UNDERSTANDING ISOLATION

PRECAUTIONS
UNC Hospitals' Isolation Precautions
for the
Prevention of Disease Transmission
Hospital Epidemiology UNC Hospitals TABLE OF CONTENTS
O Introduction
O Infection Control Manual
O Standard Precautions
O Airborne Precautions
O Checkpoint Questions
O Protective Precautions
O Identifying the patient who requires Isolation Precautions
O Droplet Precautions
O Contact Precautions
O Checkpoint Questions
O Isolation Precautions Post-Test
Introduction CONTENTS
UNC Hospitals' Isolation Precautions Policy is based upon the latest recommendations Irom the Centers Ior Disease
Control and Prevention. A simple category system is used, based upon how the inIection or disease is transmitted.
All healthcare workers must be Iamiliar with the isolation precaution system in order to prevent the spread oI
inIections to patients, coworkers, visitors, and themselves.
Infection Control Manual CONTENTS
The complete Isolation Precautions Policy is located in the InIection Control Manual. InIection Control Manuals are
located at every nurses station and in all clinical areas. The policy includes an alphabetical listing oI inIections and
the type and duration oI precautions needed, an indepth explanation oI each precaution category, and a quick
reIerence Ior the more Irequently seen inIections. All healthcare workers are encouraged to become Iamiliar with the
Isolation Precautions Policy. II help is needed, the healthcare worker may call InIection Control at 61636 or have the
operator page the InIection Control Nurse on call.
Standard Precautions CONTENTS
Standard Precautions are the primary tool Ior the successIul control oI hospitalacquired inIections. Standard
Precautions are those precautions designed Ior the care oI all patients' regardless oI their diagnosis or presumed
inIection status. These Precautions replace the old system oI "Universal Precautions" and apply to the Iollowing
body substances.
. blood
all body fluids, secretions, and excretions (except sweat)
nonintact skin
mucous membranes
There are several important components oI Standard Precautions with the most important being good handwashing.
Hands should be washed thoroughly with an antimicrobial soap (Bactoshield or Alcare Ioam) beIore and aIter
patient care. When gloves are worn, they should be removed beIore leaving the patient's room and hands washed.
Never leave the patient's room while still wearing gloves. Disease causing germs adhere well to glove surIaces and
can then be carried to the next patient or medical equipment touched.
A second important component oI Standard Precautions is the wearing oI protective attire to prevent direct contact
with a patient's blood or body Iluids. Gloves, gown, and protective eyewear are provided by the Hospitals and can be
Iound in all patientcare areas in personal protective equipment cabinets.
Remember, if it is wet and not yours, wear gloves'
Airborne Precautions CONTENTS
in addition to Standard Precautions, Airborne Precautions are used Ior those patients who have or are suspected oI
having inIections transmitted by the airborne route. This means that the bacteria or virus causing their disease is so
small that it can be suspended in the air Ior long periods oI time and may be carried Ior long distances on air
currents. Examples oI diseases that require Airborne Precautions are tuberculosis (TB), varicella (chickenpox),
zoster (shingles), and measles. The Iollowing measures are required Ior Airborne Precautions.
The patient must be placed in a special isolation room. Isolation rooms are private rooms with a negative air
pressure in relation to the outside corridor, have 6 air exchanges per hour, and the room air is directly exhausted to
the outside. A complete listing oI isolation rooms is maintained by Bed Control. Hospital Epidemiology, and the
Nursing supervisors.
All employees must wear a respirator, such as the N95 respirator, to enter an Airborne Isolation room (a surgical
mask is not an approved respirator) Ior patients with known or suspected tuberculosis. Respirators must also be
worn when participating in coughinducing procedures such as bronchoscopy or sputum induction with TB patients.
Visitors oI TB patients will wear surgical masks.
II the patient's diagnosis is varicella, zoster, or measles, employees need not wear a respirator iI they have had
natural disease or have been adequately immunized. Occupational Health Service can assist you in determining your
immune status iI you are uncertain. Employees who are not immune to the disease should not enter the room unless
absolutely necessary. II they must enter, they must wear an approved respirator such as the N95. Visitors should be
assisted by the nursing or medical staII in determining their immune status (i.e., natural disease, immunization).
Immune visitors need not wear a mask. Nonimmune visitors should be discouraged Irom entering. II visitation is
essential, then the nonimmune visitor must wear a surgical mask.
Patients who require Airborne Precautions are allowed to leave the isolation room Ior essential purposes only (e.g.,
a diagnostic procedure that cannot be done in the patient's room). II the patient must be transported to another
location in the hospital, the patient must wear a surgical mask and the receiving area notiIied that the patient requires
Airborne Precautions. Both oI these steps are important to prevent the transmission oI disease to other patients,
employees, and visitors.
eckpoint Questions COA1EA1S
xamples of diseases that require Airborne Precautions include tuberculosis, varicella, :oster, and

To enter te room of a patient on Airborne Precautions who may ave tuberculosis, te employee
must wear a , not a surgical mask.
Protective Precautions CONTENTS
In addition to Standard Precautions, Protective Precautions are designed to protect the patient with impaired
resistance to inIection. These precautions will replace our Iormer categories oI Compromised Host Precautions,
Transplantation Precautions, and Bone Marrow Transplant Precautions. Such patients require varying degrees oI
protection as determined by their attending physician. Healthcare workers and visitors should pay careIul attention
to the Protective Precautions card outside the patient's room to identiIy the precautions required. For all patients
requiring Protective Precautions, the Iollowing measures are Iollowed.
The patient is placed in a private room with the air pressure positive in relation to the outside corridor.
Hands should be washed thoroughly with an antimicrobial soap beIore entering the patient's room and beIore
providing direct patient care.
Only essential personnel and visitors should enter the patient's room. No one should enter who is ill or Ieel like
they may be getting sick.
The patient is allowed no live plants, Iresh Iruits or uncooked vegetables. Exceptions to Iruits and vegetables may
be allowed with the approval oI the attending physician.
The patient should leave their room only Ior essential purposes. II the patient must leave their room, they should be
instructed to wear a surgical mask. Exceptions to this policy may be made by the attending physician. NotiIy the
receiving department that the patient requires Protective Precautions
Identifyinq the patient who requires Isolation Precautions CONTENTS
As with our old system oI isolation, we will continue to place an isolation precaution card in the wall plaque outside
the patient's room door. Each card will clearly state the type oI precautions to be observed by all employees and
visitors. These cards will be colored coded as were the old cards with gold cards Ior Airborne and Droplet
Precautions and a blue card Ior Contact Precautions. The Protective Precautions card will be white with red letters.
Isolation Precautions cards are stocked in Central Distribution and should be available Ior use in all patient care
areas. In order to protect the conIidentiality oI the patient, no disease speciIic or diagnostic inIormation should be
written on the card. Healthcare workers and visitors who are unsure oI the correct precautions to Iollow should
check at the nurses station Ior clariIication.
As wit all infection control measures, isolation precautions are designed to prevent
te spread of infection from one person to anoter. Te responsibility for te practice
of infection control lies witin te ands of every ealtcare worker.
DropIet Precautions CONTENTS
In addition to Standard Precautions, use Droplet Precautions Ior those patients who are known or suspected oI
having diseases spread by the droplet route. Droplet transmission occurs when the person coughs or sneezes and
releases large respiratory droplets into the air. Unlike airborne particles, these droplets are heavy and Iall to surIaces
rapidly, usually Ialling within 3 Ieet oI the patient. These particles are too heavy to remain in the air and to be
carried on air currents. Examples oI inIections that require Droplet Precautions are meningococcal meningitis,
Respiratory Syncytial Virus (RSV), and pertussis. The Iollowing measures are required Ior Droplet Precautions.
Place the patient in a private room. No special ventilation is required.
Employees and visitors must wear a surgical mask to enter the room.
II the patient must leave their room, notiIy the receiving area and have the patient wear a surgical mask when
possible to minimize the dispersal oI droplets.
Contact Precautions CONTENTS
In addition to Standard Precautions, use Contact Precautions Ior those diseases that are spread by direct or indirect
contact. This means that the bacteria or virus can be acquired by either directly touching the inIected site or body
Iluid or by touching equipment that may be contaminated with inIectious material. Examples oI inIections that are
spread by the contact route are multiply antibioticresistant bacteria such as methicillinresistant S. aureus (MRSA)
and vancomycinresistant enterococcus (VRE), RSV (which also requires Droplet Precautions), and lostridium
difficile enterocolitis. The Iollowing measures are required Ior Contact Precautions.
Place the patient in a private room. No special ventilation is required.
Gloves are to be worn when entering the room. A gown should be worn iI you anticipate that your clothing will
become contaminated with inIectious materials (e.g., wound drainage or respiratory secretions). Gown and gloves
should be removed beIore leaving the patient's room and hands washed thoroughly.
When possible, dedicate the use oI patientcare equipment such as stethoscopes and walkers. This avoids sharing oI
items between patients. II use oI common equipment is unavoidable, then adequately clean and disinIect the item
with Vesphene 11 or alcohol beIore use Ior another patient.
II the patient must leave their room Ior diagnostic tests or treatments, notiIy the receiving department that the
patient requires Contact Precautions.
eckpoint questions COA1EA1S
A pediatric patient wo is admitted wit a diagnosis of RSJ pneumonia would require being placed on and
Precautions.
For patients wo require ontact Precautions, all employees and visitors wo enter te patients room must wear
ISOLATION PRECAUTIONS POSTTEST CONTENTS
Read each statement careIully and circle whether the statement is True or False.
1. Standard Precautions mean that we wear gloves only Ior patients who are known
to be HIV positive or Hepatitis B positive.
True False
2. Employees and visitors who have had varicella (chickenpox) or have received
the varicella vaccine do not need to wear a respirator to enter the room oI a
patient who is on Airborne Precautions Ior active varicella.
True False
3. Everyone who enters a Droplet Precautions room must wear a surgical mask.
True False
4. Everyone who enters a Contact Precautions room must wear clean gloves.
True False
5. The isolation precaution card that is placed outside the patient's room door
should clearly state the patient's diagnosis.
True False

Isolation Precautions

AIRBORNE, DROPLET, CONTACT, AND MODIFIED CONTACT PRECAUTIONS REQUIRE A PRIVATE ROOM```
Disease Isolation
Precautions
Duration Infective
Material
Comments
AIDSAcquired Immune
DeIiciency Syndrome
Universal Precautions Duration oI
illness
Blood, body
Iluids
Handwashing!! Universal
Precautions*
Cytomegalovirus (CMV) Universal Precautions None Urine, respiratory
secretions maybe
Pregnant personnel may need special
counseling.
Gastroenteritis
Rotavirus
(Diapered or Incontinent)
Salmonella


Shigella (Diapered or
Incontinent)

Universal Precautions
(see comments)

Universal Precautions (see
comments)


Universal Precautions (see
comments)

Duration oI
Illness


Duration oI
Illness


Duration oI
Illness

Feces


Feces


Feces

Use Contact Precautions ** Ior
diapered or incontinent children
6 y.o. Ior duration oI illness.

Use Contact Precautions ** Ior
diapered or incontinent children
6 y.o. Ior duration oI illness.

Use Contact Precautions `` Ior
diapered or incontinent children
6 y.o. Ior duration oI illness.
Hepatitis A Universal Precautions (see
comments)
Until 7 days
aIter onset oI
jaundice
Feces Use Contact Precautions `` for
diapered or incontinent patients.
Hepatitis B Universal Precautions (see
comments)
Until patient is
HbsAg negative
Blood, body
Iluids
Handwashing !! Universal
Precautions`
Hepatitis C Universal Precautions Duration oI
illness
Blood, body
Iluids
Same as Hepatitis B
Herpes simplex (recurrent
oral, skin, genital)
Universal Precautions (see
comments)
Until lesions
crust
Fluid Irom
lesions
Use Contact Precautions `` for
neonatal; mucocutaneous,
disseminated; or primary, severe
for duration of illness
Herpes zoster (Shingles)
disseminated or localized
in immunocompromised
pt.
Airborne & Contact Duration oI
Illness Lesions
Lesions Persons who have not had
chickenpox should not care Ior
patient.
*Universal Precautions Do not recap or cut needles; dispose oI in sharps containers, clean blood spills with an EPA registered tuberculocidal disinIectant.
Disposable items saturated with blood or bloody Iluids should be placed in red bags Ior incineration.

Masks Ior potential splashing oI blood/body Iluids.
Gowns Ior potential splashing oI blood/body Iluids on clothing.
Protective eyewear Ior potential splashing into mucous membranes.
Gloves Ior handling all blood/body Iluids.
** WEAR GLOVES WHEN ENTERING ROOM
Wear gowns when having substantial contact with the patient or contact with the patient`s environment.
***Cohorting is acceptable at the discretion oI Healthcare Epidemiology

ISOLATION PRECAUTIONS (Continued)
Disease Isolation
Precautions
Duration Infective
Material
Comments
Chickenpox
(varicella)
Airborne & contact Until lesions are crusted
over
Lesions, respiratory
secretions
Persons who have not had
chickenpox should not care Ior
patient.
Meningitis,
H. inIluenzae
N. meningitidis
Meningococcal
pneumonia
Meningococcemia
Droplet

Droplet
Droplet
For 24 hours aIter start oI
antibiotics
Respiratory
secretions
Wear surgical mask when within
3 Ieet oI patient.
MRSA-methicillin-
resistant
Staphylococcus
aureus
(inIection or
colonization)
Contact Until 3 cultures 24 hours
apart are negative at all
sites (including nasal).
Body sites Irom
which MRSA is
isolated.
Use Contact Precautions**
Necrotizing
Enterocolitis (NEC)
Universal Precautions Duration oI illness Feces maybe

Respiratory syncytial
virus (RSV)
Contact Duration oI illness Respiratory
secretions
Use Contact
Precautions``;Iollow
established guidelines Ior
Ribavirin administration.
Tuberculosis
(Pulmonary)
Airborne Until 3 sputum smears
are negative (on
consecutive days) or TB
is ruled out
Airborne respiratory
droplet nuclei
Wear particulate respirator.
Patient wears surgical mask
when being transported.
VRE-vancomycin-
resistant enterococci
(InIection or
colonization)
ModiIied Contact Until 3 stool/rectum
cultures and other sites
are negative (1 week
apart)
Stool, body sites
Irom which VRE is
isolated
GLOVES, GOWNS MUST BE
WORN; HANDWASHING !
WASH HANDS BETWEEN ALL PATIENT CONTACTS!!
**WEAR GLOVES WHEN ENTERING ROOM
Wear gowns when having substantial contact with the patient or contact with the patients environment.
For inIormation or additional questions call Healthcare Epidemiology ext.23192.
Table 1
TABLE 1
SYNJPSIS JF TYPES JF PRECAUTIJNS AND PATIENTS REQUIRING THE PRECAUTIJNS
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===============================================================

Standard Precautions
Use Standard Precautions for the care of all patients

Airborne Precautions
In addition to Standard Precautions, use Airborne Precautions for
patients known or suspected to have serious illnesses
transmitted by airborne droplet nuclei. Examples of such illnesses include:
Measles
Varicella (including disseminated zoster) +
Tuberculosis ++

Droplet Precautions
In addition to Standard Precautions, use Droplet Precautions for patients
known or suspected to have serious illnesses
transmitted by large particle droplets. Examples of such illnesses include:
Invasive Haemophilus influenzae type b disease, including meningitis,
pneumonia, epiglottitis, and sepsis
Invasive Neisseria meningitidis disease, including meningitis,
pneumonia, and sepsis
Jther serious bacterial respiratory infections spread by droplet
transmission, including:
Diphtheria (pharyngeal)
Mycoplasma pneumonia
Pertussis
Pneumonic plague
Streptococcal pharyngitis, pneumonia, or scarlet fever in infants
and young children
Serious viral infections spread by droplet transmission, including:
Adenovirus +
Influenza
Mumps
Parvovirus B19
Rubella

Contact Precautions
In addition to Standard Precautions, use Contact Precautions for patients
known or suspected to have serious illnesses easily
transmitted by direct patient contact or by contact with items in the
patient's environment. Examples of such illnesses include:
Gastrointestinal, respiratory, skin, or wound infections or
colonization with multidrug-resistant bacteria judged by the infection
control program, based on current state, regional, or national
recommendations, to be of special clinical and epidemiologic
significance
Enteric infections with a low infectious dose or prolonged
environmental survival, including:
Clostridium difficile
For diapered or incontinent patients: enterohemorrhagic
Escherichia coil J157:H7, Shigella, hepatitis A, or rotavirus
Respiratory syncytial virus, parainfluenza virus, or enteroviral
infections in infants and young children
Skin infections that are highly contagious or that may occur on dry
skin, including:
Diphtheria (cutaneous)
Herpes simplex virus (neonatal or mucocutaneous)
Impetigo
Major (noncontained) abscesses, cellulitis, or decubiti
Pediculosis
Scabies
Staphylococcal furunculosis in infants and young children
Zoster (disseminated or in the immunocompromised host) +
Viral/hemorrhagic conjunctivitis
Viral hemorrhagic infections (Ebola, Lassa, or Marburg)

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-------------------------------------------------------------
See Appendix A for a complete listing of infections requiring precautions,
including appropriate footnotes.
+ Certain infections require more than one type of precaution.
++ See CDC "Guidelines for Preventing the Transmission of Tuberculosis in
Health-Care Facilities." (23)
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===============================================================


Table 2
TABLE 2
CLINICAL SYNDRJMES JR CJNDITIJNS WARRANTING ADDITIJNAL EMPIRIC PRECAUTIJNS TJ
PREVENT TRANSMISSIJN JF
EPIDEMIJLJGICALLY IMPJRTANT PATHJGENS PENDING CJNFIRMATIJN JF DIAGNJSIS
=============================================================================
=============================================================================
==================

Empiric
Clinical Syndrome or Condition +
Potential Pathogens ++ Precautions
-----------------------------------------------------------------------------
--------------------------------------------------------
Diarrhea
Acute diarrhea with a likely infectious cause in an incontinent or
Enteric Pathogens & Contact
diapered patient
Diarrhea in an adult with a history of recent antibiotic use
Clostridium difficile Contact

Meningitis
Neisseria meningitidis Droplet

Rash or exanthems, generalized, etiology unknown
Petechial/ecchymotic with fever
Neisseria meningitidis Droplet
Vesicular
Varicella Airborne and contact
Maculopapular with coryza and fever
Rubeola (measles) Airborne

Respiratory infections
Cough/fever/upper lobe pulmonary infiltrate in an HIV-negative
Mycobacterium tuberculosis Airborne
patient or a patient at low risk for HIV infection
Cough/fever/pulmonary infiltrate in any lung location in an
Mycobacterium tuberculosis Airborne
HIV-infected patient or a patient at high risk for HIV infection (23)
Paroxysmal or severe persistent cough during periods of
Bordetella pertussis Droplet
pertussis activity
Respiratory infections, particularly bronchiolitis and croup, in infants
Respiratory syncytial or Contact
and young children
parainfluenza virus

Risk of multidrug-resistant microorganisms
History of infection or colonization with multidrug-resistant organisms @
Resistant bacteria Contact
Skin, wound, or urinary tract infection in a patient with a recent
hospital Resistant bacteria Contact
or nursing home stay in a facility where multidrug-resistant
organisms are prevalent

Skin or Wound Infection
Abscess or draining wound that cannot be covered
Staphylococcus aureus, Contact

Group A streptococcus

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--------------------------------------------------------
Infection control professionals are encouraged to modify or adapt this
table according to local conditions. To ensure that appropriate empiric
precautions are
implemented always, hospitals must have systems in place to evaluate
patients routinely according to these criteria as part of their preadmission
and admission care.
+ Patients with the syndromes or conditions listed below may present with
atypical signs or symptoms (eg, pertussis in neonates and adults may not
have paroxysmal or
severe cough). The clinician's index of suspicion should be guided by the
prevalence of specific conditions in the community, as well as clinical
judgment.
++ The organisms listed under the column "Potential Pathogens" are not
intended to represent the complete, or even most likely, diagnoses, but
rather possible etiologic
agents that require additional precautions beyond Standard Precautions
until they can be ruled out.
& These pathogens include enterohemorrhagic Escherichia coli J157:H7,
Shigella, hepatitis A, and rotavirus.
@ Resistant bacteria judged by the infection control program, based on
current state, regional, or national recommendations, to be of special
clinical or epidemiological
significance.
=============================================================================
=============================================================================
==================


Table AA
APPENDIX A
Type and Duration of Precautions Needed for Selected Infections and
Conditions
=============================================================================
=============================================================================
=============================

Precautions

--------------------
Infection/Condition
Type Duration +
-----------------------------------------------------------------------------
---------------------------------------------
Abscess
Draining, major (1)
C DI
Draining, minor or limited (2)
S
Acquired immunodeficiency syndrome (3)
S
Actinomycosis
S
Adenovirus infection, in infants and young children
D,C DI
Amebiasis
S
Anthrax
Cutaneous
S
Pulmonary
S
Antibiotic-associated colitis (see Clostridium difficile)
Arthropodborne viral encephalitides (eastern, western,
Venezuelan equine encephalomyelitis; St. Louis, California encephalitis)
S (4)
Arthropodborne viral fevers (dengue, yellow fever, Colorado tick fever)
S (4)
Ascariasis
S
Aspergillosis
S
Babesiosis
S
Blastomycosis, North American, cutaneous or pulmonary
S
Botulism
S
Bronchiolitis (see respiratory infections in infants and young children)
Brucellosis (undulant, Malta, Mediterranean fever)
S
Campylobacter gastroenteritis (see gastroenteritis)
Candidiasis, all forms including mucocutaneous
S
Cat-scratch fever (benign inoculation lymphoreticulosis)
S
Cellulitis, uncontrolled drainage
C DI
Chancroid (soft chancre)
S
Chickenpox (varicella; see F (5) for varicella exposure)
A,C F (5)
Chlamydia trachomatis
Conjunctivitis
S
Genital
S
Respiratory
S
Cholera (see gastroenteritis)
Closed-cavity infection
Draining, limited or minor
S
Not draining
S
Clostridium
C botulinum
S
C difficile
C DI
C perfringens
Food poisoning
S
Gas gangrene
S
Coccidioidomycosis (valley fever)
Draining lesions
S
Pneumonia
S
Colorado tick fever
S
Congenital rubella
C F (6)
Conjunctivitis
Acute bacterial
S
Chlamydia
S
Gonococcal
S
Acute viral (acute hemorrhagic)
C DI
Coxsackievirus disease (see enteroviral infection)
Creutzfeldt-Jakob disease
S (7)
Croup (see respiratory infections in infants and young children)
Cryptococcosis
S
Cryptosporidiosis (see gastroenteritis)
Cysticercosis
S
Cytomegalovirus infection, neonatal or immunosuppressed
S
Decubitus ulcer, infected
Major (1)
C DI
Minor or limited (2)
S
Dengue
S (4)
Diarrhea, acute -- infective etiology suspected (see gastroenteritis)
Diphtheria
Cutaneous
C CN (8)
Pharyngeal
D CN (8)
Ebola viral hemorrhagic fever
C (9) DI
Echinococcosis (hydatidosis)
S
Echovirus (see enteroviral infection)
Encephalitis or encephalomyelitis (see specific etiologic agents)
Endometritis
S
Enterobiasis (pinworm disease, oxyuriasis)
S
Enterococcus species (see multidrug-resistant organisms if
epidemiologically significant or vancomycin resistant)
Enterocolitis, Clostridium difficile
C DI
Enteroviral infections
Adults
S
Infants and young children
C DI
Epiglottitis, due to Haemophilus influenzae
D U (24 hrs)
Epstein-Barr virus infection, including infectious mononucleosis
S
Erythema infectiosum (also see Parvovirus B19)
S
Escherichia coli gastroenteritis (see gastroenteritis)
Food poisoning
Botulism
S
Clostridium perfringens or welchii
S
Staphylococcal
S
Furunculosis -- staphylococcal
Infants and young children
C DI
Gangrene (gas gangrene)
S
Gastroenteritis
Campylobacter species
S (10)
Cholera
S (10)
Clostridium difficile
C DI
Cyptosporidium species
S (10)
Escherichia coli
Enterohemorrhagic J157:H7
S (10)
Diapered or incontinent
C DI
Jther species
S (10)
Giardia lamblia
S (10)
Rotavirus
S (10)
Diapered or incontinent
C DI
Salmonella species including S typhi)
S (10)
Shigella species
S (10)
Diapered or incontinent
C DI
Vibrio parahaemolyticus
S (10)
Viral (if not covered elsewhere)
S (10)
Yersinia enterocolitica
S (10)
German measles (rubella)
D F (22)
Giardiasis (see gastroenteritis)
Gonococcal ophthalmia neonatorum (gonorrheal opthalmia,
acute conjunctivitis of newborn)
S
Gonorrhea
S
Granuloma inguinale (donovanosis, granuloma venereum)
S
Guillain-Barre syndrome
S
Hand, foot, and mouth disease (see enteroviral infection)
Hantavirus pulmonary syndrome
S
Helicobacter pylori
S
Hemorrhagic fevers (for example, Lassa and Ebola)
C (9) DI
Hepatitis, viral
Type A
S
Diapered or incontinent patients
C F (11)
Type B -- HBsAg positive
S
Type C and other unspecified non-A, non-B
S
Type E
S
Herpangina (see enteroviral infection)
Herpes simplex (Herpesvirus hominis)
Encephalitis
S
Neonatal (12) (see F (12) for neonatal exposure)
C DI
Mucocutaneous, disseminated or primary, severe
C DI
Mucocutaneous, recurrent (skin, oral, genital)
S
Herpes zoster (varicella-zoster)
Localized in immunocompromised patient, or disseminated
A,C DI (13)
Localized in normal patient
S (13)
Histoplasmosis
S
HIV (see human immunodeficiency virus)
S
Hookworm disease (ancylostomiasis, uncinariasis)
S
Human immunodeficiency virus (HIV) infection (3)
S
Impetigo
C U (24 hrs)
Infectious mononucleosis
S
Influenza
D (14) DI
Kawasaki syndrome
S
Lassa fever
C (9) DI
Legionnaires' disease
S
Leprosy
S
Leptospirosis
S
Lice (pediculosis)
C U (24)
Listeriosis
S
Lyme disease
S
Lymphocytic choriomeningitis
S
Lymphogranuloma venereum
S
Malaria
S (4)
Marburg virus disease
C (9) DI
Measles (rubeola), all presentations
A DI
Melioidosis, all forms
S
Meningitis
S
Aseptic (nonbacterial or viral meningitis ,also see enteroviral
infections,)
Bacterial, gram-negative enteric, in neonates
S
Fungal
S
Haemophilus influenzae, known or suspected
D U (24 hrs)
Listeria monocytogenes
S
Neisseria meningitidis (meningococcal) known or suspected
D U (24 hrs)
Pneumococcal
S
Tuberculosis (15)
S
Jther diagnosed bacterial
S
Meningococcal pneumonia
D U (24 hrs)
Meningococcemia (meningococcal sepsis)
D U (24 hrs)
Molluscum contagiosum
S
Mucormycosis
S
Multidrug-resistant organisms, infection or colonization (16)
Gastrointestinal
C CN
Respiratory
C CN
Pneumococcal
S
Skin, wound, or burn
C CN
Mumps (infectious parotitis)
D F (17)
Mycobacteria, nontuberculosis (atypical)
Pulmonary
S
Wound
S
Mycoplasma pneumonia
D DI
Necrotizing enterocolitis
S
Nocardiosis, draining lesions or other presentations
S
Norwalk agent gastroenteritis (see viral gastroenteritis)
Jrf
S
Parainfluenza virus infection, respiratory in infants and young children
C DI
Parvovirus B19
D F (18)
Pediculosis (lice)
C U (24 hrs)
Pertussis (whooping cough)
D F (19)
Pinworm infection
S
Plague
Bubonic
S
Pneumonic
D U (72 hrs)
Pleurodynia (see enteroviral infection)
Pneumonia
Adenovirus
D,C DI
Bacterial not listed elsewhere (including gram-negative bacterial)
S
Burkholderia cepacia in cystic fibrosis (CF) patients, including
respiratory tract colonization S (20)
Chlamydia
S
Fungal
S
Haemophilus influenzae
Adults
S
Infants and children (any age)
D U (24 hrs)
Legionella
S
Meningococcal
D U (24 hrs)
Multidrug-resistant bacterial (see multidrug-resistant organisms)
Mycoplasma (primary atypical pneumonia)
D DI
Pneumococcal
Multidrug-resistant (see multidrug-resistant organisms)
Pneumocystis carinii
S (21)
Pseudomonas cepacia (see Burkholderia cepacia)
S (20)
Staphylococcus aureus
S
Streptococcus, Group A
Adults
S
Infants and young children
D U (24 hrs)
Viral
Adults
S
Infants and young children (see respiratory infectious disease, acute)
Poliomyelitis
S
Psittacosis (ornithosis)
S
Q fever
S
Rabies
S
Rat-bite fever (Streptobacillus moniliformis disease, Spirillum minus
disease) S
Relapsing fever
S
Resistant bacterial infection or colonization (see multidrug-resistant
organisms)
Respiratory infectious disease, acute (if not covered elsewhere)
Adults
S
Infants and young children (3)
C DI
Respiratory syncytial virus infection, in infants and young children, and
immunocompromised adults C DI
Reye's syndrome
S
Rheumatic fever
S
Rickettsial fevers, tickborne (Rocky Mountain spotted fever, tickborne typhus
fever) S
Rickettsialpox (vesicular rickettsiosis)
S
Ringworm (dermatophytosis, dermatomycosis, tinea)
S
Ritter's disease (staphylococcal scalded skin syndrome)
S
Rocky Mountain spotted fever
S
Roseola infantum (exanthem subitum)
S
Rotavirus infection (see gastroenteritis)
Rubella (German measles; also see congenital rubella)
D F (22)
Salmonellosis (see gastroenteritis)
Scabies
C U (24 hrs)
Scalded skin syndrome, staphylococcal (Ritter's disease)
S
Schistosomiasis (bilharziasis)
S
Shigellosis (see gastroenteritis)
Sporotrichosis
S
Spirillum minus disease (rat-bite fever)
S
Staphylococcal disease (S aureus)
S
Skin, wound, or burn
Major (1)
C DI
Minor or limited (2)
S
Enterocolitis
S (10)
Multidrug-resistant (see multidrug-resistant organisms)
Pneumonia
S
Scalded skin syndrome
S
Toxic shock syndrome
S
Streptobacillus moniliformis disease (rat-bite fever)
S
Streptococcal disease (group A streptococcus)
Skin, wound, or burn
Major (1)
C U (24 hrs)
Minor or limited (2)
S
Endometritis (puerperal sepsis)
S
Pharyngitis in infants and young children
D U (24 hrs)
Pneumonia in infants and young children
D U (24 hrs)
Scarlet fever in infants and young children
D U (24 hrs)
Streptococcal disease (group B streptococcus), neonatal
S
Streptococcal disease (not group A or B) unless covered elsewhere
S
Multidrug-resistant (see multidrug-resistant organisms)
Strongyloidiasis
S
Syphilis
Skin and mucous membrane, including congenital, primary, secondary
S
Latent (tertiary) and seropositivity without lesions
S
Tapeworm disease
Hymenolepis nana
S
Taenia solium (pork)
S
Jther
S
Tetanus
S
Tinea (fungus infection dermatophytosis, dermatomycosis, ringworm)
S
Toxoplasmosis
S
Toxic shock syndrome (staphylococcal disease)
S
Trachoma, acute
S
Trench mouth (Vincent's angina)
S
Trichinosis
S
Trichomoniasis
S
Trichuriasis (whipworm disease)
S
Tuberculosis
Extrapulmonary, draining lesion (including scrofula)
S
Extrapulmonary, meningitis (15)
S
Pulmonary, confirmed or suspected or laryngeal disease
A F (23)
Skin-test positive with no evidence of current pulmonary disease
S
Tularemia
Draining lesion
S
Pulmonary
S
Typhoid (Salmonella typhi) fever (see gastroenteritis)
Typhus, endemic and epidemic
S
Urinary tract infection (including pyelonephritis), with or without urinary
catheter S
Varicella (chickenpox)
A,C F (5)
Vibrio parahaemolyticus (see gastroenteritis)
Vincent's angina (trench mouth)
S
Viral diseases
Respiratory (if not covered elsewhere)
Adults
S
Infants and young children (see respiratory infectious disease, acute)
Whooping cough (pertussis)
D F (19)
Wound infections
Major (1)
C DI
Minor or limited (2)
S
Yersinia enterocolitica gastroenteritis (see gastroenteritis)
Localized in immunocompromised patient, disseminated
A,C DI (13)
Localized in normal patient
S (13)
Zygomycosis (phycomycosis, mucormycosis)
S
Zoster (varicella-zoster)
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Abbreviations: type of precautions: A, Airborne; C, Contact; D, Droplet; S,
Standard; when A, C, and D are specified, also use S