Contact Precautions



Contact Precautions





Contact precautions are used to prevent the spread of microorganisms that are spread by direct or indirect contact with the patient or the patient’s environment. (See Conditions requiring contact precautions.) Effective contact precautions require a single room, if possible, and the use of gloves and gowns by anyone having contact with the patient, the patient’s support equipment, or items that have come in contact with the patient or the patient’s environment.1 Proper hand hygiene and handling and disposal of articles that have come in contact with the patient and his environment are essential.




Equipment

Gloves ▪ gowns ▪ isolation sign ▪ plastic bags ▪ any additional supplies needed for patient care, such as a thermometer, stethoscope, blood pressure cuff, and clean dressings.







Conditions Requiring Contact Precautions1

The Centers for Disease Control and Prevention recommends contact precautions for patients who are infected or colonized (positive for the microorganism without clinical signs or symptoms of infection) with epidemiologically important organisms that can be transmitted by direct or indirect contact.


























































































































































































Condition Precautionary Period Special Considerations (if Applicable)
Abscess, major draining

  • Duration of illness or until drainage stops or can be contained by a dressing

  • Droplet precautions should be added for the first 24 hours of appropriate antibiotic therapy if invasive group A streptococcal disease is suspected.
Acute viral (acute hemorrhagic) conjunctivitis

  • Duration of illness
  
Adenovirus gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Adenovirus pneumonia

  • Duration of illness

  • Droplet precautions should also be instituted.
  • Precautions should be extended in immunocompromised patients because viral shedding is prolonged.
Avian influenza

  • For 14 days after onset of signs and symptoms or until an alternate diagnosis is confirmed

  • Airborne precautions should also be implemented.
  • Eye protection should be worn by individuals within 3″ (1 m) of the patient.
Bronchiolitis

  • Duration of illness
  
Burkholderia cepacia pneumonia in a patient with cystic fibrosis

  • Unknown

  • Contact precautions should also be instituted for patients with cystic fibrosis whose respiratory tracts are colonized with bacteria.
  • Exposure to other patients with cystic fibrosis should be avoided.
Campylobacter species gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Cholera gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Clostridium difficile gastroenteritis

  • Duration of illness

  • Discontinue antibiotic use, if appropriate. Antibiotics change the normal intestinal flora, making it more susceptible to C. difficile.
  • Environmental cleaning and disinfection should be done consistently; a hypochlorite solution may be required if transmission continues.
  • Hand washing with soap and water is preferred because alcohol-based hand rubs aren’t effective against C. difficile spores.
Cryptosporidium species gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Diphtheria, cutaneous

  • Until two cultures (obtained 24 hours apart) are negative
  
Escherichia coli gastroenteritis (0157:H7 and other Shiga toxin–producing strains, other species) in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Enteroviral infection in a diapered or incontinent patient

  • Duration of illness
  
Giardia lamblia gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Hepatitis type A

  • Duration of hospitalization in infants and children younger than age 3 years
  • For 2 weeks after the onset of signs and symptoms in children ages 3 to 14 years
  • For 1 week after the onset of signs and symptoms in children older than age 14 years
  
Hepatitis type E in a diapered or incontinent patient

  • Duration of illness
  
Herpes simplex, neonatal

  • Until lesions are dry and crusted
  • For asymptomatic, exposed neonates, until cultures obtained at 24 and 36 hours of age are negative; incubation required for 48 hours
  
Herpes zoster, disseminated disease or localized disease in an immunocompromised patient

  • Duration of illness or until disseminated disease is ruled out in the immunocompromised patient

  • Airborne precautions should also be implemented.
  • Susceptible health care workers shouldn’t enter the room if immune staff members are available.
Human metapneumovirus

  • Duration of illness
  
Impetigo

  • For 24 hours after initiation of effective therapy
  
Monkeypox

  • Until lesions are crusted

  • Airborne precautions should also be implemented until monkeypox is confirmed and smallpox is ruled out.
Multidrug-resistant organism (MDRO) infection or colonization (such as with methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, vancomycin intermediate-resistant S. aureus, vancomycin-resistant S. aureus, extended beta-lactamase producers, and resistant Streptococcus pneumoniae)

  • Duration specified by your facility’s infection control program, which is based on local, state, regional, and national recommendations

  • Following standard precautions only may be permitted in some areas.
  • For guidance concerning new or emerging MDROs, consult your state or local health department.
Mycobacterium tuberculosis, draining extrapulmonary lesion

  • Until patient improves clinically and drainage has stopped or until three consecutive drainage cultures test negative

  • Airborne precautions should also be implemented.
  • Active pulmonary tuberculosis should be ruled out.
Norovirus gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak

  • Those who clean areas that are heavily contaminated with feces or vomitus should wear a mask.
  • Environmental cleaning and disinfection should be done consistently, with special attention given to restrooms; a hypochlorite solution may be required if transmission continues.
Parainfluenza virus infection in an infant or young child

  • Duration of illness

  • Viral shedding may be prolonged in immunocompromised patients.
  • Antigen testing to determine when contact precautions can be discontinued may be unreliable.
Pediculosis (head lice infestation)

  • For 4 hours after the initiation of effective therapy
  
Poliomyelitis

  • Duration of illness
  
Pressure ulcer; major, draining

  • Duration of illness
  • Until drainage stops or wound drainage can be contained
  
Respiratory syncytial virus infection in an infant, young child, or immunocompromised adult

  • Duration of illness

  • Viral shedding may be prolonged in immunocompromised patients.
  • Antigen testing to determine when contact precautions can be discontinued may be unreliable.
Ritter’s disease (staphylococcal scaled skin syndrome)

  • Duration of illness

  • Health care workers may be a source of nursery or neonatal intensive care unit outbreaks.
Rotavirus gastroenteritis

  • Duration of illness

  • Environmental cleaning and disinfection should be done consistently.
  • Soiled diapers should be changed and disposed of frequently.
  • Viral shedding may be prolonged in children and the elderly.
Rubella, congenital syndrome

  • Until the child is 1 year old or until nasopharyngeal and urine cultures are repeatedly negative after age 3 months
  
Salmonella species gastroenteritis, diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Scabies

  • For 24 hours following initiation of effective therapy
  
Severe acute respiratory syndrome

  • Duration of illness plus 10 days after fever resolves (provided respiratory signs and symptoms have improved or resolved)

  • Airborne precautions should also be implemented.
Shigella species gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Staphylococcus aureus enterocolitis in a diapered or incontinent child

  • Duration of illness
  
Staphylococcus aureus–infected draining major skin wound or burn

  • Duration of illness
  
Streptococcus group A–infected draining major skin wound or burn

  • For 24 hours following initiation of effective therapy

  • Droplet precautions should also be initiated.
Vaccinia, eczema; fetal, generalized, or progressive

  • Until lesions are dry and crusted and scabs are separated
  
Vaccinia blepharitis or conjunctivitis with copious drainage

  • Until drainage ceases
  
Vibrio parahaemolyticus gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Yersinia enterocolitica gastroenteritis in a diapered or incontinent patient

  • Duration of illness or a duration that’s appropriate to control a facility outbreak
  
Zoster (chickenpox, disseminated zoster, or localized zoster in an immunodeficient patient)

  • Until all lesions are crusted; requires airborne precautions
  

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Jul 21, 2016 | Posted by in NURSING | Comments Off on Contact Precautions

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