Guideline for Isolation Precautions: Preventing ...

1 Page 1 of 206 Accessable version: 2007 Guideline for Isolation precautions : Preventing Transmission of infectious Agents in Healthcare Settings Last update: July 2019 Jane D. Siegel, MD; Emily Rhinehart, RN MPH CIC; Marguerite Jackson, PhD; Linda Chiarello, RN MS; the Healthcare Infection Control Practices Advisory Committee Acknowledgement: The authors and HICPAC gratefully acknowledge Dr. Larry Strausbaugh for his many contributions and valued guidance in the preparation of this Guideline . Suggested citation: Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation precautions : Preventing Transmission of infectious Agents in Healthcare Settings Guideline for Isolation precautions : Preventing Transmission of infectious Agents in Healthcare Settings (2007) Last update: July 2019 Page 2 of 206 Healthcare Infection Control Practices Advisory Committee (HICPAC): Chair Patrick J.

2 Brennan, MD Professor of Medicine Division of infectious Diseases University of Pennsylvania Medical School Executive Secretary Michael Bell, MD Division of Healthcare Quality Promotion National Center for infectious Diseases Centers for Disease Control and Prevention Members BRINSKO, Vicki L., RN, BA Infection Control Coordinator Vanderbilt University Medical Center DELLINGER, E. Patchen., MD Professor of Surgery University of Washington School of Medicine ENGEL, Jeffrey, MD Head General Communicable Disease Control Branch North Carolina State Epidemiologist GORDON, Steven M., MD Chairman, Department of Infections Diseases Hospital Epidemiologist Cleveland Clinic Foundation Department of infectious Disease HARRELL, Lizzie J.

3 , PhD, D(ABMM) Research Professor of Molecular Genetics, Microbiology and Pathology Associate Director, Clinical Microbiology Duke University Medical Center O BOYLE, Carol, PhD, RN Assistant Professor, School of Nursing University of Minnesota PEGUES, David Alexander, MD Division of infectious Diseases David Geffen School of Medicine at UCLAPERROTTA, Dennis M. PhD., CIC Adjunct Associate Professor of Epidemiology University of Texas School of Public Health Texas A&M University School of Rural Public Health PITT, Harriett M., MS, CIC, RN Director, Epidemiology Long Beach Memorial Medical Center RAMSEY, Keith M., MD Professor of Medicine Medical Director of Infection Control The Brody School of Medicine at East Carolina University SINGH, Nalini, MD, MPH Professor of Pediatrics Epidemiology and International Health The George Washington University Children s National Medical Center STEVENSON, Kurt Brown, MD, MPH Division of infectious Diseases Department of Internal Medicine The Ohio State University Medical Center SMITH, Philip W.

4 , MD Chief, Section of infectious Diseases Department of Internal Medicine University of Nebraska Medical Center HICPAC membership (past) Robert A. Weinstein, MD (Chair) Cook County Hospital Chicago, IL Jane D. Siegel, MD (Co-Chair) University of Texas Southwestern Medical Center Dallas, TX Michele L. Pearson, MD (Executive Secretary) Centers for Disease Control and Prevention Atlanta, GA Guideline for Isolation precautions : Preventing Transmission of infectious Agents in Healthcare Settings (2007) Last update: July 2019 Page 3 of 206 Raymond Chinn, MD Sharp Memorial Hospital San Diego, CA Alfred DeMaria, Jr, MD Massachusetts Department of Public Health Jamaica Plain, MA James T.

5 Lee, MD, PhD University of Minnesota Minneapolis, MN William A. Rutala, PhD, MPH University of North Carolina Health Care System Chapel Hill, NC William E. Scheckler, MD University of Wisconsin Madison, WI Beth H. Stover, RN Kosair Children s Hospital Louisville, KY Marjorie A. Underwood, RN, BSN CIC Mt. Diablo Medical Center Concord, CA HICPAC Liaisons William B. Baine, MD Liaison to Agency for Healthcare Quality Research Joan Blanchard, RN, MSN, CNOR Liaison to Association of periOperative Registered Nurses Patrick J. Brennan, MD Liaison to Board of Scientific Counselors Nancy Bjerke, RN, MPH, CIC Liaison to Association of Professionals in Infection Prevention and Control Jeffrey P.

6 Engel, MD Liaison to Advisory Committee on Elimination of Tuberculosis David Henderson, MD Liaison to National Institutes of HealthLorine J. Jay MPH, RN, CPHQ Liaison to Healthcare Resources Services Administration Stephen F. Jencks, MD, MPH Liaison to Center for Medicare and Medicaid Services Sheila A. Murphey, MD Liaison to Food and Drug Administration Mark Russi, MD, MPH Liaison to American College of Occupational and Environmental Medicine Rachel L. Stricof, MPH Liaison to Advisory Committee on Elimination of Tuberculosis Michael L. Tapper, MD Liaison to Society for Healthcare Epidemiology of America Robert A. Wise, MD Liaison to Joint Commission on the Accreditation of Healthcare Organizations Authors Associations Jane D.

7 Siegel, MD Professor of Pediatrics Department of Pediatrics University of Texas Southwestern Medical Center Emily Rhinehart RN MPH CIC CPHQ Vice President AIG Consultants, Inc. Marguerite Jackson, RN PhD CIC Director, Administrative Unit, National Tuberculosis Curriculum Consortium, Department of Medicine University of California San Diego Linda Chiarello, RN MS Division of Healthcare Quality Promotion National Center for infectious Diseases, CDC Guideline for Isolation precautions : Preventing Transmission of infectious Agents in Healthcare Settings (2007) Last update: July 2019 Page 4 of 206 TABLE OF CONTENTS Updates .. 7 Executive Summary .. 8 Parts I - III: Review of the Scientific Data Regarding Transmission of infectious Agents in Healthcare Settings.

8 9 Tables, Appendices, and Other Information .. 10 Appendix A: Type and Duration of precautions Recommended for Selected Infections and Conditions . 10 Pre- Publication of the Guideline on Preventing Transmission of MDROs .. 11 Summary .. 11 Part I: Review of Scientific Data Regarding Transmission of infectious Agents in Healthcare 13 Evolution of the 2007 Document .. 13 Changes or clarifications in terminology.. 14 Scope.. 14 Rationale for Standard and Transmission-Based precautions in healthcare settings .. 15 Sources of infectious agents.. 15 Susceptible hosts.. 15 Modes of transmission.. 16 Contact transmission.. 16 Direct contact transmission.. 16 Indirect contact transmission.

9 17 Droplet transmission.. 18 Airborne transmission.. 19 Emerging issues concerning airborne transmission of infectious agents.. 20 Transmission from patients.. 20 Transmission from the environment.. 21 Other sources of infection.. 21 infectious Agents of Special Infection Control Interest for Healthcare Settings .. 21 Epidemiologically important organisms.. 22 C. difficile.. 22 b. Multidrug-resistant organisms (MDROs).. 23 Agents of bioterrorism.. 24 Pre-event administration of smallpox (vaccinia) vaccine to healthcare personnel.. 25 Prions.. 25 Severe Acute Respiratory Syndrome (SARS).. 27 Monkeypox.. 29 Noroviruses.. 30 Hemorrhagic fever viruses (HFV).

10 31 Transmission Risks Associated with Specific Types of Healthcare Settings .. 32 Hospitals.. 33 Intensive care units.. 33 Burn 33 Pediatrics.. 34 Non-acute healthcare settings.. 35 Long-term care.. 35 Ambulatory care.. 37 Guideline for Isolation precautions : Preventing Transmission of infectious Agents in Healthcare Settings (2007) Last update: July 2019 Page 5 of 206 Home care.. 38 Other sites of healthcare delivery.. 39 Transmission Risks Associated with Special Patient Populations .. 39 Immunocompromised patients.. 40 Cystic fibrosis patients.. 40 New Therapies Associated with Potentially Transmissible infectious Agents .. 41 Gene therapy.