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2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

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Table 2. Clinical Syndromes Or Conditions Warranting Empiric Transmission-Based Precautions In Addition To Standard Precautions Pending Confirmation Of Diagnosis*

Clinical Syndrome or Condition† Potential Pathogens‡ Empiric Precautions (Always includes Standard Precautions)
Diarrhea
Acute diarrhea with a likely infectious cause in an incontinent or diapered patient Enteric pathogens§ Contact Precautions (pediatrics and adult)
Meningitis Neisseria meningitidis Droplet Precautions for first 24 hrs of antimicrobial therapy; mask and face protection for intubation
Enteroviruses Contact Precautions for infants and children
M. tuberculosis Airborne Precautions if pulmonary infiltrate
Airborne Precautions plus Contact Precautions if potentially infectious draining body fluid present

Rash Or Exanthems, Generalized, Etiology Unknown

Petechial/ecchymotic with fever (general) Neisseria meningitides Droplet Precautions for first 24 hrs of antimicrobial therapy
- If positive history of travel to an area with an ongoing outbreak of VHF in the 10 days before onset of fever Ebola, Lassa, Marburg viruses Droplet Precautions plus Contact Precautions, with face/eye protection, emphasizing safety sharps and barrier precautions when blood exposure likely. Use N95 or higher respiratory protection when aerosol-generating procedure performed
Vesicular Varicella-zoster, herpes simplex, variola (smallpox), vaccinia viruses Airborne plus Contact Precautions;
Vaccinia virus Contact Precautions only if herpes simplex, localized zoster in an immunocompetent host or vaccinia viruses most likely
Maculopapular with cough, coryza and fever Rubeola (measles) virus Airborne Precautions

Respiratory Infections

Cough/fever/upper lobe pulmonary infiltrate in an HIV-negative patient or a patient at low risk for human immunodeficiency virus (HIV) infection M. tuberculosis,
Respiratory viruses, S. pneumoniae, S. aureus (MSSA or MRSA)
Airborne Precautions plus Contact precautions
Cough/fever/pulmonary infiltrate in any lung location in an HIV-infected patient or a patient at high risk for HIV infection M. tuberculosis,
Respiratory viruses, S. pneumoniae, S. aureus (MSSA or MRSA)
Airborne Precautions plus Contact Precautions
Use eye/face protection if aerosol-generating procedure performed or contact with respiratory secretions anticipated.
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
Cough/fever/pulmonary infiltrate in any lung location in a patient with a history of recent travel (10-21 days) to countries with active outbreaks of SARS, avian influenza M. tuberculosis, severe acute respiratory syndrome virus (SARS-CoV), avian influenza Airborne plus Contact Precautions plus eye protection.
If SARS and tuberculosis unlikely, use Droplet Precautions instead of Airborne Precautions.
Respiratory infections, particularly bronchiolitis and pneumonia, in infants and young children Respiratory syncytial virus, parainfluenza virus, adenovirus, influenza virus,
Human metapneumovirus
Contact plus Droplet Precautions; Droplet Precautions may be discontinued when adenovirus and influenza have been ruled out
Skin or Wound Infection
Abscess or draining wound that cannot be covered Staphylococcus aureus (MSSA or MRSA), group A streptococcus Contact Precautions
Add Droplet Precautions for the first 24 hours of appropriate antimicrobial therapy if invasive 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.

‡ 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.

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