C-0506-14-60344 Word Table Of Recommended Precautions ...



IC.05.02 TABLE OF RECOMMENDED PRECAUTIONS SELECTED INFECTIOUS DISEASES, CONDITIONS &/OR MICROORGANISMS REV. Mar 2020Disease, Condition, MicroorganismPresentationType of PrecautionsDuration of PrecautionsMother/Infant (MI) considerationsBF = breast feeding, RI = rooming-inCommentsReportable diseases reported by IPACSAbscessMinorMajor (drainage not contained by dressing)RoutineContactDuration of drainage MI contact and RI permitted if drainage adequately controlled. Mother:Breast abscess-consult physician prior to breast feedingAcquired Immune Deficiency SyndromeRoutineMI contact and RI permittedAssess mothers individually for possibility of other infections.Reportable diseaseAdenovirusAdenovirus (cont) Adenovirus (cont)Respiratory Droplet and ContactAdult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom free Mother ill: Droplet and contact precautions for motherRoutine practices for infantHealthy term infant: MI contact, BF and RI permitted Mother to wear mask when within 2 metres of infant Infant in NICU:Mother should be encouraged not to visit until symptom free* BF permitted as expressed milk Infant ill: Droplet and contact precautions for infantRoutine practices for motherMI contact and BF permittedStrict attention to hand hygiene. *If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICU Mother to wear mask for duration of visit in NICUDiarrheaContact*Until stool is formed or back to baseline for the patient for 48 hoursConsult IPACS if immune compromisedMother ill: Contact precautions for motherRoutine practices for infantHealthy Term Infant:MI contact, BF and RI permitted. Infant in NICU:Mother should be encouraged not to visit until stool is formed or back to baseline for the mother for 48 hours* Infant ill:Contact precautions for infant**Routine practices for MotherMI contact, BF and RI permittedStrict attention to hand hygiene*Prolonged fecal shedding may occur in immunocompromised patients after recovery. Contact precautions for duration of hospitalization may be justified. If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICU**Ensure immediate disposal of diapers into leak proof bag.ConjunctivitisContactUntil symptom freeMother ill: Contact precautions for motherRoutine practices for infantHealthy Term infant:MI contact, BF and RI permitted Baby in NICU:Mother should be encouraged not to visit until symptom free*BF permitted as expressed breast milkInfant ill:Contact precautions for infantRoutine precautions for MotherNo sharing of towels, linens, etc.Strict attention to hand hygiene.*If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICUAeromonasDiarrhea, dysenteryContactUntil stool is formed or back to baseline for the patientStrict attention to hand hygiene.Reportable diseaseAmoebiasis(Dysentery)(Entamoeba histolytica)Asymptomatic, to severe diarrhea to grossly bloody dysenteryContactUntil stool is formed or back to baseline for the patientStrict attention to hand hygiene.Reportable diseaseAnthraxSkin lesions, pneumoniaRoutineContact precautions for patients with draining woundsDuration of drainageNotify IPACS immediately.Notify Public Health immediately. Notify Microbiology laboratory before sending specimens. Does not spread from person to person. Acquired from infected animals or animal products. Reportable diseaseAntibiotic Resistant Organisms (ARO)Refer to:Extended-Spectrum Beta-Lactamases (ESBL)Carbapenemase-Producing Organisms (CPO)Methicillin-Resistant Staphylococcus aureus (MRSA)Multi-drug Resistant Organism (MDRO)Vancomycin-Resistant Enterococci (VRE)Infection or colonization of any body siteContact* For duration of hospital stay Refer to the infection control manual for specific information on ARO’s.*Refer to specific organism in table for further guidance on precautions required Strict attention to hand hygieneArthropod-Borne Viral Infections(Arboviruses) (West Nile virus, Dengue, Japanese Encephalitis, Yellow Fever, Zika virus etc.)*Several hundred different viruses, most limited to geographic areas.Encephalitis, fever, rashMost infections are subclinical (asymptomatic)Routine No person-to-person spread except by transfusion, organ transplantation, intrauterine transmission and possibly human milk. Reportable diseaseAscariasisAscaris lumbricoides, (roundworm)Usually asymptomaticRoutineNo person-to-person spread.AspergillosisAspergillus speciesSkin, lung, wound or central nervous system infectionRoutineAtypical Mycobacteria (Mycobacterium other than tuberculosis “MOTT”) e.g. Mycobacterium avium complex “MAC”Lymphadenitis; pneumonia; disseminated disease in immune compromised host.Mycobacterium abscessus in CF patientsRoutine ContactFor duration of hospital stayNo person-to-person transmission, except for Mycobacterium abscessus in CF patients. Please refer to CF standard in section 6.Acquired from soil, water, animal, reservoirs.Babesiosis Often asymptomaticRoutineTick-borne. No person-to-person spread except by transfusion, and congenital/perinatal route Bedbugsblood-sucking ectoparasites (external parasites)Mild to severe allergic reaction to the bitesRoutine PracticesConsider wearing a gown to protect clothing when providing direct bedside care to a heavily infested patient.Contact Housekeeping Services who will arrange for Pest Control Services as required. For more information see BC Health File # 95 at dermatitdisAsymptomatic, pulmonary, cutaneous or disseminatedRoutineNo person-to-person spread.Notify Microbiology laboratory before sending specimensBK Virus (BKV)PolyomavirusAsymptomatic or cystitis in healthy peopleCauses lower and upper renal tract disease in immunocompromised patients*-painful hematuria most common symptomRoutine* Disease can include hemorrhagic cystitis, interstitial nephritis, renal allograph loss, nephropathyBocavirusSee “Respiratory Viral Infections”Droplet and ContactAdult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom freeBornholms DiseasePleurodyniaSee Enteroviral infectionContact NICU: Droplet and ContactUntil symptom freeUntil discontinued by IPACSBotulismClostridium botulinumDescending flaccid Paralysis, cranial nerve palsiesRoutineNo person-to-person spreadReportable diseaseBronchiolitisSee “ Respiratory Viral Infections”Droplet and ContactMinimum of eleven days from onset and child is symptom freeBrucellosis (Undulant fever)Manifestations are non-specific & include:fever, night sweats, weakness, malaise, and arthralgiaRoutineContact precautions for patients with draining woundsDuration of drainagePerson-to-person spread is rare. Congenital brucellosis has been reported. Infected mothers can transmit brucella species to their infants through breast feeding.Notify Microbiology laboratory before sending specimensReportable diseaseBurkholderia cepacia complexAssociated with severe pulmonary infections in patients with cystic fibrosis and Chronic Granulomatous Diseases (CGD)RoutineFor CF patientsContact**Refer to section 6 for specific information on Cystic Fibrosis CampylobacterSee “Diarrhea”DiarrheaContactUntil stool is formed or back to baseline for the patient. Reportable disease Candida aurisCandida auris (cont)Blood stream infections, wound infections, otitisCan be multi-drug resistantContact PlusFor duration of hospital stayMother ill:Contact plus precautions for motherContact plus precautions for all newborns of positive mothers.Healthy Term Infant: MI contact, BF and RI permittedMother uses routine practices for infant (Mother may choose to use contact plus precautions)Baby in NICU:Baby to be placed in single roomMI contact and BF permitted Mother uses routine practices for infant (Mother may choose to use contact plus precautions)Mother to limit visits to her child only and go directly in and out of NICU. Infant ill:Contact plus precautions for infantRoutine practices for MotherMI Contact, BF and RI permittedStrict attention to hand hygieneCandidiasis(Moniliasis) Mucocutaneous infection in oropharynx (thrush) or vaginal candidiasis. Can be disseminated or invasiveRoutineMI contact, BF, and RI permittedCarbapenemase-Producing Organisms (CPO)Infection or colonization of any body siteContact PlusAdd Droplet Precautions for any coughing or ventilated patient with CPO For duration of hospital stayMother has CPO:Contact plus precautions for motherContact plus precautions for newborns of positive mothers.Healthy Term Infant: MI contact, BF and RI permittedMother uses routine practices for infant (Mother may choose to use contact precautions)Baby in NICU:Baby to be placed in single roomMI contact and BF permitted Mother uses routine practices for infant (Mother may choose to use contact precautions)Mother to limit visits to her child only and go directly in and out of NICU. Infant has CPO:Contact plus precautions for infantContact plus precautions for MotherMI Contact, BF and RI permittedRefer to the infection control manual for specific information on CPO.Notify IPACS immediatelyReportable DiseaseCat Scratch Fever Bartonella henselaeLymphadenopathy (regional)RoutineNo person-to-person spreadCellulitis, with drainage See “Abscess”MinorMajor (drainage not contained by dressing)RoutineContact*Duration of drainage*Implement Droplet precautions if H. influenzae type b is suspected in non-immune children < 5years old.Cervical lymphadenitisNo drainage, intact skinFor draining, see abscess or specific organismRoutineChancroidHaemophilus ducreyiGenital UlcersRoutineSexually transmitted.Reportable diseaseChickenpoxVaricellaChickenpox (cont)VaricellaVesicular rash, mild fever and systemic symptoms. Airborne and ContactFor a minimum of 5 days after onset of rash and until all lesions are crusted which can be a week or longer in immuno-compromised patients.Susceptible contacts of patients with chickenpox should be placed on airborne and contact isolation on day 8 from the first known contact and up to and including day 21 if they have not received VZIG, 28 days if they have received VZIG Mother with active lesions -Mother-airborne and contact precautions-Infant-needs to be assessed for VZIG and treated as a susceptible contact. Healthy term infant:-Once infant has received VZIG, RI, BF and MI contact is allowed. -Will require isolation from day 8-21 (28 if VZIG given)Infant in NICU: -Mother may not go to NICU for a minimum of 5 days or until all lesions have crusted over. -MI contact not permitted-BF by expressed breast milk onlyInfant has chickenpox:-Airborne and contact precautions-Only immune visitors/siblings may visit*-MI contact permitted if mother is immune-BF permittedInfant is Chickenpox contact: Assess need for VZIGWill require isolation from day 8-21 (28 if VZIG given)Notify IPACS of all cases of suspected or confirmed chickenpox. Patients with active chickenpox should be placed in an airborne isolation room away from severely immuno-compromised patients (e.g., they should not be cared for on the oncology ward).HCW should have their immune status validated with PHSA Workplace HealthNon-immune HCW should not care for patients with active chickenpox * *Immunity is defined as any of the following: Documentation of age appropriate varicella vaccine.Laboratory evidence of immunity or laboratory confirmation of disease.Varicella diagnosed or a verification of history from family members by the physician or delegate.History of herpes zoster diagnosed by physician or delegateVisitors who have active chickenpox or shingles must not visit. HCW with suspected chickenpox should not be at work and must report toPHSA Workplace Health.Chlamydia Chlamydia trachomatis(CT)Chlamydophila pneumoniae(CPn)Chlamydophila psittaci(CPs)Neonatal conjunctivitisPneumoniaTrachomaGenital tract infection and lymphogranuloma venereum (LGV), Respiratory tract infectionPneumoniaRoutine MI contact, BF, and RI permittedChlamydia disease including Psittacosis is reportable.Reportable diseaseCholeraVibrio choleraVoluminous watery diarrhea, dehydration and other serious complicationsContactUntil stool is formed or back to baseline for the patient.Consult IPACSNotify IPACSReportable diseaseClostridium botulinumSee “Botulism”RoutineReportable disease Clostridium difficileClostridium difficile(cont)DiarrheaPseudo membranous colitisContact PlusUntil diarrhea has subsided for 72 hours and stools are formed or back to baseline for the patient. Contact IPACS prior to discontinuation of precautions.Mother ill and Healthy Term Infant: -MI contact, RI, and BF permitted-Mother: Contact precautions-Infant: Routine practices Mother ill and Baby in NICU: -Baby to be placed in single room-Mother to limit visits and go directly in and out of NICU-MI contact and BF permitted; mother uses routine practices for infantStrict attention to hand hygieneBacterial spores may persist in the environment; therefore, special attention must be paid to cleaning of the environment.Note: Asymptomatic colonization is common in newborns and infants. Clostridium perfringensGas GangreneRoutineNo person-to-person spreadCoccidioido-mycosis(Valley Fever)Pneumonia, cutaneous or soft tissue infection, RoutineNo person-to-person spreadNotify Microbiology laboratory before sending specimensCold, commonSee “Respiratory Viral Infections”Cold, common(cont)Droplet and ContactAdult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom freeCongenital RubellaSee “Rubella”Droplet and Contact for congenital rubellaContinue precautions for at least 1 year, unless 2 urine and nasopharyngeal culture results after 3 months of age are negativeReportable disease ConjunctivitisEye dischargeContactUntil viral etiology ruled out or for duration of symptoms*.Mother ill: -Contact precautions for mother-Routine practices for infantHealthy Term infant: MI contact, RI, and BF permittedBaby in NICU:-Mother should be encouraged not to visit until symptom free** -BF permitted as expressed breast milk.Infant ill:-Contact precautions for infant-Routine practices for motherStrict attention to hand hygiene*If viral etiology established, see specific organism.**If Mother must visit Baby inNICU:Place infant in private roomMother to limit visits and go directly in and out of NICUCoronavirus 229E/OC43/NL63/HKU1See “Respiratory Viral infections”Droplet and ContactAdult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom freeCOVID-19 (SARS-CoV-2, novel coronavirus 2019, nCoV2019)Fever, new onset of (or exacerbation of chronic) cough, pneumonia, diarrhea, nausea.Droplet and ContactAdd Airborne precautions if Aerosol-Generating Medical Procedures (AGMP) are likely to be required (e.g. nebulized therapy, CPR, CPAP, Endotracheal intubation & extubation, High frequency oscillatory ventilation, Bronchoscopy and bronchoalveolar lavage, Laryngoscopy, Positive pressure ventilation (BiPAP & CPAP), sputum induction).Consult IPACMother/Caregiver ill:Droplet and contact precautions for mother and infantMother/Caregiver to wear mask when within 2 metres of infant if contact occurs.Risk of transmission via breast milk is unlikely but evidence is limited. No evidence of virus in breast milk in small studies; EBM likely safe. If BF occurs mask must be worn by mother and diligent hand hygiene practiced. Healthy infant:Assess MI contact and RI on acase by case basis inconsultation with the clinicalteam(s).*Infant in NICU:Caregivers with COVID-19 may not enter the NICU until at least symptom free.* Consult IPAC as required Family members and visitors must be approved by NICU staff on a case by case basis prior to entering NICUFamily members and visitors with an acute respiratory infection or those under quarantine should not participate in care or enter the hospital with the exception of child's parent/primary caregiver. The parent/primary caregiver should continue to follow BCCDC recommendations for self-isolation while in hospital. Strict attention to hand hygieneIf Mother/caregiver mustparticipate in care:Place infant in private roomMother/caregiver to limit visits and go directly in and out of NICU.Mother/caregiver to wear mask for duration of time in NICUReportable diseaseCoxsackievirusSee “ Enterovirus infections”Contact NICU: Droplet and ContactUntil symptom free for 48 hoursUntil discontinued by IPACSCreutzfeldt-Jakob Disease(CJD)EncephalopathyRoutine*Notify IPACS immediately if CJD is suspected.Tissues associated with high levels of infectivity include brain, eyes, spinal cord*Please follow Public Health Agency of Canada guidelines for CJD Reportable diseaseCroupSee “Respiratory Viral Infections”Droplet and Contact Minimum of eleven days from onset and child is symptom free CryptococcosisCryptococcus neoformans, Cryptococcus gattiPneumonia, dissemination, meningitis.RoutineNo person-to-person spread Reportable diseaseCryptosporidiosis DiarrheaContactUntil stool is formed or back to baseline for the patient.Reportable diseaseCysticercosisCysts in various organs including brain (neurocysticercosisRoutineNo person-to-person spreadCytomegalovirus(CMV)Usually asymptomatic; Infectious Mononucleosis, Congenital infection, Retinitis, colitis, disseminated infection in immunocompromised hostRoutineCongenital CMV disease is reportableDecubitus UlcerMinorMajor (drainage not contained by dressing)RoutineContactDuration of drainageMI contact, RI permitted if drainage adequately controlledDengue FeverSee “Arthopod-borne viral infections”RoutineDermatitisMany causes (bacteria, virus, fungus).MinorMajor (drainage not contained by dressing)RoutineContactIf compatible with scabies, see scabies.Dermatophyte infectionSee “Tinea” RingwormRoutineDiarrheaSeveral bacteria, viruses, parasites which may include: norovirus, rotavirus, enteric adenovirus, Salmonella, Shigella, Campylobacter, E. coli, YersiniaSee specific organism for more detailsAcute diarrhea, sometimes accompanied by vomiting, abdominal crampsContactAdd Droplet if vomitingUntil infectious cause ruled out or until specific etiology established and then refer to specific organism for appropriate precautions.If no organism identified, continue precautions until stool is formed or back to baseline for the patient. Mother ill: -Contact precautions for Mother-Routine practices for infantHealthy Term Infant: -MI contact, RI, and BF permittedInfant in NICU:-Mother should be encouraged not to visit until stool is formed or back to baseline for the mother * Infant ill:-Contact precautions for infant**-Routine practices for Mother-MI contact, RI and breastfeeding permittedEmphasize hand hygiene with mother as shedding may be prolonged. *If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICUStrict attention to hand hygiene**Ensure immediate disposal of diapers into leak proof bagReinforce hand hygieneConsult IPACS if you suspect an outbreak.Reportable disease-depending on etiologyDiphtheriaCorynebacterium diphtheriaDiphtheria (cont)Corynebacterium diphtheriaeCutaneous (characteristic ulcerative lesion)ContactUntil 2 cultures of skin lesions taken 24 hours apart and 24 hours after completing antimicrobial treatment are negative for C. diphtheriaeContact IPACSClose contacts should be given antibiotic prophylaxis:-carriers-casesReportable diseasePharyngeal (adherent grayish membrane)DropletUntil 2 cultures from both the nose and throat taken 24 hours apart and 24 hours after completing antimicrobial treatment are negative for C. diphtheriaEbola virusSee “Hemorrhagic fevers”Airborne + goggles and ContactUntil hemorrhagic fever virus ruled out or until discontinued by IPACSNotify IPACS immediately.Notify Public Health immediately. Echinococcosis “Hydatid Disease”Echinococcus granulosus and Echinococcus multilocularisCysts in various organs, including liverRoutineNo person to person spreadEchovirus DiseaseSee Enterovirus infectionContact NICU: Droplet and ContactUntil symptom freeUntil discontinued by IPACSEmpyema (draining)Common organisms include Staph aureus (including MRSA), GASContactDuration of Drainage.Consult IPACS as neededEncephalitis or encephalomyelitisAdult: RoutinePediatric: Contact NICU: Droplet and ContactUntil specific etiology established and then refer to specific diseases for appropriate precautionsMay be associated with HSV, Enterovirus, arbovirus. measles, mumps, varicella, Mycoplasma pneumonie, Epstein-Barr virus (EBV).Reportable Disease EndometritisRoutineMI contact, RI and BF permitted.If infection is due to Group A Streptococcus, see “Streptococcal Disease– Group A”.Enterobiasis See “Pinworms”RoutineEnterovirus Enterovirus (nonpolio):Coxsackieviruses- Echoviruses- EnterovirusesEnterovirus (cont)Acute febrile respiratory illness, e.g., cough, feverAcute febrile illness, aseptic meningitis, encephalitis, pharyngitis, herpangina, rash, pleurodynia, hand foot and mouth diseaseGastroenteritis may occur but is not common.Droplet and ContactContact NICU: Droplet and ContactUntil symptom freeUntil symptom freeUntil discontinued by IPACSMother ill:-Additional precautions as indicated for mother-Routine practices for infantHealthy term infant:- MI contact, RI and BF permittedInfant in NICU:-MI contact NOT permitted in the NICU until mother asymptomatic* -BF as expressed milkInfant ill:-Additional precautions as indicated for infant.-Routine practices for mother-MI contact, RI and BF permitted Infant ill and in NICU:-Droplet and contact precautions for infant.-Mother uses routine practices for infant (Mother may choose to use droplet and contact precautions)-Mother to limit visits to her child only and go directly in and out of NICU. Strict attention to hand hygieneShedding of Enterovirus can occur in stool.*If Mother must visit infant in NICU, consult IPACS. Epiglottitis Haemophilus influenzae type b; Streptococcus group A, Staphylococcus aureusAdult: RoutinePediatric: Droplet until H. influenzae is ruled outIf H. influenzae:Until 24 hours of appropriate antimicrobial therapy received Epstein-Barr virusEpstein-Barr virus(cont)Infectious Mononucleosis, X-linked lymphoproliferative syndrome, post-transplantation lymphoproliferative disorder, Burkitts lymphoma, nasopharyngeal carcinoma RoutineSpread via intimate contact with oral secretions or from articles contaminated with oral secretions.ErysipelasSee “Streptococcus group A” Acute, cutaneous inflammatory disease Droplet and ContactUntil 24 hours of appropriate antimicrobial therapy receivedErythema InfectiosumFifth DiseaseParvovirus B19”Rash, anemia, aplastic crisis. In pregnancy: hydrops foetalisRoutineDroplet for the following patients: -Aplastic crisis -Immuno-compromised -Papulopurpuric gloves-socks (PGS) syndromeTransient aplastic or erthyrocyte crisisFor duration of hospitalization (aplastic crisis, immuno-compromised, PGS) For 7 days for patients with transient aplastic crisis (TAC)Escherichia coli(E coli O157 and other shiga-toxin producing strains)See “Diarrhea” and “HUS”Diarrhea, abdominal cramps, hemolytic-uremic syndrome (HUS), thrombotic thrombocytopenic purpuraContactUntil stool is formed or back to baseline for the patient and the results of two stool cultures are negative for E. coli 0157Reportable diseaseExtended Spectrum Beta-Lactamases (ESBL)See also “Multi-drug Resistant Organism”Infection or colonization of any body siteContact*For duration of hospital stayMother has an ESBL:Contact precautions for motherContact precautions for newborns of positive mothers.Healthy Term Infant: MI contact, BF and RI permittedMother uses routine practices for infant (Mother may choose to use contact precautions)Baby in NICU:Baby to be placed in single roomMI contact and BF permitted Mother uses routine practices for infant (Mother may choose to use contact precautions)Mother to limit visits to her child only and go directly in and out of NICU. Infant has an ESBL:Contact precautions for infantContact precautions for MotherMI Contact, BF and RI permitted*Patients who are only colonized may only require routine practices. Consult IPACS.Fifth DiseaseSee “Erythema Infectiosum” RoutineDroplet for the following patients: -Aplastic crisis -Immuno-compromised -Papulopurpuric gloves-socks (PGS) syndromeTransient aplastic or erthyrocyte crisisFor duration of hospitalization (aplastic crisis, immunocompromised, PGS) For 7 days for patients with transient aplastic crisis (TAC)Food Poisoning/Food-Borne IllnessE.g. Bacillus cereus, Clostridium perfringens, Staphylococcus aureus, Salmonella, vibrio parahaemolyticus, Escherichia coli 0157 and othersSee specific organism for more detailsDiarrhea, vomiting and abdominal cramps ContactAdd Droplet if vomitingUntil specific etiology established and then refer to specific organism for appropriate precautions.If no organism identified, continue precautions until stool is formed or back to baseline for the patient. Mother ill: -Contact precautions for mother-Routine practices for infantHealthy Term Infant: -MI contact, RI, and BF permittedInfant in NICU:-Mother should be encouraged not to visit until stool is formed or back to baseline for the mother * Infant ill:-Contact precautions for infant**-Routine practices for mother-MI contact, RI and BF permittedEmphasize hand hygiene with mother as shedding may be prolonged. *If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICUStrict attention to hand hygiene**Ensure immediate disposal of diapers into leak proof bagReinforce hand hygieneConsult IPACS if you suspect an outbreak.Reportable diseaseFurunculosisStaphylococcus aureus, including MRSASee “Abscess”MinorMajor (drainage not contained by dressing)RoutineContactDuration of drainageGastroenteritis Several bacteria, viruses, parasites which may include: norovirus, rotavirus, enteric adenovirus, Salmonella, Shigella, Campylobacter, E. coli, YersiniaSee specific organism for more detailsAcute diarrhea, vomiting, abdominal crampsContactAdd Droplet if vomitingUntil infectious cause ruled out or until specific etiology established and then refer to specific organism for appropriate precautions.If no organism identified, continue precautions until stool is formed or back to baseline for the patient. Mother ill: -Contact precautions for mother-Routine practices for infantHealthy Term Infant: MI contact, BF and RI permitted Infant in NICU:-Mother should be encouraged not to visit until stool is formed or back to baseline for the mother * Infant ill:-Contact precautions for infant**-Routine practices for mother-MI contact, RI and breastfeeding permittedEmphasize hand hygiene with mother as shedding may be prolonged. *If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICUStrict attention to hand hygiene**Ensure immediate disposal of diapers into leak proof bagReinforce hand hygieneConsult IPACS if you suspect an outbreak.Reportable disease-depending on etiology German MeaslesSee “Rubella”DropletDroplet and Contact for congenital rubellaUntil 7 days after onset of rashContinue precautions for at least 1 year, unless 2 urine and nasopharyngeal culture results after 3 months of age are negativeReportable diseaseGiardiasisGiardia lambliaDiarrheaContactUntil stool is formed or back to baseline for the patient.Reportable diseaseGonococcal InfectionsNeisseria gonorrhoeaeOphthalmia neonatorum, gonorrhea, arthritis, pelvic inflammatory diseaseRoutineMother ill: -routine practices for Mother and infant-MI contact, BF and RI permitted.Infant ill (conjunctivitis, scalp abscess, sepsis):-MI contact, BF and RI permitted.Reportable diseaseGranuloma inguinale/DonovanosisKlebsiella granulomatisPainless genital ulcers, inguinal ulcers, nodulesRoutineSexual transmissionHaemophilus influenzae type bInvasive disease:Pneumonia, meningitis, epiglottis, septic arthritis, cellulitis, otitis media, endocarditis, periorbital cellulitis in non-immune child < 5 years old, etc.Adult: DropletPediatric: DropletUntil 24 hours of appropriate antimicrobial therapyInvasive Haemophilus influenzae type b is a reportable disease Haemophilus influenzae non bRoutineAll invasive Haemophilus influenza are a reportable disease by type Hand, Foot & Mouth DiseaseSee “Enterovirus infection”Contact NICU: Droplet and ContactUntil symptom freeUntil discontinued by IPACSHansen’s DiseaseSee “Leprosy”RoutineReportable diseaseHantavirusHemorrhagic fever, pulmonary syndrome, renal syndromeRoutineInfection acquired from rodents.Reportable diseaseHelicobacter pyloriGastritis, ulcerRoutineHemolytic Uremic Syndrome(HUS)Shiga toxin-producing Enterohemorrhagic E. coli (EHEC) or ShigellaA prodromal illness with abdominal pain, vomiting, and diarrhea that immediately precedes the development of HUS: (Hemolytic anemia, Thrombocytopenia, Acute renal injury)ContactAdd Droplet if vomitingUntil E.coli 0157 or other infectious cause ruled out and then refer to specific organism for appropriate precautions.Reportable diseaseHemorrhagic FeversLassa, Ebola, Marburg, and othersSevere Febrile diseases with bleeding, shock and multisystem involvementAirborne + goggles and ContactUntil hemorrhagic fever virus ruled out or until discontinued by IPACSNotify IPACS immediately.Notify Public Health immediately. Hepatitis of unknown etiologyHepatitis, jaundiceContactFor 7 days after onset of jaundice or until hepatitis A and E ruled outHepatitis A and EHepatitis, jaundice, acute febrile illness.ContactDuration of symptoms or at least one week from onset of symptoms, whichever is longerMI contact, BF and RI are permittedIf mother has Hepatitis A or E infection, notify the infant’s physician. Asymptomatic HAV infection in infants can occur: Excretion of virus in stool can be prolonged.Reportable diseaseHepatitis BHepatitis, jaundice, acute and chronic often asymptomaticRoutine -MI contact and RI permitted-BF permitted if infant of an HBsAg positive Mother has received HBIG and Hepatitis B vaccine-consult physicianReportable diseaseHerpanginaSee “Enterovirus”Contact NICU: Droplet and ContactUntil symptom freeUntil discontinued by IPACSHerpes Simplex Herpes Simplex (cont)Genital,Mucocutaneous, oral, Herpetic Whitlow, Eczema Herpeticum,encephalitis and meningitisNeonatal HSV infections can be severe, can involve multiple organs.Children, Adolescents and Adults are often asymptomatic. Symptoms may include: gingivostomatitis,vesicular lesions, genital herpes, conjunctivitis, keratitis,encephalitis.After primary infection HSV persists for life. Routine practices for:Patients with localized recurrent lesionsPatients with CNS infectionMother has lesions:-MI contact permitted* -Total rooming in preferred -Observe strict hand hygiene -Mother may choose to wear a gown when caring for infant-Mothers with herpes labialis should wear a disposable surgical mask when touching infant until lesions are crusted over and dried. -BF permitted if no herpetic lesions on the breast-For mothers with herpetic whitlow-gloves should be worn* For mothers with mucotaneous HSV lesions: instruct the Mother on hand hygiene, to wear a mask or cover lesion when around her infant, not kiss the infant while lesion is present and to avoid touching affected areas.HCW with active herpes lesions (cold sores, herpetic whitlow) should consult PHSA Workplace Health for direction.Herpes genitalis and congenital Herpes Simplex infection are reportable diseasesContact precautions for:Neonates with mucacutaneous lesionsNeonates exposed to active HSV lesions during birthWomen in labor and postpartum women with active HSV lesionsPatients with severe mucocutaneous diseaseUntil lesions are crusted over and driedBirth to 6 weeks of age or until neonatal HSV infection has been ruled out.Until lesions are crusted over and driedUntil lesions are crusted over and driedHerpes zoster(Shingles, Zoster, Varicella Zoster)See “Shingles”Immunocompetent patient:Localized and can be coveredExtensive or localized that cannot be coveredImmunocompromised host or disseminated diseaseContactAirborne and ContactAirborne and ContactUntil lesions have crusted over and dried.HistoplasmosisHistoplasma capsulatumHistoplasmosis (cont)Asymptomatic, pulmonary or disseminatedRoutineNo person-to-person spread. Notify Microbiology laboratory before sending specimensHIVHuman Immunodeficiency VirusA wide range of clinical manifestationsRoutine- MI contact and RI permittedAssess mothers individually for possibility of other infections.Reportable diseaseHuman AstrovirusAcute gastroenteritisContact*Until stool is formed or back tobaseline for thepatient for 48hoursConsult IPACS ifimmunecompromisedMother ill:- Contact precautions formother- Routine practices forinfantHealthy Term Infant:- MI contact, BF and RI permitted.Infant in NICU:- Mother should beencouraged not to visituntil stool is formed orback to baseline for themother for 48 hours*Infant ill:- Contact precautions forinfant**- Routine practices for Mother- MI contact, BF and RI permittedo Strict attention to hygiene*Prolonged fecal sheddingmay occur in immunocompromised patients after recovery.Contact precautions for duration of hospitalization may be justified.If Mother must visit:o Place infant in privateroomo Mother to limit visitsand go directly in andout of NICU**Ensure immediatedisposal of diapers into leakproof bag.Reportable DiseaseHuman Herpesvirus 6See “RoseolaFever followed by rashRoutineHuman MetapneumovirusSee “Respiratory Viral Infections”Droplet and ContactAdult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom freeHuman PapillomavirusesSkin warts, anogenital warts (condylomata acuminate)RoutineHuman T-Cell Lymphotropic Virus I/II (HTLV I/II)AsymptomaticRoutine-MI contact and RI permittedImpetigoe.g. Staphylococcus aureus, and Group A StreptococcusVariants of impetigo include: bullous, non-bullous or ecthymaMinorMajor (drainage not contained by dressing)RoutineContactDuration of drainage or can be contained by a dressing MI contact, RI permitted if drainage adequately controlled. Mother: If impetigo on breast-consult physician prior to breast feeding. Instruct the Mother on hand hygiene, to cover lesion when around her infant, not kiss the infant while peri-oral lesion is present and to avoid touching affected areas.InfluenzaInfluenza (cont)Acute febrile respiratory illness, e.g., cough, fever, muscle and joint pain, headache, etcDroplet and ContactContinue precautions for 5 days after onset of illness or until symptoms resolve, whichever is longer.Mother ill: -Contact and droplet precautions for mother-Routine practices for infantHealthy term infant:MI contact, BF and RI permitted -Mother to wear mask when within 2 metres of infant. Infant in NICU: -Mother should be encouraged not to visit until symptom free.* -BF permitted as expressed milk. -Consult IPACS as requiredInfant ill: -Droplet and contact precautions for infant-Routine practices for mother- MI contact, BF and RI permitted Family members and visitors with an acute respiratory infection should not visit or enter the hospital.Pregnant women and infants are at high risk of complications of influenza. Women who are or will be pregnant or who will deliver during influenza season are a high priority group for receiving influenza vaccine.Strict attention to hand hygiene*If ill Mother must visit infant in NICU:Place infant in private roomMother to limit visits and go directly in and out of NICU. Mother to wear mask for duration of visit in NICUAll HCW should receive annual influenza vaccine. Consult IPACS if you suspect an outbreak.Refer to Section 6 for specific information on InfluenzaReportable diseaseInfluenza Vaccine (Live Attenuated Influenza Vaccine – LAIV) intranasal spraye.g FluMist?Patients, staff and visitors who have received LAIV Routine (see comments)Patients, staff, visitors and family members who have received LAIV should not have direct contact with severely immunocompromised patients for 14 days post immunization.Severely immunocompromised patients include those in the Bone Marrow Transplant Unit and other patients on Protective Isolation. NICU:Children visiting, who have received FluMist, must wear a mask before entering NICU for 7 days following the vaccine.Consult IPACS as neededKawasakiAcute febrile, self-limited, systemic vasculitis of early childhoodRoutineLassa Fever See “Hemorrhagic Fevers”Airborne + goggles and ContactUntil hemorrhagic fever virus ruled out or until discontinued by IPACSLegionella pneumophila Infections Legionnaires disease: Varies in severity from mild to severe pneumonia, fever, cough and progressive respiratory distressPontiac Fever:Mild febrile illness without pneumoniaRoutineNo person-to-person spreadNotify IPACSReportable diseaseLeprosy(Hansen’s disease)Mycobacterium lepraeInfection involving skin, peripheral nerves, mucosa of the upper respiratory tract, and testesRoutineTransmission between persons only with very prolonged extensive close personal contact.Household contacts should be given prophylaxisReportable diseaseLeptospirosisLeptospira speciesAcute febrile disease with varied manifestations characterized by vasculitisRoutineReportable diseaseLice (Pediculosis)Pediculus capitis: Head lice-lice and eggs in hair, behind ears and nape of neckPediculus corporis: Body licePthirius pubis: Pubic lice/Crab LiceItchingSome children with head lice may be asymptomatic Secondary bacterial infectionContact Until 24 hours after treatment is complete Mother symptomaticContact for motherHealthy term Infant:-MI contact, RI, BF permittedInfant in NICU:-MI contact and BF permitted once mother has been treatedTreatment should be applied as soon as possible.Repeat the treatment in 7-10 days to ensure that head lice which hatch after the first treatment will be killed. No approved pediculicide is completely ovicidal. After each treatment, checking the hair and combing with a nit comb to remove nits and lice every 2-3 days may decrease the chance of self-re-infestation. Continue to check for 2-3 weeks to be sure all lice and nits are gone.Refer to Section 6 for more specific information on lice.ListeriosisListeria monocytogenesPrimarily food borneInfluenza like illness, malaise, headache, and gastrointestinal symptoms. More severe in neonates (early and late onset disease). Central nervous system infections.Routine- MI contact , RI and BF permittedReportable diseaseLyme diseaseBorrelia burgdorferi3 stages:Early localized, early disseminated, and late disease.RoutineReportable disease LymphadenitisNo drainage, intact skinFor draining, see abscess or specific organismRoutineLymphogranuloma Venereum (LGV)See “Chlamydia trachomatis”RoutineMalariaPlasmodium speciesFebrile illness with a history of travel RoutineMalaria in pregnancy carries significant risks of morbidity and mortality for both the mother and fetusReportable diseaseMastitisSee “Staphylococcus aureus”MinorMajor (drainage not contained by dressingRoutineContactDuration of drainage Measles“Red Measles”(Rubeola)Measles“Red Measles”(Rubeola) (cont)Fever, cough, coryza, conjunctivitis, an erythematous maculopapular rash, and a pathognomonic enanthema (Koplik’s spots)Airborne Until 4 days after start of rash. For duration of illness if illness in immune compromised patients.Susceptible contacts of known measles cases should be placed on airborne precautions from 5 days after their first exposure to 21 days after their last exposure, or 28 days if they have received Immune Globulin. Mother has measles:-Mother: airborne-Infant: should receive Immune Globulin (IG) and remain on airborne precautions until 28 days from last exposure Healthy term infant:-MI contact, RI permitted-BF permitted if RIInfant in NICU: -Mother not permitted in NICU until 4 days after appearance of the rash, or if immune compromised for duration of illness -BF permitted as expressed breast milkInfant has measles -Mother immune – permitted to see infant and BF permitted-Mother susceptible – consult IPACS -Infant on Airborne Precautions until 4 days after start of rashInfant is measles contact: Airborne precautions 5 days after first exposure to 21 days after last exposure, or 28 days if they have received IG.Refer to Section 6 for specific information on measlesNotify IPACS as soon as you suspect measlesHCW:- HCW should have their immune status validated with PHSA Workplace Health - - Non-immune HCW should not care for patients with measles.- HCW with suspected measles should not be at work and report to PHSA Workplace HealthOnly immune family and visitors to visitImmunity is defined as a previous history of measles or having received 2 doses of measles vaccine or born before 1957Reportable diseaseMeningitis Meningitis (cont)Symptoms include headache, neck stiffness, fever, petechiae, etc. Severity of symptoms depends on causative organism.Etiology unknown:Droplet and contactUntil etiology determined or infectious cause ruled out. Notify IPACS of all cases of meningitisMeningitis is a reportable disease – all causes.Fungal MenigitisRoutineHaemophilius influenzae type bDropletUntil 24 hours of appropriate antimicrobial therapyLysteria monocytogenesRoutineMeningococcal(Neisseria meningitidis)DropletUntil 24 hours of appropriate antimicrobial therapyStreptococcus pneumoniae RoutineOther bacterial: Routine PracticesTuberculosis:AirborneIf TB is causative organism the patient should be placed on airborne precautions until pulmonary TB is ruled out in patient and family members.If TB confirmed: See “Tuberculosis”Viral: Adult - RoutinePediatric - Contact NICU – Droplet and ContactSee specific organism for more detailsContinue for 7 days after onset of illness unless a non-enteroviral diagnosis is establishedMeningococcal Disease(Neisseria meningitidis)Meningococcemia meningitis, pneumonia, sepsisDroplet Until 24 hours of appropriate antimicrobial therapy Close contacts may require chemoprophylaxis.Reportable diseaseMethicillin-resistant Staphylococcus aureus (MRSA)Infection or colonization of any body siteContact Add Droplet Precautions for any coughing patient with MRSAFor duration of hospital stay Mother has MRSA:Contact precautions for motherContact precautions for newborns of positive mothers.Healthy Term Infant: MI contact, BF and RI permittedMother uses routine practices for infant (Mother may choose to use contact precautions)Baby in NICU:Baby to be placed in single roomMI contact and BF permitted Mother uses routine practices for infant (Mother may choose to use contact precautions)Mother to limit visits to her child only and go directly in and out of NICU, if she has an infection. Infant has MRSA:Contact precautions for infantContact precautions for MotherMI Contact, BF and RI permittedRefer to the infection control manual for specific information on MRSA Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Severe acute respiratory illness and feverAirborne, Droplet and ContactUntil MERS-CoV is ruled out or until discontinued by IPACSNotify IPACS immediately.Notify Public Health immediately. Molluscum ContagiosumInfection of the skin with no systemic manifestations; characterized by umbilicated papulesRoutineRequires intimate direct personal contact for transmission.Mononucleosis, See “Epstein-barr virus” and “Cytomegalovirus”RoutineMucormycosis (Zygomycosis-Rhizopus, Mucor, Rhizomucor, Absidia species)Fungal DiseaseRhinocerebral, pulmonary, skin, or disseminated.Disease in Immunosuppression (e.g. malignancy, Diabetes, Renal Failure)RoutineMulti-drug Resistant OrganismSee also “Extended Spectrum Beta-Lactamases (ESBL)”Infection or colonization of any body siteContact*For duration of hospital stay Mother has an MDRO:Contact precautions for motherContact precautions for newborns of positive mothers.Healthy Term Infant: MI contact, BF and RI permittedMother uses routine practices for infant (Mother may choose to use contact precautions)Baby in NICU:Baby to be placed in single roomMI contact and BF permitted Mother uses routine practices for infant (Mother may choose to use contact precautions)Mother to limit visits to her child only and go directly in and out of NICU. Infant has an MDRO:Contact precautions for infantContact precautions for MotherMI Contact, BF and RI permitted*Patients who are only colonized may only require routine precautions. Consult IPACS.MumpsParotitisMumps (cont)ParotitisSwelling of one or more of the salivary glands (usually the parotid glands), orchitis, meningitisDroplet Continue precautions for 5 days after onset of parotid swelling.Susceptible contacts of known mumps cases should be placed on droplet precautions from 10 days after their first exposure to 26 days after their last exposure. Mother has mumps:Mother – Droplet precautionsTerm Infant:-MI contact, BF, and RI permittedInfant in NICU:-Mother not to go to NICU until 5 days after the onset of the parotid swelling-BF as expressed milk until 5 days after onset of parotid swellingInfant has mumps Mother immune:permitted to see infantMother susceptible:Consult IPACS. BF as expressed breast milk Infant is mumps contactDroplet precautions from 10 days to 26 days from last exposureNotify IPACS as soon as you suspect mumps. HCW:- HCW should have their immune status validated with PHSA Workplace Health - Non-immune HCW should not care for patients with mumps.- HCW with suspected mumps should not be at work and report to PHSA Workplace Health.Only immune family and visitors to visitImmunity is defined as a previous history of mumps or having received mumps vaccine or born before 1957- One dose is recommended for individuals born between 1957 and 1969.- Two doses are recommended for all individuals born on or after 1970Reference: BCCDC Immunization manual. Reportable diseaseMycobacteria, other than tuberculosisSee “Atypical mycobacteria”Mycobacterium abscessus in CF patientsRoutine ContactFor duration of hospital stayNo person-to-person transmission, except for Mycobacterium abscessus in CF patients. Please refer to CF standard in section 6.Mycobacterium tuberculosis,See “Tuberculosis”AirborneReportable diseaseMycoplasma pneumoniaeUpper respiratory tract infections, acute bronchitis, pneumoniaUnusual manifestations: CNS disease, myocarditis, hemolytic anemia.Droplet Until symptom freeNecrotizing Enterocolitis (NEC)RoutineContact Precautions may be indicated for clusters/outbreaks-Consult IPACSUnknown if transmissible. Neisseria MeningitidisSee “Meningococcal Disease”Droplet Until 24 hours of appropriate antimicrobial therapy Reportable diseaseNipah virusEncephalitisDroplet and ContactUntil symptoms resolveReportable diseaseNocardiosisNocardia speciesFever, pulmonary or CNS infectionRoutineNo person-to-person transmission.NorovirusGastroenteritisDroplet and ContactUntil stool is formed or back to baseline for the patient for 48 hoursIf ongoing GI symptoms (e.g. immunocompromised, chronic GI disease):Continue contact precautions until 2 PCR negative results are obtained or until stool is formed or back to baseline for the patient for 48 hours.Test stool every 2 weeks if results continue to be positiveIf previous result was negative, repeat stool test in 1 week. Discontinue precautions if a second negative result is obtainedMother ill: Contact precautions for motherRoutine practices for infantHealthy Term Infant:MI contact, BF and RI permitted. Infant in NICU:Mother should be encouraged not to visit until stool is formed or back to baseline for the mother for 48 hours* Infant ill:Contact precautions for infant**Routine practices for MotherMI contact, BF and RI permittedStrict attention to hand hygiene*Prolonged fecal shedding may occur in immunocompromised patients after recovery. Contact precautions for duration of hospitalization may be justified. If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICU**Ensure immediate disposal of diapers into leak proof bag.Reportable DiseaseOphthalmia NeonatorumSee “Conjunctivitis”ContactUntil symptom free OsteomyelitisOsteomyelitis (cont)May result from contiguous spread from adjacent soft tissues and joints, hematogenous seeding, or direct inoculation into the bone as a result of trauma or surgeryRoutineParainfluenza VirusSee “Respiratory Viral infections”Droplet and ContactAdult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom freeParatyphoid FeverSalmonella paratyphiSee “Salmonellosis”Contact Adults: Until stool is formed or back to baseline for the patient.Pediatrics: Continue precautions until culture results for 3 consecutive stool specimens obtained at least 48 hours after cessation of antimicrobial therapy are negativeReportable diseaseParechovirusAcute febrile respiratory illness, e.g., cough, feverAcute febrile illness, meningitis, encephalitisGastroenteritis may occur but is not common.Droplet and ContactContact NICU: Droplet and ContactUntil symptom freeUntil symptom freeUntil discontinued by IPACSMother ill:-Additional precautions as indicated for mother-Routine practices for infantHealthy term infant:- MI contact, RI and BF permittedInfant in NICU:-MI contact NOT permitted in the NICU until mother asymptomatic* -BF as expressed milkInfant ill:-Additional precautions as indicated for infant.-Routine practices for mother-MI contact, RI and BF permitted Infant ill and in NICU:-Droplet and contact precautions for infant.-Mother uses routine practices for infant (Mother may choose to use droplet and contact precautions)-Mother to limit visits to her child only and go directly in and out of NICU. Strict attention to hand hygieneShedding of Parechovirus can occur in stool.*If Mother must visit infant in NICU, consult IPACS. Parvovirus B19Fifth Disease,See “Erythema Infectiosum”RoutineDroplet for the following patients: -Aplastic crisis -Immuno-compromised -Papulopurpuric gloves-socks (PGS) syndromeTransient aplastic or erthyrocyte crisisFor duration of hospitalization (aplastic crisis, immuno-compromised, PGS) For 7 days for patients with transient aplastic crisis (TAC)PediculosisSee “Lice”ContactUntil 24 hours after treatment is completeRefer to Section 6 for specific information on Lice.Pertussis(Whooping cough)Bordetella pertussisWhooping cough, non specific respiratory tract infectionDropletUntil 5 days of appropriate antimicrobial treatment has been completed.If appropriate antimicrobial therapy is not given, until 3 weeks after the onset of coughMother ill:Mother - dropletHealthy Term Infant:-MI contact not permitted until 5 days of effective therapy or infant is on chemoprophylaxis-BF permitted if infant on chemoprophylaxis or as expressed breast milk if not on prophylaxisInfant in NICU:-MI contact not permitted in NICU until 5 days of appropriate antimicrobial treatment has been completed-BF permitted as expressed breast milkInfant ill:-MI contact permitted-BF permittedNotify IPACS of all confirmed or suspected cases of Pertussis.Reportable disease as prompt use of chemoprophylaxis in household contacts is effective in limiting secondary transmission.No HCW, family members or visitors are to enter hospital with an acute respiratory infection.HCW should have their immune status validated with PHSA Workplace HealthReportable diseasePinworms Enterobius vermicularisPerianal itchingRoutineClose household contacts may need treatment.Plague(Yersinia pestis)BubonicFever, chills, headache, lymphadenitis, Routine Notify IPACS immediately.Notify Public Health immediately. Notify Microbiology laboratory before sending specimensIf left untreated, plague often will progress to sepsis with renal failure, acute respiratory distress syndrome, and death. Reportable diseasePneumonic -cough, fever, dyspnea, hemoptysisDropletUntil 48 hours after appropriate antimicrobial treatmentPlesiomonasSecretory or dysenteric diarrhea, vomitingContactAdd Droplet if vomitingUntil stool is formed or back to baseline for the patientStrict attention to hand hygiene.Reportable diseasePneumococcal DiseaseSee “Streptococcal Disease”Droplet Until 24 hours after appropriate antimicrobial therapyReportable disease if invasive.Pneumocystis jirovecii (carinii)Pneumonia in immunocompromised hostRoutineEnsure room mates not immunocompromised.Pneumonia Etiology unknownSee “Respiratory Viral Infections”“ or specific organismFever, coughDroplet and contactContinue precautions until etiology established or infectious cause ruled outMay be reportable depending on the organism. PoliomyelitisAsymmetric acute flaccid paralysisContactFor duration of hospitalization or in consultation with IPACS Reportable diseasePseudo-membranous ColitisSee “Clostridium difficile”Pseudo-membranous Colitis (cont)Contact PlusUntil diarrhea has subsided for 72 hours and stools are formed or back to baseline for patient. Contact IPACS prior to discontinuation of precautions.Mother ill and Healthy Term Infant: -MI contact, RI, and BF permitted-Mother: Contact precautions-Infant: Routine practices Mother ill and Baby in NICU: -Baby to be placed in single room-Mother to limit visits and go directly in and out of NICU-MI contact and BF permitted; mother uses routine practices for infantStrict attention to hand hygieneBacterial spores may persist in the environment; therefore, special attention must be paid to cleaning of the environment.Note: Asymptomatic colonization is common in newborns and infants. PsittacosisSee “Chlamydia” RoutineQ feverCoxiella burnetiiAcute: fever, pneumonia, hepatitisChronic: endocarditisRoutineNo person to person transmission.Reportable diseaseRabiesAcute illness with rapidly progressive central nervous system manifestationsRoutineNotify IPACSReportable disease Rat-bite feverStreptobacillus moniliformis disease, Spirillum minus diseaseFever, rash, arthralgiaRoutineNo person to person spreadResistant organismSee “ARO”Contact For duration of hospital stay Respiratory Viral Infections,Parainfluenza, RSV, Human Metapneumovirus,Rhinovirus, Coronavirus 229E/OC43/NL63/HKU1See influenza and adenovirus for specific informationAcute cough, fever, pneumonia. Symptoms may vary in infants and small children, e.g., lethargy, change in respirations, etc. Droplet and ContactAdult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom freeMother ill: -Droplet and contact precautions for mother-Routine practices for infantHealthy term infant:-MI contact, BF and RI permitted-Mother to wear mask when within 2 metres of infantInfant in NICU: -Mother should be encouraged not to visit until symptom free.* BF permitted as expressed breast milk. Consult IPACS as requiredInfant ill: -Infant - droplet and contact -Routine practices for mother-MI contact, RI and BF permittedFamily members and visitors with an acute respiratory infection should not visit or enter the hospital.Strict attention to hand hygiene*If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICU. Mother to wear mask for duration of visit in NICUDuring outbreak situations, additional precautions may be required.Consult IPACS if you suspect an outbreak.Reye’s SyndromeNot an infectious conditionRoutineMay be associated with viral infection, (influenza, varicella) and aspirin.Reportable diseaseRheumatic FeverMay include arthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules. RoutineRhinovirusSee Respiratory Viral InfectionsDroplet and ContactAdult: Until symptom freePediatric: Minimum of eleven days from onset and child is symptom freeRingwormSee tineaRoutineRarely, have outbreaks occurred in healthcare settings. Use Contact Precautions for outbreak.Roseola Infantum(Exanthem Subitum, Sixth disease, HHV-6)Fever followed by rashRoutineRotavirusSee “Diarrhea”Acute diarrhea, sometimes accompanied by vomiting, abdominal crampsContact*Add Droplet if vomitingUntil stool is formed or back to baseline for the patient for 48 hoursConsult IPACS if immune compromisedMother ill: Contact precautions for motherRoutine practices for infantHealthy Term Infant:MI contact, BF and RI permitted. Infant in NICU:Mother should be encouraged not to visit until stool is formed or back to baseline for the mother for 48 hours* Infant ill:Contact precautions for infant**Routine practices for MotherMI contact, BF and RI permittedStrict attention to hand hygiene*Prolonged fecal shedding may occur in immunocompromised patients after recovery. Contact precautions for duration of hospitalization may be justified. If Mother must visit:Place infant in private roomMother to limit visits and go directly in and out of NICU**Ensure immediate disposal of diapers into leak proof bag.Reportable DiseaseRotavirus Vaccinee.g. RotaTeq?Rotarix?Infants who receive rotavirus vaccine while in hospital.Contact Until 14 days from date of immunization.Mother infant contact, breast feeding and rooming in is permitted.Parents are not required to use contact precautions but must be instructed on the need for strict hand hygiene and the proper disposal of diapers. They should go directly in and out of NICU/PICU and visit their infant only.Siblings who have received Rotavirus vaccine must wait 2 weeks post vaccine to visit. Visitation may be reviewed with IPACS on a case-by-case basis Rubella(German Measles)Most cases are subclinicalClinical disease is usually mild, characterized by fever, rash, lymphadenopathy and polyarthralgiaCongenital (baby born with rubella)**DropletDroplet and Contact for congenital rubellaUntil 7 days after onset of rashCongenital - continue precautions for at least 1 year, unless 2 urine and nasopharyngeal culture results after 3 months of age are negativeSusceptible contacts of known rubella cases should be placed on droplet precautions from 7 days after their first exposure to 21 days after their last exposure.Mother has rubella:-Droplet precautions for mother.-Routine practices for infantHealthy term infant: -MI contact, RI and BF permittedInfant in NICU:-Mother cannot go to NICU until 7 days after onset of rash-Expressed breast milk allowedInfant has congenital rubella: -MI contact, BF permitted-Total rooming in preferredHCW:- HCW should have their immune status validated with PHSA Workplace Health - Only immune HCW can care for patients with rubella.Only immune family and visitors to visitImmunity is defined as:Being born before 1957Having received 1 dose of rubella vaccine if born on or after Jan 1, 1957 Laboratory evidence of disease. (BCCDC Immunization manual)**Congenitally infected infants may shed virus for up to 3 years.Reportable diseaseRubeolaSee “Measles” AirborneUntil 4 days after start of rash. For duration of illness in immune compromised patients Reportable diseaseSalmonellosis(Salmonella species)Diarrhea, enteric fever, typhoid feverContactNon-typhoid:Contact precautions until stool is formed or back to baseline for the patient. Typhoid:Contact precautions should be continued until culture results for 3 consecutive stool specimens obtained at least 48 hours after cessation of antimicrobial therapy are negativeNotify IPACS Reportable diseaseSapovirusAcute gastroenteritisContact*Until stool is formed or back to baseline for the patient for 48 hoursConsult IPACS ifImmune compromisedMother ill:- Contact precautions formother- Routine practices forinfantHealthy Term Infant:- MI contact, BF and RI permitted.Infant in NICU:- Mother should beencouraged not to visituntil stool is formed orback to baseline for themother for 48 hours*Infant ill:- Contact precautions forinfant**- Routine practices forMother- MI contact, BF and RIpermittedo Strict attention to hygiene*Prolonged fecal sheddingmay occur in immunocompromised patients after recovery.Contact precautions for duration of hospitalization may be justified.If Mother must visit:o Place infant in privateroomo Mother to limit visitsand go directly in andout of NICU**Ensure immediatedisposal of diapers into leakproof bag.Reportable DiseaseScabiesSarcoptes scabieiLimited or typical -papular rash, intense itching,Crusted (Norwegian) or Atypical -severe and highly infectious due to large number of mitesContactUntil 24 hours after the treatment is completeFor crusted or atypical, please consult IPACS before discontinuing precautionsMother symptomatic:-Contact precautions-Routine Practices for infantHealthy Term Infant:-MI contact permitted 24 hours after treatment is complete-If MI contact necessary before treatment mother should use contact precautions when holding baby-BF permitted once mother has been appropriately treated or may be provided as expressed breast milkInfant in NICU:-MI contact permitted 24 hours after treatment is complete-BF permitted once Mother treatment complete or may be provided as expressed breast milk*For optimum control, all contacts suspected of having substantial contact with a symptomatic patient should be treated at the same time. Eg: household contacts, playmates.See Section 6 for further details on Scabies. Severe Acute Respiratory Syndrome (SARS)Fever, pneumonia, acute respiratory distress syndromeAirborne and Contact + gogglesUntil discontinued by IPACSNotify Public Health immediatelyNotify IPACS Reportable diseaseScalded Skin SyndromeSee “Abscess major” if drainage not contained by dressingContactDuration of drainage Scarlet FeverSee Streptococcal Disease, Group A StreptococcusOccurs in association with pharyngitis Characteristic confluent erythematous sandpaper like rashDroplet Until 24 hours after appropriate antimicrobial therapyShigellosisShigella speciesSee “Diarrhea”ContactUntil stool is formed or back to baseline for the patient.Reportable diseaseShinglesHerpes zoster, Zoster, Varicella ZosterShingles (cont)Herpes zoster, Zoster, Varicella ZosterVesicular skin lesions in dermatomal distributionImmunocompetent patient:Localized and can be coveredExtensive or localized that cannot be coveredContactAirborne and ContactUntil lesions have crusted over and dried. Mother with localized shingles-MI contact and RI permitted-Total rooming in preferred -Mother may not go to nursery/NICU until lesions are crusted-BF allowed if lesions not on breastMother has extensive or localized lesions that cannot be covered-Mother on airborne and contact-Infant-rooming in on routine precautions-Total rooming in preferred-Mother may not go to nursery until lesions are crusted-BF permitted if lesions not on breastNotify IPCAS of all cases of suspected or confirmed shingles. Visitors who have active chickenpox or shinglesmust not visit.Note: Non-immune individuals who are a shingles contact may develop chickenpox.Only chickenpox immune visitors/siblings to visit. HCW should have their immune status validated with PHSA Workplace Health*. Non-immune HCW should not care for patients with active chickenpox or shingles.*Immunity is defined as any of the following: Documentation of age appropriate varicella vaccine.Laboratory evidence of immunity or laboratory confirmation of disease.Varicella diagnosed or a verification of history from family members by the physician or delegate.History of herpes zoster diagnosed by physician or delegateHCW with suspected shingles should report to PHSA Workplace Health before commencing work.Immunocompromised host or disseminated diseaseAirborne and ContactContinue until all lesions have crusted over Chickenpox susceptible contacts of patients with shingles should be placed on airborne (and contact precautions if lesions develop) from day 8 from the first known contact and up to and including day 21 if they have not received VZIG, 28 days if they have received VZIGMother is immunocompromised: -Mother on airborne and contact-Infant-rooming in -on routine precautions and contact precautions if lesions develop -Total rooming in preferred-Mother may not go to nursery until lesions are crusted-BF permitted if lesions not on breastInfant in NICU:-Mother may not visit NICU until lesions are crustedInfant who is a contact in NICU: -Airborne precautions from day 8 from first exposure up to and including day 21 of last exposure (if infant has been given VZIG up to day 28)-BF by expressed breast milk until lesions are crusted overSmallpox“Variola”Declared eradicated world-wide by WHO in 1979 Severe prodromal illness (high fever, malaise, severe headache), mucous lesions of the moth or pharynx, rashAirborne and ContactUntil discontinued by IPACS Notify Public Health immediatelyNotify IPACS Reportable diseaseStaphylococcal DiseaseStaphylococcus aureusSee ARO for more information on MRSAStaphylococcal Disease (cont)Staphylococcus aureusSee ARO for more information on MRSAFood poisoningSee “Food poisoning”Skin, wound or burn infection, impetigoSee “Abscess” or “Impetigo”ContactMinor-routineMajor: contact -drainage not contained by dressingUntil symptom free for 48 hours Duration of drainage -MI contact, RI and BF allowedMother has draining wound:-Mother-contact precautions-Infant-routine practices Healthy Term Infant:-MI contact, RI allowed.-BF allowed if lesion not on breast*-Mother –change dressing, and gown and have mother perform hand hygiene prior to contact with infantInfant in NICU:-MI contact permitted as long as drainage is contained-BF allowed or by expressed milk-mother-change dressing and gown, and have mother perform hand hygiene prior to leaving unit and prior to contact with infant. Infant has draining wound:Infant-contact precautionsMother- routine-MI contact, RI, and BF preferredInfant in NICU:- private room if drainage not contained*It may be advisable to withhold milk from breast with mastitis until 24 hours of effective treatment. During outbreak situations, additional precautions and cohorting of infants may be required.PneumoniaDropletUntil 24 hours after appropriate antimicrobial therapy-MI contact, RI and BF allowedInfant in NICU has pneumonia:-Droplet precautions and private room-MI contact, BF permittedTracheitis with a tracheostomy tube in placeDropletFor the duration of illnessToxic Shock SyndromeRoutine -MI contact, RI and BF allowed as tolerated by MotherStaphylococcus epidermidis and other coagulase negative staphylococcal infections Health-care associated infections (related to catheters, shunts, grafts, prosthesis, etc.)Late-onset bacteremia among preterm infantsRoutine-MI contact, RI and BF permittedStreptococcal DiseaseGroup A StreptococcusStreptococcal Disease (cont)Group A StreptococcusNecrotizing fasciitisDroplet and ContactUntil 24 hours after appropriate antimicrobial therapyMother ill:-Mother contact and droplet until 24 hours after appropriate antimicrobial therapy-Infant -routine practices-MI contact, RI and BF permitted**It may be advisable to withhold milk from breast with mastitis until 24 hours of effective treatment. If mother has invasive GAS, notify infants’ physician.Notify IPACS Reportable disease if invasiveSkin, wound or burn infectionContactToxic shock like syndrome (TSLS)Droplet and ContactMother ill:-Mother- contact and droplet until 24 hours after appropriate antimicrobial therapy-Infant-routine practices-MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapyPneumoniaDroplet Mother ill:-Mother contact and droplet, until 24 hours after appropriate antimicrobial therapy-Infant-routine practices-MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapy Pharyngitis/scarlet fever Droplet Mother ill:-Mother contact and droplet until 24 hours after appropriate antimicrobial therapy-Infant-routine practices-MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapy Endometritis(Puerperal Sepsis)RoutineMother ill:-Mother -contact until 24 hours after appropriate antimicrobial therapy-Infant-routine practices-MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapyStreptococcal disease Group B StreptococcusColonization in Mother or infection in Mother and/or infantRoutine -MI contact, RI and BF permittedIf mother has invasive disease, notify the infant’s physician.Notify IPACS Neonatal invasive GBS disease is reportableStreptococcus pneumoniaeSee “Meningitis”RoutineInvasive Streptococcus pneumoniae infection is reportable.StrongyloidiasesStrongyloides stercoralisAsymptomaticEosinophiliaSeveral manifestations due to larvae migrationDissemination (hyper infection) in immunocompromised patientsRoutineInfective larvae in soilSyphilisTreponema pallidumAcquired?:Genital, skin or mucous lesions, systemic symptoms, gummatous changes of the skin, bone, or viscera, CVS or CNS involvementMucocutaneous lesions: ContactUntil 24 hours after appropriate antimicrobial therapyMother has lesions:-Mother contact -Infant routine precautions-MI contact, RI and BF permitted after 24 hours of appropriate antimicrobial treatmentAs moist open lesions, secretions and possibly blood are contagious in all patients with syphilis,contact precautions should be used when caring for patients with congenital, primary and secondary syphilis with skin and mucous membrane lesions until 24 hours after appropriate antimicrobial therapy*If mother has syphilis, notify the infant’s physician.Reportable diseaseCongenital?:Range from stillbirth to being symptom free at birth. Contact*Until 24 hours after appropriate antimicrobial therapyInfant has congenital:Mother: routineInfant :contact until 24 hours after appropriate antimicrobial therapy-MI contact, RI and BF permittedTapeworm DiseaseDiphyllobothrium latum (fish)Hymenolepis nana, Taenia saginata (beef)Taenia solium (pork)See ”Echinococcosis”Usually asymptomatic or mild GI symptomsCNS involvement in Taenia solium “neurocysticercosis”RoutineTetanus Clostridium tetaniTrismus and severe muscular spasmsRoutineNo person-to-person spreadReportable diseaseThrushSee “Candidiasis”RoutineTinea “Ringworm”Dermatophytes:-Epidermophyton,-Trichophyton, and -Microsporum) or Malassezia furfurFungal infection of the skin or nails e.g. tinea capitis, athlete’s foot, pityriasis versicolorRoutineToxoplasmosisToxoplasma gondiiAsymptomatic or fever, lymphadenopathy, retinitis, encephalitis in immune compromised host.Congenital infectionRoutineMother and/or Infant ill:-MI contact, BF and RI permittedNo person-to-person spreadCongenital toxoplasmosis is reportableTrench mouthSee ‘Vincent’s angina”RoutineTrichinellosisTrichinella spiralisAsymptomatic, GI upset, periorbital edema, rash, muscle calcification, myocarditis, neurologic involvement and pneumonitisRoutineNo person-to-person spreadTrichomoniasisTrichomonas vaginalisAsymptomatic, vaginal discharge, vulvovaginal pruritis and irritationMales: Urithritis, but most are asymptomaticRoutineSexual transmission.Trichuriasis “Whipworm”Trichuris trichiuraAsymptomatic, abdominal pain, diarrhea, rectal prolapseRoutineTuberculosis“TB” Mycobacterium tuberculosisTuberculosis (cont)“TB” Mycobacterium tuberculosisExtrapulmonary, no draining lesions*RoutineMI contact, RI, and BF permitted*Assess for concurrent pulmonary tuberculosis. Notify IPACS of all suspected or confirmed TB patientsTuberculosis in young children is rarely infectious; assess visiting family members for cough.**Usually considered no longer infectious after 2 weeks of effective therapy, is improving and has three consecutive sputum smears negative for AFB, collected 24 hours apartIf multidrug-resistant TB, until culture negative Refer to Section 6 for specific information on Tuberculosis Reportable diseaseExtrapulmonary, draining lesions*AirborneContinue precautions until drainage ceased or three consecutive negative AFB smears. Consult IPACSPulmonary-confirmed or suspected or laryngeal disease AirborneContinue precautions until TB ruled out. If confirmed, until no longer considered infectious by IPACS **Mother has TB-MI contact is not permitted until mother is no longer infectious**-Mother may provide expressed breast milkInfant has TB (mother source)-Infant on airborne precautions with mother -MI contact, RI and BF permitted Skin test positive with no evidence of active disease RoutineMI contact, RI and BF permittedTularemiaFrancisella tularensisFever, ulcerative lesion, lymphadenopathy, conjunctivitis, GI symptoms, pneumoniaRoutineNo person to person spreadNotify Microbiology laboratory before sending specimensReportable diseaseTyphoid FeverSee “Salmonellosis”Typhoid Fever(cont)Contact Adults: Until stool is formed or back to baseline for the patient.Pediatrics: Continue precautions until culture results for 3 consecutive stool specimens obtained at least 48 hours after cessation of antimicrobial therapy are negativeReportable diseaseVancomycin-Resistant Enterococci (VRE)Infection or colonization of any body siteContact For duration of hospital stayMother has VRE:Contact precautions for motherContact precautions for newborns of positive mothers.Healthy Term Infant: MI contact, BF and RI permittedMother uses routine practices for infant (Mother may choose to use contact precautions)Baby in NICU:Baby to be placed in single roomMI contact and BF permitted Mother uses routine practices for infant (Mother may choose to use contact precautions)Mother to limit visits to her child only and go directly in and out of NICU, if she has an infection. Infant has VRE:Contact precautions for infantContact precautions for MotherMI Contact, BF and RI permittedRefer to the infection control manual for specific information on VREVancomycin-IntermediateStaphlyococcus aureus (VISA) orVancomycin-Resistant Staphylococcus aureus (VRSA)Infection or colonization of any body siteContact For duration of hospital Mother has VISA/VRSA:Contact precautions for motherContact precautions for newborns of positive mothers.Healthy Term Infant: MI contact, BF and RI permittedMother uses routine practices for infant (Mother may choose to use contact precautions)Baby in NICU:Baby to be placed in single roomMI contact and BF permitted Mother uses routine practices for infant (Mother may choose to use contact precautions)Mother to limit visits to her child only and go directly in and out of NICU, if she has an infection. Infant has VISA/VRSA:Contact precautions for infantContact precautions for MotherMI Contact, BF and RI permittedVaricella(Chickenpox)See “Chickenpox” Airborne and contactFor a minimum of 5 days after onset of rash and until all lesions are crusted which can be a week or longer in immunocompromised patientNotify IPACS of all confirmed or suspected cases of chickenpoxVaricella Zoster(Shingles, Herpes Zoster, Zoster)See “Shingles”Immunocompetent patient:Localized and can be coveredExtensive or localized that can not be coveredImmunocompromised host or disseminated diseaseContactAirborne and ContactAirborne and ContactUntil lesions have crusted over and dried.Notify IPACS of all confirmed or suspected cases of Shingles and Herpes Zoster.VariolaSee “Smallpox”Airborne and ContactUntil discontinued by IPACS Notify Public Health immediatelyNotify IPACS Reportable diseaseVibrio cholerae See “Cholera”ContactUntil discontinued by IPACSNotify IPACS Reportable diseaseVibrioNon CholeraVibrio parahaemolyticus, Vibrio vulnificusGastroenteritis, wound infections and bacteriemiaContact Until stool is formed or back to baseline for the patient.Vincent’s angina(Trench mouth or acute necrotizing ulcerative gingivitis)Acute onset of fetid breath, pain, blunting of the interdental papilla, and an ulcerative necrotic slough of the gingivaRoutineViral Hemorrhagic FeversSee “Hemorrhagic Fevers” (Lassa, Ebola, Marburg, Crimean-Congo fever viruses)Airborne + goggles and ContactUntil hemorrhagic fever virus ruled out or until discontinued by IPACSReportable diseaseViral wartsSee “Human papilloma virus”RoutineWhooping CoughSee “Pertussis”Droplet and contactUntil 5 days of appropriate antimicrobial treatment has been completed.If appropriate antimicrobial therapy is not given, until 3 weeks after the onset of coughReportable diseaseWound infections See “Abscess”MinorMajor (drainage not contained by dressing)RoutineContactDuration of drainage Yellow feverSee “Arthropod-borne viral fevers”RoutineReportable diseaseYersinia enterocolitiaSee “Diarrhea”Contact Until stool is formed or back to baseline for the patient.Reportable diseaseYersinia pestisSee “Plague”BubonicFever, chills, headache, lymphadenitis, Routine PracticesReportable diseasePneumonic -cough, fever, dyspneia, hemoptysisDroplet Until 48 hours after appropriate antimicrobial treatmentZosterSee “Herpes Zoster”Immunocompetent patient:Localized and can be coveredExtensive or localized that cannot be coveredImmunocompromised host or disseminated diseaseContactAirborne and ContactAirborne and ContactUntil lesions have crusted over and dried.Refer to Section 6 for specific information on Shingles, Herpes Zoster. Developed ByC&W Infection Control – Medical MicrobiologistVersion HistoryDATEDOCUMENT NUMBER and TITLEACTION TAKEN22-Aug-2019C-0506-14-60344 Table Of Recommended Precautions: Selected Infectious Diseases, Conditions & MicroorganismsApproved at: CW Infection Control Committee11-Mar-2020“Action: C&W Infection Control added information re: COVID-1918-Mar-2020“Updated by C&W IPAC; Approved by Professional Practice DirectorDISCLAIMERThis document is intended for use?within?BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document.?This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download