviruses, and influenza viruses, can cause significant lower respiratory disease; thus, precautions to prevent their spread are generally indicated.
Pericarditis, myocarditis, or meningitis
Contact Feces For 7 days after onset
Enteroviruses frequently cause these infections. See
Notifiable Diseases.
Viral Hemorrhagic Fever
Crimean-Congo Standard
Ebola Airborne; Contact;
Blood and body substances
Duration of illness
Follow hemorrhagic fever specific barrier precautions: 1) use of sharps safety devices and safe work practices, 2)
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 48 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
Additional Precautions
hand hygiene, 3) barrier protection against blood and body fluids upon entry into room (single gloves, fluid –resistant or impermeable gown, N-95 masks, face/eye protection with goggles or face shields, leg and shoe covering), and 4) appropriate waste handling. Limit blood draws to those essential to care. Hospital Epidemiology and Public Health officials should be notified immediately if VHF is suspected/known. See Emerging Infections Policy.
Lassa Airborne; Contact; Additional Precautions
Blood and body substances
Follow hemorrhagic fever specific barrier precautions: 1) use of sharps safety devices and safe work practices, 2) hand hygiene, 3) barrier protection against blood and body fluids upon entry into room (single gloves, fluid –resistant or impermeable gown, N-95 masks, face/eye protection with goggles or face shields, leg and shoe covering), and 4) appropriate waste handling. Limit blood draws to those essential to care. Hospital Epidemiology and Public Health officials should be notified immediately if VHF is suspected/known. See Emerging Infections Policy.
Marburg Airborne; Contact; Additional Precautions
Blood and body substances
Follow hemorrhagic fever specific barrier precautions: 1) use of sharps safety devices and safe work practices, 2) hand hygiene, 3) barrier protection against blood and body fluids upon entry into room (single gloves, fluid –resistant or impermeable gown, N-95 masks, face/eye protection with goggles or face shields, leg and shoe covering), and 4) appropriate waste handling. Limit blood draws to those essential to care. Hospital Epidemiology and Public Health officials should be notified immediately if VHF is suspected/known. See Emerging Infections Policy.
Whooping Cough
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 49 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
(See Pertussis, Bordatella)
Wound Infections If specific organism isolated, see specific listing for further precautions.
Major Contact Drainage Duration of drainage
Major = no dressing or dressing does not adequately contain the drainage.
Minor or limited Standard
Minor or limited = dressing covers and adequately contains the drainage, closed drainage system adequately contains the pus, or infected area is small, such as a stitch abscess.
Xanthomonas maltophilia (See Stenotrophomonas maltophilia)
Yersinia enterocolitica (See Gastroenteritis)
Zika Standard Blood and body fluids
Duration of illness
Most people infected with Zika virus are asymptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache. Clinical illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. However, there have been cases of Guillain-Barre syndrome reported in patients following suspected Zika virus infection. Recently, CDC concluded that Zika virus infection during pregnancy is a cause of microcephaly and other severe fetal brain defects. Due to concerns of microcephaly caused by maternal Zika virus infection, fetuses and infants of women infected with Zika virus during pregnancy should be evaluated for possible
Transmission Based Precautions: Initiation and Discontinuance (929) Addendum I, Alphabetical Disease/Organism Listing for Transmission-Based Precautions
Page 50 of 50
DISEASE/ORGANISM CATEGORY OF
PRECAUTIONS INFECTIVE
MATERIAL DURATION OF
PRECAUTIONS COMMENTS
Addendum No.: 1
For Policy No.: 929
Originally Issued: 10/01/1988
Last Revision: July 2016
congenital infection and neurologic abnormalities.
Zycomycosis (Phycomycosis, Mucormycosis)
Standard
Responsibility Hospital Epidemiology is responsible for communicating current recommendations by the Centers for Disease Control. This listing will be updated as needed. All healthcare workers are responsible for following and implementing the proper Transmission-based Precautions.
Top Related