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5.10QuickReferenceGuide

5.10QuickReferenceGuide

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Stanford Hospital & Clinics Infection Control Manual

Section 5.10

QUICK REFERENCE GUIDE for INFECTIOUS DISEASES/CONDITIONS and REQUIRED PRECAUTIONS I. PURPOSE The following table lists selected infectious diseases/conditions and delineates the room placement, specific precautions and pertinent instructions. It provides a reference for nurses/healthcare workers (HCWs) and physicians responsible for the appropriate placement and management of patients with infectious diseases and conditions. The table is not intended to be all inclusive. If a disease or condition is not listed, use Standard Precautions and contact the Infection Control and Epidemiology Department (ICED) for assistance. II. POLICY Standard/Universal Precautions and good hand hygiene practices are used by all HCWs for all patients regardless of diagnosis. Additional precautions/isolation is initiated as indicated in Appendices A and B below. III. IMPLEMENTATION A. If a disease or condition is not listed in Appendix A, use Standard Precautions. The Appendix is not intended to be all inclusive, but rather a guideline for commonly recognized conditions or diseases. The yellow highlighted conditions are those most commonly requiring precautions/isolation. If a patient requires Respiratory Precautions/Isolation, see Appendix C to determine if a negative airflow room is necessary. A private room is recommended for any patient if the nurse/HCW determines that the patient’s secretions/excretions cannot be contained within the patient’s immediate environment. For more information, refer to the policies on Standard Precautions, Contact Precautions, Respiratory Precautions and Droplet Precautions elsewhere in Section 5 of the Infection Control Manual. For questions, contact the ICED (extension 5-1106 or pager 16167).

B. C.

D.

E. Appendices:

Appendix A: Quick Reference Guide for Infectious Diseases/Conditions and Required Precautions Appendix B: Quick Reference Guide for Placement of Patients: Negative Airflow Rooms Appendix C: Limited Negative Airflow Room Prioritization Scheme Appendix D: Quick Reference Guide for Placement of Patients: Positive Airflow Rooms Approved by: Infection Control Committee, 2/12 Quality, Patient Safety and Effectiveness Committee, [pending] Stanford Hospital & Clinics Medical Executive Committee, [pending] Stanford Hospital & Clinics Board Credentials, Policies and Procedures Committee, [pending]

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Stanford Hospital & Clinics Infection Control Manual

Section 5.10

Original Date: 7/91 Reviewed Date: 8/93, 1/98 Revised Date: 6/97, 1/01, 3/02, 8/03, 12/04 (addition of Appendix B), 10/05, 8/06, 10/07, 2/08, 6/09, 8/09, 2/10, 9/10, 3/11, 2/12 This document is intended for use by staff of Stanford Hospital and Clinics. No representations or warranties are made for outside use. Not for outside reproduction or publication without permission. Direct inquiries to: Infection Control and Epidemiology -- (650) 725-1106 Stanford Hospital and Clinics Stanford, CA 94305

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Exception: If patient on E1. Droplet Precautions. Any room Any room Contact Precautions may be used at the discretion of the nurse/HCW if the patient’s hygiene is poor and the environment is likely to be soiled.  Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. Door may remain open.  Surgical style mask for patients when leaving room. drainage contained Abscess.41. or to control institutional outbreaks. Private room if diarrhea is not contained. major.See Clostridium difficile Aspergillosis Avian Influenza-See Influenza. drainage uncontained Standard Contact Any room Private room Until drainage stops or is contained with dressing Acquired Immunodeficiency Syndrome (AIDS) Adenovirus  Gastroenteritis Standard Any room Standard  Pneumonia Droplet and Contact Any private room if diarrhea is contained. place in Room E139 only. Durations of illness Amebiasis Anthrax.30.  Cutaneous  Pulmonary Antibiotic-associated colitis. IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Abscess.Stanford Hospital & Clinics Infection Control Manual Section 5. Contact Precautions and 5. See Appendix B.10 Appendix A QUICK REFERENCE GUIDE FOR INFECTIOUS DISEASES/CONDITIONS AND REQUIRED PRECAUTIONS Highlighted conditions/diseases are those frequently asked about. Pandemic Standard Standard Contact Precautions if large amounts of drainage cannot be contained with dressings Standard Any room Standard Any room -3- . Any room for Droplet Precautions.  Promptly notify the ICED.* x 5-1106 or pager 16167  For more information see ICM Policy 5.

Until all crops of lesions are crusted over Exposed susceptible patients should be placed in respiratory isolation from day 8 post initial exposure to day 21(day 28 if VZIG given) post last exposure. Surgical style mask for patients when leaving room.10. negative air pressure room with anteroom. Surgical style mask for patients when leaving room. negative air pressure room with anteroom. Wear gown and gloves for contact with lesion material. N95 mask required for staff. Keep door closed. Keep door closed. Wear gown and gloves for direct contact with lesion material. Respiratory and Contact Private room.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Botulism Burkholderia cepaciainfection or colonization. Respiratory Precautions and 6. Cholera See Gastroenteritis -4- . Surgical mask required for all visitors. Respiratory Precautions and 6.10. Chickenpox and Herpes Zoster Patient Management and Exposure Follow-up.40. Surgical mask required for all visitors. For more information see Infection Control Manual (ICM) Policy 5.      Chickenpox exposed patient with:  Negative history for chickenpox or  Chickenpox vaccine and negative Varicella titer. Chickenpox and Herpes Zoster Patient Management and Exposure Follow-up.40. See Multi-Drug Resistant Organisms (MDRO) Campylobacteriosis See Gastroenteritis Cat Scratch Fever Chickenpox (Varicella) Standard Any room Standard Respiratory and Contact Any room Private room. For more information see ICM Policy 5.       N95 mask required for all staff. Persons who have not had chickenpox should not enter room for any reason.Stanford Hospital & Clinics Infection Control Manual Section 5.

Contact Precautions may be used at the discretion of the nurse/HCW if the patient is incontinent and the environment is likely to be soiled. Standard Any room Standard Private room Do not cohort with another cystic fibrosis patient.  For more information see ICM Policy 5. diff treatment for 48 hours Coccidioidomycosis (Valley Fever) Creutzfeld-Jakob Disease Cryptococcosis Cryptosporidiosis See Gastroenteritis Cystic Fibrosis without any multi-drug resistant organism Cytomegalovirus (CMV) Diarrhea. uncontrolled etiology unknown Standard Standard Any room Any room Refer to OR department-specific policies for additional information related to the OR.30.Stanford Hospital & Clinics Infection Control Manual Section 5. Standard Standard Standard Any room Any room Private room Diphtheria.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Clostridium difficile diarrhea Contact Private room     Avoid use of shared equipment Use Purple Bleach Protocol Contact Precaution sign Bleach Protocol used:  IN room from which patient transferred  Upon discharge  Isolation discontinued For more information see ICM Policy 5. Cutaneous Contact Private room Patient is able to use the bathroom. controlled etiology unknown Diarrhea. Contact Precautions   48 hours after diarrhea has resolved and Off antibiotics for C. x 51106 or pager 16167  Report promptly to Santa Clara County Health Department (408) 885-4214. -5- . patient no longer soils environment Until 2 cultures taken at least 24 hours apart are negative for Corynebacterium diphtheriae.  Promptly notify the Infection Control and Epidemiology Department (ICED*).30. Contact Precautions Duration of illness.

Durations of illness Standard Any room -6- . Drug Resistant Microorganisms.Stanford Hospital & Clinics Infection Control Manual Section 5. Exception: If patient on E1. x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214. Door may remain open.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Diphtheria.41. See Meningitis Hansen’s Disease (leprosy) Standard Any room Standard Standard Any room Any room if diarrhea is contained. Pharyngeal Droplet Private room. See Appendix B. Patient to wear surgical style mask when leaving room.. coli (0157:H7)  Giardia  Rotavirus  Salmonella sp  Shigella sp  Vibrio  Viral German Measles See Rubella Giardiasis See Gastroenteritis Haemophilus influenzae meningitis. place in Room E139 only. Contact Precautions may be used at the discretion of the nurse/HCW if the patient’s hygiene is poor and the environment is likely to be soiled or to control institutional outbreaks. Private room if diarrhea is not contained. For more information see ICM Policy 5.      Surgical style mask with face shield or surgical style mask plus goggles for all persons entering room. no special ventilation required. Droplet Precautions. See Multi-Drug Resistant Organisms (MDRO’s) Ebola-Marburg Virus See Hemorrhagic Fever Encephalitis (viral) ESBL (Extended spectrum beta lactamase)See MDRO Gas Gangrene Gastroenteritis (not listed elsewhere) caused by:  Campylobacter sp  Cholera  Cryptosporidium sp  E. Promptly notify the ICED*. Until 2 cultures from both nose and throat taken at least 24 hours apart are negative for Corynebacterium diphtheriae.

5. vomiting. Don and remove protective wear in the anteroom. N95 mask required for staff. Keep door closed. N95 Respirator mask for all persons entering room. Wear gown/gloves for direct contact with lesion material. gloves and shoe covers to enter room.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Hemorrhagic Fevers. Discard all waste in red bags. Duration of hospitalization Hepatitis A  Continent patient  Incontinent patient Hepatitis B. including Lassa and Ebola virus fevers Respiratory and Contact Private room. Surgical mask required for all visitors. Chickenpox. and during the performance of invasive procedures.          Only essential personnel should enter the patient room. For more information see ICM Policy 5.Stanford Hospital & Clinics Infection Control Manual Section 5. Surgical style mask for patients when leaving room.40. 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214. D Until continent Standard Contact Standard Any room Private room Any room See hemodialysis departmentspecific policies for additional information       Persons who have not had chickenpox should not enter room for any reason. bleeding. Wear gown. Herpes Zoster Patient Management and Exposure Follow-up. negative air pressure room with anteroom. C. Contact Precautions. ext.30. disoriented or uncooperative. Respiratory Precautions and 6.10. Herpes Simplex Herpes Zoster (Shingles or Varicella Zoster)  Disseminated disease (including pneumonia) in any patient  Localized disease in an immunocompromised patient Standard Respiratory and Contact Any room Private room. For high risk procedures use PAPR (see ICM 9.10) Protective eyewear for care of patients who are coughing. -7- . Duration of illness and until all lesions are completely crusted over. Promptly notify the ICED*.. negative air pressure with anteroom.

after effective antibiotic therapy is initiated  For 7 days after onset of symptoms and  Until 24 hours after resolution of fever and respiratory symptoms whichever is longer and no longer receiving antiviral therapy (e.. Droplet Precautions. Place a notice on the door stating only immune staff should enter the room. Wear gown/gloves for direct contact with lesion material. For 24 hours. Door may remain open. Or if E139 not available. place in a double door room. See Metapneumovirus (Human) Impetigo Standard Private room     Persons who have not had chickenpox should not enter room for any reason. C. including H1N1 Droplet Private room or may be cohorted with patient with like type. place in Room E139 only. B.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Herpes Zoster (Shingles or Varicella Zoster) Localized in a patient with an intact immune system with lesions that can be contained/covered and lesions confined to 1 dermatome Highly Resistant Organism (refer to MDRO) Human Metapneumovirus. For more information see ICM Policy 5. Tamiflu). Contact Precautions Influenza: Type A. For more information see ICM Policy 5.41.    Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. Exception: If patient on E1. Until all lesions are completely crusted over Contact Private room.g. No mask necessary for immune caregivers/visitors.30.Stanford Hospital & Clinics Infection Control Manual Section 5. -8- . No special ventilation. Surgical style mask for patients when leaving room.

       N95 respirator mask for hospital personnel entering room. For more information see ICM Policy 5.90. negative air pressure room with an anteroom. PAPR for high risk procedures (see ICM 9. 5-1106 or pager 16167. See manager for more information. Patient to wear surgical style mask when leaving room. If patient is immunocompromised.10). Duration of hospitalization Kawasaki Syndrome Lassa Fever. SARS Precautions/Isolation. Requires fit testing by designated individual.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Influenza.      Persons who have not had measles should not enter room for any reason.20.40. Keep door closed. Measles Patient Management and Exposure Follow-up. Room may not be occupied for 3 hours after patient is discharged. room negative air pressure room with ante-room. For 5 days after onset of rash. Promptly notify the ICED*. -9- . Respiratory Precautions and 6. ext. (Avian or Novel) Respiratory and Contact Private. See Hemorrhagic Fever Legionellosis Lice. Keep door closed. for duration of hospitalization. See Pediculosis Listeriosis Malaria Measles (Rubeola) Standard Any room Standard Standard Standard Respiratory Any room Any room Any room Private room. N95 mask required for all staff. Promptly notify the ICED*.. For more information see ICM Policy 6. x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214.Stanford Hospital & Clinics Infection Control Manual Section 5. Report promptly to Santa Clara County Health Department (408) 885-4214.

10 - . Exception: If patient on E1. no special ventilation required. due to Neisseria meningitides Droplet Private room. pneumonia) Standard Any room Standard Droplet Any room Private room.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Meningitis due to Haemophilus influenzae Droplet Private room.41.30. no special ventilation required. Surgical style mask for patients when leaving room. Report promptly to Santa Clara County Health Department (408) 885-4214. For 24 hours after appropriate antibiotic therapy is initiated For 24 hours after appropriate antibiotic therapy is initiated Meningitis. x 5-1106 or pager 16167. For more information see ICM Policy 5. Surgical style mask for patients when leaving room. Promptly notify the ICED. Surgical style mask with face shield or surgical style mask plus goggles for persons entering room.       Meningitis. place in Room E139 only. Door may remain open. no special ventilation required. Droplet Precautions. place in Room E139 only. Droplet For 24 hours after appropriate antibiotic therapy is initiated . Exception: If patient on E1. other bacterial such as Listeria or Strep Meningitis (Viral) Meningococcal Infections (meningitis.* x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214.41. See Appendix B. Exception: If patient on E1. suspected or confirmed. For more information see ICM Policy 5. See Appendix B.41.Stanford Hospital & Clinics Infection Control Manual Section 5.     Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. place in Room E139 only. meningococcemia.* x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214. Promptly notify the ICED*.      Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. Door may remain open. Droplet Precautions and 6. Meningococcal Meningitis or Meningococcemia Exposure Follow-up. See Appendix B. For more information see ICM Policy 5. Door may remain open. Promptly notify the ICED. Surgical style mask for patients when leaving room.

30.30. Duration of symptoms. Keep door closed.11 - . Methicillin-Resistant Staphylococcus aureus (MRSA) – Infection Contact Private room or may cohort with other MRSA patient Precautions and 6. Contact Precautions and 5. Contact Precautions and 5. negative air pressure.  For more information see ICM Policy 5. (Refer to Appendix B of this policy. Meningococcal Meningitis or Meningococcemia Exposure Follow-up. follow Contact/Droplet Precautions. Duration of hospitalization. If positive culture (other than nares) place on precautions.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Metapneumovirus (Human) receiving inhaled Ribavirin therapy Ribavirin Precautions (Respiratory for room placement) and Contact/Droplet Private room. Contact / Droplet Precautions for the duration of symptoms. Contact Precautions Ribavirin Precautions for the duration of inhaled Ribavirin therapy.  Instruct patient to perform hand hygiene after contact with respiratory secretions. upon entry into room. Droplet Precautions. . Droplet Precautions.  Review record for previous six months.41.  Instruct patient to perform hand hygiene after contact with respiratory secretions.  For more information see ICM Policy 5.30.Stanford Hospital & Clinics Infection Control Manual Section 5.  For more information regarding Ribavirin contact the RT shift supervisor (37709)  Every time. upon entry into room.30.  Every time.  Remove your soft contacts or wear goggles  Follow instructions on the Ribavirin precautions sign. If patient on E1 place in room E139.  N95 mask for persons entering room during a treatment.41.  For more information see ICM Policy 5.) Metapneumovirus (Human) Contact/Droplet Private Room No negative air pressure required. follow Contact/Droplet Precautions. Ribavirin Precautions Include:  Pregnant healthcare workers must not care for patient.

    Avoid use of shared electronic thermometers For more information see ICM Policy 5.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Multi-Drug Resistant Organism (MDRO) – Infection or Colonization (ex. pneumonia. 48 hours after diarrhea has resolved Duration of illness or treatment . resistant S. pneumoniae. resistant gram negative rods.Stanford Hospital & Clinics Infection Control Manual Section 5. Droplet Precautions. Droplet Precautions. sepsis) See Meningitis Norovirus (Norwalk virus) diarrhea Contact Private room   Parainfluenza receiving inhaled Ribavirin therapy   Droplet Respiratory Private Room No negative air pressure required.  Patient does not soil environment  Antibiotic therapy completed. follow Droplet Precautions. ESBLs. Until 9 days after the onset of swelling Neisseria meningitides. For more information see ICM Policy 5. Promptly notify the ICED. no special ventilation required.41. Door may remain open. Burkholderia cepacia. Every time. Reviewed case by case by Infection Control.For more information see ICM Policy 5. Contact Precautions Surgical style mask with/without face shield plus goggles for persons entering room..30.* x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214. Until all devices are DC’d. Acinetobactor) Mumps (infectious parotitis) Contact Private room or may cohort with another patient with the same resistant organism Call Infection Control pager #16167 if additional guidance required.12 - . Contact Precautions  Droplet Private room. upon entry into room. invasive disease (meningitis. place in Room E139 only.41. Instruct patient to perform hand hygiene after contact with respiratory secretions. Exception: If patient on E1. See Appendix B.30.       Non-immune persons should not enter room. For more information see ICM Policy 5. Surgical style mask for patients when leaving room. Surgical style mask with face shield or surgical style mask plus goggles for persons entering room.

in an immunocompromised patient with chronic disease Droplet Private room.41.  Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. Door may remain open. Duration of illness For 7 days For duration of hospitalization For 24 hours after treatment is completed.  Promptly notify the ICED. Pediculosis (Lice) Contact Private room For more information see ICM Policy 5.  For more information see ICM Policy 5. Pediculosis Exposure Follow-up.13 - .30. Door may remain open.  Surgical style mask with face shield or surgical style mask plus goggles for persons entering room.Stanford Hospital & Clinics Infection Control Manual Section 5. Droplet Precautions  Pregnant HCWs should not enter the room. See Appendix B.41. no special ventilation required. place in Room E139 only.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Parainfluenza no inhaled Ribavirin therapy Parvovirus B19 – patient in aplastic crisis Droplet Any room  Droplet Private room.* x 5-1106 or pager 16167  Report promptly to Santa Clara County Health Department (408) 885-4214.  Surgical style mask for patients when leaving room. Droplet Precautions.  Promptly notify the ICED. Parvovirus B19 (fifth disease or Erythema infectiosum).  For more information see ICM Policy 5. Exception: If patient on E1.* x 5-1106 or pager 16167  Report promptly to Santa Clara County Health Department (408) 885-4214. See Appendix B. .  Surgical style mask for patients when leaving room. Contact Precautions and 6. Exception: If patient on E1. no special ventilation.50. For more information see ICM Policy 5.  Pregnant HCWs should not enter the room. place in Room E139 only.41. Droplet Precautions.

* x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214. See Appendix B. Bubonic Plague. Surgical style mask and clean gown for patients when leaving room.Stanford Hospital & Clinics Infection Control Manual Section 5.* x 5-1106 or pager 16167 For more information see ICM Policy 5.      Surgical style mask with/without face shield plus goggles. Droplet Precautions. Promptly notify the ICED.41. place in Room E139 only. Exception: If patient on E1. Duration of illness . Droplet Precautions. Door may remain open. Promptly notify the ICED. no special ventilation required.14 - . No special ventilation required. no special ventilation required. See Appendix B. pneumonic Yersinia pestis Standard Droplet Any room Private room.41.      For 48 hours after appropriate antibiotic therapy is initiated Pneumonia  Bacterial (including pneumococcal) and viral not listed elsewhere  Mycoplasma Standard Any room Droplet Private room. Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. Exception: If patient on E1. place in Room E139 only. place in Room E139 only. Exception: If patient on E1. Door may remain open. Until 5 days after initiation of appropriate antibiotic therapy Plague.* x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214.41. gloves and gown for persons entering room. Surgical style mask for patients when leaving room. Door may remain open. For more information see ICM Policy 5.     Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. Droplet Precautions. Promptly notify the ICED.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Pertussis (whooping cough) Droplet Private room. See Appendix B. Surgical style mask for patients when leaving room. For more information see ICM Policy 5.

Contact/Droplet Precautions for duration of symptoms. see ICM Policy 5. Promptly notify the ICED. Ribavirin Precautions for the duration of inhaled Ribavirin therapy.. follow Contact/Droplet Precautions. upon entry into room.) . Droplet Precautions. N95 mask for staff entering the room.*x 5-1106 or pager 16167 For more information see ICM Policy 5. Surgical style mask for patients when leaving room. i.30.15 -  Every time.30. negative air pressure (Respiratory for room placement).*x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214. ESBL. etiology unknown Respiratory and Contact Private room with negative air pressure and an ante room.41.  Pregnant healthcare workers must not care for patient.Stanford Hospital & Clinics Infection Control Manual Section 5. See MDRO Respiratory Syncytial Virus (RSV) in an immunocompromised host receiving Ribavirin Therapy Ribavirin Precautions and Contact/ Droplet Private room. If patient on E1. To be determined when diagnosis is made Resistant Microorganisms. Contact Precautions and 5. (Refer to Appendix B of this policy. Exception: If patient on E1.e. Droplet Precautions. no special ventilation required.  For more information see ICM Policy 5. place in Room E139 only. place in room E139. For more information see ICM Policy 5. Keep door closed.         Rash.30. generalized. Only staff immune to childhood illnesses should enter room. Door may remain open. Burkholderia. Keep door closed. For more information. Contact Precautions Duration of hospitalization Q Fever Rabies Standard Droplet Any room Private room. Contact Precautions Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. Resistant Pseudomonas. etc. Ribavirin Precautions Include:  N95 mask for persons entering room during a treatment.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Pneumocystis carinii pneumonia (PCP) Poliomyelitis Standard Contact Any room Private room   Promptly notify the ICED. See Appendix B. .41.

follow Contact/Droplet Precautions. Staff must not touch eyes. Droplet Precautions.30.* x 5-1106 or pager 16167 Report promptly to Santa Clara County Health Department (408) 885-4214. no special ventilation required. For more information see Until 7 days after onset of rash.41. Instruct patient to perform hand hygiene after contact with respiratory secretions. Contact Precautions and 5. Droplet Precautions. Exception: If patient on E1. For more information see ICM Policy 5. upon entry into room. For more information regarding Ribavirin contact the RT shift supervisor (37709) Every time. Infants with congenital rubella shed virus for months .41. Duration of Symptoms Duration of Symptoms Ringworm ( tinea) Rotavirus See Gastroenteritis Rubella (German measles) Standard Any room  Droplet Private room. Patient to wear surgical style mask when leaving room. Contact Precautions and 5. For more information see ICM Policy 5. See Appendix B. . Instruct patient to perform hand hygiene after contact with respiratory secretions. Door may remain open. Promptly notify the ICED. Staff must not touch eyes. Every time.Stanford Hospital & Clinics Infection Control Manual Section 5.16 -     Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. Remove your soft contacts or wear goggles Follow instructions on the Ribavirin precautions sign.30. follow Contact/Droplet Precautions. place in Room E139 only. upon entry into room.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS     Respiratory Syncytial Virus (RSV) in an immunocompromised patient not receiving inhaled Ribavirin therapy Contact/Droplet Private Room No negative air pressure required     Respiratory Syncytial Virus (RSV) in a patient with an intact immune system and not receiving inhaled Ribavirin therapy Droplet Any room Duration of Precautions Duration of Symptoms     Gloves and gown must be worn when in contact with the patient.

Requires fit testing by designated individual (see manager).  Scabies Contact Private room until treatment is completed N95 respirator mask for personnel entering room. SARS Precautions/Isolation  Persons with crusted (Norwegian) scabies generally must be treated at least twice. Refer to Disaster Response and Recovery Guide. follow Contact Precautions. See gastroenteritis SARS (Severe Acute Respiratory Syndrome) Respiratory and Contact Private.41.30. upon entry into room. Keep door closed.  Requires fit testing by designated individual. Do NOT discharge from hospital until determined no longer infectious. Rubella Exposure Follow-up. Promptly notify the ICED* x 5-1106 or pager 16167.90.Every time. See manager for more information.Stanford Hospital & Clinics Infection Control Manual Section 5.  Patient to wear surgical style mask when leaving room.21.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS ICM Policy 5. See Measles Salmonella. negative air pressure room with ante-room.  For more information see ICM Policy 6. See Gastroenteritis Smallpox Respiratory and Contact Private negative air pressure room with anteroom  N 95 respirator mask for staff entering room.) . a week apart  Persons with crusted (Norwegian) scabies require contact precautions until skin scraping is negative For more information see ICM Policy 5.17 - . Droplet Precautions and 6.  Promptly notify the ICED* x 5-1106 or pager 16167  Report promptly to Santa Clara County Health Department (408) 885-4214. (Disappearance of scabs generally 14-28 days. Rubeola. Contact Precautions   Duration of hospitalization For 24 hours after treatment is completed See note in “Special Instructions” Shigella.

For more information see ICM Policy 5.Stanford Hospital & Clinics Infection Control Manual Section 5. Patient to wear surgical style mask when leaving room. Pulmonary and Pharyngeal Standard Standard Standard Standard Respiratory Private room.41. See ICM Policy 5. Exception: If patient on E1. may DC after 24 hours of effective antibiotic therapy     N 95 respirator mask for staff entering room. for criteria . Report immediately to the ICED at x 5-1106 or pager 16167. Respiratory Precautions.18 - .10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS Staphylococcus aureus Disease Standard Any room May need Contact Precautions if wound drainage is not adequately contained with dressing. extrapulmonary Tuberculosis. Respiratory Precautions can only be discontinued after consultation with ICED. Surgical style mask with face shield or surgical style mask plus goggles for persons entering room. place in Room E139 only. Duration of illness if Contact Precautions needed Streptococcal Disease (Group A)  Minor wounds  Major wounds   Standard Contact Any room Private room       Pneumonia Droplet Syphilis Toxic Shock Syndrome Toxoplasmosis Tuberculosis. Droplet Precautions.   May need Contact Precautions if wound drainage is not adequately contained with dressing. Any room Any room Any room Any room Private.30. See Appendix B. Requires fit testing by designated individual (see manager). Wear a surgical style mask with face shield or surgical style mask with goggles if the wound is irrigated-could cause aerosolization For more information see ICM Policy 5.40. Door may remain open. Surgical style mask for patients when leaving room. Contact Precautions. negative air pressure room with an anteroom. no special ventilation required. If Contact Precautions needed.

6.19 - . Contact Precautions For more information see ICM Policy 5. Tuberculosis Precautions and 9.40. Tularemia Typhoid Fever (Salmonella typhi). Any room Private room or room with VRE patient only  Review record for previous six months. If positive culture (other than rectal swab) place on precautions.Stanford Hospital & Clinics Infection Control Manual Section 5. Do not discharge patient until approval obtained from Santa Clara County Health Dept.30.  For more information see ICM Policy 5.0. Yellow fever. ICED with assistance from physician complete “Report of Discharge/ Treatment Plan” and fax to Santa Clara County Disease Control 24 hours prior to discharge. Pulmonary Tuberculosis Exposure Control Plan. Respiratory Precautions.  Every time. Generalized Valley Fever (Coccidiomycosis) Vancomycin resistant enterococcus (VRE) – Infection or Colonization or with a history of during a prior hospitalization Standard Any room Contact Standard Contact Private room. Colorado Tick fever) Contact Private room Duration of hospitalization Standard Any room .30.10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS     Report promptly to Santa Clara County Health Department (408) 885-4214. For more information see ICM Policy 5. See Chickenpox Varicella – Zoster: See Herpes Zoster Viral Fevers (Dengue. follow Contact Precautions. upon entry into room.70. See Gastroenteritis Vaccinia. Contact Precautions Duration of hospitalization Vancomycin intermediate/resistant Staphylococcus aureus (VISA) Varicella.

10 IF A DISEASE OR CONDITION IS NOT LISTED IN THIS TABLE USE STANDARD PRECAUTIONS DISEASE/CONDITION PRECAUTIONS ROOM PLACEMENT SPECIAL INSTRUCTIONS DURATION OF PRECAUTIONS West Nile Virus Standard Any room   Report immediately to ICED* at x 5-1106 or pager 16167. Contact Precautions.20 - . Whooping Cough: See Pertussis Wound Infections  Major (where drainage is not adequately contained with a dressing) Contact Private Room Minor or limited or contained Yersiniosis See Plague  Standard Any Room Contact Precautions necessary if the patient’s hygiene is poor and soiling of the environment is likely.  Until drainage has stopped or can be contained with a dressing * Infection Control and Epidemiology Department . Report promptly to Santa Clara County Health Department (408) 885-4214.  For more information see ICM Policy 5.30. Dressing adequately contains all drainage.Stanford Hospital & Clinics Infection Control Manual Section 5.

21 - .10 Appendix B QUICK REFERENCE GUIDE FOR PLACEMENT OF PATIENTS: NEGATIVE AIRFLOW ROOMS .Stanford Hospital & Clinics Infection Control Manual Section 5.

Ribavirin Therapy 2.10 Appendix C LIMITED NEGATIVE AIRFLOW ROOMS PRIORITIZATION SCHEME 1. R/O Tuberculosis . Chickenpox/Disseminated zoster 3.22 - .Stanford Hospital & Clinics Infection Control Manual Section 5. Smear Positive Tuberculosis 4.

Stanford Hospital & Clinics Infection Control Manual Section 5.10 Appendix D QUICK REFERENCE GUIDE FOR PLACEMENT OF PATIENTS: POSITIVE AIRFLOW ROOMS .23 - .

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