INFECTIOUS DISEASES, CONDITIONS AND/OR MICRO ORGANISMSpolicyandorders.cw.bc.ca/resource-gallery/Documents... · 2018-09-12 · INFECTIOUS DISEASES, CONDITIONS AND/OR MICRO ORGANISMS

INFECTIOUS DISEASES, CONDITIONS AND/OR MICRO ORGANISMS

Consult Infection Prevention and Control Services (IPACS) where information on mother/infant considerations is absent and/or as required. IC.05.02 Infection Prevention & Control Manual Page 1 of 70 July 2018

IC.05.02 TABLE OF RECOMMENDED PRECAUTIONS SELECTED INFECTIOUS DISEASES, CONDITIONS &/OR MICROORGANISMS REV. July 2018

Disease, Condition, Microorganism Presentation Type of Precautions Duration of

Precautions

Mother/Infant (MI) considerations

BF = breast feeding, RI = rooming-in

Comments

Reportable diseases reported by IPACS

Abscess Minor Major (drainage not contained by dressing)

Routine Contact

Duration of drainage

MI contact and RI permitted if drainage adequately controlled. Mother: - Breast abscess-consult

physician prior to breast feeding

Acquired Immune Deficiency Syndrome

Routine MI contact and RI permitted

Assess mothers individually for possibility of other infections. Reportable disease




Precautions



Comments


Adenovirus

Respiratory Droplet and Contact

Adult: Until symptom free Pediatric: Minimum of eleven days from onset and child is symptom free

Mother ill: - Droplet and contact

precautions for mother - Routine practices for infant Healthy 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 infant - Routine practices for

mother - MI contact and BF

permitted

Strict attention to hand hygiene. *If Mother must visit: o Place infant in private

room o Mother to limit visits

and go directly in and out of NICU

o Mother to wear mask for duration of visit in NICU




Precautions



Comments


Adenovirus (cont)

Diarrhea Contact* Until stool is formed or back to baseline for the patient for 48 hours Consult IPACS if immune compromised

Mother ill: - Contact precautions for

mother - Routine practices for infant Healthy 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

Mother - MI contact, BF and RI

permitted

o Strict 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: o Place infant in private



**Ensure immediate disposal of diapers into leak proof bag.

Conjunctivitis Contact

Until symptom free Mother ill: - Contact precautions for

mother - Routine practices for infant Healthy Term infant: - MI contact, BF and RI

permitted

No sharing of towels, linens, etc. Strict attention to hand hygiene.




Precautions



Comments


Adenovirus (cont)

Baby in NICU: - Mother should be

encouraged not to visit until symptom free*

- BF permitted as expressed breast milk


infant - Routine precautions for

Mother

*If Mother must visit: o Place infant in private



Aeromonas Diarrhea, dysentery Contact Until stool is formed or back to baseline for the patient

Strict attention to hand hygiene. Reportable disease

Amoebiasis (Dysentery) (Entamoeba histolytica)

Asymptomatic, to severe diarrhea to grossly bloody dysentery

Contact Until stool is formed or back to baseline for the patient


Anthrax Skin lesions, pneumonia

Routine Contact precautions for patients with draining wounds


Notify IPACS immediately. Notify Public Health immediately. Notify Microbiology laboratory before sending specimens. Does not spread from




Precautions



Comments


person to person. Acquired from infected animals or animal products. Reportable disease

Antibiotic Resistant Organisms (ARO) E.g. MRSA, VRE, CPO, ESBL*

Infection or colonization of any body site

Contact

For duration of hospital stay

Mother has ARO: - Contact precautions for

mother - Contact precautions for all

newborns of positive mothers.

Healthy Term Infant: - MI contact, BF and RI

permitted - Mother uses routine

practices for infant (Mother may choose to use contact precautions)

Baby in NICU: - Baby to be placed in

single room - MI contact and BF


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.

Refer to Section 6 for specific information on ARO’s. *For other resistant organisms, consult IPACS as required. Strict attention to hand hygiene




Precautions



Comments


Antibiotic Resistant Organisms (ARO) (cont)

Infant has ARO: - Contact precautions for

infant - Routine practices for

Mother - MI Contact, BR and RI

permitted Arthropod-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, rash Most infections are subclinical (asymptomatic)

Routine No person-to-person spread except by transfusion, organ transplantation, intrauterine transmission and possibly human milk. Reportable disease

Ascariasis Ascaris lumbricoides, (roundworm)

Usually asymptomatic

Routine No person-to-person spread.

Aspergillosis Aspergillus species

Skin, lung, wound or central nervous system infection

Routine

Atypical Mycobacteria (Mycobacterium other than tuberculosis “MOTT”) e.g. Mycobacterium

Lymphadenitis; pneumonia; disseminated disease in immune compromised host.

Routine

No person-to-person transmission, except for Mycobacterium abscessus in CF patients. Please refer to CF standard in section 6.




Precautions



Comments


avium complex “MAC”

Mycobacterium abscessus in CF patients

Contact For duration of hospital stay

Acquired from soil, water, animal, reservoirs.

Babesiosis Often asymptomatic Routine Tick-borne. No person-to-person spread except by transfusion, and congenital/perinatal route

Bedbugs blood-sucking ectoparasites (external parasites)

Mild to severe allergic reaction to the bites

Routine Practices Consider 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 http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=za1160

Blastomycosis Blastomyces dermatitdis

Asymptomatic, pulmonary, cutaneous or disseminated

Routine No person-to-person spread. Notify Microbiology laboratory before sending specimens

BK Virus (BKV) Polyomavirus

Asymptomatic or cystitis in healthy people Causes lower and upper renal tract

Routine * Disease can include hemorrhagic cystitis, interstitial nephritis, renal allograph loss, nephropathy




Precautions



Comments


disease in immunocompromised patients*-painful hematuria most common symptom

Bocavirus See “Respiratory Viral Infections”

Droplet and Contact


Bornholms Disease Pleurodynia See Enteroviral infection

Contact NICU: Droplet and Contact

Until symptom free Until discontinued by IPACS

Botulism Clostridium botulinum

Descending flaccid Paralysis, cranial nerve palsies

Routine No person-to-person spread Reportable disease

Bronchiolitis See “ Respiratory Viral Infections”

Droplet and Contact

Minimum of eleven days from onset and child is symptom free

Brucellosis (Undulant fever)

Manifestations are non-specific & include: fever, night sweats, weakness, malaise, and arthralgia

Routine Contact precautions for patients with draining wounds


Person-to-person spread is rare. Congenital brucellosis has been reported. Infected mothers can transmit brucella species to their infants through breast feeding.




Precautions



Comments


Brucellosis (cont)

Notify Microbiology laboratory before sending specimens Reportable disease

Burkholderia cepacia complex

Associated with severe pulmonary infections in patients with cystic fibrosis and Chronic Granulomatous Diseases (CGD)

Routine For CF patients Contact*

*Refer to section 6 for specific information on Cystic Fibrosis

Campylobacter See “Diarrhea”

Diarrhea Contact Until stool is formed or back to baseline for the patient.

Reportable disease

Candida auris

Blood stream infections, wound infections, otitis Can be multi-drug resistant

Contact Plus For duration of hospital stay

Mother ill: - Contact plus precautions

for mother - Contact plus precautions

for all newborns of positive mothers.

Healthy Term Infant: - MI contact, BF and RI


practices for infant (Mother may choose to use contact plus precautions)

Strict attention to hand hygiene




Precautions



Comments


Candida auris (cont)

Baby in NICU: - Baby to be placed in

single room - MI contact and BF


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 infant - Routine practices for

Mother - MI Contact, BR and RI

permitted Candidiasis (Moniliasis)

Mucocutaneous infection in oropharynx (thrush) or vaginal candidiasis. Can be disseminated or invasive

Routine MI contact, BF, and RI permitted

Cat Scratch Fever Bartonella henselae

Lymphadenopathy (regional)

Routine No person-to-person spread




Precautions



Comments


Cellulitis, with drainage See “Abscess”

Minor Major (drainage not contained by dressing)

Routine Contact*


*Implement Droplet precautions if H. influenzae type b is suspected in non-immune children < 5years old.

Cervical lymphadenitis

No drainage, intact skin For draining, see abscess or specific organism

Routine

Chancroid Haemophilus ducreyi

Genital Ulcers Routine Sexually transmitted. Reportable disease

Chickenpox Varicella

Vesicular rash, mild fever and systemic symptoms.

Airborne and Contact

For 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

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)

Notify IPCAS 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




Precautions



Comments


Chickenpox (cont) Varicella

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

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 only Infant has chickenpox: -Airborne and contact precautions -Only immune visitors/siblings may visit* -MI contact permitted if mother is immune -BF permitted Infant is Chickenpox contact: Assess need for VZIG Will require isolation from day 8-21 (28 if VZIG given)

with PHSA Workplace Health Non-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 delegate

Visitors who have active chickenpox or shingles must not visit. HCW with suspected chickenpox should not be at work and must report to PHSA Workplace Health.




Precautions



Comments


Chlamydia Chlamydia trachomatis(CT) Chlamydophila pneumoniae(CPn) Chlamydophila psittaci(CPs)

Neonatal conjunctivitis Pneumonia Trachoma Genital tract infection and lymphogranuloma venereum (LGV), Respiratory tract infection Pneumonia

Routine

MI contact, BF, and RI permitted

Chlamydia disease including Psittacosis is reportable. Reportable disease

Cholera Vibrio cholera

Voluminous watery diarrhea, dehydration and other serious complications

Contact Until stool is formed or back to baseline for the patient.

Consult IPACS Notify IPACS Reportable disease

Clostridium botulinum See “Botulism”

Routine Reportable disease

Clostridium difficile

Diarrhea Pseudo membranous colitis

Contact Plus Until 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

Strict attention to hand hygiene Bacterial spores may persist in the environment; therefore, special attention must be paid to cleaning of the environment.




Precautions



Comments


Clostridium difficile (cont)

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 infant

Note: Asymptomatic colonization is common in newborns and infants.

Clostridium perfringens

Gas Gangrene Routine No person-to-person spread

Coccidioido-mycosis (Valley Fever)

Pneumonia, cutaneous or soft tissue infection,

Routine No person-to-person spread Notify Microbiology laboratory before sending specimens

Cold, common See “Respiratory Viral Infections” Cold, common (cont)

Droplet and Contact


Congenital Rubella See “Rubella”

Droplet and Contact for congenital rubella

Continue precautions for at least 1 year, unless 2 urine and nasopharyngeal culture results after 3 months of age are negative

Reportable disease




Precautions



Comments


Conjunctivitis

Eye discharge Contact Until viral etiology ruled out or for duration of symptoms*.

Mother ill: -Contact precautions for mother -Routine practices for infant Healthy Term infant: MI contact, RI, and BF permitted Baby 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 mother

Strict attention to hand hygiene *If viral etiology established, see specific organism. **If Mother must visit Baby in NICU: o Place infant in private



Coronavirus 229E/OC43/NL63/HKU1 See “Respiratory Viral infections”

Droplet and Contact


Coxsackievirus See “ Enterovirus infections”


Until symptom free for 48 hours Until discontinued by IPACS




Precautions



Comments


Creutzfeldt-Jakob Disease (CJD)

Encephalopathy Routine* 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 disease

Croup See “Respiratory Viral Infections”

Droplet and Contact

Minimum of eleven days from onset and child is symptom free

Cryptococcosis Cryptococcus neoformans, Cryptococcus gatti

Pneumonia, dissemination, meningitis.


Cryptosporidiosis

Diarrhea Contact Until stool is formed or back to baseline for the patient.

Reportable disease

Cysticercosis Cysts in various organs including brain (neurocysticercosis)

Routine

No person-to-person spread




Precautions



Comments


Cytomegalovirus (CMV)

Usually asymptomatic; Infectious Mononucleosis, Congenital infection, Retinitis, colitis, disseminated infection in immunocompromised host

Routine Congenital CMV disease is reportable

Decubitus Ulcer


Routine Contact


MI contact, RI permitted if drainage adequately controlled

Dengue Fever See “Arthopod-borne viral infections”

Routine

Dermatitis Many causes (bacteria, virus, fungus).


Routine Contact

If compatible with scabies, see scabies.

Dermatophyte infection See “Tinea” Ringworm

Routine




Precautions



Comments


Diarrhea Several bacteria, viruses, parasites which may include: norovirus, rotavirus, enteric adenovirus, Salmonella, Shigella, Campylobacter, E. coli, Yersinia See specific organism for more details

Acute diarrhea, sometimes accompanied by vomiting, abdominal cramps

Contact Add Droplet if vomiting

Until 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 infant Healthy Term Infant: -MI contact, RI, and BF 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 permitted

Emphasize hand hygiene with mother as shedding may be prolonged. *If Mother must visit: o Place infant in private




**Ensure immediate disposal of diapers into leak proof bag Reinforce hand hygiene Consult IPACS if you suspect an outbreak. Reportable disease-depending on etiology

Diphtheria Corynebacterium diphtheria

Cutaneous (characteristic ulcerative lesion)

Contact Until 2 cultures of skin lesions taken 24 hours apart and 24 hours after completing antimicrobial treatment are negative for C. diphtheriae

Contact IPACS Close contacts should be given antibiotic prophylaxis: -carriers -cases Reportable disease

Pharyngeal Droplet Until 2 cultures




Precautions



Comments


Diphtheria (cont) Corynebacterium diphtheriae

(adherent grayish membrane)

from both the nose and throat taken 24 hours apart and 24 hours after completing antimicrobial treatment are negative for C. diphtheria

Ebola virus See “Hemorrhagic fevers”

Airborne + goggles and Contact

Until hemorrhagic fever virus ruled out or until discontinued by IPACS

Notify IPACS immediately. Notify Public Health immediately.

Echinococcosis “Hydatid Disease” Echinococcus granulosus and Echinococcus multilocularis

Cysts in various organs, including liver

Routine No person to person spread

Echovirus Disease See Enterovirus infection



Empyema (draining)

Common organisms include Staph aureus (including MRSA), GAS

Contact Duration of Drainage.

Consult IPACS as needed

Encephalitis or encephalomyelitis

Adult: Routine

Until specific etiology established

May be associated with HSV, Enterovirus,




Precautions



Comments


Pediatric: Contact NICU: Droplet and Contact

and then refer to specific diseases for appropriate precautions

arbovirus. measles, mumps, varicella, Mycoplasma pneumonie, Epstein-Barr virus (EBV). Reportable Disease

Endometritis Routine MI contact, RI and BF permitted.

If infection is due to Group A Streptococcus, see “Streptococcal Disease– Group A”.

Enterobiasis See “Pinworms”

Routine

Enterovirus Enterovirus (nonpolio): Coxsackieviruses - Echoviruses - Enteroviruses

Acute febrile respiratory illness, e.g., cough, fever Acute febrile illness, aseptic meningitis, encephalitis, pharyngitis, herpangina, rash, pleurodynia, hand foot and mouth disease Gastroenteritis may

Droplet and Contact Contact

Until symptom free Until symptom free

Mother ill: -Additional precautions as indicated for mother -Routine practices for infant Healthy term infant: - MI contact, RI and BF permitted Infant in NICU: -MI contact NOT permitted in the NICU until mother asymptomatic* -BF as expressed milk Infant ill: -Additional precautions as indicated for infant. -Routine practices for mother

Strict attention to hand hygiene Shedding of Enterovirus can occur in stool. *If Mother must visit infant in NICU, consult IPACS.




Precautions



Comments


Enterovirus (cont)

occur but is not common.

NICU: Droplet and Contact

Until discontinued by IPACS

-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.

Epiglottitis Haemophilus influenzae type b; Streptococcus group A, Staphylococcus aureus

Adult: Routine Pediatric: Droplet until H. influenzae is ruled out

If H. influenzae: Until 24 hours of appropriate antimicrobial therapy received

Epstein-Barr virus Epstein-Barr virus (cont)

Infectious Mononucleosis, X-linked lymphoproliferative syndrome, post-transplantation lymphoproliferative disorder, Burkitts lymphoma, nasopharyngeal carcinoma

Routine Spread via intimate contact with oral secretions or from articles contaminated with oral secretions.

Erysipelas See “Streptococcus group A”

Acute, cutaneous inflammatory disease

Droplet and Contact

Until 24 hours of appropriate antimicrobial therapy received




Precautions



Comments


Erythema Infectiosum Fifth Disease Parvovirus B19”

Rash, anemia, aplastic crisis. In pregnancy: hydrops foetalis

Routine Droplet for the following patients: -Aplastic crisis -Immuno-compromised -Papulopurpuric gloves-socks (PGS) syndrome Transient aplastic or erthyrocyte crisis

For 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 purpura

Contact

Until stool is formed or back to baseline for the patient and the results of two stool cultures are negative for E. coli 0157

Reportable disease

Fifth Disease See “Erythema Infectiosum”

Routine Droplet for the following patients: -Aplastic crisis -Immuno-compromised -Papulopurpuric gloves-socks (PGS) syndrome

For duration of hospitalization (aplastic crisis, immunocompromised, PGS)




Precautions



Comments


Transient aplastic or erthyrocyte crisis

For 7 days for patients with transient aplastic crisis (TAC)

Food Poisoning/Food-Borne Illness E.g. Bacillus cereus, Clostridium perfringens, Staphylococcus aureus, Salmonella, vibrio parahaemolyticus, Escherichia coli 0157 and others See specific organism for more details

Diarrhea, vomiting and abdominal cramps


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 infant Healthy Term Infant: -MI contact, RI, and BF 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 BF permitted





**Ensure immediate disposal of diapers into leak proof bag Reinforce hand hygiene Consult IPACS if you suspect an outbreak. Reportable disease




Precautions



Comments


Furunculosis Staphylococcus aureus, including MRSA See “Abscess”


Routine Contact


Gastroenteritis Several bacteria, viruses, parasites which may include: norovirus, rotavirus, enteric adenovirus, Salmonella, Shigella, Campylobacter, E. coli, Yersinia See specific organism for more details

Acute diarrhea, vomiting, abdominal cramps


Until 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 infant Healthy 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 permitted





**Ensure immediate disposal of diapers into leak proof bag Reinforce hand hygiene Consult IPACS if you suspect an outbreak. Reportable disease-depending on etiology

German Measles See “Rubella”

Droplet

Until 7 days after onset of rash

Reportable disease




Precautions



Comments


Droplet and Contact for congenital rubella

Continue precautions for at least 1 year, unless 2 urine and nasopharyngeal culture results after 3 months of age are negative

Giardiasis Giardia lamblia

Diarrhea Contact

Until stool is formed or back to baseline for the patient.

Reportable disease

Gonococcal Infections Neisseria gonorrhoeae

Ophthalmia neonatorum, gonorrhea, arthritis, pelvic inflammatory disease

Routine

Mother 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 disease

Granuloma inguinale/ Donovanosis Klebsiella granulomatis

Painless genital ulcers, inguinal ulcers, nodules

Routine

Sexual transmission

Haemophilus influenzae type b

Invasive disease: Pneumonia, meningitis, epiglottis, septic arthritis, cellulitis, otitis media,

Adult: Droplet Pediatric: Droplet

Until 24 hours of appropriate antimicrobial therapy

Invasive Haemophilus influenzae type b is a reportable disease




Precautions



Comments


endocarditis, periorbital cellulitis in non-immune child < 5 years old, etc.

Haemophilus influenzae non b

Routine All invasive Haemophilus influenza are a reportable disease by type

Hand, Foot & Mouth Disease See “Enterovirus infection”



Hansen’s Disease See “Leprosy”


Hantavirus Hemorrhagic fever, pulmonary syndrome, renal syndrome

Routine Infection acquired from rodents. Reportable disease

Helicobacter pylori

Gastritis, ulcer Routine

Hemolytic Uremic Syndrome (HUS) Shiga toxin-producing Enterohemorrhagic E. coli (EHEC) or

A prodromal illness with abdominal pain, vomiting, and diarrhea that immediately precedes the development of


Until E.coli 0157 or other infectious cause ruled out and then refer to specific organism for appropriate precautions.

Reportable disease




Precautions



Comments


Shigella

HUS: (Hemolytic anemia, Thrombocytopenia, Acute renal injury)

Hemorrhagic Fevers Lassa, Ebola, Marburg, and others

Severe Febrile diseases with bleeding, shock and multisystem involvement




Hepatitis of unknown etiology

Hepatitis, jaundice Contact For 7 days after onset of jaundice or until hepatitis A and E ruled out

Hepatitis A and E

Hepatitis, jaundice, acute febrile illness.

Contact

Duration of symptoms or at least one week from onset of symptoms, whichever is longer

MI contact, BF and RI are permitted

If 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 disease

Hepatitis B Hepatitis, jaundice, acute and chronic often asymptomatic

Routine -MI contact and RI permitted-BF permitted if infant of an HBsAg positive Mother has received HBIG and Hepatitis B vaccine-consult physician

Reportable disease




Precautions



Comments


Herpangina See “Enterovirus”



Herpes Simplex

Genital, Mucocutaneous, oral, Herpetic Whitlow, Eczema Herpeticum, encephalitis and meningitis Neonatal 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

Routine practices for: o Patients with

localized recurrent lesions

o Patients with CNS infection

Mother 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 diseases




Precautions



Comments


Herpes Simplex (cont)

infection HSV persists for life. Contact

precautions for: Neonates with mucacutaneous lesions Neonates exposed to active HSV lesions during birth Women in labor and postpartum women with active HSV lesions Patients with severe mucocutaneous disease

Until lesions are crusted over and dried Birth to 6 weeks of age or until neonatal HSV infection has been ruled out. Until lesions are crusted over and dried Until lesions are crusted over and dried




Precautions



Comments


Herpes zoster (Shingles, Zoster, Varicella Zoster) See “Shingles”

Immunocompetent patient: - Localized and

can be covered o Extensive or

localized that cannot be covered

Immunocompromised host or disseminated disease

Contact Airborne and Contact Airborne and Contact

Until lesions have crusted over and dried.

Histoplasmosis Histoplasma capsulatum Histoplasmosis (cont)

Asymptomatic, pulmonary or disseminated

Routine No person-to-person spread. Notify Microbiology laboratory before sending specimens

HIV Human Immunodeficiency Virus

A wide range of clinical manifestations

Routine - MI contact and RI permitted

Assess mothers individually for possibility of other infections. Reportable disease

Human Herpesvirus 6 See “Roseola

Fever followed by rash

Routine




Precautions



Comments


Human Metapneumovirus See “Respiratory Viral Infections”

Droplet and Contact


Human Papillomaviruses

Skin warts, anogenital warts (condylomata acuminate)

Routine

Human T-Cell Lymphotropic Virus I/II (HTLV I/II)

Asymptomatic Routine -MI contact and RI permitted

Impetigo e.g. Staphylococcus aureus, and Group A Streptococcus Variants of impetigo include: bullous, non-bullous or ecthyma


Routine Contact

Duration 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.

Influenza

Acute febrile respiratory illness, e.g., cough, fever, muscle and joint pain, headache, etc

Droplet and Contact

Continue 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 infant Healthy term infant: - MI contact, BF and RI

permitted -Mother to wear mask when within 2 metres of infant.

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




Precautions



Comments


Influenza (cont)

Infant in NICU: -Mother should be encouraged not to visit until symptom free.* -BF permitted as expressed milk. -Consult IPACS as required Infant ill: -Droplet and contact precautions for infant -Routine practices for mother - MI contact, BF and RI permitted

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: o Place infant in private


and go directly in and out of NICU.


All HCW should receive annual influenza vaccine. Consult IPACS if you suspect an outbreak. Refer to Section 6 for specific information on Influenza Reportable disease




Precautions



Comments


Influenza Vaccine (Live Attenuated Influenza Vaccine – LAIV) intranasal spray e.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 needed

Kawasaki

Acute febrile, self-limited, systemic vasculitis of early childhood

Routine




Precautions



Comments


Lassa Fever See “Hemorrhagic Fevers”



Legionella pneumophila Infections

Legionnaires disease: Varies in severity from mild to severe pneumonia, fever, cough and progressive respiratory distress Pontiac Fever: Mild febrile illness without pneumonia

Routine

No person-to-person spread Notify IPACS Reportable disease

Leprosy (Hansen’s disease) Mycobacterium leprae

Infection involving skin, peripheral nerves, mucosa of the upper respiratory tract, and testes

Routine Transmission between persons only with very prolonged extensive close personal contact. Household contacts should be given prophylaxis Reportable disease

Leptospirosis Leptospira species

Acute febrile disease with varied manifestations characterized by vasculitis





Precautions



Comments


Lice (Pediculosis) Pediculus capitis: Head lice-lice and eggs in hair, behind ears and nape of neck Pediculus corporis: Body lice Pthirius pubis: Pubic lice/Crab Lice

Itching Some children with head lice may be asymptomatic Secondary bacterial infection

Contact Until 24 hours after treatment is complete

Mother symptomatic Contact for mother Healthy term Infant: -MI contact, RI, BF permitted Infant in NICU: -MI contact and BF permitted once mother has been treated

Treatment 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.

Listeriosis Listeria monocytogenes

Primarily food borne Influenza 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 permitted

Reportable disease




Precautions



Comments


Lyme disease Borrelia burgdorferi

3 stages: Early localized, early disseminated, and late disease.


Lymphadenitis

No drainage, intact skin For draining, see abscess or specific organism

Routine

Lymphogranuloma Venereum (LGV) See “Chlamydia trachomatis”

Routine

Malaria Plasmodium species

Febrile illness with a history of travel

Routine Malaria in pregnancy carries significant risks of morbidity and mortality for both the mother and fetus Reportable disease

Mastitis See “Staphylococcus aureus”

Minor Major (drainage not contained by dressing

Routine Contact





Precautions



Comments


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 RI Infant 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 milk Infant 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 rash Infant 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 measles Notify IPACS as soon as you suspect measles HCW: - 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 Health Only immune family and visitors to visit Immunity is defined as a previous history of measles or having received 2 doses of measles vaccine or born before 1957 Reportable disease




Precautions



Comments


Meningitis Meningitis (cont)

Symptoms include headache, neck stiffness, fever, petechiae, etc. Severity of symptoms depends on causative organism.

Etiology unknown:Droplet and contact

Until etiology determined or infectious cause ruled out.

Notify IPACS of all cases of meningitis Meningitis is a reportable disease – all causes.

Fungal Menigitis Routine

Haemophilius influenzae type b Droplet


Lysteria monocytogenes Routine

Meningococcal (Neisseria meningitidis) Droplet


Streptococcus pneumoniae Routine

Other bacterial: Routine Practices

Tuberculosis: Airborne

If TB is causative organism the patient should be placed on airborne precautions until pulmonary TB is ruled out in patient and family




Precautions



Comments


members. If TB confirmed: See “Tuberculosis”

Viral: Adult - Routine Pediatric - Contact NICU – Droplet and Contact See specific organism for more details

Continue for 7 days after onset of illness unless a non-enteroviral diagnosis is established

Meningococcal Disease (Neisseria meningitidis)

Meningococcemia meningitis, pneumonia, sepsis

Droplet Until 24 hours of appropriate antimicrobial therapy

Close contacts may require chemoprophylaxis. Reportable disease

Methicillin-resistant Staphylococcus aureus (MRSA) See “ARO”

Contact


Refer to Section 6 for specific information on MRSA (ARO)




Precautions



Comments


Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Severe acute respiratory illness and fever

Airborne, Droplet and Contact

Until MERS-CoV is ruled out or until discontinued by IPACS


Molluscum Contagiosum

Infection of the skin with no systemic manifestations; characterized by umbilicated papules

Routine Requires intimate direct personal contact for transmission.

Mononucleosis, See “Epstein-barr virus” and “Cytomegalovirus”

Routine

Mucormycosis (Zygomycosis- Rhizopus, Mucor, Rhizomucor, Absidia species) Fungal Disease

Rhinocerebral, pulmonary, skin, or disseminated. Disease in Immunosuppression (e.g. malignancy, Diabetes, Renal Failure)

Routine

Multidrug-resistant organism (MDRO) See “ARO”

Contact





Precautions



Comments


Mumps Parotitis Mumps (cont) Parotitis

Swelling of one or more of the salivary glands (usually the parotid glands), orchitis, meningitis

Droplet

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 precautions Term Infant: -MI contact, BF, and RI permitted Infant 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 swelling Infant has mumps Mother immune: permitted to see infant Mother susceptible: Consult IPACS. BF as expressed breast milk Infant is mumps contact Droplet precautions from 10 days to 26 days from last exposure

Notify 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 visit Immunity 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 1970 Reference: BCCDC Immunization manual. Reportable disease




Precautions



Comments


Mycobacteria, other than tuberculosis See “Atypical mycobacteria”

Mycobacterium abscessus in CF patients

Routine Contact


No person-to-person transmission, except for Mycobacterium abscessus in CF patients. Please refer to CF standard in section 6.

Mycobacterium tuberculosis, See “Tuberculosis”

Airborne

Reportable disease

Mycoplasma pneumoniae

Upper respiratory tract infections, acute bronchitis, pneumonia Unusual manifestations: CNS disease, myocarditis, hemolytic anemia.

Droplet Until symptom free

Necrotizing Enterocolitis (NEC)

Routine Contact Precautions may be indicated for clusters/outbreaks-Consult IPACS Unknown if transmissible.

Neisseria Meningitidis See “Meningococcal Disease”

Droplet Until 24 hours of appropriate antimicrobial therapy

Reportable disease




Precautions



Comments


Nipah virus Encephalitis Droplet and Contact

Until symptoms resolve

Reportable disease

Nocardiosis Nocardia species

Fever, pulmonary or CNS infection

Routine No person-to-person transmission.

Norovirus

Droplet and Contact*

Until stool is formed or back to baseline for the patient for 48 hours If 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 positive

- If previous result was negative, repeat stool test in 1 week. Discontinue precautions if a second negative result is obtained








permitted


*Prolonged fecal shedding may occur in immunocompromised patients after recovery. Contact precautions for duration of hospitalization may be justified. If Mother must visit: o Place infant in private

room o Mother to limit visits and

go directly in and out of NICU

**Ensure immediate disposal of diapers into leak proof bag. Reportable Disease




Precautions



Comments


Ophthalmia Neonatorum See “Conjunctivitis”

Contact Until symptom free

Osteomyelitis Osteomyelitis (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 surgery

Routine

Parainfluenza Virus See “Respiratory Viral infections”

Droplet and Contact


Paratyphoid Fever Salmonella paratyphi See “Salmonellosis”

Contact Adults: Until stool is formed or back to baseline for the patient. Pediatrics: Continue precautions until culture results for 3 consecutive stool




Precautions



Comments


specimens obtained at least 48 hours after cessation of antimicrobial therapy are negative

Reportable disease

Parechovirus Acute febrile respiratory illness, e.g., cough, fever Acute febrile illness, meningitis, encephalitis Gastroenteritis may occur but is not common.

Droplet and Contact Contact

Until symptom free Until symptom free

Mother ill: -Additional precautions as indicated for mother -Routine practices for infant Healthy term infant: - MI contact, RI and BF permitted Infant in NICU: -MI contact NOT permitted in the NICU until mother asymptomatic* -BF as expressed milk Infant 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

Strict attention to hand hygiene Shedding of Parechovirus can occur in stool. *If Mother must visit infant in NICU, consult IPACS.




Precautions



Comments


NICU: Droplet and Contact


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.

Parvovirus B19 Fifth Disease, See “Erythema Infectiosum”

Routine Droplet for the following patients: -Aplastic crisis -Immuno-compromised -Papulopurpuric gloves-socks (PGS) syndrome Transient aplastic or erthyrocyte crisis

For duration of hospitalization (aplastic crisis, immuno-compromised, PGS) For 7 days for patients with transient aplastic crisis (TAC)

Pediculosis See “Lice”

Contact Until 24 hours after treatment is complete

Refer to Section 6 for specific information on Lice.

Pertussis (Whooping cough) Bordetella pertussis

Whooping cough, non specific respiratory tract infection

Droplet

Until 5 days of appropriate antimicrobial treatment has been completed.

Mother ill: Mother - droplet Healthy Term Infant: -MI contact not permitted until 5 days of effective

Notify IPACS of all confirmed or suspected cases of Pertussis. Reportable disease as prompt use of




Precautions



Comments


Pertussis (cont) (Whooping cough) Bordetella pertussis

If appropriate antimicrobial therapy is not given, until 3 weeks after the onset of cough

therapy or infant is on chemoprophylaxis -BF permitted if infant on chemoprophylaxis or as expressed breast milk if not on prophylaxis Infant in NICU: -MI contact not permitted in NICU until 5 days of appropriate antimicrobial treatment has been completed -BF permitted as expressed breast milk Infant ill: -MI contact permitted -BF permitted

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 Health Reportable disease

Pinworms Enterobius vermicularis

Perianal itching Routine Close household contacts may need treatment.

Plague (Yersinia pestis)

Bubonic Fever, chills, headache, lymphadenitis,

Routine Notify IPACS immediately. Notify Public Health immediately. Notify Microbiology laboratory before sending specimens If left untreated, plague

Pneumonic -cough, fever, dyspnea, hemoptysis

Droplet Until 48 hours after appropriate antimicrobial treatment




Precautions



Comments


Plague (cont)

often will progress to sepsis with renal failure, acute respiratory distress syndrome, and death. Reportable disease

Plesiomonas Secretory or dysenteric diarrhea, vomiting


Until stool is formed or back to baseline for the patient


Pneumococcal Disease See “Streptococcal Disease”

Droplet Until 24 hours after appropriate antimicrobial therapy

Reportable disease if invasive.

Pneumocystis jirovecii (carinii)

Pneumonia in immunocompromised host

Routine Ensure room mates not immunocompromised.

Pneumonia Etiology unknown See “Respiratory Viral Infections”“ or specific organism

Fever, cough Droplet and contact

Continue precautions until etiology established or infectious cause ruled out

May be reportable depending on the organism.

Poliomyelitis

Asymmetric acute flaccid paralysis

Contact For duration of hospitalization or in consultation with IPACS

Reportable disease

Pseudo-membranous Colitis See “Clostridium difficile”

Contact Plus Until diarrhea has subsided for 72 hours and stools are formed or back to baseline for

Mother ill and Healthy Term Infant: -MI contact, RI, and BF permitted -Mother: Contact

Strict attention to hand hygiene Bacterial spores may persist in the environment;




Precautions



Comments


Pseudo-membranous Colitis (cont)

patient. Contact IPACS prior to discontinuation of precautions.

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 infant

therefore, special attention must be paid to cleaning of the environment. Note: Asymptomatic colonization is common in newborns and infants.

Psittacosis See “Chlamydia”

Routine

Q fever Coxiella burnetii

Acute: fever, pneumonia, hepatitis Chronic: endocarditis

Routine No person to person transmission. Reportable disease

Rabies

Acute illness with rapidly progressive central nervous system manifestations

Routine Notify IPACS Reportable disease

Rat-bite fever Streptobacillus moniliformis disease, Spirillum minus disease

Fever, rash, arthralgia





Precautions



Comments


Resistant organism See “ARO”

Contact


Respiratory Viral Infections, Parainfluenza, RSV, Human Metapneumovirus, Rhinovirus, Coronavirus 229E/OC43/NL63/HKU1 See influenza and adenovirus for specific information

Acute cough, fever, pneumonia. Symptoms may vary in infants and small children, e.g., lethargy, change in respirations, etc.

Droplet and Contact


Mother ill: -Droplet and contact precautions for mother -Routine practices for infant Healthy 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 breast milk. Consult IPACS as required Infant ill: -Infant - droplet and contact -Routine practices for mother -MI contact, RI and BF permitted

Family members and visitors with an acute respiratory infection should not visit or enter the hospital. Strict attention to hand hygiene *If Mother must visit: o Place infant in private


and go directly in and out of NICU.


During outbreak situations, additional precautions may be required. Consult IPACS if you suspect an outbreak.




Precautions



Comments


Reye’s Syndrome

Not an infectious condition

Routine

May be associated with viral infection, (influenza, varicella) and aspirin. Reportable disease

Rheumatic Fever May include arthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules.

Routine

Rhinovirus See Respiratory Viral Infections

Droplet and Contact


Ringworm See tinea

Routine Rarely, have outbreaks occurred in healthcare settings. Use Contact Precautions for outbreak.

Roseola Infantum (Exanthem Subitum, Sixth disease, HHV-6)

Fever followed by rash

Routine

Rotavirus See “Diarrhea”

Acute diarrhea, sometimes accompanied by vomiting, abdominal cramps

Contact* Add Droplet if vomiting

Until stool is formed or back to baseline for the patient for 48 hours Consult IPACS if immune




*Prolonged fecal shedding may occur in immunocompromised patients after recovery.




Precautions



Comments


Rotavirus (cont)

compromised






permitted

Contact precautions for duration of hospitalization may be justified. If Mother must visit: o Place infant in private



**Ensure immediate disposal of diapers into leak proof bag. Reportable Disease

Rotavirus Vaccine e.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




Precautions



Comments


Rubella (German Measles) Rubella (cont)

Most cases are subclinical Clinical disease is usually mild, characterized by fever, rash, lymphadenopathy and polyarthralgia Congenital (baby born with rubella)**

Droplet Droplet and Contact for congenital rubella

Until 7 days after onset of rash Congenital - continue precautions for at least 1 year, unless 2 urine and nasopharyngeal culture results after 3 months of age are negative Susceptible 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 infant Healthy term infant:

-MI contact, RI and BF permitted

Infant in NICU: -Mother cannot go to NICU until 7 days after onset of rash -Expressed breast milk allowed

Infant has congenital rubella: -MI contact, BF permitted -Total rooming in preferred

HCW: - 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 visit Immunity is defined as:

- Being born before 1957

- Having 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 disease

Rubeola See “Measles”

Airborne Until 4 days after start of rash. For duration of illness in immune

Reportable disease




Precautions



Comments


compromised patients

Salmonellosis (Salmonella species)

Diarrhea, enteric fever, typhoid fever

Contact Non-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 negative

Notify IPACS Reportable disease

Scabies Sarcoptes scabiei

Limited or typical -papular rash, intense itching, Crusted (Norwegian) or Atypical -severe and highly infectious

Contact

Until 24 hours after the treatment is complete For crusted or atypical, please consult IPACS before

Mother symptomatic: -Contact precautions -Routine Practices for infant Healthy Term Infant: -MI contact permitted 24 hours after treatment is complete

*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.




Precautions



Comments


due to large number of mites

discontinuing precautions

-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 milk Infant 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

See Section 6 for further details on Scabies.

Severe Acute Respiratory Syndrome (SARS)

Fever, pneumonia, acute respiratory distress syndrome

Airborne and Contact + goggles


Notify Public Health immediately Notify IPACS Reportable disease

Scalded Skin Syndrome See “Abscess major” if drainage not contained by dressing

Contact Duration of drainage




Precautions



Comments


Scarlet Fever See Streptococcal Disease, Group A Streptococcus

Occurs in association with pharyngitis Characteristic confluent erythematous sandpaper like rash

Droplet Until 24 hours after appropriate antimicrobial therapy

Shigellosis Shigella species See “Diarrhea”

Contact


Reportable disease

Shingles Herpes zoster, Zoster, Varicella Zoster

Vesicular skin lesions in dermatomal distribution Immunocompetent patient: - Localized and

can be covered - Extensive or


Contact Airborne and Contact


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 breast Mother has extensive or localized lesions that cannot be covered -Mother on airborne and

Notify IPCAS of all cases of suspected or confirmed shingles. Visitors who have active chickenpox or shingles must not visit. Note: Non-immune individuals who are a shingles contact may develop chickenpox. Only chickenpox immune




Precautions



Comments


Shingles (cont) Herpes zoster, Zoster, Varicella Zoster

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 breast

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 delegate

HCW with suspected shingles should report to PHSA Workplace Health



Continue 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 VZIG

Mother 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 breast Infant in NICU: -Mother may not visit NICU until lesions are crusted Infant who is a contact in NICU: -Airborne precautions from day 8 from first exposure up




Precautions



Comments


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 over

before commencing work.

Smallpox “Variola” Declared eradicated world-wide by WHO in 1979

Severe prodromal illness (high fever, malaise, severe headache), mucous lesions of the moth or pharynx, rash




Staphylococcal Disease Staphylococcus aureus See ARO for more information on MRSA

Food poisoning See “Food poisoning” Skin, wound or burn infection, impetigo See “Abscess” or “Impetigo”

Contact Minor-routine Major: contact -drainage not contained by dressing

Until symptom free for 48 hours Duration of drainage

-MI contact, RI and BF allowed Mother 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 infant

Infant in NICU: -MI contact permitted as long as drainage is

*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.




Precautions



Comments


Staphylococcal Disease (cont) Staphylococcus aureus See ARO for more information on MRSA

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 precautions Mother- routine -MI contact, RI, and BF preferred Infant in NICU: - private room if drainage not contained

Pneumonia Droplet Until 24 hours after appropriate antimicrobial therapy

-MI contact, RI and BF allowed Infant in NICU has pneumonia: -Droplet precautions and private room -MI contact, BF permitted

Tracheitis with a tracheostomy tube in place

Droplet For the duration of illness

Toxic Shock Syndrome

Routine -MI contact, RI and BF allowed as tolerated by Mother




Precautions



Comments


Staphylococcus epidermidis and other coagulase negative staphylococcal infections

Health-care associated infections (related to catheters, shunts, grafts, prosthesis, etc.) Late-onset bacteremia among preterm infants

Routine -MI contact, RI and BF permitted

Streptococcal Disease Group A Streptococcus

Necrotizing fasciitis Droplet and Contact

Until 24 hours after appropriate antimicrobial therapy

Mother 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 invasive

Skin, wound or burn infection

Contact

Toxic shock like syndrome (TSLS)

Droplet and Contact

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

Pneumonia Droplet Mother ill: -Mother contact and droplet,




Precautions



Comments


Streptococcal Disease (cont) Group A Streptococcus

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)

Routine Mother ill: -Mother -contact until 24 hours after appropriate antimicrobial therapy -Infant-routine practices -MI contact, RI, and BF permitted 24 hours after appropriate antimicrobial therapy

Streptococcal disease Group B Streptococcus

Colonization in Mother or infection in Mother and/or infant

Routine -MI contact, RI and BF permitted

If mother has invasive disease, notify the infant’s physician. Notify IPACS




Precautions



Comments


Neonatal invasive GBS disease is reportable

Streptococcus pneumoniae See “Meningitis”

Routine Invasive Streptococcus pneumoniae infection is reportable.

Strongyloidiases Strongyloides stercoralis

Asymptomatic Eosinophilia Several manifestations due to larvae migration Dissemination (hyper infection) in immunocompromised patients

Routine Infective larvae in soil

Syphilis Treponema pallidum

Acquired : Genital, skin or mucous lesions, systemic symptoms, gummatous changes of the skin, bone, or viscera, CVS or CNS involvement

Mucocutaneous lesions: Contact


Mother has lesions: -Mother contact -Infant routine precautions -MI contact, RI and BF permitted after 24 hours of appropriate antimicrobial treatment

As 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,

Congenital : Range from stillbirth to being symptom free at birth.

Contact*


Infant has congenital: Mother: routine Infant :contact until 24 hours after appropriate




Precautions



Comments


antimicrobial therapy -MI contact, RI and BF permitted

notify the infant’s physician. Reportable disease

Tapeworm Disease Diphyllobothrium latum (fish) Hymenolepis nana, Taenia saginata (beef) Taenia solium (pork) See ”Echinococcosis”

Usually asymptomatic or mild GI symptoms CNS involvement in Taenia solium “neurocysticercosis”

Routine

Tetanus Clostridium tetani

Trismus and severe muscular spasms


Thrush See “Candidiasis”

Routine

Tinea “Ringworm” Dermatophytes: -Epidermophyton, -Trichophyton, and -Microsporum) or Malassezia furfur

Fungal infection of the skin or nails e.g. tinea capitis, athlete’s foot, pityriasis versicolor

Routine

Toxoplasmosis Toxoplasma gondii

Asymptomatic or fever, lymphadenopathy,

Routine Mother and/or Infant ill: -MI contact, BF and RI permitted

No person-to-person spread




Precautions



Comments


retinitis, encephalitis in immune compromised host. Congenital infection

Congenital toxoplasmosis is reportable

Trench mouth See ‘Vincent’s angina”

Routine

Trichinellosis Trichinella spiralis

Asymptomatic, GI upset, periorbital edema, rash, muscle calcification, myocarditis, neurologic involvement and pneumonitis

Routine No person-to-person spread

Trichomoniasis Trichomonas vaginalis

Asymptomatic, vaginal discharge, vulvovaginal pruritis and irritation Males: Urithritis, but most are asymptomatic

Routine Sexual transmission.

Trichuriasis “Whipworm” Trichuris trichiura

Asymptomatic, abdominal pain, diarrhea, rectal prolapse

Routine




Precautions



Comments


Tuberculosis “TB” Mycobacterium tuberculosis Tuberculosis (cont) “TB” Mycobacterium tuberculosis

Extrapulmonary, no draining lesions*

Routine MI contact, RI, and BF permitted

*Assess for concurrent pulmonary tuberculosis. Notify IPACS of all suspected or confirmed TB patients Tuberculosis 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 apart If multidrug-resistant TB, until culture negative Refer to Section 6 for specific information on Tuberculosis Reportable disease

Extrapulmonary, draining lesions*

Airborne Continue precautions until drainage ceased or three consecutive negative AFB smears.

Consult IPACS

Pulmonary-confirmed or suspected or laryngeal disease

Airborne Continue 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 milk Infant 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

Routine MI contact, RI and BF permitted

Tularemia Francisella tularensis

Fever, ulcerative lesion, lymphadenopathy,





Precautions



Comments


conjunctivitis, GI symptoms, pneumonia

Notify Microbiology laboratory before sending specimens Reportable disease

Typhoid Fever See “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 negative

Reportable disease

Vancomycin-Resistant Enterococci (VRE) See ARO

Contact


Vancomycin-Intermediate Staphlyococcus aureus (VISA) or Vancomycin-

Contact

For duration of hospital




Precautions



Comments


Resistant Staphylococcus aureus (VRSA) See ARO Varicella (Chickenpox) See “Chickenpox”

Airborne and contact

For a minimum of 5 days after onset of rash and until all lesions are crusted which can be a week or longer in immunocompromised patient

Notify IPACS of all confirmed or suspected cases of chickenpox

Varicella Zoster (Shingles, Herpes Zoster, Zoster) See “Shingles”

Immunocompetent patient: - Localized and

can be covered - Extensive or

localized that can not be covered

- - Immunocomprom

ised host or disseminated disease



Notify IPACS of all confirmed or suspected cases of Shingles and Herpes Zoster.




Precautions



Comments


Variola See “Smallpox”




Vibrio cholerae See “Cholera”

Contact Until discontinued by IPACS

Notify IPACS Reportable disease

Vibrio Non Cholera Vibrio parahaemolyticus, Vibrio vulnificus

Gastroenteritis, wound infections and bacteriemia

Contact


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 gingiva

Routine




Precautions



Comments


Viral Hemorrhagic Fevers See “Hemorrhagic Fevers” (Lassa, Ebola, Marburg, Crimean-Congo fever viruses)



Reportable disease

Viral warts See “Human papilloma virus”

Routine

Whooping Cough See “Pertussis” Whooping Cough (con’t)

Droplet and contact

Until 5 days of appropriate antimicrobial treatment has been completed. If appropriate antimicrobial therapy is not given, until 3 weeks after the onset of cough

Reportable disease

Wound infections See “Abscess”


Routine Contact





Precautions



Comments


Yellow fever See “Arthropod-borne viral fevers”


Yersinia enterocolitia See “Diarrhea”

Contact


Reportable disease

Yersinia pestis See “Plague”

Bubonic Fever, chills, headache, lymphadenitis,

Routine Practices Reportable disease

Pneumonic -cough, fever, dyspneia, hemoptysis

Droplet Until 48 hours after appropriate antimicrobial treatment

Zoster See “Herpes Zoster”

Immunocompetent patient:

- Localized and can be covered

- Extensive or





Refer to Section 6 for specific information on Shingles, Herpes Zoster.