Considerations for Reducing Monkeypox Transmission in Congregate Living Settings

Overview

Monkeypox is caused by infection with monkeypox virus, which is part of the same family as smallpox. People with monkeypox often get a rash along with other symptoms. In the United States, monkeypox can spread through:

• Close contact (including intimate contact) with a person with monkeypox
• Direct contact with contaminated materials

In general, infectious diseases involving person-to-person contact, like monkeypox, may spread more easily within congregate settings and among staff, volunteers, and residents. For the purposes of this document, congregate living settings are facilities or other housing where people who are not related reside in close proximity and share at least one common room, such as a sleeping room, kitchen, bathroom, or living room. Congregate living settings can include:

• Correctional and detention facilities
• Homeless, emergency, and domestic violence shelters and transitional housing
• Group homes
• Dormitories at institutions of higher education (IHE) such as colleges and universities
• Seasonal worker housing
• Residential substance use treatment facilities
• Assisted living communities
• Hotels, motels, and hostels

In this document, a "resident" refers to anyone living in a congregate setting, including students, guests, people who are incarcerated, and other types of residents.

Monkeypox in congregate living facilities

If a monkeypox case has been identified in a congregate living facility, consider the following actions.

Communicate with staff and residents

Provide clear information to staff and residents about how monkeypox is spread, including through close sexual or intimate contact, and how to help prevent the disease. Keep messages fact-based to avoid introducing stigma when communicating about monkeypox or people who may be at risk for the disease.

Respond to cases

The following actions can help prevent the spread of monkeypox in congregate settings.

• If staff or residents have signs and symptoms of monkeypox and potential risk factors, ensure they're medically evaluated, and if indicated, tested for monkeypox.
• Require staff and volunteers who have monkeypox to stay home until they are fully recovered. Flexible sick leave policies for paid staff members are critical to prevent spread of monkeypox.

Isolate residents for infection control

• Isolate residents with monkeypox away from others to the extent possible until the rash fully heals, which means scabs have fallen off and a fresh layer of skin has formed. This typically takes 2 to 4 weeks.
  • Isolation spaces should have a door that can be closed and a dedicated bathroom that other residents and staff do not use.
• Some congregate living facilities may be able to provide isolation onsite while others may need to move residents offsite to isolate.
• Multiple people who test positive for monkeypox can stay in the same room.
• Consult your state, tribal, local, or territorial health department before ending isolation.
• Reduce the number of staff who are entering the isolation areas to those who are essential to operations in those areas.
  • Ensure staff who operate in the area have access to and know how to properly use personal protective equipment (PPE). Employers are responsible for protecting workers from exposure to monkeypox virus and from harmful levels of chemicals used for cleaning and disinfection.
  • Employers must comply with OSHA's standards on Bloodborne Pathogens (29 CFR 1910.1030), PPE (29 CFR 1910.132), Respiratory Protection (29 CFR 1910.134), and other requirements, including those established by state plans, whenever such requirements apply.
  • Residents who are not under isolation for monkeypox should not enter the isolation area.

Clean and disinfect

• Residents with monkeypox should help clean and disinfect the isolation spaces they occupy regularly to limit contamination.
• Identify dedicated laundry space for residents in isolation if possible. If this isn't possible, consider additional laundering options to protect staff and residents.
• Anyone who touches the rash, or clothing, linens, or surfaces that may have had contact with the rash should wash their hands immediately.
• Ensure access to hand hygiene materials. Provide soap and water or hand sanitizer with at least 60% alcohol at no cost.

Dispose of waste safely

• Generally, waste management should continue as normal. Facilities should comply with state and local regulations for handling, storage, treatment, and disposal of waste. Healthcare facilities should follow guidance specifically for that setting.
• The person with monkeypox should use a dedicated, lined trash can in the room where they are isolating. Any gloves, bandages, or other waste and disposable items that have been in direct contact with skin should be placed in a sealed plastic bag, then thrown away in the dedicated trash can.
• The person with monkeypox and facility staff should use gloves when removing garbage bags and handling and disposing of trash.
• If professional cleaning services are used, treat and/or dispose of waste in accordance with applicable state, local, tribal, and territorial laws and regulations for waste management. For more information, the Department of Transportation has monkeypox-specific information in Appendix F-2 of this document.

If someone may have been exposed

Facilities should work with their health departments to identify and monitor the health of any staff or residents who may have had close contact with someone with suspected, probable, or confirmed monkeypox. When feasible, contact tracing can help identify people with exposure and prevent additional cases.

• Determine exposure risks and follow-up actions for staff, volunteers, and residents with potential monkeypox exposures.
• Your healthcare providers or jurisdictional health department can provide post-exposure vaccination for people who have been exposed to monkeypox.

Resources