Isolation guidelines


This is an abbreviated list of isolation guidelines for common infectious conditions. Please refer to CDC for complete guidelines.

Quicklinks to some common isolation needs: Herpes simplex, Influenza, Meningitis, Pneumonia, Tuberculosis, Shingles and Clostridium difficile (see gastroenteritis),

*Type of Precautions: A, Airborne Precautions; C, Contact; D, Droplet; S, Standard.

** Duration of precautions: CN, until off antimicrobial treatment and culture-negative; DI, duration of illness (with wound lesions, DI means until wounds stop draining); DE, until environment completely decontaminated; U, until time specified in hours (hrs) after initiation of effective therapy; Unknown: criteria for establishing eradication of pathogen has not been determined

Infection/Condition Type of isolation* Duration of isolation** Precautions/Comments
Abscess Draining, major C DI No dressing or containment of drainage; until drainage stops or can be contained by dressing
Arthropod-borne viral encephalitides (eastern, western, Venezuelan equine encephalomyelitis; St Louis, California encephalitis; West Nile Virus) and viral fevers (dengue, yellow fever, Colorado tick fever) S Not transmitted from person to person except rarely by transfusion, and for West Nile virus by organ transplant
Aspergillosis S Contact Precautions and Airborne Precautions if massive soft tissue infection with copious drainage and repeated irrigations required
Blastomycosis, North American, cutaneous or pulmonary S Not transmitted from person to person
Campylobacter gastroenteritis (see gastroenteritis)
Candidiasis, all forms including mucocutaneous S
Cellulitis S
Chickenpox (see varicella)
Closed-cavity infection with open drain in place; limited or minor drainage S Contact Precautions if there is copious uncontained drainage
C. difficile (see Gastroenteritis, C. difficile) C DI
Gas gangrene S Transmission from person to person rare. Use Contact Precautions if wound drainage is extensive.
Coccidioidomycosis (valley fever) Pneumonia S Not transmitted from person to person except under extraordinary circumstances, (e.g., inhalation of aerosolized tissue phase endospores during necropsy, transplantation of infected lung) because the infectious arthroconidial form of Coccidioides immitis is not produced in humans
Cryptococcosis S Not transmitted from person to person
Cysticercosis S Not transmitted from person to person
Cytomegalovirus infection, including in neonates and immunosuppressed patients S No additional precautions for pregnant HCWs
Gangrene (gas gangrene) S Not transmitted from person to person
Gastroenteritis S Use Contact Precautions for diapered or incontinent persons for the duration of illness
Noroviruses S Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks. Persons who clean areas heavily contaminated with feces or vomitus may benefit from wearing masks since virus can be aerosolized from these body substances. Hypochlorite solutions may be required when there is continued transmission. Alcohol is less active, but there is no evidence that alcohol antiseptic handrubs are not effective for hand decontamination.
Salmonella species (including S. typhi) S Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks
Herpes simplex (Herpesvirus hominis)
Encephalitis S
Mucocutaneous, disseminated or primary, severe C Until lesions dry and crusted
Mucocutaneous, recurrent (skin, oral, genital) S
Herpes zoster (varicella-zoster) (shingles)
Disseminated disease in any patient, Localized disease in immunocompromised patient until disseminated infection ruled out A, C DI Susceptible HCWs should not enter room if immune caregivers are available; no recommendation for protection of immune HCWs; no recommendation for type of protection, i.e. surgical mask or respirator; for susceptible HCWs.
Localized in patient with intact immune system with lesions that can be contained/covered S DI Susceptible HCWs should not provide direct patient care when other immune caregivers are available.
Histoplasmosis S Not transmitted from person to person
Human immunodeficiency virus (HIV) S
Impetigo C U 24 hrs
Infectious mononucleosis S
Influenza
Human (seasonal influenza) D 5 days except DI in immuno compromised persons Single patient room when available or cohort; avoid placement with high-risk patients; mask patient when transported out of room; chemoprophylaxis/vaccine to control/prevent outbreaks
Avian (e.g., H5N1, H7, H9 strains) look here for current avian influenza guidance
Pandemic influenza (also a human influenza virus) D 5 days from onset of symptoms See here for current pandemic influenza guidance
Lice See CDC for detailed information
Head (pediculosis) C U 24 hrs
Body S Transmitted person to person through infested clothing. Wear gown and gloves when removing clothing; bag and wash clothes according to CDC guidance above
Pubic S Transmitted person to person through sexual contact
Listeriosis (listeria monocytogenes) S Person-to-person transmission rare
Lyme disease S Not transmitted from person to person
Malaria S Not transmitted from person to person except through transfusion rarely
Meningitis
Aseptic (nonbacterial or viral; also see enteroviral infections) S Contact for infants and young children
Bacterial, gram-negative enteric, in neonates S
Fungal S
Haemophilus influenzae, type b known or suspected D U 24 hrs
Listeria monocytogenes (See Listeriosis) S
Neisseria meningitidis (meningococcal) known or suspected D U 24 hrs See meningococcal disease below
Streptococcus pneumoniae S
M. tuberculosis S Concurrent, active pulmonary disease or draining cutaneous lesions may necessitate addition of Contact and/or Airborne Precautions
Other diagnosed bacterial S
Meningococcal disease: sepsis, pneumonia, meningitis D U 24 hrs Postexposure chemoprophylaxis for household contacts, HCWs exposed to respiratory secretions; postexposure vaccine only to control outbreaks
Multidrug-resistant organisms (MDROs), infection or colonization (e.g., MRSA, VRE, VISA/VRSA, ESBLs, resistant S. pneumoniae) S/C MDROs judged by the infection control program, based on local, state, regional, or national recommendations, to be of clinical and epidemiologic significance. Contact Precautions recommended in settings with evidence of ongoing transmission, acute care settings with increased risk for transmission or wounds that cannot be contained by dressings.
Mumps (infectious parotitis) D U 9 days After onset of swelling; susceptible HCWs should not provide care if immune caregivers are available. Note: (Recent assessment of outbreaks in healthy 18–24 year olds has indicated that salivary viral shedding occurred early in the course of illness and that 5 days of isolation after onset of parotitis may be appropriate in community settings; however the implications for healthcare personnel and high-risk patient populations remain to be clarified.)
Mycobacteria, nontuberculosis (atypical) Not transmitted person-to-person
Mycoplasma pneumonia D
Norovirus (see gastroenteritis)
Norwalk agent gastroenteritis (see gastroenteritis)
Parvovirus B19 (Erythema infectiosum) D Maintain precautions for duration of hospitalization when chronic disease occurs in an immunocompromised patient. For patients with transient aplastic crisis or red-cell crisis, maintain precautions for 7 days. Duration of precautions for immunosuppressed patients with persistently positive PCR not defined, but transmission has occurred
Pediculosis (lice) C U 24 hrs after treatment
Pertussis (whooping cough) D U 5 days Single patient room preferred. Cohorting an option. Post-exposure chemoprophylaxis for household contacts and HCWs with prolonged exposure to respiratory secretions.
Pneumonia
Adenovirus D, C DI Outbreaks in pediatric and institutional settings reported
Bacterial not listed elsewhere (including gram-negative bacterial) S
Chlamydia S
Fungal S
Haemophilus influenzae, type b Adults S, Infants and children D U 24 hrs
Legionella spp. S
Meningococcal D U 24 hrs See meningococcal disease above
Multidrug-resistant bacterial (see multidrug-resistant organisms)
Mycoplasma (primary atypical pneumonia) D DI
Pneumococcal pneumonia S
Pneumocystis jiroveci (Pneumocystis carinii ) S Avoid placement in the same room with an immunocompromised patient.
Staphylococcus aureus S For MRSA, see MDROs
Streptococcus, group A D U 24 hrs
Rickettsial fevers, tickborne (Rocky Mountain spotted fever, tickborne typhus fever) S Not transmitted from person to person except through transfusion, rarely
Ringworm (dermatophytosis, dermatomycosis, tinea) S Rarely, outbreaks have occurred in healthcare settings, (e.g., NICU
Rocky Mountain spotted fever S
Rubella (German measles) ( also see congenital rubella) D U 7 days after onset of rash Susceptible HCWs should not enter room if immune caregivers are available. No recommendation for wearing face protection (e.g., a surgical mask) if immune. Pregnant women who are not immune should not care for these patients. Administer vaccine within three days of exposure to non-pregnant susceptible individuals. Place exposed susceptible patients on Droplet Precautions; exclude susceptible healthcare personnel from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine.
Scabies C U 24
Scalded skin syndrome, staphylococcal C DI
Severe acute respiratory syndrome (SARS) A, D,C DI plus 10 days after resolution offever, provided respiratory symptoms are absent or improving Airborne Precautions preferred; D if AIIR unavailable. N95 or higher respiratory protection; surgical mask if N95 unavailable; eye protection (goggles, face shield); aerosol-generating procedures and “supershedders” highest risk for transmission via small droplet nuclei and large droplets 93, 94, 96.Vigilant environmental disinfection (see CDC SARS)
Staphylococcal disease (S aureus)
Skin, wound, or burn
Major C DI No dressing or dressing does not contain drainage adequately
Minor or limited S Dressing covers and contains drainage adequately
Enterocolitis S Use Contact Precautions for diapered or incontinent children for duration of illness
Pneumonia S
Scalded skin syndrome C DI Consider healthcare personnel as potential source of nursery, NICU outbreak.
Toxic shock syndrome S
Streptococcal disease (group A streptococcus)
Skin, wound, or burn
Major C, D U 24 hrs No dressing or dressing does not contain drainage adequately
Minor or limited S Dressing covers and contains drainage adequately
Endometritis (puerperal sepsis) S
Pharyngitis in infants and young children D U 24 hrs
Pneumonia D U 24 hrs
Scarlet fever in infants and young children D U 24 hrs
Serious invasive disease D U 24 hrs Outbreaks of serious invasive disease have occurred secondary to transmission among patients and healthcare personnel Contact Precautions for draining wound as above; follow rec. for antimicrobial prophylaxis in selected conditions.
Streptococcal disease (group B streptococcus), neonatal S
Syphilis
Latent (tertiary) and seropositivity without lesions S
Skin and mucous membrane, including congenital, primary, Secondary S
Tuberculosis (M. tuberculosis)
Extrapulmonary, draining lesion) A, C Discontinue precautions only when patient is improving clinically, and drainage has ceased or there are three consecutive negative cultures of continued drainage. Examine for evidence of active pulmonary tuberculosis.
Extrapulmonary, no draining lesion, meningitis S Examine for evidence of pulmonary tuberculosis. For infants and children, use Airborne Precautions until active pulmonary tuberculosis in visiting family members ruled out
Pulmonary or laryngeal disease, confirmed A Discontinue precautions only when patient on effective therapy is improving clinically and has three consecutive sputum smears negative for acid-fast bacilli collected on separate days (MMWR 2005; 54: RR–17)
Pulmonary or laryngeal disease, suspected A Discontinue precautions only when the likelihood of infectious TB disease is deemed negligible, and either 1) there is another diagnosis that explains the clinical syndrome or 2) the results of three sputum smears for AFB are negative. Each of the three sputum specimens should be collected 8–24 hours apart, and at least one should be an early morning specimen
Skin-test positive with no evidence of current active disease S
Urinary tract infection (including pyelonephritis), with or without urinary catheter S
Varicella Zoster (shingles) A, C Until lesions dry and crusted Susceptible HCWs should not enter room if immune caregivers are available; no recommendation for face protection of immune HCWs; no recommendation for type of protection, i.e. surgical mask or respirator for susceptible HCWs. In immunocompromised host with varicella pneumonia, prolong duration of precautions for duration of illness. Post-exposure prophylaxis: provide post-exposure vaccine ASAP but within 120 hours; for susceptible exposed persons for whom vaccine is contraindicated (immunocompromised persons, pregnant women, newborns whose mother’s varicella onset is <5days before delivery or within 48 hrs after delivery) provide VZIG, when available, within 96 hours; if unavailable, use IVIG, Use Airborne Precautions for exposed susceptible persons and exclude exposed susceptible healthcare workers beginning 8 days after first exposure until 21 days after last exposure or 28 if received VZIG, regardless of postexposure vaccination.

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