Considerations for Reducing Monkeypox Transmission in Congregate Living Settings
Summary of Recent Changes
- Streamlined content and added considerations for other congregate settings such as institutions of higher education (IHE)
Monkeypox is a disease that can cause flu-like symptoms and a rash. In general, infectious diseases involving person-to-person contact may spread more easily within congregate settings and may spread among staff (paid or unpaid) 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.
For guidance on healthcare settings please see CDC’s Infection Control: Healthcare Settings page. 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 monkeypox prevention, including the potential for spread through close, sustained physical contact, including sexual activity. Provide prevention guidance including considerations for safer sex. IHEs and shelters for youth can share additional information for young adults. Keep messages fact-based to avoid introducing stigma when communicating about monkeypox.
- Respond to cases—Consider the following actions to respond to cases in the facility:
- Test and medically evaluate staff and residents who are suspected to have monkeypox.
- Isolate staff who have monkeypox away from congregate settings until they are fully recovered. Flexible sick leave policies for paid staff members are critical to prevent spread of monkeypox.
- Isolate residents with monkeypox away from others, to the extent possible, until there is full healing of the rash with formation of a fresh layer of skin, which typically takes two to four weeks.
- Some congregate living facilities may be able to provide isolation on-site while others may need to move residents off-site to isolate. Isolation spaces should have a door that can be closed and a dedicated bathroom that other residents do not use.
- Multiple people who test positive for monkeypox can stay in the same room.
- If it is not possible to follow isolation recommendations fully, consult CDC’s webpage on Preventing Spread to Others.
- Consult your state, tribal, local, or territorial health department before ending isolation.
- Reduce the number of staff who are entering the isolation areas to staff who are essential to isolation area operations.
- Residents who are not under isolation for monkeypox should not enter the isolation area.
- Residents with monkeypox should help clean and disinfect the isolation spaces they occupy regularly to limit contamination.
- Dedicated laundry space should be identified for residents in isolation. If dedicated laundry space is not able to be identified, refer to Cleaning and Disinfecting Your Home, Workplace, and Other Community Settings for Monkeypox for additional laundering options.
- Manage waste appropriately.
- Generally, management of waste 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 or other 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 state, tribal, local, or territorial health department to identify and monitor the health of any staff or residents who might have had close contact with someone who has monkeypox. Contact tracing can help identify people with exposure and help prevent additional cases. However, this might not be feasible in all settings.
- Use exposure risk assessment recommendations to identify people who had high degree of exposure to someone with monkeypox, where possible. The state, tribal, local, or territorial health department can provide post-exposure vaccination for people with high degree exposures.
- In facilities where contact tracing is not feasible, staff and residents who spent time in the same area as someone with monkeypox should be considered to have intermediate or low degree of exposure, depending on the characteristics of the setting and exposure (e.g., level of crowding). Post-exposure vaccination is not necessary for low or intermediate degree exposures unless deemed appropriate by the state or local health department.
- Ensure access to handwashing. Soap and water or hand sanitizer with at least 60% alcohol should be available at all times and at no cost to all 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.
- Provide appropriate personal protective equipment (PPE) for staff entering isolation areas—Employers are responsible for ensuring that workers are protected from exposure to Monkeypox virus and that workers are not exposed to harmful levels of chemicals used for cleaning and disinfection. Staff who enter isolation areas should wear a gown, gloves, eye protection, and a NIOSH-approved particulate respirator equipped with N95 filters or higher. Staff should consult CDC guidance for Cleaning and Disinfecting Your Home, Workplace, and Other Community Settings for Monkeypox for further details on how to clean and disinfect isolation areas.
- 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.