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IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Infection Prevention and Control (IPC) Resource Manual for Continuing Care February 2014 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Acknowledgements The Infection Prevention and Control Resource Manual was developed by a committee of Alberta Health Services Infection Prevention and Control Professionals. Co-Chairs Pamela Armstrong Christine Knaus Core Committee Members Karen Cargill Yvette Gable Nicole Henderson Karen Hope Brenda Jenkins Maureen Kano Heather MacLaurin Lori Pohl Linda Siminoski Betty Soanes Joy Scott Jan Stoesz Ad Hoc Members Karen Hope, IPC Director Sue Lafferty, IPC Director Standards and Projects Sara Gallinger Isabelle Ho 1 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Introduction Quick Links Glossary RPAP Additional Precautions for ARO Positive Residents in Continuing Care Airborne and Contact Precautions Airborne Precautions Contact Precautions Droplet and Contact Precautions Droplet Precautions Routine Practices Additional Precaution Signs Airborne Airborne and Contact Droplet Droplet and Contact Contact Fact Sheets Choosing Personal Protective Equipment for Resident Interactions in Continuing Care (RP) General Instructions for Putting on an N95 Respirator (Mask) Proper Glove Use as part of Personal Protective Equipment Additional Resources AHS Donning and Doffing PPE posters AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites. Alberta Health Notifiable Disease List Alberta Health, Public Health Act – Bodies of Deceased Persons Regulation Bedbug Management Protocols for Health Care Workers Dermatome Chart This manual is intended to support staff in caring for residents living in Alberta Health Services (AHS) owned and contracted Continuing Care settings who have a known or suspected infectious disease or condition. It is organized in alphabetical order based on either the common or scientific spelling of the disease, condition or microorganism. The most up-to-date version of the Manual is the electronic version on the website. Printed copies of the document should be considered current only on the date printed. Instructions 1. To view a disease, condition or microorganism: • If you know what you are looking for; click on its first letter in the list below to move to an alphabetical index of diseases and conditions for that letter. Click on the organism or disease you are looking for to view its table. ABCDEFGHIJKLMNOPQRSTUVWXYZ • If you are unsure what you are looking for; review the Index of Diseases and Conditions on the next pages. Click the disease or condition you would like to see. You will be brought directly to its table. 2. If a disease, condition or microorganism you are looking for is not listed; follow Routine Practices and contact Infection Control or your Zone Medical Officer of Health or designate as needed for additional information. 3. To access interactive features: • In the specific disease or condition, click the hyperlink that you would like to view. This will open the linked document. • Routine Practices and Additional Precautions (RPAP) information sheets are linked to this document and appear in the tables as follows: Routine Practices; Airborne Precautions; Airborne and Contact Precautions; Droplet and Contact Precautions; Droplet Precautions; Contact Precautions • Other links in this document are underlined • Additional Precautions (AP) information sheets are linked to their Precautions sign, Routine Practices (RP) information sheet and other information. Links in the RPAP information sheets are underlined. Click on the underlined words to access the link. • RPAP information sheets, signs and additional resources may also be accessed by the links in the left hand column. Please contact Infection Prevention and Control (IPC) or your Zone Medical Officer of Health (MOH) or designate with any questions. 2 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Index of Diseases and Conditions A Abscess – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Acinetobacter – (Multi-drug Resistant) (MDRA) Acquired Immunodeficiency Syndrome (AIDS) Actinomycosis (Actinomyces sp.) Adenovirus – Conjunctivitis C Calicivirus (Norwalk-like, Norovirus) See Norovirus Campylobacter jejuni Candidiasis (Candida sp.) Carbapenem-Resistant Enterobacteriaceae (CRE) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Cat-scratch Fever (Bartonella henselae) Adenovirus – Gastroenteritis Cellulitis – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) Adenovirus – Respiratory tract infection Chancroid (Hemophilus ducreyi) Aeromonas spp. Amebiasis – diarrhea (Entamoeba histolytica) Chickenpox – Exposed Susceptible Contact (Varicella zoster virus) Anthrax – confirmed, probable or suspect case Chickenpox – Known Case (Varicella zoster virus) Antibiotic Resistant Organisms (ARO) Chikungunya virus (alphavirus CHIKV) Arthropod borne virus (Arboviruses) Chlamydia (Chlamydia trachomatis) Ascariasis – Roundworm (Ascaris lumbricoides) Cholera (Vibrio cholerae) Aspergillosis (Aspergillus spp.) Citrobacter spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Astrovirus – diarrhea Avian Influenza See Influenza -Avian B Bedbugs (Cimex lectularius) Blastomycosis – Pneumonia (Blastomyces dermatitidis) Clostridium difficile Infection (CDI) Clostridium perfringens – Food poisoning Clostridium perfringens – Gas gangrene Coccidioidomycosis (Coccidioides immitis) Blastomycosis – Skin lesions (Blastomyces dermatitidis) Colorado tick fever (Arbovirus) Botulism (Clostridium botulinum) Conjunctivitis – Pink Eye; Viral Bronchiolitis Coronavirus – (Severe Acute Respiratory Syndrome, SARS CoV) Brucellosis – Skin lesions (Brucella sp.) Brucellosis – Undulant fever, Malta fever, Mediterranean fever (Brucella sp.) Burkholderia cepacia – Non-respiratory infections Burkholderia cepacia – Respiratory infection Burns (infected) – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds 3 Conjunctivitis – Pink Eye; Bacterial Coronavirus – not SARS Cough, fever, acute upper respiratory tract infection (Rhinovirus, Respiratory syncytial virus [RSV], Parainfluenza virus, Influenza, Adenovirus, Coronavirus, Bordetella pertussis, Mycoplasma pneumoniae) Cough, fever, pulmonary infiltrates in person at risk for tuberculosis (Mycobacterium tuberculosis) IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Coxsackievirus Disease (Enterovirus and Picornavirdae) Creutzfeldt-Jakob Disease – classic (CJD) and variant (vCJD) Crimean-Congo Hemorrhagic Fever (Arbovirus) See Hemorrhagic Viral Fevers Croup (Hemophilus influenzae, Mycoplasma pneumoniae, adenoviruses, RSV, influenza virus, parafluenza virus, measles virus , human metapneumovirus) Cryptococcosis (Cryptococcus neoformans) Cryptosporidiosis (Cryptosporidium parvum) Cyclosporiasis (Cyclospora cayetanensis) Cytomegalovirus D Decubitus ulcer, infected – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Dengue Fever (Arbovirus) Dermatitis – (Many bacteria, viruses, fungi) See Draining Wounds Diarrhea – (Many bacteria, viruses, parasites) Diphtheria: skin or pharyngeal (Corynebacterium diphtheriae) Draining Wounds E Eastern Equine Encephalitis (alpha virus) Ebola See Hemorrhagic Viral Fevers Echinococcosis/Hydatidosis (Echinococcus granulosis, Echinococcus multilocularis) Encephalitis – (Herpes Simplex Virus [HSV types 1 and 2], Enterovirus, Arbovirus) Endometritis – (Streptococcus [Group A]) Enterobacter spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) 4 Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Enterobiasis (pinworm) (Oxyuriasis, Enterobius vermicularis) Enteroviral Infections Epiglottitis – (Haemophilus influenza type B [HIB], Streptococcus [Group A], Staphylococcus aureus) Epstein-Barr virus (Human Herpes Virus 4) Erysipelas – (Streptococcus [Group A]) See Streptococcus [Group A] – Skin Infection ESBL (Extended Spectrum Beta Lactamase producers) Escheria coli (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Escherichia coli 0157: H7 F Febrile respiratory illness, acute respiratory tract infection – (Rhinovirus, Respiratory syncytial virus, [RSV], Parainfluenza virus, Influenza, Adenovirus, Coronavirus, Bordetella pertussis, Mycoplasma pneumoniae) Fever unknown origin, fever without focus (acute) – (Many bacteria, viruses, fungi) Fifth Disease – Parvovirus B-19 See Parvovirus B-19 Food poisoning – (Bacillus cereus, Clostridium perfringens, Staphylococcus aureus, Salmonella sp., Vibro paraheaemolyticus, Escherichia coli 0157: H7) G Gas Gangrene (Clostridium sp.) See Clostridium perfringens – Gas gangrene GAS – Group A Streptococcus (Streptococcus pyogenes) Scarlet fever, pharyngitis See Streptococcus [Group A] (Streptococcus pyogenes) – Scarlet Fever, Pharyngitis IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents GAS – Group A Streptococcus (Streptococcus pyogenes)-skin infections See Streptococcus [Group A] – Skin Infection GAS – Group A Streptococcus (Streptococcus pyogenes) invasive disease, toxic shock See Streptococcus [Group A] (Streptococcus pyogenes) – Invasive Gastroenteritis – (Several bacteria, viruses, parasites) German measles (Rubella virus) – Acquired See Rubella: German measles – Acquired German measles (Rubella virus) – Exposed Susceptible Contact See Rubella virus (German measles) - Exposed Susceptible Contact Giardiais (Giardia lamblia) Gingivostomatitis – (Herpes simplex virus) Gonococcus (Neisseria gonorrhoeae) See Neisseria gonorrhoeae Guillain-Barre Syndrome H Haemophilus influenzae type b (HIB) – invasive disease Hafnia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Herpes simplex – Recurrent Herpes zoster: Shingles (Varicella zoster virus) – Disseminated See Shingles: (Herpes zoster) Varicella zoster virus – Disseminated Herpes zoster: Shingles (Varicella zoster virus) – Exposed Susceptible Contact See Shingles: (Herpes zoster) Varicella zoster virus – Exposed Susceptible Contact Herpes zoster: Shingles (Varicella zoster virus) – Immunocompromised Host WITH Localized Lesions (1 or 2 dermatomes) See Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host WITH Localized lesions (1 or 2 dermatomes) Herpes zoster: Shingles (Varicella zoster virus) – Normal Host With Localized Lesions(1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host, Localized (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Herpes zoster: Shingles (Varicella zoster virus) – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host, Localized (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Histoplasmosis (Histoplasma capsulatum) Hook worm (Necator americanus, Ancyclostoma duodenale) Hand, foot and mouth disease – (Enterovirus) Human Immunodeficiency Virus (HIV) Hantavirus Human Metapneumovirus Helicobacter pylori Hemolytic uremic syndrome (HUS) – May be associated with Escherichia coli 0157: H7 Hemorrhagic viral fever acquired in identified endemic geographic location – (Ebola virus, Lassa virus, Marburg virus, Crimean-congo and others) Hepatitis – A, E Hepatitis – B, C, D, and other unspecified non-A, nonB I Impetigo – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Influenza – New Pandemic Strain, Novel Influenza Viruses Influenza – Seasonal Herpangina (vesicular pharyngitis) – (Enterovirus) J Herpes simplex – Mucocutaneous Disseminated or primary and extensive No organisms at this time 5 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents K Klebsiella spp. (Multi-Drug Resistant; Carbapenem resistant {CRE}; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Mononucleosis (Epstein-Barr virus) See Epstein – Barr virus (Human Herpes Virus 4) Morganella spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) L Mucormycosis (phycomycosis, zygomycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) Lassa fever (Lassa Virus) See Hemorrhagic Viral Fevers Multi-Drug Resistant (MDR) Gram Negative Bacilli Legionella (Legionella spp.) Leprosy (Hansen’s disease) (Mycobacterium leprae) Leptospirosis (Leptospira sp.) Lice (Pediculosis) – (Pediculus humanus, Phthirus pubis) Listeriosis (Listeria monocytogenes) Mumps (Mumps virus) – Known Case Mumps – (Mumps virus) Exposed Susceptible Contact Mycobacterium – Non-tuberculosis (atypical) (e.g., Mycobacterium avium complex) Mycobacterium tuberculosis (TB) –extrapulmonary disease or not respiratory; (also M. africanum, M.bovis, M. caprae, M. microti, M. pinnipedii) Lymphocytic choriomeningitis virus Mycobacterium tuberculosis (TB) –respiratory or pulmonary disease; (also M. africanum, M.bovis, M. caprae, M. microti, M. pinnipedii) Lymphogranuloma venereum (Chlamydia trachomatis) Mycoplasma pneumoniae M N Malaria (Plasmodium spp.) Neisseria gonorrhoeae Marburg virus See Hemorrhagic Viral Fevers Neisseria meningitidis Measles – (Rubeola) – Exposed Susceptible Contact Nocardiosis (Nocardia sp.) Measles – (Rubeola) – Known Case Norovirus Lyme disease (Borrelia burgdorferi) Melioidosis (Burkholderia pseudomallei) Meningitis O Meningococcus (Neisseria meningitidis) See Neisseria meningitidis Orf – parapoxvirus MERS - Middle Eastern Respiratory Syndrome; Coronavirus) See Coronavirus – Severe Acute Respiratory Syndrome (SARS-CoV), Middle Eastern Respiratory Syndrome (MERS-CoV) Methicillin Resistant Staphylococcus aureus (MRSA) Osteomyelitis (Haemophilus influenzae type B (HIB) [possible in non-immune infant <2 yrs of age], Staphylococcus aureus, other bacteria) Otitis, draining (Streptococcus [Group A], Staphylococcus aureus, Many other bacteria) See Draining Wounds Molluscum contagiosum (Molluscum contagiosum virus) Monkey Pox P Parainfluenza virus 6 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Parvovirus B19 – Fifth’s Disease, Erythema infectiosum (rash), Aplastic crisis Rash, petechial or purpuric – (Suspected Neisseria meningitidis) Pediculosis (Lice) – (Pediculus humanus, Phthirus pubis) See Lice (Pediculosis) – (Pediculus humanus, Phthirus pubis) Rash, vesicular – (Suspected Varicella virusChickenpox) Pertussis – Whooping Cough (Bordetella pertussis) Pharyngitis – (Streptococcus [Group A], Corynebacterium diphtheriae, many viruses) Pinworm (Oxyuriasis) – (Enterobius vermicularis) See Enterobiasis (pinworm) (Oxyuriasis, Enterobius vermicularis) Plague – Bubonic (Yersinia pestis) Plague – Pneumonic (Yersinia pestis) Pleurodynia (Enterovirus, Coxsackievirus) Pneumocystis jiroveci Pneumonia (PJP) – formerly known as P. carinii (PCP) Pneumonia Poliomyelitis Prion Disease – Creutzfeldt-Jakob Disease (CJD); classic and variant (vCJD) See Creutzfeldt-Jakob Disease – classic (CJD) and variant (vCJD) Providencia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Pseudomembraneous colitis – (Clostridium difficile) See Clostridium difficile Infection (CDI) Rat-bite fever – (Streptobacillus moniliformis; Spirillum minus) Relapsing fever (Borrelia sp.) Rhinovirus Rickettsialpox (Rickettsia akari) Ringworm (Tinea) – (Trichophyton sp., Microsporum sp., Epidermophyton sp.) Ritters Disease – Staphylococcal scalded skin syndrome (SSSS) See Scalded skin syndrome – Ritter’s Disease (Staphylococcus aureus) Rocky Mountain Spotted Fever (Rickettsia rickettsii) Roseola infantum – Human herpes virus 6 Rotavirus Roundworm – Ascariasis (Ascaris spp.) See Ascariasis – Round worm (Ascaris lumbricoides) RSV – Respiratory syncytial virus Rubella – Acquired Rubella – Exposed Susceptible Contact Rubeola – (Measles) – Known Case See Measles – (Rubeola) – Known Case Rubeola – (Measles) Exposed Susceptible Contact See Measles – (Rubeola) – Exposed Susceptible Contact Pseudomonas aeruginosa (Multi-Drug Resistant or Metallo-Carbapenamase producing**) Psittacosis (Ornithosis) – (Chlamydia psittaci) S Salmonella (Salmonella sp.) Q Q Fever (Coxiella burnetii) R Rabies Rash, compatible with scabies – (Ectoparasite) Rash, maculopapular – (Suspected Rubeola virus [Measles]) 7 Salmonella spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) SARS – (Severe Acute Respiratory Syndrome; Coronavirus) See Coronavirus – Severe Acute Respiratory Syndrome (SARS-CoV), Middle Eastern Respiratory Syndrome (MERS-CoV) Scabies (Sarcoptes scabiei) Scalded skin syndrome – (Staphylococcus aureus) IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Scarlet Fever –Streptococcus pyogenes [Group A] See Streptococcus, [Group A] (Streptococcus pyogenes) – Scarlet Fever, Pharyngitis Schistosomiasis (Schistosoma sp.) Septic arthritis – (Haemophilus influenza type B [HIB] [possible in non-immune child <5 years of age], Streptococcus [Group A], Staphylococcus aureus, many other bacteria) Streptococcus [Group A] (Streptococcus pyogenes) Skin Infection Streptococcus [Group A] (Streptococcus pyogenes) – Invasive, Toxic shock Streptococcus pneumoniae Stronglyoidiasis (Stronglyoides stercoralis) Syphilis (Treponema pallidum) Serratia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) T Shigella (Shigella sp.) Tetanus (Clostridium tetani) Shingles: (Herpes zoster) Varicella zoster virus – Disseminated Tinea (Ringworm) – (Trichophyton sp., Microsporum sp., Epidermophyton sp., Malazzezia sp.) See Ringworm (Tinea) – (Trichophyton sp., Microsporum sp., Epidermophyton sp., Malassezia furfur) Shingles: (Herpes zoster) Varicella zoster virus – Exposed Susceptible Contact Tapeworm (Taenia saginata, Taenia solium, Diphyllobothrium latum, Hymenolepsis nana) Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host WITH Localized lesions (1 or 2 dermatomes) Toxic shock syndrome – (Streptococcus pyogenes [Group A], Staphylococcus aureus) Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions(1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Toxoplasmosis (Toxoplasma gondii) Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Trench Fever (Bartonella quintana) Skin Infection – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Cellulitis – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) Trichuriasis – Whipworm (Trichuris trichiura) Smallpox (Variola major virus, Variola minor virus) Sporotrichosis (Sporothrix schenckii) Staphylococcus aureus – MRSA See Methicillin Resistant Staphylococcus aureus (MRSA) Staphylococcus aureus – pneumonia (not MRSA) Toxocariasis (Toxocara canis, Toxocara cati) Trachoma (Chlamydia trachomatis) See Chlamydia (Chlamydia trachomatis) Trichinosis (Trichinella spiralis) Trichomoniasis (Trichomonas vaginalis) Tuberculosis – non-respiratory or extrapulmonary (Mycobacterium tuberculosis) See Mycobacterium tuberculosis (TB) – extrapulmonary disease or not respiratory Tuberculosis – respiratory or pulmonary (Mycobacterium tuberculosis) See Mycobacterium tuberculosis (TB) –respiratory or pulmonary disease Tularemia (Francisella tularenis) Staphylococcus aureus – toxic shock syndrome Typhoid or Paratyphoid fever (Salmonella typhi, Salmonella paratyphi) See Salmonella (Salmonella sp.) Stenotrophomonas maltophilia Typhus fever (Rickettsia typhi, Rickettsia prowazekii) Staphylococcus aureus – skin infection (not MRSA) Streptococcus [Group A] (Streptococcus pyogenes) – Scarlet Fever 8 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents U Western Equine Encephalitis Urinary tract infection Whipworm (Trichuris trichiura) See Trichuriasis – Whipworm (Trichuris trichiura) V Whooping cough – Pertussis (Bordetella pertussis) See Pertussis – Whooping Cough (Bordetella pertussis) Vancomycin-intermediate Staphylococcus aureus (VISA) Vancomycin-resistant Enterococcus (VRE) Wound infection – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Vancomycin-resistant Staphylococcus aureus (VRSA) Varicella zoster virus: Chickenpox – Exposed Susceptible Contact See Chickenpox – Exposed Susceptible Contact (Varicella zoster virus) X No organisms at this time Varicella zoster virus: Chickenpox – Known Case See Chickenpox – Known Case (Varicella zoster virus) Varicella zoster virus: Herpes zoster (Shingles) – Disseminated See Shingles: (Herpes zoster) Varicella zoster virus – Disseminated Varicella zoster virus: Herpes zoster (Shingles) – Exposed Susceptible Contact See Shingles: (Herpes zoster) Varicella zoster virus – Exposed Susceptible Contact Varicella zoster virus: Herpes zoster (Shingles) – Immunocompromised Host With Localized Lesions (1 or 2 dermatomes) See Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host With Localized lesions (1 or 2 dermatomes) Varicella zoster virus: Herpes zoster (Shingles) – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Varicella zoster virus: Herpes zoster (Shingles) – Normal Host With Localized Lesions(1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Vibrio parahaemolyticus Enteritis W West Nile (West Nile Virus) 9 Y Yaws (Treponema pallidum) Yellow Fever Yersinia enterocolitica; Yersinia pseudotuberculosis Z Zygomycosis (Phycomycosis, Mucormycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) See Mucormycosis (phycomycosis, zygomycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents AA Abscess – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Acinetobacter – (Multi-drug Resistant) (MDRA) Acquired Immunodeficiency Syndrome (AIDS) Actinomycosis (Actinomyces sp.) Adenovirus – Conjunctivitis Adenovirus – Gastroenteritis Adenovirus – Respiratory tract infection Aeromonas spp. Amebiasis – diarrhea (Entamoeba histolytica) Anthrax – confirmed, probable or suspect case Antibiotic Resistant Organisms (ARO) Arthropod borne virus (Arboviruses) Ascariasis – Roundworm (Ascaris lumbricoides) Aspergillosis (Aspergillus spp.) Astrovirus – diarrhea Avian Influenza See Influenza - Avian A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 10 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Abscess (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 11 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Acinetobacter – Multi-drug Resistant (MDRA) MDRA is an Antibiotic Resistant Organism (ARO) Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected secretions or excretions Direct Contact Indirect Contact Large Droplets if symptoms of acute respiratory tract infection Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change Additional precautions for ARO positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for ARO positive resident Incubation Period Period of Communicability Variable While organism is present in secretions/excretions Comments *Precautions required are in addition to Routine Practices • Acinetobacter is classified as multi-drug resistant if it is resistant to all agents in at least 3 antimicrobial classes usually tested, including cephalosporins and/or carbapenems. Screening specimens for MDR Acinetobacter include nares, groins, draining wounds and urine. If the resident is intubated or has a tracheostomy; sputum/endotracheal secretions also need to be screened. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 12 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Acquired Immunodeficiency Syndrome (AIDS) Clinical Presentation Asymptomatic; multiple clinical presentations Infectious Substances How it is Transmitted Blood and certain body fluids* Mucous membrane or percutaneous exposure to infected blood or body fluids Sexual transmission Vertical mother to newborn Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Weeks to years From onset of infection Comments *Fluids include: blood; semen; uterine/vaginal fluid; breast milk; pleural, amniotic, pericardial, peritoneal, synovial, and cerebral spinal fluids, but exclude other body fluids (feces, nasal secretions, sputum, saliva, tears, urine or emesis) unless these fluids are visibly blood stained. • Refer to your facility’s policy for care of body after death • See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 13 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Actinomycosis (Actinomyces sp.) Clinical Presentation Cervicofacial, thoracic or abdominal infection Infectious Substances How it is Transmitted Actinomyces bacteria when part of normal flora in the lining of mouth, throat, digestive system and vagina Not person-to-person transmission Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Not person-to-person transmission Comments • Normal flora; infection is usually secondary to trauma A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 14 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Adenovirus – Conjunctivitis Clinical Presentation Conjunctivitis Infectious Substances How it is Transmitted Discharge from eyes Direct Contact Indirect Contact Precautions Needed* Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 5 – 12 days Late in incubation period until 14 days after onset Comments *Precautions required are in addition to Routine Practices • Careful attention to aseptic technique and reprocessing of ophthalmology equipment is required. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 15 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Adenovirus – Gastroenteritis Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have been resolved for at least 48 hours and stools are normal Incubation Period Period of Communicability 3 – 10 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 16 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Adenovirus – Respiratory tract infection Clinical Presentation Respiratory tract infection, pneumonia Infectious Substances How it is Transmitted Respiratory secretions Large Droplets Direct Contact Indirect Contact Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved For immunocompromised hosts (i.e. oncology, transplant residents), isolation precautions need to be maintained for a longer duration due to prolonged viral shedding. Consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions Incubation Period Period of Communicability 1 – 10 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Different strains responsible for respiratory and gastrointestinal disease A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 17 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Aeromonas spp. Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Feces Direct Contact (Fecal/oral) Indirect Contact (Fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have been resolved for at least 48 hours and stools are normal Incubation Period Period of Communicability 3 – 10 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 18 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Amebiasis – Diarrhea (Entamoeba histolytica) Clinical Presentation Dysentery, diarrhea Infectious Substances How it is Transmitted Feces Direct Contact (Fecal/oral) Indirect Contact (Fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have been resolved for at least 48 hours and stools are normal Incubation Period Period of Communicability Days to weeks Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 19 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Anthrax – Cutaneous, Pulmonary - confirmed, probable or suspect case - (Bacillus anthracis) Clinical Presentation Skin lesions or pneumonia Infectious Substances How it is Transmitted Anthrax spores of B. anthracis in soil and in infected animals, including livestock and wild life Not person-to-person transmission for inhalational forms of anthrax; acquired from contact with infected animals and animal products. Lesion drainage (very rare) Very rarely reported for cutaneous anthrax where it requires direct contact with skin lesions. Precautions Needed* Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 1 – 7 days Not person-to-person transmission for inhalational anthrax. Very rarely reported for cutaneous anthrax. Comments *Consider Contact Precautions in addition to Routine Practices if drainage from skin lesions cannot be contained until drainage has resolved or can be contained • May be Bioterrorism related • Notify Zone Medical Officer of Health of case by fastest means possible. • Refer to your facility’s existing policy re: care of body after death • See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 20 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Antibiotic Resistant Organisms (AROs) Examples include: Methicillin Resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococci (VRE), Vancomycin Resistant Staphylococcus aureus (VRSA), Extended Spectrum Beta-lactamase (ESBL), Carbapenem-resistant Enterobacteriaceae (CRE), Multi Drug resistant Acinetobacter (MDRA) Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected secretions or excretions Direct Contact Indirect Contact Large Droplets if symptoms of acute respiratory tract infection Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change Additional precautions for ARO positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for ARO positive resident Incubation Period Period of Communicability Variable While organism is present in secretions or excretions Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 21 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Arthropod borne virus (Arboviruses) Clinical Presentation Encephalitis, fever, rash, arthralgia, meningitis Infectious Substances How it is Transmitted Infected tick/mosquito Vector-borne: spread by ticks, mosquitos Blood, tissues** Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable 3 – 21 days **Not person-to-person transmission except rarely by blood transfusion or organ transplantation. For West Nile virus extremely rarely by breast milk or transplacentally (CDC) Comments • • • • • Several hundred different viruses exist. Most are limited to specific geographic areas. Most common North American diseases caused by Arboviruses: Colorado tick fever (reovirus) West Nile encephalitis (flavivirus) Other North American diseases caused by Arboviruses: o California encephalitis (bunyavirus) o St. Louis encephalitis (flavivirus) o Western equine encephalitis (alphavirus) o Eastern equine encephalitis (alphavirus) o Powassan encephalitis (flavivirus) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 22 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Ascariasis – Roundworm (Ascaris lumbricoides) Clinical Presentation Usually asymptomatic, gastric upsets Infectious Substances How it is Transmitted Soil containing infective ascarid eggs Not person-to-person transmission Acquired from ingestion of infective eggs/larvae Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Life cycle requires 4 – 8 weeks for completion Not person-to-person transmission. Comments • • Transmission occurs by ingestion of infective eggs from contaminated soil. Ova must hatch in soil to become infectious. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 23 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Aspergillosis (Aspergillus spp.) Clinical Presentation Infection of skin, lung, wound or central nervous system Infectious Substances How it is Transmitted Ubiquitous in nature, particularly in decaying material and in soil, air, water and food Not person-to-person transmission. Acquired from inhalation of airborne spores Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Not person-to-person transmission Comments • Spores may be present in dust; infections in immunocompromised residents have been associated with exposure to construction dust. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 24 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Astrovirus – diarrhea Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have been resolved for at least 48 hours and stools are normal Incubation Period Period of Communicability 3 – 4 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 25 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Avian Influenza See Influenza – Avian Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 26 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents B Bedbugs (Cimex lectularius) Blastomycosis – Pneumonia (Blastomyces dermatitidis) Blastomycosis – Skin lesions (Blastomyces dermatitidis) Botulism (Clostridium botulinum) Bronchiolitis Brucellosis – Skin lesions (Brucella sp.) Brucellosis – Undulant fever, Malta fever, Mediterranean fever (Brucella sp.) Burkholderia cepacia – Non-respiratory infections Burkholderia cepacia – Respiratory infection Burns - Infected (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 27 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Bedbugs (Cimex lectularius) Clinical Presentation Allergic reactions and itchy welts. Bites are usually in rows. Infectious Substances How it is Transmitted Not applicable Not applicable Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable Not applicable Comments • Bedbugs are not known to transmit disease. Consult professional pest control for infestation or consult Alberta Health Services, Environmental Public Health http://www.albertahealthservices.ca/eph.asp • See Alberta Health Services, Environmental Health and Infection Prevention and Control, Bedbug Management Protocols for Health Care Workers A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 28 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Blastomycosis – Pneumonia (Blastomyces dermatitidis) Clinical Presentation Pneumonia Infectious Substances How it is Transmitted Spores in soil Not person-to-person transmission. Acquired from inhalation of spore-laden dust Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 30 – 45 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 29 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Blastomycosis – Skin lesions (Blastomyces dermatitidis) Clinical Presentation Skin lesions Infectious Substances How it is Transmitted Spores in soil Not person-to-person transmission Hematogenous dissemination following primary lung infection Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 30 – 45 days Not person-to-person transmission Comments • Acquired from spores in soil A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 30 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Botulism (Clostridium botulinum) Clinical Presentation Flaccid paralysis, cranial nerve palsies Infectious Substances How it is Transmitted Toxin producing spores in soil, agricultural products, honey, and animal intestine Not person-to-person transmission. Acquired from ingestion of spores/toxin in contaminated food or wounds contaminated by spores in soil Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Not person-to-person transmission Comments • May be bioterrorism related • Notify Zone Medical Officer of Health of case by fastest means possible A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 31 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Bronchiolitis (Various causative agents: respiratory syncytial virus (RSV), parainfluenza virus, adenovirus, influenza virus, human metapneumovirus) Clinical Presentation Respiratory infection Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability Variable Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • May cohort individuals infected with the same virus. If possible, residents should not share room with high-risk immunocompromised roommates A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 32 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Brucellosis – Skin lesions (Brucella sp.) Clinical Presentation Skin lesions Infectious Substances How it is Transmitted Drainage from open lesions Person-to-person transmission is extremely rare – possible direct contact. Precautions Needed* Major drainage not contained: Contact Precautions Minor drainage contained: Routine Practices Duration of Precautions Until drainage has resolved or can be contained Incubation Period Period of Communicability Weeks to months Person-to-person transmission is extremely rare Comments *Precautions required are in addition to Routine Practices • Acquired from direct contact through breaks in skin tissues with infected animals or ingestion of unpasteurized dairy products from infected animals. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 33 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Brucellosis – Undulant fever, Malta fever, Mediterranean fever (Brucella sp.) Clinical Presentation Systemic bacterial disease of acute or insidious onset Infectious Substances How it is Transmitted Infected animals and contaminated food from infected animals Not person-to-person transmission except rarely via banked spermatozoa and sexual contact Acquired contact with infected animals or from contaminated food, mostly dairy products. Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Weeks to months Rarely person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 34 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Burkholderia cepacia – Non-respiratory infections Clinical Presentation Based on site of infection Infectious Substances How it is Transmitted Potentially skin and body fluids Direct Contact Indirect Contact Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Variable Comments • Do not room with resident with cystic fibrosis (CF) who is not infected or colonized with Burkholderia cepacia A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 35 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Burkholderia cepacia – Respiratory infection Clinical Presentation Exacerbation of chronic lung disease in residents with cystic fibrosis Infectious Substances How it is Transmitted Respiratory Secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions Incubation Period Period of Communicability Variable Variable Comments *Precautions required are in addition to Routine Practices • Do not room with resident with cystic fibrosis (CF) who is not infected or colonized with Burkholderia cepacia A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 36 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Burns - Infected (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 37 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents C Calicivirus (Norwalk-like, Norovirus) See Norovirus Campylobacter jejuni Candidiasis (Candida spp.) Carbapenem-Resistant Enterobacteriaceae (CRE) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Cat-scratch Fever (Bartonella henselae) Cellulitis – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) Chancroid (Hemophilus ducreyi) Chickenpox – Exposed Susceptible Contact (Varicella zoster virus) Chickenpox – Known Case (Varicella zoster virus) Chikungunya virus (alphavirus CHIKV) Chlamydia (Chlamydia trachomatis) Cholera (Vibrio cholerae) Citrobacter spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clostridium difficile Infection (CDI) Clostridium perfringens – Food poisoning Clostridium perfringens – Gas gangrene Coccidioidomycosis (Coccidioides immitis) Colorado tick fever (Arbovirus) Conjunctivitis – Pink Eye; Bacterial Conjunctivitis – Pink Eye; Viral Coronavirus – Severe Acute Respiratory Syndrome (SARS-CoV); Middle Eastern respiratory syndrome (MERS-CoV) Coronavirus – not SARS, not MERS Cough, fever, acute upper respiratory tract infection (Rhinovirus, Respiratory syncytial virus [RSV], Parainfluenza virus, Influenza, Adenovirus, Coronavirus, Bordetella pertussis, Mycoplasma pneumoniae) Cough, fever, pulmonary infiltrates in person at risk for tuberculosis (Mycobacterium tuberculosis) Coxsackievirus Disease (Enterovirus and Picornavirdae) Creutzfeldt-Jakob Disease – classic (CJD) and variant (vCJD) Crimean-Congo Hemorrhagic Fever (Arbovirus) See Hemorrhagic Viral Fevers Croup (Hemophilus influenzae, Mycoplasma pneumoniae, adenoviruses, RSV, influenza virus, parafluenza virus, measles virus , human metapneumovirus) Cryptococcosis (Cryptococcus neoformans) Cryptosporidiosis (Cryptosporidium parvum) Cyclosporiasis (Cyclospora cayetanensis) Cytomegalovirus A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 38 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Calicivirus (Norwalk-like, Norovirus) See Norovirus Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 39 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Campylobacter jejuni Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Contaminated Food Indirect Contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have been resolved for at least 48 hours and stools are normal Incubation Period Period of Communicability 2 – 5 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 40 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Candidiasis (Candida spp.) Clinical Presentation Mucocutaneous lesions, systemic disease Infectious Substances How it is Transmitted Mucocutaneous secretions and excretions Contact with infected/colonized secretions or excretions Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Not applicable Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 41 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Carbapenem-Resistant Enterobacteriaceae (CRE) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 42 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cat-scratch Fever (Bartonella henselae) Clinical Presentation Fever, lymphadenopathy Infectious Substances How it is Transmitted Infected domestic cats Not person-to-person transmission Acquired from scratch, bite, lick or other exposure to a cat Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 16 – 22 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 43 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cellulitis – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) Clinical Presentation Purulent inflammation of cellular or subcutaneous tissue Infectious Substances How it is Transmitted Wound drainage Direct Contact Indirect Contact Precautions Needed* ** Major drainage not contained: Contact Precautions Minor drainage contained: Routine Practices Duration of Precautions Until drainage has resolved or can be contained Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices **Droplet and Contact Precautions until 24 hours of effective antimicrobial therapy has been received If invasive group A streptococcal infection suspected • Periorbital cellulitis in children <5 years old may be caused by H. influenzae and require Droplet Precautions A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 44 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Chancroid (Hemophilus ducreyi) Clinical Presentation Genital ulcers Infectious Substances How it is Transmitted Drainage Sexually transmitted Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 3 – 5 days As long as the infectious agent present in unhealed lesions. Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 45 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Chickenpox – Exposed Susceptible Contact (Varicella zoster virus) Clinical Presentation Susceptible contact. Asymptomatic - may develop chickenpox Infectious Substances How it is Transmitted Respiratory secretions Lesion drainage Airborne Direct Contact Indirect Contact Precautions Needed* 8 days after first contact until 21 days after last contact (or 28 days if given varicella zoster immunoglobulin (VZIG)) with person with active disease during their period of communicability: Airborne Precautions If lesions develop: Airborne and Contact Precautions Duration of Precautions From 8 days after first contact until 21 days after last contact (or 28 days if given VZIG) with person with active disease during their period of communicability If lesions develop: Until all lesions have crusted and dried Incubation Period Period of Communicability 10 – 21 days 2 days before rash starts and until all lesions have crusted and dried Comments *Precautions required are in addition to Routine Practices • Defer non-urgent admission if a non-immune person is incubating the disease • Individuals with known immunity to chicken pox (history of past illness or vaccination with 2 appropriately timed doses of varicella vaccine) are not required to wear the N95 respirator when entering the room. • Susceptible HCWs should not enter the room if immune staff are available. If they must enter the room, an N95 respirator must be worn. Other non-immune persons should not enter except in urgent or compassionate circumstances. If immunity is unknown, assume person is non-immune Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours has passed and non-immune, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes has passed and non-immune, wear an N95 respirator. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 46 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Chickenpox – Known Case (Varicella zoster virus) Clinical Presentation Vesicular rash, Fever Infectious Substances How it is Transmitted Lesion drainage Airborne Respiratory secretions Direct Contact Indirect Contact Precautions Needed* Airborne and Contact Precautions Duration of Precautions Until all lesions have crusted and dried Incubation Period Period of Communicability 10 – 21 days 2 days before rash starts and until all lesions have crusted and dried Comments *Precautions required are in addition to Routine Practices • Defer non-urgent admissions if chicken pox or disseminated zoster is present • Individuals with known immunity (history of past illness or vaccination with 2 appropriately timed doses of varicella vaccine) are not required to wear the N95 respirator when entering the room. • Susceptible HCWs should not enter the room if immune staff are available. If they must enter the room, an N95 respirator must be worn. Other non-immune persons should not enter except in urgent or compassionate circumstances • If immunity is unknown, assume person is non-immune Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours has passed and non-immune, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes has passed and non-immune, wear an N95 respirator. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 47 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Chikungunya virus (alphavirus CHIKV) Clinical Presentation Crippling arthritic manifestations Infectious Substances How it is Transmitted Aedes albopictus mosquitoes Not person-to-person transmission Vector borne: Mosquito bite Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 48 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Chlamydia (Chlamydia trachomatis) Clinical Presentation Urethritis, cervicitis, pelvic inflammatory disease; neonatal conjunctivitis, infant pneumonia; trachoma Infectious Substances How it is Transmitted Conjunctival and genital secretions Sexually transmitted Mother to newborn at birth Trachoma: Direct/indirect contact Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable As long as organism present in secretions Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 49 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cholera (Vibrio cholerae) Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Contaminated food or water Direct Contact (fecal/oral) Feces Indirect Contact (fecal/oral) Ingestion of contaminated food or water Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 1 – 5 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. • Notify Zone Medical Officer of Health of case by fastest means possible. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 50 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Citrobacter spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 51 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Clostridium difficile Infection (CDI) Clinical Presentation Diarrhea, toxic megacolon, pseudomembranous colitis Infectious Substances How it is Transmitted Feces Direct contact (fecal/oral) Indirect contact (fecal/oral) Precautions Needed* Contact Precautions Duration of Precautions Until symptoms have been resolved for at least 48 hours and stools are normal A negative Clostridium difficile test is not required to discontinue Contact Precautions. Incubation Period Period of Communicability Variable Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Use soap and water for hand washing, alcohol-based hand rubs are not as effective. • Bacterial spores persist in the environment. Ensure thorough cleaning of the resident’s environment particularly toileting equipment, e.g., commodes, toilet grab rails. Careful discharge cleaning is required. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 52 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Clostridium perfringens – Food poisoning Clinical Presentation Gastroenteritis (abdominal pain, severe diarrhea) Infectious Substances How it is Transmitted Feces Not person-to-person transmission Soil contaminated food Foodborne Precautions Needed Routine Practices Duration of Precautions 6 – 24 hours Incubation Period Period of Communicability Not applicable Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 53 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Clostridium perfringens – Gas Gangrene Clinical Presentation Crepitus abscesses, myonecrosis Infectious Substances How it is Transmitted Found in normal gut flora, soil Not person-to-person transmission Precautions Needed* Routine Practices If wound drainage is present and not contained: Contact Precautions Duration of Precautions If on Contact Precautions, discontinue when drainage has resolved or can be contained Incubation Period Period of Communicability Variable Not person-to-person transmission Comments *Precautions required are in addition to Routine Practices • Infection related to devitalized tissue A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 54 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Coccidioidomycosis (Coccidioides immitis) Clinical Presentation Pneumonia, draining lesions Infectious Substances How it is Transmitted Spores from soil and dust in endemic areas Not person-to-person transmission Acquired from inhalation of spores Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 1 – 4 weeks Not person-to-person transmission Comments • Transmission occurs by inhalation of spores in soil and dust • Exercise care when changing or discarding dressings, casts or other materials that may be contaminated with exudate. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 55 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Colorado tick fever (Arbovirus) Clinical Presentation Fever Infectious Substances How it is Transmitted Tick Not person-to-person transmission Vector borne: Tick Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 3 – 6 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 56 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Conjunctivitis – Pink Eye; Bacterial Clinical Presentation Swelling, redness and soreness of the whites of the eyes, purulent discharge, itching Infectious Substances How it is Transmitted Eye discharge Direct Contact Indirect Contact Precautions Needed* Adult: Routine Practices Children: Contact Precautions Duration of Precautions Adults: Not applicable Children: Until 24 hours of effective antimicrobial therapy has been received Incubation Period Period of Communicability 24 – 72 hours During active infection Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 57 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Conjunctivitis – Pink Eye; Viral Clinical Presentation Swelling, redness and soreness of the whites of the eyes, purulent discharge, itching Infectious Substances How it is Transmitted Eye discharge and respiratory secretions Direct Contact Indirect Contact Precautions Needed* Adults: Contact Precautions Children: Contact Precautions or, if child is also coughing: Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved or a non-viral cause is found Incubation Period Period of Communicability Adenovirus: 5 – 12 days Up to 14 days Picornavirus: 12 hours – 3 days Comments *Precautions required are in addition to Routine Practices • If the cause of the conjunctivitis is adenovirus: See Adenovirus-Conjunctivitis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 58 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Coronavirus – Severe Acute Respiratory Syndrome (SARS-CoV), Middle Eastern Respiratory Syndrome (MERS-CoV) Clinical Presentation Febrile respiratory illness- new or worsening cough, shortness of breath; Pneumonia; acute respiratory distress syndrome Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Aerosols during AGMP Precautions Needed* Droplet and Contact Precautions Wear fit tested N95 respirator when performing Aerosol Generating Medical Procedures (AGMP) Duration of Precautions For SARS-CoV: 10 days following resolution of fever if respiratory symptoms have also resolved For MERS-CoV: Until symptoms have resolved. For residents with prolonged symptoms or for immunocompromised hosts consult IPC or Zone Medical Officer of Health or designate for assistance determining when to discontinue additional precautions Incubation Period Period of Communicability 3 – 10 days Undetermined Comments *Precautions required are in addition to Routine Practices • Notify Zone Medical Officer of Health (or designate) of case by fastest means possible. • AGMPs include: o intubation o open tracheal suctioning o CPR o high frequency oscillatory ventilation o bronchoscopy o tracheostomy care o sputum induction o aerosolized medication administration o BiPAP A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 59 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Coronavirus – not SARS; not MERS Clinical Presentation Common cold Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 2 – 4 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 60 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cough, fever, acute upper respiratory tract infection (Rhinovirus, Respiratory syncytial virus [RSV], Parainfluenza virus, Influenza, Adenovirus, Coronavirus, Bordetella pertussis, Mycoplasma pneumoniae) Clinical Presentation Acute upper respiratory tract infection Infectious Substances How it is Transmitted Respiratory Secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved or until infectious cause ruled out Incubation Period Period of Communicability Not applicable Until symptoms have resolved or until infectious cause ruled out Comments *Precautions required are in addition to Routine Practices • May cohort individuals infected with the same virus. • Minimize exposure of immunocompromised residents. These residents should not be cohorted. • For outbreaks: Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 61 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cough, fever, pulmonary infiltrates in person at risk for tuberculosis (Mycobacterium tuberculosis) Clinical Presentation Fever, weight loss, cough, night sweats, abnormal chest x-ray Infectious Substances How it is Transmitted Respiratory Secretions Airborne Precautions Needed* Airborne Precautions Duration of Precautions Until tuberculosis ruled out or until resident has received at least two weeks of effective treatment and is clinically improved and 3 sputum samples taken 24 hours apart are negative for AFB. Until negative sputum culture if multi-drug resistant tuberculosis. Incubation Period Period of Communicability Not applicable If tuberculosis ruled out: Until symptoms have resolved or until infectious cause ruled out If tuberculosis: While organisms are in sputum Comments *Precautions required are in addition to Routine Practices • Airborne Precautions should be maintained until an expert in tuberculosis management deems the resident non-infectious. Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours has passed and non-immune, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes has passed and non-immune, wear an N95 respirator A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 62 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Coxsackievirus Disease (Enterovirus and Picornavirdae) Clinical Presentation Acute febrile illness, aseptic, meningitis, encephalitis, pharyngitis, herpangina, rash, pleurodynia, hand, foot and mouth disease Infectious Substances How it is Transmitted Feces Direct Contact including fecal/oral) Respiratory secretions Indirect Contact (including fecal/oral) Large Droplets Precautions Needed* Adults: Routine Practices Children: Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 3 – 5 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 63 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Creutzfeldt-Jakob Disease – classic (CJD) and variant (vCJD) Clinical Presentation Chronic encephalopathy (swelling and tissue damage of the cerebrum) Infectious Substances How it is Transmitted Contaminated surgical instruments Contaminated surgical instruments (classical) Tissues of infected animals and humans Tissue grafts from infected donors High Risk Tissues: Brain including dura mater, spinal cord, eyes and tonsils Ingestion of infected central nervous system tissue Precautions Needed Routine Practices except special precautions are needed for surgery and autopsy in all suspect and confirmed cases* Duration of Precautions Not applicable Incubation Period Period of Communicability Months to years Highest level of infectivity during symptomatic illness Comments *Special precautions for surgery and autopsy: • • • • Immediately consult IPC or Zone Medical Officer of Health (MOH) or designate if resident requires surgery or invasive procedure(s). Special precautions are needed for neurosurgical procedures, autopsy and handling/autopsy of body after death. Refer to AHS policy and procedure: Prion Disease (CJD) Precautions for the Surgical Patient at http://insite.albertahealthservices.ca/Files/clp-policy-creutzfeldt-jacob-disease.pdf Refer to your facility’s policy for care of body after death. See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 64 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Crimean-Congo Hemorrhagic Fever (Arbovirus) See Hemorrhagic Viral Fevers Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 65 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Croup (Hemophilus influenzae, Mycoplasma pneumoniae, adenoviruses, RSV, influenza virus, parainfluenza virus, measles virus , human metapneumovirus) Clinical Presentation Respiratory tract infection Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability Variable Variable Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 66 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cryptococcosis (Cryptococcus neoformans) Clinical Presentation Meningitis, pneumonia, adenopathy Infectious Substances How it is Transmitted Spores in soil Not person-to-person transmission Acquired presumably from inhalation of the fungal spores Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 67 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cryptosporidiosis (Cryptosporidium parvum) Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Fecal oocysts Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 1 – 12 days From onset of symptoms until several weeks after symptoms are gone Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 68 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cyclosporiasis (Cyclospora cayetanensis) Clinical Presentation Asymptomatic, vomiting, diarrhea, weight loss, abdominal pain, nausea, fever Infectious Substances How it is Transmitted Contaminated water, fruits and vegetables. Imported, fresh raspberries, other fruits and lettuce from Central America Not person-to-person transmission Acquired from ingestion of contaminated food or water Precautions Needed* Adult: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions for diapered or incontinent children Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 2 – 14 days Not person-to-person transmission Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 69 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Cytomegalovirus Clinical Presentation Usually asymptomatic; congenital infection, retinitis, disseminated infection in immunocompromised person Infectious Substances How it is Transmitted Saliva, genital secretions, urine, breast milk, transplanted organs or stem cells, blood products Direct Sexual Contact Direct Contact Vertical mother to child in utero, at birth or through breast milk. Transfusion, transplantation Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown for person-to-person transmission Neonates: 5 – 6 years 3 – 12 weeks for blood transfusions, Adults: Variable, linked to immuno-suppressed status 1 – 4 months for tissue transplants Comments • Requires intimate personal contact for transmission. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 70 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents D Decubitus ulcer - Infected (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Dengue Fever (Arbovirus) Dermatitis – (Many bacteria, viruses, fungi) See Draining Wounds Diarrhea** – (Many bacteria, viruses, parasites) Diphtheria: Skin or Pharyngeal (Corynebacterium diphtheriae) Draining Wounds (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 71 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Decubitus ulcer - Infected (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 72 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Dengue Fever (Arbovirus) Clinical Presentation Fever, joint pain, rash Infectious Substances How it is Transmitted Infected mosquito Not person-to-person transmission Vector borne: Mosquito bite Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 3 – 14 days Not person-to-person transmission Comments Infection in humans is incidental and is acquired most frequently during blood feeding by the infected mosquito. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 73 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Dermatitis – (Many bacteria, viruses, fungi) See Draining Wounds Clinical Presentation Drainage Infectious Substances How it is Transmitted Drainage Direct Contact Indirect Contact Precautions Needed* Contact Precautions Duration of Precautions Until drainage has resolved or can be contained and infectious cause ruled out Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices • If compatible with scabies take appropriate precautions pending diagnosis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 74 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Diarrhea** – (Many bacteria, viruses, parasites) Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Feces Direct Contact (Fecal/oral) Indirect Contact (Fecal/oral) Precautions Needed* Refer to specific organism, otherwise: Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions If organism identified, see specific organism, otherwise: Until symptoms have resolved and stools are normal and infectious cause ruled out Incubation Period Period of Communicability Variable Variable Comments *Precautions required are in addition to Routine Practices **Diarrhea = loose or watery stools above what is normally expected for that resident AND not attributed to another cause (e.g., medication, laxatives, diet or prior medical condition) • Symptomatic residents must not participated in food handling activities. • For outbreaks: Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 75 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Diphtheria: Skin or Pharyngeal (Corynebacterium diphtheriae) Clinical Presentation Cutaneous (skin): Characteristic ulcerative lesions Pharyngeal: Adherent grayish membrane Infectious Substances How it is Transmitted Skin: Lesion drainage Direct Contact Pharyngeal: Nasopharyngeal secretions Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Cutaneous: Until two cultures from skin lesions are negative Pharyngeal: Until both nose and throat cultures are negative Incubation Period Period of Communicability 2 – 5 days If untreated, 2 weeks to several months Comments *Precautions required are in addition to Routine Practices • Notify Zone Medical Officer of Health of case by fastest means possible. • Cultures should be taken at least 24 hours apart and at least 24 hours after the completion of antimicrobial treatment. If cultures are not available, maintain precautions until 2 weeks after completion of antimicrobial therapy. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 76 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Draining Wounds (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) Clinical Presentation Draining wounds Infectious Substances How it is Transmitted Wound drainage Direct Contact Indirect Contact Precautions Needed* Major drainage not contained: Contact Precautions** Minor drainage contained: Routine Practices Duration of Precautions Until drainage has resolved or can be contained Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices ** Droplet and Contact Precautions until 24 hours of effective antimicrobial therapy has been received If invasive group A streptococcal infection suspected A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 77 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents E Eastern Equine Encephalitis (alpha virus) Ebola See Hemorrhagic Viral Fevers Echinococcosis/Hydatidosis (Echinococcus granulosis, Echinococcus multilocularis) Encephalitis – (Herpes Simplex Virus [HSV types 1 and 2], Enterovirus, Arbovirus Endometritis – (Streptococcus [Group A]) Enterobacter spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Enterobiasis (pinworm) (Oxyuriasis, Enterobius vermicularis) Enteroviral Infections Epiglottitis – (Haemophilus influenza type B [HIB], Streptococcus [Group A], Staphylococcus aureus) Epstein-Barr virus (Human Herpes Virus 4) Erysipelas (Streptococcus [Group A]) See Streptococcus [Group A] - Skin Infection ESBL (Extended Spectrum Beta Lactamase producers) Escheria coli (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Escherichia coli 0157: H7 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 78 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Eastern Equine Encephalitis (alpha virus) Clinical Presentation Fever, encephalomyelitis (headache, chills, vomiting, disorientation, seizures) Infectious Substances How it is Transmitted Aedes mosquito bite (virus found in birds, bats, and possibly rodents) Not person-to-person transmission Vector borne: Mosquito bite Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 5 – 15 days Not person-to-person transmission Comments • Notify Zone Medical Officer of Health of case by fastest means possible. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 79 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Ebola See Hemorrhagic Viral Fevers Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 80 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Echinococcosis/Hydatidosis (Echinococcus granulosis, Echinococcus multilocularis) Clinical Presentation Cyst present in various organs, typically asymptomatic except for noticeable mass. Rupture or leaking cysts can cause anaphylactic reactions. Infectious Substances How it is Transmitted Worm eggs in feces from dogs. Contaminated food and water. Not person-to-person transmission Acquired by ingestion of eggs passed in the feces of infected animals Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 12 months to years Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 81 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Encephalitis – (Herpes Simplex Virus [HSV types 1 and 2], Enterovirus, Arbovirus) Clinical Presentation Encephalitis Infectious Substances How it is Transmitted Feces Direct Contact Respiratory Secretions Indirect Contact Large Droplets Precautions Needed* Adult: Routine Practices Children: Droplet and Contact Precautions Duration of Precautions Until specific cause established Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices • May be associated with measles, mumps, varicella, Mycoplasma pneumoniae, Epstein-Barr Virus (EBV). If so, take appropriate precautions for associated disease. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 82 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Endometritis – (Streptococcus [Group A], many other bacteria) Clinical Presentation Abdominal distension or swelling, abnormal vaginal bleeding or discharge, fever, lower abdominal pain Infectious Substances How it is Transmitted Not applicable Not applicable Precautions Needed* Routine Practices** Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices **Droplet and Contact Precautions until 24 hours of effective antimicrobial therapy has been received If invasive group A streptococcal infection suspected A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 83 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Enterobacter spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 84 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected secretions or excretions Direct Contact Indirect Contact Large Droplets if symptoms of acute respiratory tract infection Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change. Additional precautions for MDR Enteobacteriaceae positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for CRE positive resident Incubation Period Period of Communicability Variable While organism is present in secretions or excretions Comments *Precautions required are in addition to Routine Practices • Any of the above listed organisms if they are reported to be resistant to one or more carbapenem antibiotic (i.e., at least one of ertapenem, imipenem, meropenem, or doripenem) • Lab report may identify organism as a CRE A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 85 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Enterobiasis (pinworm) (Oxyuriasis, Enterobius vermicularis) Clinical Presentation Perianal itching. Occasionally ulcer-like bowel lesions Infectious Substances How it is Transmitted Ova in stool, perianal region Direct Contact (fecal/oral) Contaminated fomites Indirect Contact (fecal/oral) Precautions Needed Routine Practices and careful handling of contaminated linens and undergarments Duration of Precautions Not applicable Incubation Period Period of Communicability 1 – 2 months Until host colonization no longer occurs Comments • Close contacts may need treatment. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 86 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Enteroviral Infections (Coxsackievirus A and B, Echovirus, Enterovirus, Poliovirus) Clinical Presentation Acute febrile illness, aseptic meningitis, encephalitis, pharyngitis, herpangina, rash, pleurodynia, hand, foot and mouth disease Infectious Substances How it is Transmitted Respiratory secretions Direct Contact (including fecal/oral) Feces Indirect Contact (including fecal/oral) Large Droplets Precautions Needed* Adults: Routine Practices Children: Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 3 – 5 days Until symptoms have resolved. If poliovirus see Poliomyelitis Comments *Precautions required are in addition to Routine Practices • If the respiratory viral panel test has a combined Enterovirus-Rhinovirus positive result; manage as for Rhinovirus. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 87 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Epiglottitis – (Haemophilus influenza type B [HIB], Streptococcus [Group A], Staphylococcus aureus) Clinical Presentation Sore throat, muffling or change in voice, difficulty speaking or swallowing, fever Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet Precautions Duration of Precautions Until 24 hours of effective antimicrobial therapy has been received or until HIB ruled out Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 88 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Epstein-Barr virus (Human Herpes Virus 4) Clinical Presentation Infectious mononucleosis; fever, sore throat, lymphadenopathy, splenomegaly Infectious Substances How it is Transmitted Saliva Direct oropharyngeal route via saliva Transplanted organs or stem cells Transplantation Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 30 – 50 days 30 – 50 days Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 89 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Erysipelas – (Streptococcus [Group A]) See Streptococcus [Group A] – Skin Infection Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 90 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents ESBL (Extended Spectrum Beta Lactamase producers) E. coli, Klebsiella spp., Others See Specific Organism Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 91 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Escherichia coli (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 92 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Escherichia coli 0157: H7 Clinical Presentation Diarrhea, hemolytic-uremic syndrome (HUS), thrombotic thrombocytopenic purpura Infectious Substances How it is Transmitted Feces Ingestion of contaminated food Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have resolved and stools are normal If HUS: Until two (2) successive stools are negative for E. coli 0157: H7 or 10 days from onset of diarrhea Incubation Period Period of Communicability 10 hours to 8 days As long as organism present in feces Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 93 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents F Febrile respiratory illness, acute respiratory tract infection – (Rhinovirus, Respiratory syncytial virus, [RSV], Parainfluenza virus, Influenza, Adenovirus, Coronavirus, Bordetella pertussis, Mycoplasma pneumoniae) Fever unknown origin, fever without focus (acute) – (Many bacteria, viruses, fungi) Fifth Disease – Parvovirus B-19 See Parvovirus B 19 Food poisoning – (Bacillus cereus, Clostridium perfringens, Staphylococcus aureus, Salmonella spp., Vibro paraheaemolyticus, Escherichia coli 0157: H7) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 94 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Febrile respiratory illness, acute respiratory tract infection – (Rhinovirus, Respiratory syncytial virus, [RSV], Parainfluenza virus, Influenza, Adenovirus, Coronavirus, Bordetella pertussis, Mycoplasma pneumoniae) Clinical Presentation Respiratory Tract Infection Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability Variable Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • May cohort individuals infected with the same virus. • Minimize exposure of immunocompromised residents. These residents should not be cohorted. • For outbreaks: Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR the AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 95 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Fever unknown origin, fever without focus (acute) – (Many bacteria, viruses, fungi) Clinical Presentation Fever Infectious Substances How it is Transmitted Feces Direct Contact (including fecal/oral) Respiratory secretions Indirect Contact (including fecal/oral) Precautions Needed* Adult: Routine Practices Children: Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices • If findings suggest a specific transmissible infection, take precautions for that infection pending diagnosis. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 96 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Fifth Disease – Parvovirus B-19 See Parvovirus B19 Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 97 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Food poisoning – (Bacillus cereus, Clostridium perfringens, Staphylococcus aureus, Salmonella spp., Vibrio paraheaemolyticus, Escherichia coli 0157: H7) Clinical Presentation Nausea, vomiting, diarrhea, abdominal cramps/pain Infectious Substances How it is Transmitted Contaminated food Foodborne Feces Direct Contact (Fecal/oral) Indirect Contact (Fecal/oral) Precautions Needed* See specific organism, otherwise: Adult: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have resolved and stools are normal Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 98 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents G Gas Gangrene (Clostridium spp.) See Clostridium perfringens – Gas gangrene GAS – Group A Streptococcus (Streptococcus pyogenes) Invasive disease, Toxic shock See Streptococcus [Group A] (Streptococcus pyogenes) – Invasive GAS – Group A Streptococcus (Streptococcus pyogenes) Scarlet fever, pharyngitis See Streptococcus [Group A] (Streptococcus pyogenes) – Scarlet Fever, Pharyngitis GAS – Group A Streptococcus (Streptococcus pyogenes) - Skin infections See Streptococcus [Group A] - Skin Infection Gastroenteritis – (Several bacteria, viruses, parasites) German measles – Acquired Rubella See Rubella – German measles –Acquired (Rubella virus) German measles – Exposed Susceptible Contact See Rubella virus: German measles - Exposed Susceptible Contact Giardiais (Giardia lamblia) Gingivostomatitis – (Herpes simplex virus) Gonococcus (Neisseria gonorrhoeae) See Neisseria gonorrhoeae Guillain-Barre Syndrome A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 99 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Gas Gangrene - (Clostridium sp.) See Clostridium perfringens – Gas gangrene Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 100 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents GAS – Group A Streptococcus (Streptococcus pyogenes) Invasive disease – iGAS, Toxic Shock See Streptococcus [Group A] (Streptococcus pyogenes) – Invasive Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 101 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents GAS – Group A Streptococcus (Streptococcus pyogenes) Scarlet fever, pharyngitis See Streptococcus [Group A] (Streptococcus pyogenes) – Scarlet Fever, Pharyngitis Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 102 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents GAS – Group A Streptococcus (Streptococcus pyogenes) - Skin, infections See Streptococcus [Group A] – Skin Infection Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 103 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Gastroenteritis – (Several bacteria, viruses, parasites) Clinical Presentation Diarrhea and/or vomiting Infectious Substances How it is Transmitted Feces Direct Contact (Fecal/oral) Indirect Contact (Fecal/oral) Large Droplets Precautions Needed* Refer to specific organism, otherwise Adult: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions If resident is actively vomiting: Droplet and Contact Precautions Children: Contact Precautions Duration of Precautions If organism identified, see specific organism Until symptoms have resolved and stools are normal or infectious cause is ruled out Incubation Period Period of Communicability Variable Until symptoms have resolved and stools are normal Comments *Precautions required are in addition to Routine Practices **Diarrhea = loose or watery stools above what is normally expected for that resident AND not attributed to another cause (e.g., medication, laxatives, diet or prior medical condition) • Symptomatic residents must not participate in food handling activities. • For outbreaks: Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 104 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents German measles (Rubella virus) – Acquired See Rubella Virus: German measles – Acquired Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 105 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents German measles (Rubella virus) – Exposed Susceptible Contact See Rubella virus (German measles) - Exposed Susceptible Contact Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 106 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Giardiais (Giardia lamblia) Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Feces Direct contact (fecal/oral) Indirect contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have resolved and stools are normal Incubation Period Period of Communicability 1 – 4 weeks As long as organism in feces May continue for months Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 107 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Gingivostomatitis – (Herpes simplex virus [HSV], other causes including radiation therapy, chemotherapy, idiopathic [aphthous]) Clinical Presentation Fever, redness and swelling of gingivae and oral mucosa, ulcerative lesions. Infectious Substances How it is Transmitted Oral Secretions Direct Contact Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable, 2 days to 2 weeks. While lesions present. Comments *Precautions required are in addition to Routine Practices • Consider Contact Precautions* if extensive disease is present. Maintain precautions while lesions are present. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 108 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Gonococcus (Neisseria gonorrhoeae) See Neisseria gonorrhoeae Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 109 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Guillain-Barre Syndrome Clinical Presentation Acute polyneuropathy disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk. Associated with many infections. Infectious Substances How it is Transmitted Not applicable Not applicable Precautions Needed* Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable Not applicable Comments • May follow within weeks of a respiratory or gastrointestinal infection, e.g. Mycoplasma pneumoniae, Campylobacter jejuni • Implement Additional Precautions as needed for known or suspected associated infection. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 110 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents H Haemophilus influenzae type b (HIB) – invasive disease Hafnia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Hand, foot and mouth disease – (Enterovirus) Hantavirus Helicobacter pylori Hemolytic uremic syndrome (HUS) – May be associated with Escherichia coli 0157: H7 Hemorrhagic viral fever acquired in identified endemic geographic location – (Ebola virus, Lassa virus, Marburg virus, Crimean-Congo and others) Hepatitis – A, E Hepatitis – B, C, D, and other unspecified non-A, non-B Herpangina (vesicular pharyngitis) – (Enterovirus) Herpes simplex – Mucocutaneous - Disseminated or primary and extensive Herpes simplex –Mucocutaneous - Recurrent Herpes zoster: Shingles (Varicella zoster virus) – Disseminated Herpes zoster: Shingles (Varicella zoster virus) – Exposed Susceptible Contact See Shingles: (Herpes zoster) Varicella zoster virus – Exposed Susceptible Contact Herpes zoster: Shingles (Varicella zoster virus) – Immunocompromised Host WITH Localized Lesions (1 or 2 dermatomes) See Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host WITH Localized lesions (1 or 2 dermatomes) Herpes zoster: Shingles (Varicella zoster virus) – Normal Host With Localized (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host, Localized (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Herpes zoster: Shingles (Varicella zoster virus) – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host, Localized (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Histoplasmosis (Histoplasma capsulatum) Hook worm (Necator americanus, Ancyclostoma duodenale) Human Immunodeficiency Virus (HIV) Human Metapneumovirus A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 111 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Haemophilus influenzae type b (HIB) – invasive disease Clinical Presentation Pneumonia, epiglottitis, meningitis, bacteremia, septic arthritis, cellulitis Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Large Droplets Precautions Needed* Adult: Routine Practices Children: Droplet Precautions Duration of Precautions Until 24 hours of effective antimicrobial therapy has been received. Incubation Period Period of Communicability Variable Infectious in the week prior to onset of illness and during the illness until treated Comments *Precautions required are in addition to Routine Practices • Close contact less than 48 months old and who are not immune may require chemoprophylaxis. Household contact of infected children should also receive prophylaxis. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 112 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Hafnia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 113 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Hand, foot and mouth disease – (Enterovirus) Clinical Presentation Blister-like lesions inside the mouth, sides of tongue, palms of hands, fingers, soles of feet, buttocks. Encephalitis and meningitis in rare cases. Infectious Substances How it is Transmitted Feces Direct Contact (including fecal/oral) Respiratory secretions Indirect Contact (including fecal/oral) Large Droplets Precautions Needed* Adults: Routine Practices Children: Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 4 -6 days Most contagious during first week of illness. Virus can remain in the body weeks after symptoms have resolved. Comment *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 114 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Hantavirus Clinical Presentation Fever, pneumonia Infectious Substances How it is Transmitted Infected rodent excreta Not person-to-person transmission Presumed aerosol transmission from rodent excreta Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Days to weeks Not person-to-person transmission Comments • Notify Zone Medical Officer of Health of case by fastest means possible. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 115 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Helicobacter pylori Clinical Presentation Gastritis, duodenal ulcer disease Infectious Substances How it is Transmitted Feces and gastric biopsies Direct Contact Probable ingestion of organisms; presumed fecal/oral/oral/oral Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Possibly 5 – 10 days Unknown Comments • Humans are likely the major reservoir. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 116 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Hemolytic uremic syndrome (HUS) – May be associated with Escherichia coli 0157: H7 Clinical Presentation Not applicable Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until Escherichia coli: 0157: H7 ruled out. For E. coli 0157: H7 disease: Until two (2) successive stools are negative for E. coli O157: H7 Incubation Period Period of Communicability Most E. coli strains, 10 hours to 6 days Until two (2) successive stools are negative for E. coli O157:H7 E. coli O157:H7, 1-8 days Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 117 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Hemorrhagic viral fevers – Acquired in identified endemic geographic location – (Ebola virus, Lassa virus, Marburg virus, Crimean-Congo and others) Clinical Presentation Hemorrhagic fever with or without pneumonia Infectious Substances How it is Transmitted Blood and bloody body fluids Direct Contact Indirect Contact Respiratory secretions Lassa: urine Aerosols during AGMP Lassa: Sexual contact Crimean-Congo: Tick bite Ebola: skin Precautions Needed* Droplet and Contact Precautions Wear fit tested N95 respirator when performing Aerosol Generating Medical Procedures (AGMP)** Duration of Precautions Until directed by IPC or Zone Medical Officer of Health (MOH) or designate Incubation Period Period of Communicability Variable Variable Comments *Precautions required are in addition to Routine Practices • • • • Notify Zone Medical Officer of Health of case by fastest means possible. Refer to your facility’s policy regarding care of body after death See Public Health Act – Bodies of Deceased Persons Regulation AGMPs include o o o o o intubation CPR bronchoscopy sputum induction BiPAP o o o o open tracheal suctioning high frequency oscillatory ventilation tracheostomy care aerosolized medication administration A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 118 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Hepatitis – A, E Clinical Presentation Hepatitis, anicteria acute febrile illness Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions 7 days after onset of symptoms, duration of hospitalization if newborn Incubation Period Period of Communicability Hepatitis A: 28 – 30 days Hepatitis A: Two (2) weeks before to one (1) week after onset of symptoms; shedding is prolonged in the newborn (up to 6 months) Hepatitis E: 26 – 42 days Hepatitis E: fecal shedding continues at least two (2) weeks Comments *Precautions required are in addition to Routine Practices • Post-exposure prophylaxis indicated for non-immune contacts with significant exposure to Hepatitis A • Symptomatic residents must not participate in food handling activities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 119 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Hepatitis – B, C, D, and other unspecified non-A, non-B Clinical Presentation Hepatitis, often asymptomatic; cirrhosis, hepatic cancer Infectious Substances How it is Transmitted Blood and certain body fluids* Mucosal or percutaneous exposure to infective body fluids; Sexual transmission; Vertical mother to newborn Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable B: all persons who are HBsAG positive C: indefinite D: indefinite Comments *Fluids include: blood; semen; uterine/vaginal fluid; breast milk; pleural, amniotic, pericardial, peritoneal, synovial, and cerebral spinal fluids, but exclude other body fluids (feces, nasal secretions, sputum, saliva, tears, urine or emesis) unless these fluids are visibly blood stained. • Refer to your facility’s policy regarding care of body after death • See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 120 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Herpangina (vesicular pharyngitis) – (Enterovirus) Clinical Presentation Fever, headache, loss of appetite, sore throat, ulcers or small blisters in mouth and throat Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Respiratory secretions Indirect Contact (fecal/oral) Large Droplets Precautions Needed* Adult: Routine Practices Children: Droplet Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 3 – 6 days for non-poliovirus Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 121 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Herpes simplex – Mucocutaneous – Disseminated or primary and extensive Clinical Presentation Disseminated or primary and extensive lesions Infectious Substances How it is Transmitted Skin or Mucosal lesions Direct contact Sexual transmission Mother to child at birth Precautions Needed* Contact Precautions Duration of Precautions Until all lesions have crusted and dried Incubation Period Period of Communicability 2 days to 2 weeks While lesions present Comments *Precautions required are in addition to Routine Practices • A resident with herpetic lesions should not be roomed with residents with eczema or burns or with immunocompromised residents. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 122 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Herpes simplex (mucocutaneous) – Recurrent Clinical Presentation Not applicable Infectious Substances How it is Transmitted Not applicable Not applicable Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable Not applicable Comments • A resident with herpetic lesions should not be roomed with residents with eczema or burns or with immunocompromised residents. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 123 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Herpes zoster: Shingles (Varicella zoster virus) – Disseminated See Shingles: (Herpes zoster) Varicella zoster virus – Disseminated Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 124 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Herpes zoster: Shingles (Varicella zoster virus) – Exposed Susceptible Contact See Shingles: (Herpes zoster) Varicella zoster virus – Exposed Susceptible Contact Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 125 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Herpes zoster: Shingles (Varicella zoster virus) – Immunocompromised Host With Localized Lesions (1 or 2 dermatomes) See Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host With Localized Lesions (1 or 2 dermatomes) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 126 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Herpes zoster: Shingles (Varicella zoster virus) – Normal Host With Localized Lesions(1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 127 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Herpes zoster: Shingles (Varicella zoster virus) – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 128 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Histoplasmosis (Histoplasma capsulatum) Clinical Presentation Pneumonia, lymphadenopathy, fever Infectious Substances How it is Transmitted Mold in soil Not person-to-person transmission Acquired from inhalation of spore laden soil Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 3 – 17 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 129 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Hook worm (Necator americanus, Ancyclostoma duodenale) Clinical Presentation Usually asymptomatic Infectious Substances How it is Transmitted Infective larvae Not person-to-person transmission Acquired from larvae in soil Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 4 – 6 weeks Not person-to-person transmission Comments • Larvae must hatch in soil to become infectious. Human infection occurs when larvae penetrate the skin, usually of the foot. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 130 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Human Immunodeficiency Virus (HIV) Clinical Presentation Asymptomatic; multiple clinical presentations Infectious Substances How it is Transmitted Blood and certain body fluids* Mucosal or percutaneous exposure to infective body fluids Sexual transmission; Vertical mother to newborn Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Weeks to years From onset of infection Comments *Fluids include: blood; semen; uterine/vaginal fluid; breast milk; pleural, amniotic, pericardial, peritoneal, synovial, and cerebral spinal fluids, but exclude other body fluids (feces, nasal secretions, sputum, saliva, tears, urine or emesis) unless these fluids are visibly blood stained. • Refer to your facility’s policy for care of body after death. • See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 131 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Human Metapneumovirus Clinical Presentation Acute respiratory tract infection; bronchiolitis, pneumonia, croup Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved. For immunocompromised hosts (i.e. oncology, transplant residents), isolation precautions need to be maintained for a longer duration due to prolonged viral shedding. Consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance Incubation Period Period of Communicability Likely similar to RSV, 3 – 5 days While symptomatic, although viral shedding can occur for 1 – 2 weeks Comments *Precautions required are in addition to Routine Practices • For outbreaks: Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 132 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents I Impetigo – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Influenza - Avian Influenza – New Pandemic Strain Influenza – Seasonal A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 133 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Impetigo – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 134 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Influenza – Avian Clinical Presentation Respiratory tract infection, conjunctivitis Infectious Substances How it is Transmitted Excreta of birds Direct Contact Possibly human respiratory tract secretions Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Wear fit tested N95 respirator when performing Aerosol Generating Medical Procedures (AGMP)* Duration of Precautions As directed by Zone Medical Officer of Health (MOH) or designate Incubation Period Period of Communicability 7 days or less, often 2 – 5 days 21 days Comments *Precautions required are in addition to Routine Practices • Most human infections by animal/bird influenza viruses are thought to result from direct contact with infected birds/animals • For current information on Avian influenza, see Human Health Issues Related to Domestic Avian Influenza in Canada available at http://www.phac-aspc.gc.ca/influenza/index-eng.php http://www.phac-aspc.gc.ca/publicat/daio-enia/9-eng.php • AGMPs include: o o o o o intubation CPR bronchoscopy sputum induction BiPAP o o o o open tracheal suctioning high frequency oscillatory ventilation tracheostomy care aerosolized medication administration A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 135 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Influenza – New Pandemic Strain, Novel Influenza Viruses Clinical Presentation Respiratory tract infection Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* As per Canadian Pandemic Plan Annex F, available at: http://www.phac-aspc.gc.ca/cpippclcpi/annf/index-eng.php Duration of Precautions As per Canadian Pandemic Plan Annex F, available at: http://www.phac-aspc.gc.ca/cpippclcpi/annf/index-eng.php Incubation Period Period of Communicability Unknown, possibly 1 - 7 days Unknown, possibly up to 7 days Comments *Precautions required are in addition to Routine Practices • Notify Zone Medical Officer of Health of case by fastest means possible. See Canadian Pandemic Plan Annex F, Infection Prevention and Control and Occupational Health and Hygiene guidelines during Pandemic Influenza in Existing and Temporary Healthcare Settings, available at: http://www.phac-aspc.gc.ca/cpip-pclcpi/annf/index-eng.php A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 136 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Influenza – Seasonal Clinical Presentation Respiratory tract infection Infectious Substances How it is Transmitted Respiratory secretions Direct Contact , Indirect Contact, Large Droplets Precautions Needed* Droplet and Contact Precautions Wear fit tested N95 respirator when performing Aerosol Generating Medical Procedures (AGMP) Duration of Precautions 5 days from onset of acute illness OR until they are over the acute illness and have been afebrile for 48 hours Consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions Incubation Period Period of Communicability 1 – 3 days 7 days (shedding may be longer in infants or immunocompromised hosts) Comments *Precautions required are in addition to Routine Practices • • • Minimize exposure of immunocompromised residents. For outbreaks. Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites AGMPs include: o o o o o intubation CPR bronchoscopy sputum induction BiPAP o o o o open tracheal suctioning high frequency oscillatory ventilation tracheostomy care aerosolized medication administration A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 137 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents J No organisms at this time K Klebsiella spp. (Multi-Drug Resistant; Carbapenem resistant {CRE}; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 138 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Klebsiella spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 139 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents L Lassa fever (Lassa Virus) See Hemorrhagic Viral Fevers Legionella (Legionella spp.) Leprosy (Hansen’s disease) (Mycobacterium leprae) Leptospirosis (Leptospira sp.) Lice (Pediculosis) – (Pediculus humanus, Phthirus pubis) Listeriosis (Listeria monocytogenes) Lyme disease (Borrelia burgdorferi) Lymphocytic choriomeningitis virus Lymphogranuloma venereum (Chlamydia trachomatis) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 140 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Lassa fever (Lassa Virus) See Hemorrhagic Viral Fevers Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 141 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Legionella (Legionella spp.) Clinical Presentation Pneumonia, Legionnaires’’ disease, Pontiac fever Infectious Substances How it is Transmitted Contaminated water sources Not person-to-person transmission Transmission occurs with aerosolization of contaminated water and subsequent airborne spread. Acquired from contaminated water by inhalation or aspiration. Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 2 – 10 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 142 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Leprosy (Hansen’s disease) (Mycobacterium leprae) Clinical Presentation Chronic disease of skin, nerves, nasopharyngeal mucosa Infectious Substances How it is Transmitted Nasal secretions, Direct Contact (requires prolonged and extensive personal contact) Skin lesions Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability One year to many years Until treatment is established Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 143 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Leptospirosis (Leptospira sp.) Clinical Presentation Fever, jaundice, aseptic meningitis Infectious Substances How it is Transmitted Urine or tissues of infected animals or water contaminated with the urine of infected animals. Not person-to-person transmission Transmitted through skin or mucous membrane contact with urine or tissues of infected animals or water contaminated with the urine of infected animals. Precautions Needed Routine Practices Duration of Precautions Not Applicable Incubation Period Period of Communicability 2 – 26 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 144 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Lice (Pediculosis) – (Pediculus humanus, Phthirus pubis) Clinical Presentation Scalp or body itch, itchy rash Infectious Substances How it is Transmitted Louse Head and body lice: direct and indirect contact Pubic lice: usually sexual contact Precautions Needed* Contact Precautions Duration of Precautions Until 24 hours after application of appropriate pediculicide; applied as directed Incubation Period Period of Communicability 6 – 10 days Until effective treatment to kill lice and ova and observed to be free of lice Comments *Precautions required are in addition to Routine Practices • Apply pediculicide as directed on label. If live lice found after therapy, repeat treatment. • Head lice: wash headgear, combs, pillow cases, towels with hot water or dry clean or seal in plastic bag and store for 10 days. • Body lice: as above, for all exposed clothing and bedding A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 145 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Listeriosis (Listeria monocytogenes) Clinical Presentation Fever, meningitis, congenital or neonatal infection Infectious Substances How it is Transmitted Contaminated food Acquired from contaminated food Animal reservoirs (infected/colonized domestic and wild mammals, fowl and people) Vertical mother to child in utero or at birth Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Average 21 days Days to months Comments • Rare nosocomial outbreaks reported in newborn nurseries attributed to contaminated equipment or materials. • Listeria grows well at low temperatures and is able to multiply in refrigerated foods that are contaminated. • Pregnant women and immunocompromised persons should avoid unpasteurized cheese, cold cuts, and uncooked meat products including hot dogs. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 146 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Lyme disease (Borrelia burgdorferi) Clinical Presentation Fever, rash, arthritis, meningitis Infectious Substances How it is Transmitted Tick Not person-to-person transmission Vector borne: Tick Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Rash occurs in 3 – 31 days after exposure Not person-to-person transmission Comments • Infection in humans is incidental and is acquired most frequently during blood feeding by the infected tick. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 147 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Lymphocytic choriomeningitis virus Clinical Presentation Aseptic meningitis Infectious Substances How it is Transmitted Urine of rodents Not person-to-person transmission Acquired from contact with rodents Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 6 – 21 days Not person-to-person transmission Comments • Transmission to humans is probably through oral or respiratory contact with virus contaminated excreta of infected rodents. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 148 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Lymphogranuloma venereum (Chlamydia trachomatis) Clinical Presentation Genital ulcers, inguinal adenopathy Infectious Substances How it is Transmitted Open lesions Sexual contact Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 3 – 30 days for a primary lesion As long as organism present in secretions Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 149 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents M Malaria (Plasmodium spp.) Marburg virus See Hemorrhagic Viral Fevers Measles – (Rubeola) – Exposed Susceptible Contact Measles – (Rubeola) – Known Case Melioidosis (Burkholderia pseudomallei) Meningitis Meningococcus (Neisseria meningitidis) See Neisseria meningitidis MERS – (Middle Eastern Respiratory Syndrome; Coronovirus) See Coronavirus – Severe Acute Respiratory Syndrome (SARS-CoV), Middle Eastern Respiratory Syndrome (MERS-CoV) Methicillin Resistant Staphylococcus aureus (MRSA) Molluscum contagiosum (Molluscum contagiosum virus) Monkey Pox Mononucleosis (Epstein-Barr virus) See Epstein – Barr virus (Human Herpes Virus 4) Morganella spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Mucormycosis (phycomycosis, zygomycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) Multi-Drug Resistant (MDR) Gram Negative Bacilli Mumps (Mumps virus) – Known Case Mumps – (Mumps virus) Exposed Susceptible Contact Mycobacterium – Non-tuberculosis (atypical) (e.g., Mycobacterium avium complex) Mycobacterium tuberculosis (TB) – extrapulmonary disease or not respiratory; (also M. africanum, M.bovis, M. caprae, M. microti, M. pinnipedii) Mycobacterium tuberculosis (TB) – respiratory or pulmonary disease; (also M. africanum, M.bovis, M. caprae, M. microti, M. pinnipedii) Mycoplasma pneumoniae A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 150 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Malaria (Plasmodium spp.) Clinical Presentation Fever Infectious Substances How it is Transmitted Blood Vector borne: Mosquito bite Rarely transplacental from mother to fetus Blood transfusion Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Not usually person-to-person transmission Comments • Infection in humans is incidental and is acquired most frequently during blood feeding by the infected mosquito. • Can be transmitted via blood transfusion. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 151 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Marburg virus See Hemorrhagic Viral Fevers Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 152 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Measles – (Rubeola) – Exposed Susceptible Contact Clinical Presentation Susceptible contact. Asymptomatic - may develop measles Infectious Substances How it is Transmitted Respiratory secretions Airborne Precautions Needed* Airborne Precautions Duration of Precautions From 5 days after first exposure until 21 days after last exposure If measles develop: Stop 4 days after start of rash in immunocompetent residents or until all symptoms are gone in immunocompromised residents Incubation Period Period of Communicability 7 – 18 days 5 days before start of rash (1 – 2 days before start of other symptoms) and until 4 days after onset of rash (longer in immunocompromised residents) Comments *Precautions required are in addition to Routine Practices • • • Defer non-urgent admission if a non-immune person is incubating the disease. Individuals with known immunity to measles (serological proof of immunity; immunization with 2 appropriately timed doses of measles-containing vaccine) are not required to wear the N95 respirator when entering the room. Susceptible HCWs should not enter the room if immune staff are available. If they must enter the room, an N95 respirator must be worn. Other non-immune persons should not enter except in urgent or compassionate circumstances. If immunity is unknown, assume person is non-immune. Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours has passed and non-immune, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes has passed and non-immune, wear an N95 respirator. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 153 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Measles – (Rubeola) – Known Case Clinical Presentation Fever, coryza, maculopapular skin rash, conjunctivitis, cough Infectious Substances How it is Transmitted Respiratory secretions Airborne Precautions Needed* Airborne Precautions Duration of Precautions Stop 4 days after start of rash in immunocompetent residents or until all symptoms are gone in immunocompromised residents. Incubation Period Period of Communicability 7 – 18 days 5 days before start of rash (1 – 2 days before start of other symptoms) and until 4 days after onset of rash (longer in immunocompromised residents) Comments *Precautions required are in addition to Routine Practices • • • • • Notify Zone Medical Officer of Health of case by fastest means possible. Defer non-urgent admission if measles is present. Individuals with known immunity to measles are not required to wear the N95 respirator when entering the room. Known immunity: Serological proof of immunity or documentation of 2 appropriately timed doses of vaccine, or received a minimum dose of Immunoglobulin (0.25/kg) within 5 months of exposure. Susceptible HCWs should not enter the room if immune staff are available. If they must enter the room, an N95 respirator must be worn. Other non-immune persons should not enter except in urgent or compassionate circumstances. If immunity is unknown, assume person is non-immune Immunoprophylaxis is indicated for susceptible contacts. Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours has passed and non-immune, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes has passed and non-immune, wear an N95 respirator A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 154 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Melioidosis (Burkholderia pseudomallei) Clinical Presentation Pneumonia, fever, papules with umbilical centres Infectious Substances How it is Transmitted Contaminated soil Not person-to-person transmission Acquired from direct contact with contaminated water or soil, aspiration or ingestion of contaminated water or inhalation of contaminated dust. Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 155 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Meningitis (Various causative agents: Bacterial: Neisseria meningitides, H. influenza type B (possible in non-immune infant younger than 2 years of age), Streptococcus pneumoniae, Group B Streptococcus, Listeria monocytogenes, E. coli and other Gramnegative rods, Mycobacterium tuberculosis. Viral: enterovirus, arborviruses) Clinical Presentation Meningitis Infectious Substances How it is Transmitted Respiratory secretions Feces (in viral meningitis) Bacterial: Direct contact ; Large droplets Viral: Direct and indirect contact (including fecal/oral) Precautions Needed* Adult: Cause unknown or bacterial: Droplet Precautions until Neisseria meningitidis ruled out, otherwise Routine Practices. Neisseria meningitidis: Droplet Precautions Viral: Routine Practices Children: Cause unknown or bacterial: Droplet and Contact Precautions Viral: Contact Precautions Duration of Precautions Adult: Neisseria meningitidis: Until 24 hours of effective antimicrobial therapy has been received Children: Bacterial meningitis: Until 24 hours of effective antimicrobial therapy has been received Viral meningitis: Until symptoms have resolved or until enterovirus ruled out. See specific organism. Incubation Period Period of Communicability Variable Variable Comments *Precautions required are in addition to Routine Practices • • For Mycobacterium tuberculosis meningitis rule out associated respiratory TB May be associated with measles, mumps, varicella, or herpes simplex. If identified, take appropriate precautions for associated disease. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 156 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Meningococcus (Neisseria meningitidis) See Neisseria meningitidis Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 157 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents MERS – (Middle Eastern Respiratory Syndrome; Coronovirus) See Coronavirus – Severe Acute Respiratory Syndrome (SARS-CoV), Middle Eastern Respiratory Syndrome (MERS-CoV) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 158 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Methicillin Resistant Staphylococcus aureus (MRSA) Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected skin, secretions or excretions Direct contact Indirect contact Large Droplets if symptoms of acute respiratory tract infection Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change Additional precautions for ARO positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for ARO positive resident Incubation Period Period of Communicability Variable While organism is present in secretions or excretions Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 159 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Molluscum contagiosum (Molluscum contagiosum virus) Clinical Presentation Umbilicated papules Infectious Substances How it is Transmitted Contents of the papules Direct contact* Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 1 week to 6 months Unknown Comments *Requires close direct personal contact for transmission A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 160 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Monkey Pox Clinical Presentation Resembles smallpox, swollen lymph nodes Infectious Substances How it is Transmitted Infected blood and body fluids Bite from infected animal or direct contact with their blood, body fluid or rash. Pox secretions Precautions Needed* Routine Practices, Airborne Precautions and Droplet and Contact Precautions Duration of Precautions As directed by IPC or Zone Medical Officer of Health (MOH) or designate Incubation Period Period of Communicability 12 days 2 – 4 weeks Comments *Precautions required are in addition to Routine Practices • Notify Medical Officer of Health of case by fastest means possible. • Transmission in hospital settings is unlikely • See www.cdc.gov/ncidod/monkeypox for their current recommendations • Discharge Settle Time o o Non-negative pressure rooms: Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours has passed and non-immune, wear an N95 respirator. Negative pressure rooms: Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes has passed and non-immune, wear an N95 respirator. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 161 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Mononucleosis (Epstein-Barr virus) See Epstein – Barr virus (Human Herpes Virus 4) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 162 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Morganella spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 163 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Mucormycosis (phycomycosis, zygomycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) Clinical Presentation Skin, wound, rhino-cerebral, pulmonary, gastrointestinal, disseminated infection Infectious Substances How it is Transmitted Fungal spores in dust and soil Not person-to-person transmission Acquired from inhalation or ingestion of fungal spores in dust, soil Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Not person-to-person transmission Comments • Immunocompromised residents are at risk of infection. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 164 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Multi-Drug Resistant (MDR) Gram Negative Bacilli • • • • • MDR Acinetobacter sp. MDR Pseudomonas sp. (ESBL, AmpC or MBL producing) Stenotrophomonas maltophilia** Burkholderia cepacia** MDR Enterobacteriaceae (Carbapenem resistant (CRE); ESBL or Amp C producing) E. coli, Klebsiella sp., Serratia sp., Providencia sp., Proteus sp., Citrobacter sp., Enterobacter sp., Morganella sp., Salmonella sp., Hafnia spp. Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected secretions/ or excretions Direct contact Indirect contact Large Droplets if symptoms of acute respiratory tract infection Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet for all organisms listed above except those identified by asterisks** **See specific organism for more information. Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change Additional precautions for ARO positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for ARO positive resident Incubation Period Period of Communicability Variable While organism is present in secretions or excretions Comments *Precautions required are in addition to Routine Practices • Isolation precautions are dependent on organism type and antibiotic susceptibility pattern. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 165 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Mumps (Mumps virus) – Known Case Clinical Presentation Swelling of salivary glands, orchitis, meningitis Infectious Substances How it is Transmitted Saliva Direct Contact Respiratory secretions Large Droplets Precautions Needed* Droplet Precautions Duration of Precautions Maintain isolation until 5 days after the onset of symptoms Incubation Period Period of Communicability 14 – 25 days 2 days before and up to 5 days after onset of symptoms Comments *Precautions required are in addition to Routine Practices • Droplet Precautions for exposed susceptible residents and healthcare workers should begin 10 days after first contact and continue through 26 days after last exposure. • Defer non-urgent admission if mumps is present. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 166 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Mumps – (Mumps virus) Exposed Susceptible Contact Clinical Presentation Susceptible contact. Asymptomatic - may develop mumps Infectious Substances How it is Transmitted Saliva Direct Contact Respiratory secretions Large Droplets Precautions Needed* Droplet Precautions Duration of Precautions Should begin 10 days after first contact and continue until 26 days after last exposure If mumps develop: Maintain isolation until 5 days after the onset of symptoms Incubation Period Period of Communicability 14 – 25 days 2 days before and up to 5 days after onset of symptoms Comments *Precautions required are in addition to Routine Practices • Defer non-urgent admission if a non-immune person is incubating the disease A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 167 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Mycobacterium – Non-tuberculosis (atypical) (e.g., Mycobacterium avium complex) Clinical Presentation Lymphadenitis, pneumonia, disseminated disease in immunocompromised host Infectious Substances How it is Transmitted In environmental sources – soil, water, animal reservoirs Not person-to-person transmission Acquired from soil, water, animal reservoirs Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Not person-to-person transmission Comments 168 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 169 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Mycobacterium tuberculosis (TB) – extrapulmonary disease or not respiratory; (also M. africanum, M. bovis, M. caprae, M. microti, M. pinnipedii) Clinical Presentation Extrapulmonary: meningitis, bone or joint infections, draining lesions Infectious Substances How it is Transmitted Aerosolized wound drainage if present Airborne transmission possible if procedures that may aerosolize wound drainage are being performed Precautions Needed* Routine Practices Airborne Precautions required only if procedures that may aerosolize drainage from draining lesions are being performed or for suspicion of miliary tuberculosis with pulmonary involvement (see Mycobacterium tuberculosis-Respiratory) Duration of Precautions Not applicable Incubation Period Period of Communicability Weeks to years While organisms are in drainage Comments *Precautions required are in addition to Routine Practices • Assess for concurrent pulmonary tuberculosis • Avoid procedures that may generate aerosols from drainage A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 170 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Mycobacterium tuberculosis (TB) – respiratory or pulmonary disease; (also M. africanum, M. bovis, M. caprae, M. microti, M. pinnipedii) Clinical Presentation Confirmed or suspected pulmonary tuberculosis (including pleural and laryngeal tuberculosis) Infectious Substances How it is Transmitted Respiratory secretions Airborne Precautions Needed* Airborne Precautions Duration of Precautions Contact Zone Medical Officer of Health or designate prior to stopping precautions. Criteria for discontinuing precautions include: 1) Receipt of 2 weeks effective treatment, AND, 2) Clinical improvement, AND, 3) Three (3) consecutive negative Acid Fast Bacilli (AFB) sputums collected 8 – 24 hours apart. If multi-drug resistant tuberculosis, until culture negative. Incubation Period Period of Communicability Weeks to years While organisms are in sputum Comments *Precautions required are in addition to Routine Practices • • • Refer to existing policy re: care of body after death See Public Health Act – Bodies of Deceased Persons Regulation Notify Zone Medical Officer of Health (or designate) of case by fastest means possible. Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes wear an N95 respirator A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 171 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Mycoplasma pneumoniae Clinical Presentation Pneumonia Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Large Droplets Precautions Needed* Droplet Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 1 – 4 weeks Unknown Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 172 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents N Neisseria gonorrhoeae Neisseria meningitidis Nocardiosis (Nocardia sp.) Norovirus A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 173 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Neisseria gonorrhoeae Clinical Presentation Opthalmaia, neonatorum, gonorrhea, arthritis, pelvic inflammatory disease. Infectious Substances How it is Transmitted Exudates from lesions Mother to child at birth Sexual contact Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 2 – 7 days Until effective antimicrobial therapy has been completed Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 174 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Neisseria meningitidis Clinical Presentation Rash (petechial/purpuric) with fever, meningococcemia, meningitis, pneumonia, Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Large droplets Precautions Needed* Droplet Precautions Duration of Precautions Until 24 hours of effective antimicrobial therapy has been received Incubation Period Period of Communicability Usually 2 – 10 days Until 24 hours of effective antimicrobial therapy has been received Comments *Precautions required are in addition to Routine Practices • Notify Zone Medical Officer of Health of case by fastest means possible. • Close contacts may require chemoprophylaxis. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 175 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Nocardiosis (Nocardia sp.) Clinical Presentation Fever, pulmonary or central nervous system infection or disseminated disease Infectious Substances How it is Transmitted Organisms in the soil and dust Not person-to-person transmission Acquired from inhalation or skin inoculation of the organism in dust Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Not person-to-person transmission Comments • Infections in immunocompromised residents may be associated with construction. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 176 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Norovirus Clinical Presentation Diarrhea and/or vomiting Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Emesis/vomit Indirect Contact (fecal/oral) Large Droplets Precautions Needed* Contact Precautions If resident is actively vomiting: Droplet and Contact Precautions Duration of Precautions Until symptoms have been resolved for at least 48 hours and stools are normal Incubation Period Period of Communicability 12 hours to 4 days Until 48 hours after symptoms have resolved Comments *Precautions required are in addition to Routine Practices • For outbreaks: Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 177 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents O Orf – parapoxvirus Osteomyelitis (Haemophilus influenzae type B (HIB) [possible in non-immune infant <2 yrs of age], Staphylococcus aureus, other bacteria) Otitis, draining (Streptococcus [Group A], Staphylococcus aureus, Many other bacteria) See Draining Wounds A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 178 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Orf – parapoxvirus Clinical Presentation Skin lesions Infectious Substances How it is Transmitted Organism in various animals (sheep, goats, reindeer, musk oxen) and soil Not person-to-person transmission Acquired from direct contact with infected animals Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 3 – 6 days Not person-to-person transmission Comments • Acquired from direct contact with infected animals, usually sheep and goats A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 179 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Osteomyelitis (Haemophilus influenzae type B (HIB) [possible in non-immune infant less than 2 years of age], Staphylococcus aureus, other bacteria) Clinical Presentation Inflammation, fever, wound drainage Infectious Substances How it is Transmitted Respiratory secretions if HIB Direct Contact if HIB Large Droplets if HIB Precautions Needed* Adult: Routine Practices Children: Droplet Precautions if HIB, otherwise Routine Practices Duration of Precautions Until 24 hours of effective antimicrobial therapy has been received, or HIB ruled out. Incubation Period Period of Communicability Variable Not applicable Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 180 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Otitis, draining (Streptococcus [Group A], Staphylococcus aureus, Many other bacteria) See Draining Wounds Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 181 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents P Parainfluenza virus Parvovirus B19 – Fifth’s Disease, Erythema infectiosum (rash), Aplastic crisis Pediculosis (Lice) – (Pediculus humanus, Phthirus pubis) See Lice (Pediculosis) – (Pediculus humanus, Phthirus pubis) Pertussis – Bordetella pertussis Pharyngitis – (Streptococcus [Group A], Corynebacterium diphtheriae, many viruses) Pinworm (Oxyuriasis) – (Enterobius vermicularis) See Enterobiasis (pinworm) (Oxyuriasis, Enterobius vermicularis)) Plague – Bubonic (Yersinia pestis) Plague – Pneumonic (Yersinia pestis) Pleurodynia (Enterovirus, Coxsackievirus) Pneumocystis jiroveci Pneumonia (PJP) – formerly known as P. carinii (PCP) Pneumonia Poliomyelitis Prion Disease – Creutzfeldt-Jakob Disease (CJD); classic and variant (vCJD) See Creutzfeldt-Jakob Disease – classic (CJD) and variant (vCJD) Proteus spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Providencia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Pseudomembraneous colitis – (Clostridium difficile) See Clostridium difficile Infection (CDI) Pseudomonas aeruginosa (Multi-Drug Resistant or Metallo-Carbapenamase producing**) Psittacosis (Ornithosis) – (Chlamydia psittaci) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 182 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Parainfluenza virus Clinical Presentation Respiratory tract infection Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved For immunocompromised hosts (i.e. oncology, transplant residents), isolation precautions need to be maintained for a longer duration due to prolonged viral shedding. Contact IPC or Zone Medical Officer of Health (MOH) or designate for assistance with discontinuation of precautions. Incubation Period Period of Communicability 2 – 6 days Variable Comments *Precautions required are in addition to Routine Practices • May cohort with others with same virus. Minimize exposure of immunocompromised residents • For outbreaks. Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 183 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Parvovirus B19 – Fifth Disease, Erythema infectiosum (rash), Aplastic crisis Clinical Presentation Erythema Infectiousum (rash); aplastic crisis Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Large Droplets Vertical, mother to fetus Precautions Needed* Fifth Disease: Routine Practices Aplastic crisis: Droplet Precautions Duration of Precautions If aplastic crisis maintain precautions for 7 days. For immuno-suppressed residents with chronic infection or those with papular purpuric gloves and socks syndrome (PPGS), consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions Incubation Period Period of Communicability 4 – 21 days Fifth disease: Immunocompetent residents are no longer infectious by the time the rash appears Aplastic crisis: up to 1 week after onset of crisis. Immunocompromised with chronic infection: months to years Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 184 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pediculosis (Lice) – (Pediculus humanus, Phthirus pubis) See Lice (Pediculosis) – (Pediculus humanus, Phthirus pubis) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 185 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pertussis – Whooping Cough (Bordetella pertussis) Clinical Presentation Whooping cough, non-specific respiratory tract infections in infants, adolescents and adults. Infectious Substances How it is Transmitted Respiratory secretions Large Droplets Precautions Needed* Droplet Precautions Duration of Precautions Up to 3 weeks after onset of paroxysms if not treated or until 5 days of effective antimicrobial treatment has been received Incubation Period Period of Communicability 6 – 20 days At onset of mild respiratory tract symptoms (catarrhal stage) up to 3 weeks after onset of paroxysms or coughing if not treated; or until 5 days of effective antimicrobial therapy has been received. Comments *Precautions required are in addition to Routine Practices • Close contacts may need chemoprophylaxis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 186 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pharyngitis – (Streptococcus [Group A], Corynebacterium diphtheriae, many viruses) Clinical Presentation Sneezing, coughing, fever, headache, sore throat Infectious Substances How it is Transmitted Respiratory secretions See specific organism Precautions Needed* Adult: See specific organism, otherwise: Routine Practices Children: Droplet and Contact Precautions Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Variable Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 187 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pinworm (Oxyuriasis) – (Enterobius vermicularis) See Enterobiasis (pinworm) (Oxyuriasis, Enterobius vermicularis) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 188 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Plague – Bubonic (Yersinia pestis) Clinical Presentation Lymphadenitis Infectious Substances How it is Transmitted Infected rodents and their fleas Not person-to-person transmission Acquired from the bite of an infected flea Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 1 – 7 days Not person-to-person transmission Comments • Notify Zone Medical Officer of Health of case by fastest means possible. • Refer to your facility’s policy for care of body after death. • See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 189 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Plague – Pneumonic (Yersinia pestis) Clinical Presentation Pneumonia, cough, fever, hemoptysis Infectious Substances How it is Transmitted Respiratory secretions Large Droplets Precautions Needed* Droplet Precautions Duration of Precautions Until 48 hours of effective antimicrobial therapy has been received Incubation Period Period of Communicability 1 – 4 days Until 48 hours of effective antimicrobial therapy has been received. Comments *Precautions required are in addition to Routine Practices • Notify Zone Medical Officer of Health of case by fastest means possible. • Close contacts may require prophylaxis • Refer to your facility’s policy for care of body after death. • See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 190 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pleurodynia (Enterovirus, Coxsackievirus) Clinical Presentation Brief fever, severe chest and lower back pain Infectious Substances How it is Transmitted Feces Direct Contact (including fecal/oral) Respiratory secretions Indirect Contact (including fecal/oral) Large Droplets Precautions Needed* Adult: Routine Practices Children: Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 2 – 4 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 191 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pneumocystis jiroveci Pneumonia (PJP) – formerly known as P. carinii (PCP) Clinical Presentation Pneumonia in an immunocompromised host Infectious Substances How it is Transmitted Not applicable Unknown Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Unknown Comments • Ensure roommate is not immunocompromised A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 192 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pneumonia (Various causative agents: bacteria, viruses fungi, other agents) See Specific Organism Clinical Presentation Pneumonia Infectious Substances How it is Transmitted Respiratory secretions Large Droplets Direct Contact Indirect Contact Precautions Needed As for specific organism, otherwise: Routine Practices Duration of Precautions As for specific organism Incubation Period Period of Communicability Variable Variable Comments • Minimize exposure of immumocompromised residents. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 193 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Poliomyelitis Clinical Presentation Flaccid paralysis Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Respiratory secretions Indirect Contact (fecal/oral) Precautions Needed* Contact Precautions Duration of Precautions Until 6 weeks from start of illness or until feces culture negative Incubation Period Period of Communicability 3 – 35 days Duration of shedding is up to 6 weeks. Comments *Precautions required are in addition to Routine Practices • Notify Zone Medical Officer of Health of case by fastest means possible • Most infectious during the days before and after onset of symptoms • Close contacts who are not immune should receive immunoprophylaxis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 194 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Prion Disease – Creutzfeldt-Jakob Disease (CJD); classic and variant (vCJD) See Creutzfeldt-Jakob Disease – classic (CJD) and variant (vCJD) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 195 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Proteus spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 196 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Providencia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Comments 197 Period of Communicability IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 198 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pseudomembranous colitis – (Clostridium difficile) See Clostridium difficile Infection (CDI) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 199 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Pseudomonas aeruginosa (Multi-Drug Resistant or MetalloCarbapenamase producing**) (ESBL, AmpC or MBL producing) Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected secretions or excretions Direct contact Indirect contact Large Droplets if symptoms of acute respiratory tract infection Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change Additional precautions for ARO positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for ARO positive resident Incubation Period Period of Communicability Variable While organism is present in secretions or excretions Comments *Precautions required are in addition to Routine Practices • • • Must demonstrate complete resistance to more than 3 antibiotic classes usually tested, including carbapenems **May be identified as Metallo-Carbapenamase producing or Metallo-beta-lactamase producing (MBL) Pseudomonas on the lab report. Note: β=beta A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 200 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Psittacosis (Ornithosis) – (Chlamydia psittaci) Clinical Presentation Pneumonia, fever Infectious Substances How it is Transmitted Infected birds Not person-to-person transmission Acquired from contact with infected birds Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 7 – 14 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 201 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Q Q Fever (Coxiella burnetii) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 202 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Q Fever (Coxiella burnetii) Clinical Presentation Pneumonia, fever Infectious Substances How it is Transmitted Infected animals, milk Acquired from contact with infected animals or from ingestion of raw milk Not person-to-person transmission Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 14 – 39 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 203 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents R Rabies Rash, compatible with scabies – (Ectoparasite) Rash, maculopapular –(Suspected Rubeola virus [Measles]) Rash, petechial or purpuric – (Suspected Neisseria meningitidis) Rash, vesicular – (Suspected Varicella virus - Chickenpox) Rat-bite fever – (Streptobacillus moniliformis; Spirillum minus) Relapsing fever (Borrelia sp.) Rhinovirus Rickettsialpox (Rickettsia akari) Ringworm (Tinea) – (Trichophyton sp., Microsporum sp., Epidermophyton sp.) Ritters Disease – Staphylococcal scalded skin syndrome (SSSS) See Scalded skin syndrome – Ritter’s Disease (Staphylococcus aureus) Rocky Mountain Spotted Fever (Rickettsia rickettsii) Roseola infantum – Human herpes virus 6 Rotavirus Roundworm – Ascariasis (Ascaris spp.) See Ascariasis – Round worm (Ascaris lumbricoides) RSV – Respiratory syncytial virus Rubella – Acquired Rubella – Exposed Susceptible Contact Rubeola – Measles - Known Case See Measles – (Rubeola) – Known Case Rubeola – (Measles) Exposed Susceptible Contact See Measles – (Rubeola) – Exposed Susceptible Contact A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 204 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rabies Clinical Presentation Acute encephalomyelitis Infectious Substances How it is Transmitted Saliva of infected animals Not person-to-person transmission Acquired from saliva or bite of infected animals Corneal, tissue and organ transplantation Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Highly variable, 5 days to several months Not person-to-person transmission Comments • Notify Zone Medical Officer of Health of case by fastest means possible. • Refer to existing policy re: care of body after death • Post-exposure prophylaxis is recommended for percutaneous or mucosal contamination with saliva of rabid animal A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 205 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rash, compatible with scabies – (Ectoparasite) Clinical Presentation Lesions in skin fold, severe itching, dermatitis, scaling Infectious Substances How it is Transmitted Mite Direct Contact Indirect Contact Precautions Needed* Contact Precautions Duration of Precautions If scabies confirmed, until 24 hours of effective therapy has been received Incubation Period Period of Communicability If scabies: If scabies: Until mites and eggs are destroyed by treatment, usually after 1 or 2 courses of treatment, one week apart. Initial infestation: 4 – 6 weeks Reinfestation: 1 – 4 days after re-exposure Comments *Precautions required are in addition to Routine Practices If scabies: • Apply scabicide as directed on label. • Wash clothing and bedding in hot water, dry-clean or seal in plastic bag for 1 week. Close contacts should be treated if confirmed; consult IPC or Zone Medical Officer of Health (MOH) or designate as needed. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 206 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rash, maculopapular – (Suspected Rubeola virus [Measles]) Clinical Presentation Fever and one of coryza, maculopapular skin rash, conjunctivitis, cough Infectious Substances How it is Transmitted Respiratory secretions Airborne Precautions Needed* Airborne Precautions Duration of Precautions If measles confirmed, until 4 days after start of rash in immunocompetent residents or until all symptoms have resolved in immunocompromised residents. Incubation Period Period of Communicability 7 – 18 days If measles confirmed, 5 days before start of rash (1 – 2 days before start of other symptoms) and until 4 days after onset of rash (longer in immunocompromised residents) Comments *Precautions required are in addition to Routine Practices • If measles confirmed: See Measles – (Rubeola) – Known Case A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 207 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rash, petechial or purpuric – (Suspected Neisseria meningitidis) Clinical Presentation Rash (petechial/purpuric) with fever Infectious Substances How it is Transmitted Respiratory secretions Large Droplets Direct Contact Precautions Needed* Droplet Precautions if N. meningitidis suspected, otherwise Routine Practices Duration of Precautions Discontinue if N. meningitidis ruled out, otherwise maintain until 24 hours of effective antimicrobial therapy has been received. Incubation Period Period of Communicability If N. meningitides: Usually 2 – 10 days If N. meningitides: Until 24 hours of effective antimicrobial therapy has been received Comments *Precautions required are in addition to Routine Practices • If Neisseria meningitidis confirmed: See Neisseria meningitidis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 208 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rash, vesicular – (Suspected Varicella virus - Chickenpox) Clinical Presentation Fever, vesicular rash Infectious Substances How it is Transmitted Respiratory secretions Airborne Lesion drainage Direct Contact Indirect Contact Precautions Needed* Airborne and Contact Precautions Duration of Precautions If Chickenpox is confirmed: until all lesions have crusted and dried. Incubation Period Period of Communicability See Chickenpox See Chickenpox Comments *Precautions required are in addition to Routine Practices • If Chickenpox confirmed: See Chickenpox - Known Case (Varicella zoster virus) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 209 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rat-bite fever – (Streptobacillus moniliformis; Spirillum minus) Clinical Presentation Fever, arthralgia Infectious Substances How it is Transmitted Saliva of infected rodents Not person-to-person transmission Contaminated milk Acquired from saliva or bite of infected animals or ingestion of contaminated milk Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 3 – 10 days for Streptobacillus moniliformis Not person-to-person transmission 7 – 21 days for Spirillum minus Comments • Streptobacillus moniliformis: acquired from rats and other animals, contaminated milk • Spirillum minus: acquired from rats, mice only A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 210 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Relapsing fever (Borrelia sp.) Clinical Presentation Fever comes (2 – 7 days duration) and goes (4 – 14 days), transitory petechial rashes Infectious Substances How it is Transmitted Louse, ticks Not person-to-person transmission Acquired by bite of louse or ticks Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 2 – 18 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 211 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rhinovirus Clinical Presentation Respiratory tract infection, common cold Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved For immunocompromised hosts (i.e. oncology, transplant residents), isolation precautions need to be maintained for a longer duration due to prolonged viral shedding. Contact IPC or Zone Medical Officer of Health (MOH) or designate for discontinuation of precautions. Incubation Period Period of Communicability 2 – 3 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • May cohort individuals infected with the same virus. • Resident should not share room with high-risk roommates (e.g. immunosuppressed). • Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR the AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites. If the respiratory viral panel test has a combined Enterovirus-Rhinovirus positive result; manage as for Rhinovirus. • A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 212 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rickettsialpox (Rickettsia akari) Clinical Presentation Fever, rash Infectious Substances How it is Transmitted Mouse mite Not person-to-person transmission Acquired by bite of mouse mite Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 9 – 14 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 213 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Ringworm (Tinea) – (Trichophyton sp., Microsporum sp., Epidermophyton sp.) Clinical Presentation Ringworm(skin, beard, scalp, groin, perineal region); athletes foot; pityriasis versicolor Infectious Substances How it is Transmitted Organism in skin or hair Direct or indirect contact with skin or scalp lesions of infected people/animals; or with shared brushes, combs, barber clippers, clothing, hats, shower stalls, contaminated floors and other articles used by infected people Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 4 – 10 days While lesion(s) are present Comments • While under treatment for Trichophyton, resident should be excluded from swimming pools and activities likely to lead to exposure of others. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 214 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Ritter’s Disease – Staphylococcal scalded skin syndrome (SSSS) See Scalded skin syndrome – Ritter’s Disease (Staphylococcus aureus) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 215 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rocky Mountain Spotted Fever (Rickettsia rickettsii) Clinical Presentation Fever, petechial rash, encephalitis Infectious Substances How it is Transmitted Tick Not person-to-person transmission, except rarely through transfusion Acquired by bite of infected tick Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 2 – 14 days Not person-to-person transmission except rarely through transfusion Comments • Infection in humans is incidental and is acquired most frequently during blood feeding by the infected tick, rarely through transfusion. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 216 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Roseola infantum – Human herpes virus 6 Clinical Presentation Rash, fever Infectious Substances How it is Transmitted Saliva (presumed) Direct contact Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 9 – 10 days Unknown Comments • Transmission requires close direct personal contact A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 217 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rotavirus Clinical Presentation Fever, Vomitting, Diarrhea Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Precautions Needed* Contact Precautions Duration of Precautions Until symptoms have resolved Incubation Period Period of Communicability 1 – 3 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. • Prolonged fecal shedding may occur in immunocompromised residents after diarrhea has ceased; Contact Precautions should be maintained until laboratory results are negative. • For outbreaks: Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR the AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 218 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Roundworm – Ascariasis (Ascaris spp.) See Ascariasis – Roundworm (Ascaris lumbricoides) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 219 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents RSV – Respiratory syncytial virus Clinical Presentation Respiratory tract infection Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until symptoms have resolved For immunocompromised hosts (i.e. oncology, transplant residents), isolation precautions need to be maintained for a longer duration due to prolonged viral shedding. Contact IPC or Zone Medical Officer of Health (MOH) or designate for discontinuation of precautions. Incubation Period Period of Communicability 2 – 8 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • May cohort with others of same confirmed virus. Minimize exposure of immunocompromised residents. • For outbreaks: Refer to the AHS Guidelines for Outbreak Prevention, Control and Management in Acute Care and Facility Living Sites, OR the AHS Guidelines for Outbreak Prevention, Control and Management in Supportive Living and Home Living Sites A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 220 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rubella virus: German measles – Acquired Clinical Presentation Fever, maculopapular rash Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Large Droplets Precautions Needed* Droplet Precautions Duration of Precautions Until 7 days after onset of rash Incubation Period Period of Communicability 14 – 21 days One week before to 7 days after onset of rash, can be contagious up to 14 days after rash appears Comments *Precautions required are in addition to Routine Practices • Defer non-urgent admission if rubella is present. May admit after rash has resolved. • Only immune HCWs, caretakers and visitors should enter the room. If it is essential for a nonimmune person to enter the room, a procedure mask must be worn. • If immunity is unknown, assume person is non-immune • Pregnant staff should not care for residents with rubella, regardless of their immune status. • Droplet Precautions should be maintained for exposed susceptible residents for 7 days after first contact through to 21 days after last contact. • Refer exposed susceptible non-pregnant persons to facility’s workplace health and safety or to Zone Medical Officer of Health or designate for vaccine administration within 3 days of exposure A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 221 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rubella virus (German measles) - Exposed Susceptible Contact Clinical Presentation Susceptible contact. Asymptomatic - may develop Rubella Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Large Droplets Precautions Needed* Droplet Precautions Duration of Precautions Droplet Precautions should be maintained for exposed susceptible residents for 7 days after first contact through to 21 days after last contact. If rubella rash develops: Until 7 days after onset of rash Incubation Period Period of Communicability 14 – 21 days One week before to 7 days after onset of rash; can be contagious up to 14 days after rash appears Comments *Precautions required are in addition to Routine Practices • Defer non-urgent admission if a non-immune person is incubating the disease. • Only immune HCWs, caretakers and visitors should enter the room. If it is essential for a nonimmune person to enter the room, a procedure mask must be worn. • If immunity is unknown, assume person is non-immune • Pregnant staff should not care for residents with rubella, regardless of their immune status. • Refer exposed susceptible non-pregnant persons to facility’s workplace health and safety or to Zone Medical Officer of Health for vaccine administration within 3 days of exposure A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 222 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rubeola – (Measles) – Known Case See Measles – (Rubeola) – Known Case Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 223 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Rubeola – (Measles) - Exposed Susceptible Contact See Measles – (Rubeola) – Exposed Susceptible Contact Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 224 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents S Salmonella (Salmonella sp.) Salmonella spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) SARS – (Severe Acute Respiratory Syndrome; Coronavirus) See Coronavirus – Severe Acute Respiratory Syndrome (SARS-CoV), Middle Eastern Respiratory Syndrome (MERS-CoV) Scabies (Sarcoptes scabiei) Scalded skin syndrome – (Staphylococcus aureus) Scarlet Fever –Streptococcus pyogenes [Group A] See Streptococcus [Group A] (Streptococcus pyogenes) – Scarlet Fever, Pharyngitis Schistosomiasis (Schistosoma sp.) Septic arthritis – (Haemophilus influenza type B [HIB] [possible in non-immune child <5 years of age], Streptococcus [Group A], Staphylococcus aureus, many other bacteria) Serratia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Shigella (Shigella sp.) Shingles: (Herpes zoster) Varicella zoster virus – Disseminated Shingles: (Herpes zoster) Varicella zoster virus –Exposed Susceptible Contact Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host WITH Localized Lesions(1 or 2 dermatomes) Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions(1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Skin Infection – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Cellulitis – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) Smallpox (Variola major virus, Variola minor virus) Sporotrichosis (Sporothrix schenckii) Staphylococcus aureus – MRSA See Methicillin Resistant Staphylococcus aureus (MRSA) Staphylococcus aureus – pneumonia (not MRSA) Staphylococcus aureus – skin infection (not MRSA) Staphylococcus aureus – toxic shock syndrome Stenotrophomonas maltophilia Streptococcus, [Group A] (Streptococcus pyogenes) – Invasive Streptococcus, [Group A] (Streptococcus pyogenes) – Scarlet fever, pharyngitis Streptococcus, [Group A] (Streptococcus pyogenes) Skin Infection Streptococcus pneumoniae Stronglyoidiasis (Stronglyoides stercoralis) Syphilis (Treponema pallidum) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 225 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Salmonella (Salmonella sp.) Clinical Presentation Diarrhea, enteric fever, typhoid fever, food poisoning Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Foodborne Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have resolved and stools are normal Incubation Period Period of Communicability 6 – 72 hours for diarrhea; 3 – 60 days for enteric fever Variable Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. • For Salmonella spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) also see Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 226 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Salmonella spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 227 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents SARS – (Severe Acute Respiratory Syndrome; Coronavirus) See Coronavirus – Severe Acute Respiratory Syndrome (SARS-CoV), Middle Eastern Respiratory Syndrome (MERS-CoV) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 228 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Scabies (Sarcoptes scabiei) Clinical Presentation Lesions in skin fold, severe itching, dermatitis, scaling Infectious Substances How it is Transmitted Mite Direct Contact Indirect Contact Precautions Needed* Contact Precautions Duration of Precautions Until 24 hours of effective therapy has been received Incubation Period Period of Communicability Initial infestation: 2 – 6 weeks Until mites and eggs are destroyed by treatment, usually after 1 or 2 courses of treatment, one week apart. Re-infestation: 1 – 4 days after re-exposure Comments *Precautions required are in addition to Routine Practices • Apply scabicide as directed on label. • Wash clothes and bedding in hot water, dry clean or seal in a plastic bag and store for 1 week. • Close contacts should be treated if confirmed; consult IPC or Zone Medical Officer of Health (MOH) or designate as needed. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 229 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Scalded skin syndrome – Ritter’s Disease (Staphylococcus aureus) Clinical Presentation Painful, rash with thick white/brown flakes Infectious Substances How it is Transmitted Skin exudates/drainage Direct Contact Indirect Contact Precautions Needed* Major drainage not contained: Contact Precautions Minor drainage contained: Routine Practices Duration of Precautions Until drainage has resolved or can be contained Incubation Period Period of Communicability Variable While organism is present in drainage Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 230 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Scarlet Fever –Streptococcus pyogenes [Group A] See Streptococcus [Group A] (Streptococcus pyogenes) – Scarlet Fever, Pharyngitis Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 231 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Schistosomiasis (Schistosoma sp.) Clinical Presentation Diarrhea, fever, itchy rash, Hepatosplenomegaly, hematuria Infectious Substances How it is Transmitted Larvae in contaminated water Not person-to-person transmission Acquired by contact with larvae in contaminated water Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 232 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Septic arthritis – (Haemophilus influenza type B [HIB] [possible in non-immune child <5 years of age], Streptococcus [Group A], Staphylococcus aureus, many other bacteria) Clinical Presentation Inability to move the limb with the infected joint (pseudoparalysis), intense joint pain, joint swelling, joint redness, low fever Infectious Substances How it is Transmitted Respiratory secretions if HIB Direct Contact if HIB Large droplets if HIB Precautions Needed* Adults: Routine Practices Children: Droplet Precautions if HIB, otherwise Routine Practices Duration of Precautions If HIB: Until 24 hours of effective antimicrobial therapy has been received Incubation Period Period of Communicability Not applicable Not applicable Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 233 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Serratia spp. (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) E. coli, Klebsiella spp., Serratia spp., Providencia spp., Proteus spp., Citrobacter spp., Enterobacter spp., Morganella spp., Salmonella spp., Hafnia spp. See Enterobacteriaceae (Multi-Drug Resistant; Carbapenem resistant [CRE]; ESBL or Amp-C producing) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 234 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Shigella (Shigella sp.) Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Feces Direct Contact (fecal/oral) Indirect Contact (fecal/oral) Precautions Needed* Adults: Routine Practices For incontinent residents if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have resolved and stools are normal Incubation Period Period of Communicability 1 – 3 days Usually 4 weeks unless treated Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities • Treatment with effective antibiotic shortens period of infectivity A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 235 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Shingles: (Herpes zoster) Varicella zoster virus – Disseminated Clinical Presentation Vesicular lesions that involve multiple areas (more than 2 dermatomes) with possible visceral complications. Refer to Dermatome Chart Infectious Substances How it is Transmitted Vesicular fluid Respiratory secretions Airborne Direct Contact Indirect Contact (articles freshly soiled by drainage from lesions)* Precautions Needed* Airborne and Contact Precautions Duration of Precautions Until all lesions have crusted and dried Incubation Period Period of Communicability Not applicable Until all lesions have crusted and dried Comments *Precautions required are in addition to Routine Practices • Individuals with known immunity to chicken pox (history of past illness or vaccination with 2 appropriately timed doses of varicella vaccine) are not required to wear the N95 respirator when entering the room. • Susceptible HCWs should not enter the room if immune staff are available. If they must enter the room, an N95 respirator must be worn. Other non-immune persons should not enter except in urgent or compassionate circumstances • If immunity is unknown, assume person is non-immune • Susceptible high-risk contacts should be given VZIG as soon as possible within 96 hours of exposure. Consult Zone Medical Officer of Health or designate for advice. • For susceptible contacts, Airborne Precautions should begin 8 days after first exposure to rash and continue until 21 days after last exposure (28 days if VZIG given). Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours and non-immune to chicken pox, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes, and non-immune to chicken pox wear an N95 respirator A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 236 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Shingles: (Herpes zoster) Varicella zoster virus – Exposed Susceptible Contact** Clinical Presentation **Susceptible contact with exposure to a person with a case of disseminated shingles or to an immunocompromised person with localized shingles. Asymptomatic. May develop chicken pox*** Infectious Substances How it is Transmitted If chicken pox lesions develop then lesion drainage, respiratory secretions Airborne Direct Contact Indirect Contact (articles freshly soiled by drainage from lesions)* Precautions Needed* 8 days after first contact and until 21 days after last contact with person with active disease (or 28 days if given ZVIG): Airborne Precautions. If chickenpox lesions develop: Airborne and Contact Precautions Duration of Precautions From 8 days after first contact until 21 days after last contact (or 28 days if given VZIG). If chicken pox develops – If treated: Until 72 hours of effective anti-viral treatment has been received AND no new lesions AND Existing lesions have crusted and dried. If untreated, Until all lesions have crusted and dried Incubation Period Period of Communicability 10 – 21 days 2 days before rash starts and until all skin lesion have crusted and dried Comments *Precautions required are in addition to Routine Practices • ***Exposure to shingles does not cause shingles. However, a person who has never had chicken pox or was never vaccinated for chicken pox may develop chickenpox if the shingles vesicle fluid comes into contact with their mucous membranes. In the immunocompromised person and persons with disseminated shingles the virus may also be spread by the airborne route. • Susceptible high-risk contacts should receive varicella zoster immunoglobulin as soon as possible, latest within 96 hours of exposure. Consult Zone Medical Officer of Health or designate for advice • Individuals with known immunity to chicken pox (history of past illness or vaccination with 2 appropriately timed doses of varicella vaccine) are not required to wear the N95 respirator when entering the room. • Susceptible HCWs should not enter the room if immune staff are available. If they must enter the room, an N95 respirator must be worn. Other non-immune persons should not enter except in urgent or compassionate circumstances. If immunity is unknown, assume person is non-immune Discharge Settle Time • Non-negative pressure rooms: Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours and non-immune to chicken pox, wear an N95 respirator. • Negative pressure rooms: Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes, and non-immune to chicken pox, wear an N95 respirator. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 237 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host With Localized Lesions (1 or 2 dermatomes) Clinical Presentation Vesicular lesions in a dermatomal distribution. Refer to Dermatome Chart Infectious Substances How it is Transmitted Vesicular fluid, possibly respiratory secretions Airborne Direct Contact Indirect Contact (articles freshly soiled by drainage from lesions)* Precautions Needed* Airborne and Contact Precautions Duration of Precautions Until 24 hours of effective antimicrobial therapy has been received; then as for localized zoster in normal host. Incubation Period Period of Communicability Not applicable Until all lesions have crusted and dried Comments *Precautions required are in addition to Routine Practices • Individuals with known immunity to chicken pox (history of past illness or vaccination with 2 appropriately timed doses of varicella vaccine) are not required to wear the N95 respirator when entering the room. • Susceptible HCWs should not enter the room if immune staff are available. If they must enter the room, an N95 respirator must be worn. Other non-immune persons should not enter except in urgent or compassionate circumstances • If immunity is unknown, assume person is non-immune • Susceptible high-risk contacts should be given VZIG as soon as possible within 96 hours of exposure. Consult Zone Medical Officer of Health or designate for advice. • For susceptible contacts, Airborne Precautions* should begin 8 days after first exposure to rash and continue until 21 days after last exposure (28 days if VZIG given). Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours and non-immune to chicken pox, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes, and non-immune to chicken pox wear an N95 respirator A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 238 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Clinical Presentation Vesicular lesions in a dermatomal distribution. Refer to Dermatome Chart Infectious Substances How it is Transmitted Vesicular fluid Direct Contact Indirect Contact (articles freshly soiled by drainage from lesions)* Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable Until all lesions have crusted and dried Comments *Exercise care when handling dressings, clothing or other materials that may be contaminated with vesicular fluid • Consider Contact Precautions in addition to Routine Practices for cases of extensive localized zoster that cannot be covered. • Consider Airborne and Contact Precautions in addition to Routine Practices for cases of extensive localized zoster that cannot be covered and in situations where there are varicella susceptible residents. • HCWs, roommates and caregivers should be immune to chickenpox A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 239 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Clinical Presentation Vesicular lesions in a dermatomal distribution. Refer to Dermatome Chart Infectious Substances How it is Transmitted Vesicular fluid Direct contact Indirect contact (articles freshly soiled by drainage from lesions)** Precautions Needed* Contact Precautions Duration of Precautions Until all lesions have crusted and dried Incubation Period Period of Communicability Variable Until all lesions have crusted and dried Comments *Precautions required are in addition to Routine Practices **Exercise care when handling materials that may be contaminated with vesicular fluid • Consider Airborne and Contact Precautions* for cases of extensive localized zoster that cannot be covered and in situations where there are varicella susceptible residents. • HCWs, roommates and caregivers should be immune to chickenpox. • Non-immune persons should not enter except in urgent or compassionate circumstances. If immunity is unknown, assume person is non-immune. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 240 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Skin Infection – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Cellulitis – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 241 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Smallpox (Variola major virus, Variola minor virus) Clinical Presentation Fever, vesicular/pustule in appropriate epidemiological context Infectious Substances How it is Transmitted Skin lesion exudate Oropharyngeal secretions Airborne Direct Contact Indirect Contact Precautions Needed* Airborne Precautions and Droplet and Contact Precautions Duration of Precautions Until all scabs have crusted and separated (3 – 4 weeks) Incubation Period Period of Communicability 7 – 17 days From onset of mucosal lesions until all skin lesions have crusted and separated Comments *Precautions required are in addition to Routine Practices • • • • • • May be Bioterrorism related Notify Zone Medical Officer of Health of case by fastest means possible. Refer to your facility’s policy for care of body after death. See Public Health Act – Bodies of Deceased Persons Regulation Immunization of health care workers (HCWs) was stopped in 1977. Care preferably should be provided by immune HCWs; non-vaccinated HCWs should not provide care if immune HCWs are available. N95 respirator required for all staff regardless of vaccination status Discharge Settle Time Non-negative pressure rooms: • Do not admit a new resident into this room for at least 4 hours. If staff must enter room before 4 hours and non-immune to chicken pox, wear an N95 respirator. Negative pressure rooms: • Do not admit a new resident into this room for at least 45 minutes. If staff must enter room before 45 minutes, and non-immune to chicken pox wear an N95 respirator A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 242 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Sporotrichosis (Sporothrix schenckii) Clinical Presentation Skin lesions Infectious Substances How it is Transmitted Spores in contaminated soil, on vegetation Not person-to-person transmission Acquired from spores in soil or vegetation Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 243 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Staphylococcus aureus – MRSA See Methicillin Resistant Staphylococcus aureus (MRSA) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 244 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Staphylococcus aureus – pneumonia (not MRSA) Clinical Presentation Pneumonia Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Large Droplets Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Variable Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 245 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Staphylococcus aureus – skin infection (not MRSA) Clinical Presentation Wound or burn infections, skin infection, furuncles, impetigo, scalded skin syndrome Infectious Substances How it is Transmitted Skin exudates and drainage Direct contact Indirect contact Precautions Needed* Major drainage not contained: Contact Precautions Minor drainage contained: Routine Practices Duration of Precautions Until drainage has resolved or can be contained Incubation Period Period of Communicability Variable While organism present in drainage Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 246 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Staphylococcus aureus – toxic shock syndrome Clinical Presentation High fever, diffuse macular rash, hypotension, multisystem organ involvement Infectious Substances How it is Transmitted Skin exudates and drainage if wounds or skin lesions present Direct Contact Indirect Contact Precautions Needed* If draining wounds or lesions present: Major drainage not contained: Contact Precautions Minor drainage contained: Routine Practices Duration of Precautions Until drainage has resolved or can be contained Incubation Period Period of Communicability Variable Variable Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 247 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Stenotrophomonas maltophilia Clinical Presentation Colonization or infection of respiratory tract Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Indirect Contact Precautions Needed* Routine Practices Contact Precautions for residents with tracheostomies who share a room with residents who are ventilated or with tracheostomies Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown While organism is in respiratory secretions Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 248 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Streptococcus [Group A] (Streptococcus pyogenes) – Invasive disease – iGAS, Toxic Shock Clinical Presentation Toxic shock, invasive disease including: necrotizing fasciitis, myositis, meningitis, pneumonia. Infectious Substances How it is Transmitted Respiratory secretions Direct Contact Infected body fluids Indirect Contact Wound drainage Large Droplets Precautions Needed* Droplet and Contact Precautions Duration of Precautions Until 24 hours of effective antimicrobial therapy has been received Incubation Period Period of Communicability Variable While organism in respiratory secretions, infected body fluids or wound drainage Comments *Precautions required are in addition to Routine Practices • • • • Notify Zone Medical Officer of Health of case by fastest means possible Refer to your facility’s policy for care of body after death. See Public Health Act – Bodies of Deceased Persons Regulation Close contacts of invasive disease may require prophylaxis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 249 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Streptococcus [Group A] (Streptococcus pyogenes) – Scarlet Fever, Pharyngitis Clinical Presentation Scarlet fever, Pharyngitis Infectious Substances How it is Transmitted Respiratory secretions Large Droplets Precautions Needed* Adults: Routine Practices Children: Droplet and Contact Precautions Duration of Precautions Children: Until 24 hours of effective antimicrobial therapy has been received Incubation Period Period of Communicability 2 – 5 days While organism in respiratory secretions, 10 – 21 days if not treated Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 250 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Streptococcus [Group A] – (Streptococcus pyogenes) Skin Infection Clinical Presentation Erysipelas, wound or burn infection, skin infection, impetigo, cellulitis. Infectious Substances How it is Transmitted Drainage, skin exudates Direct Contact Indirect Contact Precautions Needed* Major drainage not contained: Contact Precautions** Minor drainage contained: Routine Practices Duration of Precautions Until 24 hours of effective antimicrobial therapy has been received and drainage has resolved or can be contained Incubation Period Period of Communicability Variable As long as organism is in the exudates or drainage Comments *Precautions required are in addition to Routine Practices ** Droplet and Contact Precautions until 24 hours of effective antimicrobial therapy has been received If invasive group A streptococcal infection suspected A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 251 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Streptococcus pneumoniae Clinical Presentation Pneumonia, meningitis, bacteremia, epiglottitis, Infectious Substances How it is Transmitted Respiratory secretions Large Droplets Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown, infection is thought to be preceded by asymptomatic colonization As long as sufficient numbers of pneumococci are in respiratory secretions Comments • Streptococcus pneumoniae is commonly found in the upper respiratory tract of healthy people and is the most common bacterial cause of community-acquired pneumonia among all ages A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 252 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Stronglyoidiasis (Stronglyoides stercoralis) Clinical Presentation Usually asymptomatic Infectious Substances How it is Transmitted Larvae in feces Penetration of skin by larvae in soil* Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Rarely person-to-person transmission Comments *Although usual route of transmission is through skin contact of contaminated soil, fecal/oral transmission can occur. May cause disseminated disease in immunocompromised resident. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 253 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Syphilis (Treponema pallidum) Clinical Presentation Genital, skin or mucosal lesions, disseminated disease, neurological or cardiac disease, latent infection Infectious Substances How it is Transmitted Genital secretions Mom to newborn or fetus Lesion exudates Sexual contact Direct contact with infectious exudates or lesions Precautions Needed* Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 10 – 90 days When moist mucocutaneous lesions of primary and secondary syphilis are present Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 254 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents T Tapeworm (Taenia saginata, Taenia solium, Diphyllobothrium latum, Hymenolepsis nana) Tetanus (Clostridium tetani) Tinea (Ringworm) – (Trichophyton sp., Microsporum sp., Epidermophyton sp., Malazzezia sp.) See Ringworm (Tinea) – (Trichophyton sp., Microsporum sp., Epidermophyton sp., Malassezia furfur) Toxic shock syndrome – (Streptococcus pyogenes [Group A], Staphylococcus aureus) Toxocariasis (Toxocara canis, Toxocara cati) Toxoplasmosis (Toxoplasma gondii) Trachoma (Chlamydia trachomatis) See Chlamydia (Chlamydia trachomatis) Trench Fever (Bartonella quintana) Trichinosis (Trichinella spiralis) Trichomoniasis (Trichomonas vaginalis) Trichuriasis – Whipworm (Trichuris trichiura) Tuberculosis – non-respiratory or extrapulmonary (Mycobacterium tuberculosis) See Mycobacterium tuberculosis (TB) – extrapulmonary disease or not respiratory Tuberculosis – respiratory or pulmonary (Mycobacterium tuberculosis) See Mycobacterium tuberculosis (TB) – respiratory or pulmonary disease; Tularemia (Francisella tularenis) Typhoid or Paratyphoid fever (Salmonella typhi, Salmonella paratyphi) See Salmonella (Salmonella sp.) Typhus fever (Rickettsia typhi, Rickettsia prowazekii) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 255 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Tapeworm (Taenia saginata, Taenia solium, Diphyllobothrium latum, Hymenolepsis nana) Clinical Presentation Usually asymptomatic Infectious Substances How it is Transmitted Ova in feces Direct Contact with infected feces (fecal/oral) Larvae in food Foodborne (Consumption of larvae in raw or undercooked beef, pork or raw fish) Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable when foodborne, 2 – 4 weeks if contact with feces T. saginata is not direct person-to-person transmission, however T. solium can be. Eggs may be viable in the environment for months. Comments • Larvae develop into adult tapeworms in gastrointestinal tract A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 256 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Tetanus (Clostridium tetani) Clinical Presentation Tetanus Infectious Substances How it is Transmitted Spores in soil Not person-to-person transmission. Fomites contaminated with animal and human feces Tetanus spores are usually introduced through a puncture wound contaminated with soil or feces. Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 2 days to 2 months No person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 257 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Tinea (Ringworm) – (Trichophyton sp., Microsporum sp., Epidermophyton sp., Malassezia sp.) See Ringworm (Tinea) – (Trichophyton sp., Microsporum sp., Epidermophyton sp., Malassezia furfur) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 258 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Toxic shock syndrome – (Streptococcus pyogenes [Group A], Staphylococcus aureus) Clinical Presentation Toxic shock syndrome Infectious Substances How it is Transmitted Wound drainage (if wound or skin lesions present) Direct Contact Indirect Contact Precautions Needed See specific organism Duration of Precautions Dependent on organism Incubation Period Period of Communicability Variable Variable Comments • Notify Zone Medical Officer of Health of case by fastest means possible. • Close contacts of invasive disease may require prophylaxis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 259 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Toxocariasis (Toxocara canis, Toxocara cati) Clinical Presentation Fever, wheeze, rash, eosinophilia Infectious Substances How it is Transmitted Ova in dog or cat feces Not person-to-person transmission Acquired from contact with infected dogs, cats Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 260 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Toxoplasmosis (Toxoplasma gondii) Clinical Presentation Asymptomatic or fever, lymphadenopathy, retinitis, encephalitis in immunocompromised host, congenital infection Infectious Substances How it is Transmitted Oocysts in cat feces, contaminated soil Acquired by contact with infected cat feces or soil contaminated by cats, consumption of raw meat, contaminated raw vegetables or contaminated water Intrauterine transmission from mother-to-fetus Transplantation of stem cells or organs Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 5 – 23 days Not person-to-person transmission except mother to fetus. Oocysts shed by cats become infective 1 – 5 days later and can remain viable in the soil for a year. Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 261 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Trachoma (Chlamydia trachomatis) See Chlamydia (Chlamydia trachomatis) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 262 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Trench Fever (Bartonella quintana) Clinical Presentation Headache, malaise, pain and tender shins, splenomegaly, rash Infectious Substances How it is Transmitted Organism in feces of human body lice Vector borne- by inoculation of the organism in louse feces through a break in the skin Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Not applicable Not person-to-person transmission in the absence of lice Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 263 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Trichinosis (Trichinella spiralis) Clinical Presentation Fever, rash, diarrhea Infectious Substances How it is Transmitted Organism in infected meat Not person-to-person transmission Acquired from consumption of infected meat Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 5 – 45 days Not person-to-person transmission Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 264 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Trichomoniasis (Trichomonas vaginalis) Clinical Presentation Vaginitis, Urethritis Infectious Substances How it is Transmitted Vaginal secretions Sexual contact Urethral discharges Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 4 – 28 As long as organism present in secretions Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 265 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Trichuriasis – Whipworm (Trichuris trichiura) Clinical Presentation Abdominal pain, diarrhea Infectious Substances How it is Transmitted Ova in soil Not person-to-person transmission Acquired from ingestion of contaminated soil or contaminated vegetables Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Unknown Not person-to-person transmission Comments • Ova must hatch in soil to be infective. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 266 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Tuberculosis – Extrapulmonary or Not Respiratory (Mycobacterium tuberculosis) See Mycobacterium tuberculosis (TB) – extrapulmonary disease or not respiratory; (also M. africanum, M. bovis, M. caprae, M. microti, M. pinnipedii) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 267 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Tuberculosis – Respiratory or Pulmonary disease (Mycobacterium tuberculosis) See Mycobacterium tuberculosis (TB) – extrapulmonary disease or not respiratory; (also M. africanum, M. bovis, M. caprae, M. microti, M. pinnipedii) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 268 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Tularemia (Francisella tularenis) Clinical Presentation Fever, lymphadenopathy, pneumonia Infectious Substances How it is Transmitted Organism in infected animals, ticks Not person-to-person transmission Acquired from contact with infected animals Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 1 – 14 days Not person-to-person transmission Comments • May be Bioterrorism related • Notify Zone Medical Officer of Health of case by fastest means possible. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 269 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Typhoid or Paratyphoid fever (Salmonella typhi, Salmonella paratyphi) See Salmonella (Salmonella sp.) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 270 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Typhus fever (Rickettsia typhi, Rickettsia prowazekii) Clinical Presentation Fever, rash Infectious Substances How it is Transmitted Fleas, lice Not person-to-person transmission Acquired from bite of fleas or lice Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 6 – 14 days Not person-to-person transmission Comments • Notify Zone Medical Officer of Health of case by fastest means possible. • Refer to your facility’s policy for care of body after death. • See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 271 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents U Urinary tract infection A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 272 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Urinary tract infection Clinical Presentation Urinary Tract Infection Infectious Substances How it is Transmitted Many bacteria, viruses, fungi See specific organism Precautions Needed* See specific organism, otherwise: Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable Variable Comments *Additional precautions not required unless infection caused by a multi-drug resistant organism or required by a specific organism A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 273 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents V Vancomycin-intermediate Staphylococcus aureus (VISA) Vancomycin-resistant Enterococcus (VRE) Vancomycin-resistant Staphylococcus aureus (VRSA) Varicella zoster virus: Chickenpox – Exposed Susceptible Contact See Chickenpox – Exposed Susceptible Contact (Varicella zoster virus) Varicella zoster virus: Chickenpox – Known Case See Chickenpox – Known Case (Varicella zoster virus) Varicella zoster virus: Herpes zoster (Shingles) – Disseminated See Shingles: (Herpes zoster) Varicella zoster virus – Disseminated Varicella zoster virus: Herpes zoster (Shingles) – Exposed Susceptible Contact See Shingles: (Herpes zoster) Varicella zoster virus – Exposed Susceptible Contact Varicella zoster virus: Herpes zoster (Shingles) – Immunocompromised Host With Localized Lesions(1 or 2 dermatomes) See Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host With Localized lesions (1 or 2 dermatomes) Varicella zoster virus: Herpes zoster (Shingles) – Normal Host With Localized Lesions(1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Varicella zoster virus: Herpes zoster (Shingles) – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Vibrio parahaemolyticus Enteritis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 274 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Vancomycin-intermediate Staphylococcus aureus (VISA) Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected skin, secretions or excretions Direct Contact Indirect Contact Large Droplets if symptoms of acute respiratory tract infection Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change Additional precautions for ARO positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for ARO positive resident Incubation Period Period of Communicability Variable While organism is present in secretions or excretions Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 275 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Vancomycin-resistant Enterococcus (VRE) Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected skin, secretions or excretions Direct Contact Indirect Contact Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change Additional precautions for ARO positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for ARO positive resident Incubation Period Period of Communicability Variable While organism is present in secretions orexcretions Comments *Precautions required are in addition to Routine Practices • Enterococcus persists in the environment, ensure thorough cleaning of the resident’s environment particularly toileting equipment, e.g. commodes, toilet grab rails. Careful discharge cleaning is required. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 276 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Vancomycin-resistant Staphylococcus aureus (VRSA) Clinical Presentation Colonization or infection of any body site Infectious Substances How it is Transmitted Colonized or infected skin, secretions or excretions Direct Contact Indirect Contact Large Droplets if symptoms of acute respiratory tract infection Precautions Needed* See Additional Precautions for ARO Positive Residents in Continuing Care information sheet Duration of Precautions Residents must be reassessed regularly and as conditions and behaviours change Additional precautions for ARO positive residents in continuing care may be discontinued when resident is cooperative with hygiene practices and drainage and body fluids are contained. If needed, consult IPC or Zone Medical Officer of Health (MOH) or designate for assistance determining when to discontinue additional precautions for ARO positive resident Incubation Period Period of Communicability Variable While organism is present in secretions or excretions Comments *Precautions required are in addition to Routine Practices A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 277 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Varicella zoster virus: Chickenpox – Exposed Susceptible Contact See Chickenpox – Exposed Susceptible Contact (Varicella zoster virus) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 278 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Varicella zoster virus: Chickenpox – Known Case See Chickenpox – Known Case (Varicella zoster virus) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 279 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Varicella zoster virus: Herpes zoster (Shingles) – Disseminated See Shingles: (Herpes zoster) Varicella zoster virus – Disseminated Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 280 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Varicella zoster virus: Herpes zoster (Shingles) – Exposed Susceptible Contact See Shingles: (Herpes zoster) Varicella zoster virus – Exposed Susceptible Contact Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 281 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Varicella zoster virus: Herpes zoster (Shingles) – Immunocompromised Host With Localized Lesions (1 or 2 dermatomes) See Shingles: (Herpes zoster) Varicella zoster virus – Immunocompromised Host With Localized Lesions (1 or 2 dermatomes) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 282 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Varicella zoster virus: Herpes zoster (Shingles) – Normal Host With Localized Lesions(1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CAN be covered with dressings or clothing Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 283 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Varicella zoster virus: Herpes zoster (Shingles) – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing See Shingles: (Herpes zoster) Varicella zoster virus – Normal Host With Localized Lesions (1 or 2 dermatomes) AND lesions that CANNOT be covered with dressings or clothing Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 284 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Vibrio parahaemolyticus Enteritis Clinical Presentation Diarrhea, food poisoning Infectious Substances How it is Transmitted Contaminated food, particularly seafood Not person-to-person transmission Foodborne Precautions Needed Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment: Contact Precautions Duration of Precautions Not applicable Incubation Period Period of Communicability 4 – 30 hours Not person-to-person transmission Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 285 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents W West Nile (West Nile Virus) Western Equine Encephalitis Whipworm (Trichuris trichiura) See Trichuriasis – Whipworm (Trichuris trichiura) Whooping cough – Pertussis (Bordetella pertussis) See Pertussis – Whooping Cough (Bordetella pertussis) Wound infection – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 286 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents West Nile (West Nile Virus) Clinical Presentation Sudden onset fever, headache, muscle pain and weakness, abdominal pain, nausea, vomiting and diarrhea, may have rash Infectious Substances How it is Transmitted Culex mosquito Vector borne: Mosquito bite Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability Variable, usually 3 – 21 days Not person-to-person transmission except rarely by blood transfusion or organ transplantation, and extremely rarely by breast milk or transplacentally Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 287 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Western Equine Encephalitis Clinical Presentation Fever, encephalomyelitis Infectious Substances How it is Transmitted Aedes and Culex mosquito Not person-to-person transmission Vector borne: Mosquito bite Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 5 – 15 days Not person-to-person transmission Comments • Virus found in birds, bats, and possible rodents A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 288 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Whipworm (Trichuris trichiura) See Trichuriasis – Whipworm (Trichuris trichiura) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 289 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Whooping cough – Pertussis (Bordetella pertussis) See Pertussis – Whooping Cough (Bordetella pertussis) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 290 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Wound infection – (Staphylococcus aureus, Streptococcus [Group A], many other bacteria) See Draining Wounds Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed* Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 291 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents X No organisms at this time A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 292 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Y Yaws (Treponema pallidum) Yellow Fever Yersinia enterocolitica; Yersinia pseudotuberculosis A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 293 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Yaws (Treponema pallidum) Clinical Presentation Cutaneous lesions, late stage destructive lesions of skin and bone Infectious Substances How it is Transmitted Exudates from skin lesions Direct contact Indirect contact Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 2 weeks to 3 months Variable Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 294 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Yellow Fever Clinical Presentation Sudden fever, chills, headache, back and muscle aches, nausea, vomiting, prostration Infectious Substances How it is Transmitted Infected mosquitoes Not person-to-person transmission Vector borne: Mosquito bite Precautions Needed Routine Practices Duration of Precautions Not applicable Incubation Period Period of Communicability 3 – 6 days Not person-to-person transmission Comments • Refer to your facility’s policy for care of body after death. • See Public Health Act – Bodies of Deceased Persons Regulation A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 295 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Yersinia enterocolitica; Yersinia pseudotuberculosis Clinical Presentation Diarrhea Infectious Substances How it is Transmitted Feces Direct Contact Indirect Contact Foodborne Precautions Needed* Adults: Routine Practices For incontinent residents, if stool cannot be contained or for residents with poor hygiene who soil the environment Contact Precautions Children: Contact Precautions Duration of Precautions Until symptoms have been resolved for at least 48 hours and stools are normal Incubation Period Period of Communicability 1 – 14 days Until symptoms have resolved Comments *Precautions required are in addition to Routine Practices • Symptomatic residents must not participate in food handling activities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 296 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Z Zygomycosis (Phycomycosis, Mucormycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) See Mucormycosis (phycomycosis, zygomycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 297 IPC Diseases and Conditions Table: Recommendations for Management of Continuing Care Residents Zygomycosis (Phycomycosis, Mucormycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) See Mucormycosis (phycomycosis, zygomycosis) – (Mucor sp., Zygomycetes sp., Rhizopus sp.) Clinical Presentation Infectious Substances How it is Transmitted Precautions Needed Duration of Precautions Incubation Period Period of Communicability Comments A B C D E F G H I J K L M N O P Q R S T U V W X Y Z HOME 298