Table 2.
Clinical syndromes or conditions warranting empiric transmission-based precautions in addition to Standard Precautions pending confirmation of diagnosis∗
| Clinical syndrome or condition† | Potential pathogens‡ | Empiric precautions (always includes Standard Precautions) |
|---|---|---|
| Diarrhea | ||
| Acute diarrhea with a likely infectious cause in an incontinent or diapered patient | Enteric pathogens§ | Contact Precautions (pediatrics and adult) |
| Meningitis | Neisseria meningitidis | Droplet Precautions for first 24 hours of antimicrobial therapy; mask and face protection for intubation |
| Enteroviruses | Contact Precautions for infants and children | |
| Mycobacterium tuberculosis | Airborne Precautions if pulmonary infiltrate present | |
| Airborne Precautions plus Contact Precautions if potentially infectious draining body fluid present | ||
| Rash or exanthems, generalized, etiology unknown | ||
| Petechial/ecchymotic with fever (general) | Neisseria meningitides | Droplet Precautions for the first 24 hours of antimicrobial therapy |
| Positive history of travel to an area with an ongoing outbreak of VHF in the 10 days before onset of fever | Ebola, Lassa, Marburg viruses | Droplet Precautions plus Contact Precautions, with face/eye protection, emphasizing safety sharps and Barrier Precautions when blood exposure likely. N95 or higher-level respiratory protection when aerosol-generating procedure performed |
| Vesicular | Varicella-zoster, herpes simplex, variola (smallpox), vaccinia viruses | Airborne plus Contact Precautions |
| Vaccinia virus | Contact Precautions only if herpes simplex, localized zoster in an immunocompetent host, or vaccinia virus likely | |
| Maculopapular with cough, coryza, and fever | Rubeola (measles) virus | Airborne Precautions |
| Respiratory infections | ||
| Cough/fever/upper lobe pulmonary infiltrate in an HIV-negative patient or a patient at low risk for HIV infection | M. tuberculosis, respiratory viruses, Streptococcus pneumoniae, Staphylococcus aureus (MSSA or MRSA) | Airborne Precautions plus Contact Precautions |
| Cough/fever/pulmonary infiltrate in any lung location in an HIV-infected patient or a patient at high risk for HIV infection | M tuberculosis, respiratory viruses, S pneumoniae, S aureus (MSSA or MRSA) | Airborne Precautions plus Contact Precautions; eye/face protection if aerosol-generating procedure performed or contact with respiratory secretions anticipated; Droplet Precautions instead of Airborne Precautions if tuberculosis unlikely and airborne infection isolation room and/or respirator unavailable (tuberculosis more likely in HIV-infected than in HIV-negative individuals) |
| Cough/fever/pulmonary infiltrate in any lung location in a patient with a history of recent travel (10 to 21 days) to countries with active outbreaks of SARS, avian influenza | M tuberculosis, severe acute respiratory syndrome virus (SARS-CoV), avian influenza | Airborne plus Contact Precautions plus eye protection; Droplet Precautions instead of Airborne Precautions if SARS and tuberculosis unlikely |
| Respiratory infections, particularly bronchiolitis and pneumonia, in infants and young children | Respiratory syncytial virus, parainfluenza virus, adenovirus, influenza virus, human metapneumovirus | Contact plus Droplet Precautions; discontinue Droplet Precautions if adenovirus and influenza ruled out |
| Skin or wound infection | ||
| Abscess or draining wound that cannot be covered | S aureus (MSSA or MRSA), group A streptococcus | Contact Precautions, plus Droplet Precautions for the first 24 hours of appropriate antimicrobial therapy if invasive group A streptococcal disease suspected |
Infection control professionals should modify or adapt this table according to local conditions. To ensure that appropriate empiric precautions are implemented always, hospitals must have systems in place to evaluate patients routinely according to these criteria as part of their preadmission and admission care.
Patients with the syndromes or conditions listed below may present with atypical signs or symptoms (eg, neonates and adults with pertussis may not have paroxysmal or severe cough). The clinician's index of suspicion should be guided by the prevalence of specific conditions in the community, as well as clinical judgment.
The organisms listed under the column “Potential Pathogens” are not intended to represent the complete, or even most likely, diagnoses, but rather possible etiologic agents that require additional precautions beyond Standard Precautions until they can be ruled out.
These pathogens include enterohemorrhagic Escherichia coli O157:H7, Shigella spp, hepatitis A virus, noroviruses, rotavirus, and Clostridium difficile.