UNDERSTANDING ISOLATION

PRECAUTIONS

UNC Hospitals' Isolation Precautions

for the

Prevention of Disease Transmission

Hospital Epidemiology UNC Hospitals TABLE OF CONTENTS

Introduction Infection Control Manual Standard Precautions Airborne Precautions Checkpoint Questions Protective Precautions Identifying the patient who requires Isolation Precautions Droplet Precautions Contact Precautions Checkpoint Questions Isolation Precautions Post-Test

Introduction CONTENTS 

UNC Hospitals' Isolation Precautions Policy is based upon the latest recommendations from the Centers for Disease Control and Prevention. A simple category system is used, based upon how the infection or disease is transmitted. All healthcare workers must be familiar with the isolation precaution system in order to prevent the spread of

infections to patients, coworkers, visitors, and themselves. 

Infection Control Manual CONTENTS 

The complete Isolation Precautions Policy is located in the Infection Control Manual. Infection Control Manuals are located at every nurses station and in all clinical areas. The policy includes an alphabetical listing of infections and the type and duration of precautions needed, an indepth explanation of each precaution category, and a quick reference for the more frequently seen infections. All healthcare workers are encouraged to become familiar with the Isolation Precautions Policy. If help is needed, the healthcare worker may call Infection Control at 61636 or have the

operator page the Infection Control Nurse on call. 

Standard Precautions CONTENTS 

Standard Precautions are the primary tool for the successful control of hospitalacquired infections. Standard Precautions are those precautions designed for the care of all patients' regardless of their diagnosis or presumed

infection status. These Precautions replace the old system of "Universal Precautions" and apply to the following body substances. 

. blood 

· all body fluids, secretions, and excretions (except sweat) 

· nonintact skin 

· mucous membranes 

There are several important components of Standard Precautions with the most important being good handwashing. Hands should be washed thoroughly with an antimicrobial soap (Bactoshield or Alcare foam) before and after patient care. When gloves are worn, they should be removed before 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 surfaces and can then be carried to the next patient or medical equipment touched. 

A second important component of Standard Precautions is the wearing of protective attire to prevent direct contact with a patient's blood or body fluids. Gloves, gown, and protective eyewear are provided by the Hospitals and can be

found 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 for those patients who have or are suspected of having infections 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 for long periods of time and may be carried for long distances on air currents. Examples of diseases that require Airborne Precautions are tuberculosis (TB), varicella (chickenpox), zoster (shingles), and measles. The following measures are required for 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 of 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) for 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 of TB patients will wear surgical masks. 

· If the patient's diagnosis is varicella, zoster, or measles, employees need not wear a respirator if they have had natural disease or have been adequately immunized. Occupational Health Service can assist you in determining your immune status if you are uncertain. Employees who are not immune to the disease should not enter the room unless absolutely necessary. If they must enter, they must wear an approved respirator such as the N95. Visitors should be assisted by the nursing or medical staff in determining their immune status (i.e., natural disease, immunization). Immune visitors need not wear a mask. Nonimmune visitors should be discouraged from entering. If visitation is

essential, then the nonimmune visitor must wear a surgical mask. 

· Patients who require Airborne Precautions are allowed to leave the isolation room for essential purposes only (e.g., a diagnostic procedure that cannot be done in the patient's room). If the patient must be transported to another location in the hospital, the patient must wear a surgical mask and the receiving area notified that the patient requires Airborne Precautions. Both of these steps are important to prevent the transmission of disease to other patients,

employees, and visitors. 

Checkpoint Questions   CONTENTS  

Examples of diseases that require Airborne Precautions include tuberculosis, varicella, zoster, and

_______________ 

To enter the room of a patient on Airborne Precautions who may have tuberculosis, the 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 infection. These precautions will replace our former categories of Compromised Host Precautions, Transplantation Precautions, and Bone Marrow Transplant Precautions. Such patients require varying degrees of protection as determined by their attending physician. Healthcare workers and visitors should pay careful attention to the Protective Precautions card outside the patient's room to identify the precautions required. For all patients

requiring Protective Precautions, the following measures are followed. 

· 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 before entering the patient's room and before

providing direct patient care. 

· Only essential personnel and visitors should enter the patient's room. No one should enter who is ill or feel like

they may be getting sick. 

· The patient is allowed no live plants, fresh fruits or uncooked vegetables. Exceptions to fruits and vegetables may

be allowed with the approval of the attending physician. 

· The patient should leave their room only for essential purposes. If 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. Notify the

receiving department that the patient requires Protective Precautions 

Identifyinq the patient who requires Isolation Precautions CONTENTS 

As with our old system of 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 of precautions to be observed by all employees and visitors. These cards will be colored coded as were the old cards with gold cards for Airborne and Droplet Precautions and a blue card for Contact Precautions. The Protective Precautions card will be white with red letters. Isolation Precautions cards are stocked in Central Distribution and should be available for use in all patient care areas. In order to protect the confidentiality of the patient, no disease specific or diagnostic information should be

written on the card. Healthcare workers and visitors who are unsure of the correct precautions to follow should

check at the nurses station for clarification. 

As with all infection control measures, isolation precautions are designed to prevent the spread of infection from one person to another. The responsibility for the practice of infection control lies within the hands of every healthcare worker.

DropIet Precautions CONTENTS 

In addition to Standard Precautions, use Droplet Precautions for those patients who are known or suspected of 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 fall to surfaces rapidly, usually falling within 3 feet of the patient. These particles are too heavy to remain in the air and to be carried on air currents. Examples of infections that require Droplet Precautions are meningococcal meningitis,

Respiratory Syncytial Virus (RSV), and pertussis. The following measures are required for 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. 

· If the patient must leave their room, notify the receiving area and have the patient wear a surgical mask when

possible to minimize the dispersal of droplets. 

Contact Precautions CONTENTS 

In addition to Standard Precautions, use Contact Precautions for 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 infected site or body fluid or by touching equipment that may be contaminated with infectious material. Examples of infections 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 Clostridium

difficile enterocolitis. The following measures are required for 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 if you anticipate that your clothing will become contaminated with infectious materials (e.g., wound drainage or respiratory secretions). Gown and gloves should be removed before leaving the patient's room and hands washed thoroughly. 

· When possible, dedicate the use of patientcare equipment such as stethoscopes and walkers. This avoids sharing of items between patients. If use of common equipment is unavoidable, then adequately clean and disinfect the item with Vesphene 11 or alcohol before use for another patient. 

· If the patient must leave their room for diagnostic tests or treatments, notify the receiving department that the

patient requires Contact Precautions. 

Checkpoint questions   CONTENTS  

A pediatric patient who is admitted with a diagnosis of RSV pneumonia would require being placed on and

Precautions. 

For patients who require Contact Precautions, all employees and visitors who enter the patient's room must wear 

ISOLATION PRECAUTIONS POSTTEST CONTENTS 

Read each statement carefully and circle whether the statement is True or False. 

1. Standard Precautions mean that we wear gloves only for 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 of a

patient who is on Airborne Precautions for 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

AIDS—Acquired Immune Deficiency Syndrome

Universal Precautions Duration of illness

Blood, body fluids

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 of Illness

 

 

Duration of Illness

 

 

Duration of Illness

 

Feces

 

 

Feces

 

 

Feces

 

Use Contact Precautions ** for diapered or incontinent children<6 y.o. for duration of illness.

Use Contact Precautions ** for diapered or incontinent children<6 y.o. for duration of illness.

 

Use Contact Precautions ** for diapered or incontinent children<6 y.o. for duration of illness.

Hepatitis – A Universal Precautions (see comments)

Until 7 days after onset of jaundice

Feces Use Contact Precautions ** for diapered or incontinent patients.

Hepatitis – B Universal Precautions (see comments)

Until patient is HbsAg negative

Blood, body fluids

Handwashing !! Universal Precautions*

Hepatitis – C Universal Precautions Duration of illness

Blood, body fluids

Same as Hepatitis B

Herpes simplex (recurrent oral, skin, genital)

Universal Precautions (see comments)

Until lesions crust

Fluid from 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 of Illness Lesions

Lesions Persons who have not had chickenpox should not care for patient.

*Universal Precautions – Do not recap or cut needles; dispose of in sharps containers, clean blood spills with an EPA registered tuberculocidal disinfectant. Disposable items saturated with blood or bloody fluids should be placed in red bags for incineration. 

Masks   for potential splashing of blood/body fluids.

Gowns   for potential splashing of blood/body fluids on clothing.

Protective eyewear for potential splashing into mucous membranes.

Gloves for handling all blood/body fluids.

** 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 of 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 for patient.

Meningitis,

H. influenzae

N. meningitidis

Meningococcal pneumonia

Meningococcemia

Droplet

 

Droplet

Droplet

For 24 hours after start of antibiotics

Respiratory secretions

Wear surgical mask when within 3 feet of patient.

MRSA-methicillin-resistant Staphylococcus aureus

(infection or colonization)

Contact Until 3 cultures 24 hours apart are negative at all sites (including nasal).

Body sites from which MRSA is isolated.

Use Contact Precautions**

Necrotizing Enterocolitis (NEC)

Universal Precautions Duration of illness Feces maybe  

Respiratory syncytial virus (RSV)

Contact Duration of illness Respiratory secretions

Use Contact Precautions**;follow established guidelines for 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 (Infection or colonization)

Modified Contact Until 3 stool/rectum cultures and other sites are negative (1 week apart)

Stool, body sites from which VRE is isolated

GLOVES, GOWNS MUST BE WORN; HANDWASHING !

WASH HANDS BETWEEN ALL PATIENT CONTACTS!!

**WEAR GLOVES WHEN ENTERING ROOMWear gowns when having substantial contact with the patient or contact with the patients environment.

For information or additional questions call Healthcare Epidemiology ext.23192.

Table 1

TABLE 1SYNOPSIS OF TYPES OF PRECAUTIONS AND PATIENTS REQUIRING THE PRECAUTIONS *

============================================================================================================================================

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 Other 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 O157: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) *

------------------------------------------------------------------------------------------------------------------------------------------ * 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)============================================================================================================================================

Table 2

TABLE 2CLINICAL SYNDROMES OR CONDITIONS WARRANTING ADDITIONAL EMPIRIC PRECAUTIONS TO PREVENT TRANSMISSION OFEPIDEMIOLOGICALLY IMPORTANT PATHOGENS PENDING CONFIRMATION OF DIAGNOSIS *============================================================================================================================================================================ EmpiricClinical 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

------------------------------------------------------------------------------------------------------------------------------------- * 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 O157: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 AType 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) SAcquired immunodeficiency syndrome (3) SActinomycosis SAdenovirus infection, in infants and young children D,C DIAmebiasis SAnthrax Cutaneous S Pulmonary SAntibiotic-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 SAspergillosis SBabesiosis SBlastomycosis, North American, cutaneous or pulmonary SBotulism SBronchiolitis (see respiratory infections in infants and young children)Brucellosis (undulant, Malta, Mediterranean fever) S

Campylobacter gastroenteritis (see gastroenteritis)Candidiasis, all forms including mucocutaneous SCat-scratch fever (benign inoculation lymphoreticulosis) SCellulitis, uncontrolled drainage C DIChancroid (soft chancre) SChickenpox (varicella; see F (5) for varicella exposure) A,C F (5)Chlamydia trachomatis Conjunctivitis S Genital S Respiratory SCholera (see gastroenteritis)Closed-cavity infection Draining, limited or minor S Not draining SClostridium C botulinum S C difficile C DI C perfringens Food poisoning S Gas gangrene SCoccidioidomycosis (valley fever) Draining lesions S Pneumonia SColorado tick fever SCongenital rubella C F (6)Conjunctivitis Acute bacterial S Chlamydia S Gonococcal S Acute viral (acute hemorrhagic) C DICoxsackievirus disease (see enteroviral infection)Creutzfeldt-Jakob disease S (7)Croup (see respiratory infections in infants and young children)

Cryptococcosis SCryptosporidiosis (see gastroenteritis)Cysticercosis SCytomegalovirus infection, neonatal or immunosuppressed SDecubitus ulcer, infected Major (1) C DI Minor or limited (2) SDengue S (4)Diarrhea, acute -- infective etiology suspected (see gastroenteritis)Diphtheria Cutaneous C CN (8) Pharyngeal D CN (8)Ebola viral hemorrhagic fever C (9) DIEchinococcosis (hydatidosis) SEchovirus (see enteroviral infection)Encephalitis or encephalomyelitis (see specific etiologic agents)Endometritis SEnterobiasis (pinworm disease, oxyuriasis) SEnterococcus species (see multidrug-resistant organisms if epidemiologically significant or vancomycin resistant)Enterocolitis, Clostridium difficile C DIEnteroviral infections Adults S Infants and young children C DIEpiglottitis, due to Haemophilus influenzae D U (24 hrs)Epstein-Barr virus infection, including infectious mononucleosis SErythema infectiosum (also see Parvovirus B19) SEscherichia coli gastroenteritis (see gastroenteritis)Food poisoning Botulism S Clostridium perfringens or welchii S Staphylococcal SFurunculosis -- staphylococcal Infants and young children C DI

Gangrene (gas gangrene) SGastroenteritis Campylobacter species S (10) Cholera S (10) Clostridium difficile C DI Cyptosporidium species S (10) Escherichia coli Enterohemorrhagic O157:H7 S (10) Diapered or incontinent C DI Other 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) SGonorrhea SGranuloma inguinale (donovanosis, granuloma venereum) SGuillain-Barre syndrome SHand, foot, and mouth disease (see enteroviral infection)Hantavirus pulmonary syndrome SHelicobacter pylori SHemorrhagic fevers (for example, Lassa and Ebola) C (9) DIHepatitis, 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 SHerpangina (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) SHerpes zoster (varicella-zoster) Localized in immunocompromised patient, or disseminated A,C DI (13) Localized in normal patient S (13)Histoplasmosis SHIV (see human immunodeficiency virus) SHookworm disease (ancylostomiasis, uncinariasis) SHuman immunodeficiency virus (HIV) infection (3) SImpetigo C U (24 hrs)Infectious mononucleosis SInfluenza D (14) DIKawasaki syndrome SLassa fever C (9) DILegionnaires' disease SLeprosy SLeptospirosis SLice (pediculosis) C U (24)Listeriosis SLyme disease SLymphocytic choriomeningitis S

Lymphogranuloma venereum SMalaria S (4)Marburg virus disease C (9) DIMeasles (rubeola), all presentations A DIMelioidosis, all forms SMeningitis 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 Other diagnosed bacterial SMeningococcal pneumonia D U (24 hrs)Meningococcemia (meningococcal sepsis) D U (24 hrs)Molluscum contagiosum SMucormycosis SMultidrug-resistant organisms, infection or colonization (16) Gastrointestinal C CN Respiratory C CN Pneumococcal S Skin, wound, or burn C CNMumps (infectious parotitis) D F (17)Mycobacteria, nontuberculosis (atypical) Pulmonary S Wound SMycoplasma pneumonia D DINecrotizing enterocolitis S

Nocardiosis, draining lesions or other presentations SNorwalk agent gastroenteritis (see viral gastroenteritis)Orf SParainfluenza virus infection, respiratory in infants and young children C DIParvovirus B19 D F (18)Pediculosis (lice) C U (24 hrs)Pertussis (whooping cough) D F (19)Pinworm infection SPlague 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 SPsittacosis (ornithosis) SQ fever SRabies SRat-bite fever (Streptobacillus moniliformis disease, Spirillum minus disease) SRelapsing fever SResistant bacterial infection or colonization (see multidrug-resistant organisms)Respiratory infectious disease, acute (if not covered elsewhere) Adults S Infants and young children (3) C DIRespiratory syncytial virus infection, in infants and young children, and immunocompromised adults C DIReye's syndrome SRheumatic fever SRickettsial fevers, tickborne (Rocky Mountain spotted fever, tickborne typhus fever) SRickettsialpox (vesicular rickettsiosis) SRingworm (dermatophytosis, dermatomycosis, tinea) SRitter's disease (staphylococcal scalded skin syndrome) SRocky Mountain spotted fever SRoseola infantum (exanthem subitum) SRotavirus 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) SSchistosomiasis (bilharziasis) SShigellosis (see gastroenteritis)Sporotrichosis SSpirillum 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 SStreptobacillus moniliformis disease (rat-bite fever) SStreptococcal 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 SStreptococcal disease (not group A or B) unless covered elsewhere S Multidrug-resistant (see multidrug-resistant organisms)Strongyloidiasis SSyphilis Skin and mucous membrane, including congenital, primary, secondary S Latent (tertiary) and seropositivity without lesions STapeworm disease Hymenolepis nana S Taenia solium (pork) S Other STetanus STinea (fungus infection dermatophytosis, dermatomycosis, ringworm) SToxoplasmosis S

Toxic shock syndrome (staphylococcal disease) STrachoma, acute STrench mouth (Vincent's angina) STrichinosis STrichomoniasis STrichuriasis (whipworm disease) STuberculosis 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 STularemia Draining lesion S Pulmonary STyphoid (Salmonella typhi) fever (see gastroenteritis)Typhus, endemic and epidemic SUrinary tract infection (including pyelonephritis), with or without urinary catheter SVaricella (chickenpox) A,C F (5)Vibrio parahaemolyticus (see gastroenteritis)Vincent's angina (trench mouth) SViral 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) SYersinia enterocolitica gastroenteritis (see gastroenteritis) Localized in immunocompromised patient, disseminated A,C DI (13) Localized in normal patient S (13)Zygomycosis (phycomycosis, mucormycosis) SZoster (varicella-zoster)

--------------------------------------------------------------------------------------------------------------------------Abbreviations: type of precautions: A, Airborne; C, Contact; D, Droplet; S, Standard; when A, C, and D are specified, also use S