Infection Prevention and Control of Monkeypox in Healthcare Settings

Human-to-human transmission of monkeypox virus occurs by direct contact with lesion material or from exposure to respiratory secretions. Reports of human-to-human transmission describe close contact with an infectious person. Transmission in healthcare settings has been rarely described.

Infection prevention and control recommendations for healthcare settings are provided in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007). Recommendations and practices described in this 2007 guideline are intended to be used when providing care for any patient in a healthcare setting, including those with monkeypox infection.  Additional supporting infection prevention and control information is provided below.

Precautions for Preventing Monkeypox Transmission

Standard Precautions should be applied for all patient care, including for patients with suspected monkeypox.  If a patient seeking care is suspected to have monkeypox, infection prevention and control personnel should be notified immediately.

Activities that could resuspend dried material from lesions, e.g., use of portable fans, dry dusting, sweeping, or vacuuming should be avoided.

Patient Placement

A patient with suspected or confirmed monkeypox infection should be placed in a single-person room; special air handling is not required. The door should be kept closed (if safe to do so). The patient should have a dedicated bathroom. Transport and movement of the patient outside of the room should be limited to medically essential purposes.  If the patient is transported outside of their room, they should use well-fitting source control  (e.g., medical mask) and have any exposed skin lesions covered with a sheet or gown.

Intubation and extubation, and any procedures likely to spread oral secretions should be performed in an airborne infection isolation room.

Personal Protective Equipment (PPE)

PPE used by healthcare personnel who enter the patient’s room should include:

  • Gown
  • Gloves
  • Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
  • NIOSH-approved particulate respirator equipped with N95 filters or higher

Waste Management

Waste management (i.e., handling, storage, treatment, and disposal of soiled PPE, patient dressings, etc.) should be performed in accordance with U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR; 49 CFR, Parts 171-180.)

Required waste management practices and category designation can differ depending on the monkeypox virus clade (strain).  See the DOT website for more information. Facilities should also comply with state and local regulations for handling, storage, treatment, and disposal of waste.

Environmental Infection Control

Standard cleaning and disinfection procedures should be performed using an EPA-registered hospital-grade disinfectant with an emerging viral pathogen claim. Products with Emerging Viral Pathogens claims may be found on EPA’s List Q. Follow the manufacturer’s directions for concentration, contact time, and care and handling.

Soiled laundry (e.g., bedding, towels, personal clothing) should be handled in accordance with recommended [PDF – 241 pages] standard practices, avoiding contact with lesion material that may be present on the laundry.  Soiled laundry should be gently and promptly contained in an appropriate laundry bag and never be shaken or handled in manner that may disperse infectious material.

Activities such as dry dusting, sweeping, or vacuuming should be avoided. Wet cleaning methods are preferred.

Management of food service items should also be performed in accordance with routine procedures.

Detailed information on environmental infection control in healthcare settings can be found in CDC’s Guidelines for Environmental Infection Control in Health-Care Facilities and Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings [section IV.F. Care of the environment].

Duration of Precautions

Decisions regarding discontinuation of isolation precautions in a healthcare facility should be made in consultation with the local or state health department. Isolation Precautions should be maintained until all lesions have crusted, those crusts have separated, and a fresh layer of healthy skin has formed underneath.