Healthcare-Associated Infections _ ______________________________________________________________
TYPE AND DURATION OF PRECAUTIONS REQUIRED FOR INFECTIONS WITH POTENTIAL FOR OUTBREAKS (Continued)
Infection/Condition Precaution Type Precaution Duration Notes Tuberculosis, pulmonary or laryngeal disease (confirmed) Airborne —
Only when therapy is effective, patient is clinically improving, and the cultures of 3 consecutive sputum smears, collected on different days, are negative
Tuberculosis, pulmonary or laryngeal disease (suspected)
Airborne
Only when the likelihood of infectious disease is negligible and the cultures of 3 consecutive sputum smears, collected on different days, are negative
—
Tuberculosis, latent (skin-test positive with no evidence of current pulmonary disease)
Standard
Ongoing
—
Varicella zoster (chickenpox)
Airborne, Contact
Until all lesions are crusted (10 to 21 days) Susceptible healthcare staff should not enter the room if immune caregivers are available.
Whooping cough (pertussis)
Droplet, Standard
Until 5 days after initiation of effective therapy
—
Source: [25; 339]
Table 21
Legionella The source of HAI with Legionella pneumonia is usually con- taminated water [89]. Implementation of Standard Precautions for the patient is sufficient [25]. Laboratory-based surveillance for nosocomial Legionella should be performed, and samples of tap water should be obtained for culture. If the culture is positive, it is best to obtain cultures from patients who have healthcare-associated pneumonia. There are more than 40 known types of Legionella species, but most outbreaks are caused by Legionella pneumophila serotypes 1 and 6. Antibiotic-Resistant Micro-Organisms Outbreaks of antibiotic resistance have involved MRSA, VRE, and, most recently, vancomycin-resistant S. aureus [344]. In such outbreaks, it is important to identify patients with colo- nization or infection early and isolate them or cohort them. Contact Precautions should be implemented and carried out until antibiotic therapy has been completed and cultures are negative [25]. The importance of adhering to proper hand hygiene and other elements of Contact Precautions should be emphasized. Healthcare workers who were involved with patients before isolation should be evaluated for colonization and infection and treated appropriately.
Other Outbreaks The potential for other outbreaks or epidemics vary, and the CDC website, http://www.bt.cdc.gov, offers resources on emergency preparedness for outbreaks or epidemics caused by potential agents of bioterrorism, including anthrax and viral hemorrhagic fever. A Bioterrorism Readiness Plan template is also available (https://stacks.cdc.gov/view/cdc/11287). Many aspects should be considered when planning for bioterrorism preparedness, and each department of a healthcare facility can play an important role.
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