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Infection Control

Clinical Syndromes or Conditions Warranting Empiric

Transmission-Based Precautions in Addition to
Standard Precautions
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings (2007)
Appendix A: Table 2

Format Change [February 2017]

The format of this section was changed to improve readability and accessibility. The content is unchanged.

Potential Empiric Precautions (Always Includes Standard

Disease Clinical Syndrome or Condition† Pathogens‡ Precautions)

Diarrhea Acute diarrhea with a likely Enteric pathogens§ Contact Precautions (pediatrics and adult)
infectious cause in an incontinent
or diapered patient

Meningitis Meningitis Neisseria Droplet Precautions for first 24 hours of

meningitidis antimicrobial therapy; mask and face protection
for intubation

Meningitis Meningitis Enteroviruses Contact Precautions for infants and children

Meningitis Meningitis M. tuberculosis Airborne Precautions if pulmonary infiltrate

Airborne Precautions plus Contact Precautions
if potentially infectious draining body fluid
present

Rash or Petechial/ecchymotic with fever Neisseria Droplet Precautions for first 24 hours of
Exanthems, (general) meningitides antimicrobial therapy
Generalized,
Etiology
Unknown

Rash or Petechial/ecchymotic with fever Ebola, Lassa, Droplet Precautions plus Contact Precautions,
Exanthems, (general) Marburg viruses with face/eye protection, emphasizing safety
Generalized, If positive history of travel to sharps and barrier precautions when blood
Etiology an area with an ongoing exposure likely. Use N95 or higher respiratory
Unknown outbreak of VHF in the 10 protection when aerosol-generating procedure
days before onset of fever performed.
Ebola Virus Disease for Healthcare Workers
[2014]
Update: Recommendations for healthcare
workers can be found at Ebola For Clinicians.

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Potential Empiric Precautions (Always Includes Standard

Disease Clinical Syndrome or Condition† Pathogens‡ Precautions)

Rash or Vesicular Varicella-zoster, Airborne plus Contact Precautions; Contact

Exanthems, herpes simplex, Precautions only if Herpes simplex, localized
Generalized, variola (smallpox), zoster in an immunocompetent host or vaccinia
Etiology vaccinia viruses viruses most likely
Unknown

Rash or Maculopapular with cough, Rubeola (measles) Airborne Precautions

Exanthems, coryza and fever virus
Generalized,
Etiology
Unknown

Respiratory Cough/fever/upper lobe M. tuberculosis, Airborne Precautions plus Contact precautions

Infections pulmonary infiltrate in an HIV- Respiratory viruses,
negative patient or a patient at S. pneumoniae, S.
low risk for human aureus (MSSA or
immunodeficiency virus (HIV) MRSA)
infection

Respiratory Cough/fever/pulmonary infiltrate M. tuberculosis, Airborne Precautions plus Contact Precautions

Infections in any lung location in an HIV- Respiratory viruses, Use eye/face protection if aerosol-generating
infected patient or a patient at S. pneumoniae, S. procedure performed or contact with respiratory
high risk for HIV infection aureus (MSSA or secretions anticipated.
MRSA) If tuberculosis is unlikely and there are no AIIRs
and/or respirators available, use Droplet
Precautions instead of Airborne Precautions
Tuberculosis more likely in HIV-infected
individual than in
HIV negative individual

Respiratory Cough/fever/pulmonary infiltrate M. tuberculosis, Airborne plus Contact Precautions plus eye
Infections in any lung location in a patient severe acute protection.
with a history of recent travel (10- respiratory If SARS and tuberculosis unlikely, use Droplet
21 days) to countries with active syndrome virus Precautions instead of Airborne Precautions.
outbreaks of SARS, avian (SARS- CoV), avian
influenza influenza

Respiratory Respiratory infections, Respiratory Contact plus Droplet Precautions; Droplet

Infections particularly bronchiolitis and syncytial virus, Precautions may be discontinued when
pneumonia, in infants and young parainfluenza virus, adenovirus and influenza have been ruled out
children adenovirus,
influenza virus,
Human
metapneumovirus

Skin or Abscess or draining wound that Staphylococcus Contact Precautions

Wound cannot be covered aureus (MSSA or Add Droplet Precautions for the first 24 hours of
Infection MRSA), group A appropriate antimicrobial therapy if invasive
streptococcus Group A streptococcal disease is suspected

* Infection control professionals should modify or adapt this table according to local conditions. To ensure that
appropriate empiric precautions are implemented always, hospitals must have systems in place to evaluate patients
routinely according to these criteria as part of their preadmission and admission care.

† Patients with the syndromes or conditions listed below may present with atypical signs or symptoms (e.g.neonates and
adults with pertussis may not have paroxysmal or severe cough). The clinician’s index of suspicion should be guided by
the prevalence of specific conditions in the community, as well as clinical judgment.

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‡ The organisms listed under the column “Potential Pathogens” are not intended to represent the complete, or even most
likely, diagnoses, but rather possible etiologic agents that require additional precautions beyond Standard Precautions
until they can be ruled out.

§ These pathogens include enterohemorrhagic Escherichia coli O157:H7, Shigella spp, hepatitis A virus, noroviruses,

rotavirus, C. difficile.

Page last reviewed: November 5, 2015

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