Infection Control Management of Infectious Diseases Summary Table

Version 2.8 (November 2020)

Table of Content

Scope ...... 1

Contact Precautions ...... 2

Droplet Precautions ...... 2

Airborne Precautions ...... 2

Cleaning...... 3

References ...... 4

Table: List of Diseases ...... 6

Appendix: Priority guide for allocation of isolation rooms &/or cohorting ...... 32

Version control and changes history Version Date from Date to Amendment 2.8 27/11/2020 Current Minor updates & URL references 2.7 2/12/2019 27/11/2020 Minor updates 2.6 5/04/2019 2/12/2019 Minor updates 2.5 10/02/2017 5/04/2019 Minor updates 2.4 22/06/2016 03/01/2017 Minor updates 2.3 2/10/2015 22/06/2016 Appendix added 2.2 30/06/2015 2/10/2015 Minor updates 2.1 31/01/2014 30/06/2015 Update URL references 2.0 27/06/2013 31/01/2014 Update references 1.0 27/07/2013 27/06/2013 Original version

Management of Infectious Diseases – Version 2.8 (November 2020) Page 1

Scope This document is designed to provide information regarding the management of patients with specified infectious diseases. The Infection Control Management of Infectious Diseases table is intended as an informational guide only.

Standard precautions (SP) must be applied when caring for any patient regardless of their infectious disease status. Transmission-based precautions are applied in addition to standard precautions and include the following:

Contact Precautions > Transmission occurs by either direct or indirect contact > Direct: involves close contact with a colonised / infected patient with transfer of the organism to the susceptible host, usually in the course of patient care activities e.g. turning a patient.

> Indirect: occurs if an infectious agent is transferred via a contaminated intermediate object (fomite) or person e.g. when contaminated patient-care devices are shared between patients without cleaning and / or disinfection between patients.

Droplet Precautions > Transmission occurs through large (i.e. >5 microns in size) respiratory droplets that are generated by an infected person who is coughing, sneezing or talking. The droplets do not remain suspended in the air and are propelled a short distance from the source (approximately 1 metre). There is also the potential for indirect contact transmission as the droplets settle on environmental surfaces.

Airborne Precautions > Transmission occurs by small (i.e. <5microns) respiratory droplets which are carried through the air. The droplets can remain suspended in the air for long periods and can be dispersed by air currents.

Applying Standard & Transmission-based precautions using risk based principles When a disease is unknown, a symptom based approach will reduce the risk of transmission to the health care worker and to other patients. Refer to examples below:

Symptom Management Vomiting &/or diarrhoea Isolate patient at least until causative agent is known – refer to:

Isolation section > Contact precautions (gloves, gown/apron, face protection if vomiting [fluid resistant surgical mask & eye shield]) > Obtain faecal specimen as soon as possible

Fever, cough, sore throat, Isolate patient at least until causative agent is known - refer to: croup Isolation section > Droplet precautions (fluid resistant surgical mask) > Obtain a swab from the back of nose or throat

Management of Infectious Diseases – Version 2.8 (November 2020) Page 2

Isolation Isolation includes a single room with ensuite or dedicated bathroom facilities. The use of a commode is useful when dedicated bathroom facilities cannot be made available. However, a commode should only be used in a single room.

Cohorting This term applies to the practice of grouping patients infected or colonised with the same infectious agent together to confine their care to one area and prevent contact with susceptible patients (cohorting patients). During outbreaks, healthcare workers may be assigned to a cohort of patients to further limit opportunities for transmission (cohorting staff).

Cleaning Standard clean (i.e. detergent & water) – this is required in all areas for those diseases requiring standard precautions as listed in the table. (Bathroom/toilet areas require detergent/disinfectant). (Referred to as A in table) Transmission-based precaution clean (i.e. detergent & disinfectant) – is required in all areas (including all bathroom/toilet areas) for diseases requiring transmission-based precautions as listed in the table. (Referred to as B in table) For further information refer to SA Health Cleaning Standard for Healthcare Facilities, December 2014

Management of Infectious Diseases – Version 2.8 (November 2020) Page 3

References 1. Australian Government Department of Health. 2013. Infection Control Guidelines – Creutzfeldt- Jakob Disease. http://www.health.gov.au/internet/main/publishing.nsf/Content/icg-guidelines- index.htm

2. Australian Immunisation Handbook, Australian Government Department of Health, Canberra, 2019. Available from: https://immunisationhandbook.health.gov.au/

3. Department for Health and Wellbeing, Government of South Australia. 2018. SA Health Cleaning Standards for Healthcare Facilities Policy Directive. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinica l+resources/clinical+programs+and+practice+guidelines/infection+and+injury+management/healt hcare+associated+infections/prevention+and+management+of+infections+in+healthcare+setting s/environmental+hygiene+in+healthcare

4. Department for Health and Wellbeing, Government of South Australia. 2012. Scabies management in care facilities. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/public+healt h/pest+management/scabies+management+in+care+facilities

5. Department for Health and Wellbeing. Government of South Australia. You’ve Got What? Prevention and control of notifiable and other infectious diseases in children and adults. 4th ed. Government of South Australia. 2009. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/healt hy+living/protecting+your+health/preventing+disease+and+infection/youve+got+what/youve+got +what

6. Heymann DL. Editor. Control of Communicable Diseases Manual. 20th ed. Washington DC American Public Health Association 2015

7. National Health and Medical Research Council. 2019. Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia. Available from: https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention- and-control-infection-healthcare-2019

8. South Australian Public Health Act, 2011. Available from: http://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Abou t+us/Legislation/Public+Health+Act/Public+Health+Act

Management of Infectious Diseases – Version 2.8 (November 2020) Page 4

9. Stuart RL. ASID/AICA Position statement – Infection control guidelines for patients with Clostridium difficile infection in healthcare settings. Healthcare Infect 2011. (16):33-9. Available from: http://www.publish.csiro.au/?act=view_file&file_id=HI11011.pdf

10. CDNA Ebola Virus Disease (EVD) National Guidelines for Public Health Units Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola- Information-for-Health-Professionals

11. Centers of Disease Control and Prevention (CDC) Infection prevention and control for Candida auris. Available from https://www.cdc.gov/fungal/candida-auris/c-auris-infection- control.html

12. Victorian Health Candida auris disease information and advice. Available from https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information- advice/candida-auris

Management of Infectious Diseases – Version 2.8 (November 2020) Page 5

Table: List of Diseases

Management of Infectious Diseases – Diseases Infectious of Management Type of PPE & Environmental Control Required for ListTable: of Diseases Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Transmission Gloves Droplet Infectious Diseases Contact Comments Airborne Route Standard Door Sign Door Door Shut Door Respirator Eye Shield Single Room Single Surgical Mask Cleaning Cleaning (N95) (N95) Notifiable Notifiable

Negative Pressure P2

Acinetobacter baumannii > If Carbapenem resistant  No A refer to MRO section.

Version 2. Version Anthrax - Inoculation or Bacillus anthracis inhalation; person (cutaneous or pulmonary) to person  Yes A transmission is 8

( rare. Nove Aspergillosis – Inhalation; not 20 ) 20 mber Aspergillus species person to person  No A transmitted. Botulism Ingestion: not transmitted person  Yes A to person. Bronchiolitis Contact with > Bronchiolitis is (caused by either viral or respiratory infectious in the first few bacterial infection) secretions. days of the illness.       *  # B > Restrict visitors under # notification depends on the age of 5 years. causative agent * if <1 metre. Page Page 6

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids. 6

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Brucellosis – Inoculation; Brucella species ingestion; person –



Version 2.8 (November 2020) (November 2.8 Version to person Yes A transmission rare (sexual). Candida infections – Usually Candida species endogenous. (thrush) – excluding  No A Candida auris (see relevant section) Candida auris (colonised Refer to Multi-resistant Organisms (MRO) or infected)

Carbapenem resistant Refer to Multi-resistant Organisms (MRO) GNBs (including CRE) Page Page 7 For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 7

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Chickenpox – Contact, airborne. > Duration of precautions Varicella-zoster virus until all lesions are dry –

Version 2.8 (November 2020) (November 2.8 Version (VZV) & crusted. > Regardless of immune status a P2/N95 mask must be worn          Yes B > Note: VZV in CSF It is preferable that requires standard non-immune staff precautions only should not care for patient. Post exposure prophylaxis for HCWs recommended.

Chlamydia trachomatis Chlamydia trachomatis Conjunctivitis Contact with  No A infected eye

secretions.

Genital Sexual  Yes A transmitted.

Pneumonia Infants <3 months  No A (vertical). Page Page 8 For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 8

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Cholera Ingestion of food > Consider patient to be and/or water infectious until at least –

Version 2.8 (November 2020) (November 2.8 Version contaminated with 24 hours after cessation      Yes B human faeces. of symptoms; precautions can then cease. Clostridium difficile Faecal / oral. > Consider patient to be Also known as infectious until at least 24 hours after cessation Clostridioides difficile of symptoms. Precautions can then cease. > Soap and water is

     B No preferable for hand hygiene, however ABHR may be used when gloves have been worn. > Ensuite bathroom is required Page Page 9 For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 9

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Conjunctivitis Contact with - Bacterial infected eye  – A

Version 2.8 (November 2020) (November 2.8 Version (includes gonococcal) secretions. > Viral cause most

No common. Highly - Viral contagious, causing      B (Adenovirus, enterovirus, outbreaks in eye clinics, coxsackie virus A24) paediatrics & neonate settings. Creutzfeldt-Jakob Iatrogenic: surgical Disease (CJD) instruments CNS, grafts, hormones. > Refer to National CJD  Yes A zoonotic (vCJD): Guidelines.

not transmitted person to person. Cryptosporidium Ingestion of > Consider patient to be contaminated food infectious until at least & water; contact 24 hours after cessation      Yes B transmission from of symptoms. infected animals. Precautions can then cease. Page Page 10

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 10

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Cytomegalovirus – > Pregnant HCW at CMV particular risk and may – 4

Version 2.8 (November 2020) (November 2.8 Version require testing. Refer  No A to National IC Guidelines – section C2.4. Dengue fever Vector transmission by  Yes A mosquitoes. Diarrhoea Faecal /oral. > Consider patient to be (gastroenteritis) infectious until at least - bacterial & parasitic 24 hours after cessation e.g. Campylobacter, of symptoms.      Salmonella, Giardia & Yes B Precautions can then Shiga Toxin Producing cease. Escherichia coli (STEC) > Ensuite bathroom is required Page Page 11

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 11

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Diarrhoea Faecal /oral & > Consider infectious until (gastroenteritis) vomit/faecal

– at least 24 hours after

Version 2.8 (November 2020) (November 2.8 Version - viral aerosols. cessation of symptoms. e.g. rotavirus, norovirus Precautions can then cease. Yes > Soap and water is

preferable for hand )       * ** B hygiene, however ABHR may be used if gloves have been worn. (rotavirus ** Surgical mask > Ensuite bathroom is necessary if actively required vomiting &/or having diarrhoea. If <1 metre. * Diphtheria – Corynebacterium > Duration of precautions diphtheriae until antimicrobial      treatment ceased and - Cutaneous Lesion exudate. Yes B culture negative.

    * if <1 metre. Page Page - Pharyngeal Respiratory * Yes B secretions. 12

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 12

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Extended-spectrum beta- lactamase producers Refer to Multi-resistant Organisms (MRO) –

Version 2.8 (November 2020) (November 2.8 Version (ESBL)

Fungal infections – Direct skin contact Dermatophytosis (with humans or animals) or (Ringworm, tinea,  No A athlete’s foot) indirectly from contaminated floors or soil. German Measles Respiratory (Rubella) secretions. > Infectious until 7 days after onset of rash. # if unavoidable contact > Non-immune pregnant is required by staff who    # Yes B staff should not attend are not immune or their * patient. immune status is unknown a surgical mask * If <1 metre. must be worn

Glandular fever – Contact with Epstein-Barr Virus (EBV), saliva.  No A infectious mononucleosis Page Page 13

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 13

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Hand, foot & mouth Contact with fluid disease - in blisters or        No B If <1 metre.

– * *

Version 2.8 (November 2020) (November 2.8 Version Coxsackie virus faeces.

Haemophilus influenzae Direct or indirect > Can cease precautions (type b) contact with after 24-48 hours of Meningitis, bacteraemia airborne droplets effective antibiotic from nose &     # B * treatment. throat. # All H.influenzae - * If <1 metre. invasive disease only Haemophilus influenzae Direct or indirect > Patient is infectious until (type b) contact with 24-48 hours of effective Pneumonia in airborne droplets antibiotic treatment. from nose & If <1 metre. - Children throat.      Yes B * * - Adults  Yes A (Consequences of transmission in adults are not profound). Page Page 14

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 14

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Hepatitis A Faecal /oral. Duration of precautions:

– > Adults – for 7 days

Version 2.8 (November 2020) (November 2.8 Version after onset of jaundice. > Children <3 years – for duration of

hospitalisation.

     Yes B > Immunise high risk;

# provide vaccine or normal human # Ensuite bathroom immunoglobulin (NHIG) post-exposure as

recommended by Communicable Disease

Control Branch. Hepatitis B, C & D Blood-borne. > Immunise & test all HCW (Hepatitis B).  Yes A > Occupational exposure protocol for blood-borne viruses. Page Page 15

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 15

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Hepatitis E Faecal / oral. > Period of communicability –

Version 2.8 (November 2020) (November 2.8 Version unknown, probably at      Yes B least 14 days after onset of jaundice. > Ensuite bathroom is required. Herpes simplex virus HSV1 - contact infection (HSV 1 or 2) with saliva.  No A Skin, oral, genital or HSV2 – usually by encephalitis sexual contact Herpes simplex virus Contact with fluid > Duration of precautions

- Disseminated from lesions or until all lesions are dry contaminated and crusted. - Severe      No B fomites / > Immune-compromised - Neonatal environment. staff should not care for patients.

Page Page 16

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 16

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Human Blood-borne. > Occupational exposure Immunodeficiency protocol for blood-borne –

Version 2.8 (November 2020) (November 2.8 Version Virus viruses. (HIV/AIDS)  Yes A > HIV infection is notifiable. AIDS is no longer a notifiable condition. Human Contact with nasal > Precautions for duration Metapneumovirus & respiratory of illness. secretions. > Patient to wear surgical       *  No B mask when outside of room.

*if <1 metre.

Impetigo Contact with sores > Patient is infectious as (School sores) or indirectly with long as there is contaminated discharge from the clothing. sores or until 24 hours      No B after effective antibiotic treatment. > Cover sores with water- tight dressing. Page Page 17

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 17

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Influenza Contact with > Annual immunisation of (i.e. A, B, including droplets from nose staff recommended. –

Version 2.8 (November 2020) (November 2.8 Version pandemic) or mouth or > Patient is infectious for indirectly from 3-5 days after onset of contaminated symptoms (longer in fomites / 2 children). environment.       *  # Yes B > Patients to wear surgical mask when outside of room * If <1 metre # When performing aerosol generating

procedures (AGP) Legionellosis Legionella longbeachae Inhalation of Yes A

contaminated soil  & potting mix. > Not transmitted person Yes A to person. Legionella pneumophila Inhalation of aerosolised  contaminated water. Page Page 18

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 18

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Leprosy – Possible close contact with – M. leprae  Yes A

Version 2.8 (November 2020) (November 2.8 Version respiratory & nasal secretions. Leptospirosis - Inhalation or Leptospira species contact of skin or mucous membranes with > Person to person water, moist soil or  Yes A transmission is rare. vegetation contaminated with urine of infected animals.

Lice (hair & body) – Close person to > Patient is infective until pediculosis person contact. 24 hours of effective treatment.

> Repeat treatment after - Head      No A 7 days.  Body > For further information refer to National IC Guidelines – section B5.2. Page Page 19

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 19

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Linezolid-resistant enterococci Refer to Multi-resistant Organisms (MRO) –

Version 2.8 (November 2020) (November 2.8 Version (LRE) Linezolid-resistant vancomycin-resistant enterococci Refer to Multi-resistant Organisms (MRO) (LRVRE) Listeriosis - Ingestion of > Person to person Listeria monocytogenes contaminated transmission is rare, food.  Yes A except for vertical transmission from mother to foetus.

Malaria Vector > Not transmitted person transmission by  Yes A to person. mosquitos. Page Page 20

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 20

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Measles Inhalation of > Regardless of (Rubeola virus) respiratory immune status a –

Version 2.8 (November 2020) (November 2.8 Version secretions. P2/N95 mask must be worn

> It is preferable that       Yes B non-immune staff should not care for patient.. > Duration of precautions for 4 days after the rash appears.

Melioidosis – Inoculation, Burkholderia inhalation of > Not transmitted person  No A pseudomallei contaminated soil to person. or water. Meningococcal Close contact with > Patient is infectious until Infection - Neisseria respiratory 24 hours after effective meningitidis droplets. antibiotic treatment.

    Yes B > Post exposure * prophylaxis where required. Page Page *if <1 metre. 21

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 21

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Methicillin resistant Staphylococcus aureus Refer to Multi-resistant Organisms (MRO) –

Version 2.8 (November 2020) (November 2.8 Version (MRSA) Middle East Respiratory Close contact with > Uncertain, consider Syndrome (MERS-CoV) respiratory infectious for duration of droplets, possibly illness        *   Yes B inhalation of respiratory > *N95/P2 mask must be secretions worn (fit tested). Molluscum Direct skin to skin Contagiosium – contact where skin > Common skin infection,  molluscipoxvirus is broken. No A especially amongst children.

Page Page 22

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 22

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Multi-resistant Contact with Organisms (MRO) contaminated skin –

Version 2.8 (November 2020) (November 2.8 Version includes: or secretions, * A surgical mask should MRSA, VRE, LRE, HCW hands, environment. be worn if patient is LRVRE, MRGNs and coughing & MRO is Candida auris - identified in sputum. - Multi-resistant Pseudomonas aeruginosa # Ensuite bathroom for  Candida auris, VRE, - Carbapenem resistant     No B GNBs # * LRE, LRVRE and all - ESBL-producers^ MRGNs especially if faecally incontinent

(other uncommon resistant organisms ^ Review requirement for include vancomycin contact precautions intermediate/resistant once all indwelling S. aureus, metallo-beta devices are removed lactamase producers and all antibiotics and Candida auris). ceased Page Page 23

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 23

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Mumps Contact with (infectious parotitis) droplets from nose > Patient is infectious until –

Version 2.8 (November 2020) (November 2.8 Version or mouth; OR 5 days after the onset of indirectly from throat swelling # if unavoidable contact contaminated is required by staff who > Non-immune staff fomites /       * # Yes B are not immune or their should avoid caring environment. immune status is for the patient. unknown a surgical mask if <1 metre. must be worn *

Mycobacteria – Inoculation, e.g.M. avium, M. kansasii inhalation. (non-TB atypical Contaminated > Not transmitted person  Yes A Mycobacteria) environment e.g. to person. soil, milk, water.

Page Page 24

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 24

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Mycobacterium Inhalation of # Precautions required tuberculosis (TB) airborne, until x3 negative sputum

–

smears.

Version 2.8 (November 2020) (November 2.8 Version aerosolised - Pulmonary (or       Yes B droplet nuclei. # Patients to wear laryngeal) # surgical mask when outside of room. - Extra-pulmonary,  * Yes A *P2 (N95) mask must be draining lesion* used when performing wound care due to possible aerosolisation of exudate.

Mycoplasma Respiratory     No B If <1 metre. pneumoniae secretions. * * Parainfluenza Respiratory > Precautions required for secretions. duration of illness. > Patients to wear    *  No B surgical mask when outside of room. * If <1 metre. Page Page 25

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 25

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Parvovirus B19 - Initially transmitted (Fifth disease, slapped by droplets > Immuno-compromised –

Version 2.8 (November 2020) (November 2.8 Version cheek/face, Erythema however, in most people may be  No A infectiosum) cases not infectious for long infectious once the periods. rash appears. Pneumococcal Respiratory pneumonia droplets. > Use droplet precautions if evidence of Streptococcus  # A pneumonia transmission within a facility. # invasive infections only Poliomyelitis Faecal / oral. > HCW should be

vaccinated if have not had childhood       Yes B vaccinations; > Non-immune staff should not care for patient. Psittacosis / Ornithosis Inhalation of > Not transmitted person -Chlamydophila psittaci infected bird  Yes A to person. droppings. Pseudomonas Contact. > Standard precautions Page Page infections  No A apply unless multi- resistant. 26

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 26

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Pseudomonas aeruginosa

– Refer to Multi-resistant Organisms (MRO)

Version 2.8 (November 2020) (November 2.8 Version Multi-resistant (MRGN) Q fever – Inhalation infected > Not transmitted person Coxiella burnetii animal tissue or  Yes A to person (rarely by contaminated soil, sexual contact). dust. Rabies / Australian Bat Transmitted by  Yes A Lyssavirus animal bites Respiratory Syncytial Respiratory        No B If <1 metre. Virus (RSV) secretions. * * Rhinovirus Respiratory > Droplet precautions

(common cold) secretions. will be required in paediatric & high risk patient areas e.g.   No A * haematology / oncology. * If <1 metre.

Roseola infantum – Transmission exanthum subitum, thought to be via  No A

Page Page human herpes virus 6 oral secretions; low infectivity. 27

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 27

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Ross river virus Vector > Not transmitted person transmission by  Yes A – to person.

Version 2.8 (November 2020) (November 2.8 Version mosquitoes. Rubella Refer to German measles Scabies Skin to skin > Patient is infectious until contact or from 24 hours after effective infested fomites. treatment has been administered.      No B > Refer to Scabies Management in care facilities, 2012 for management of Crusted

Scabies Severe acute respiratory Inhalation or > Infectious for duration of syndrome (SARS) contact with illness, plus 10 days respiratory after resolution of fever secretions, urine provided respiratory or faeces.           Yes B symptoms are absent or improving. > N95/P2 mask must be worn (fit tested). Page Page 28

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 28

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Shingles Contact with fluid > Duration of precautions (Herpes zoster) from lesions or until all lesions are dry –

Version 2.8 (November 2020) (November 2.8 Version Varicella zoster virus contaminated and crusted. fomites / - Localised      Yes B > Direct contact with environment. blister fluid can cause - Disseminated          Yes B chickenpox in a non- immune person. > Post exposure prophylaxis in high-risk cases of late pregnancy. > Staff not immune to Chickenpox should

not care for patient. Staphylococcus Contact. > Standard precautions infections  No A apply unless multi- (skin, wound, pneumonia) resistant (MRSA)

Page Page 29

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 29

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Streptococcal Contact with infections - Group A respiratory

–

Version 2.8 (November 2020) (November 2.8 Version droplets. - in minor wounds, minor  burns, endometritis > Infectious until 24 hours (purpural sepsis) after effective antibiotic treatment. in major wounds or        No B burns * * If <1 metre. Scarlet fever or pharyngitis in infants &    *  B young children Streptococcal Vertical (mother to infections - Group B baby).  No A (neonatal) Streptococcus Refer to Pneumococcal pneumonia pneumoniae Syphilis Sexual or vertical (mother to baby)  Yes A transmission. Tetanus Inoculation from > Not transmitted person contaminated  Yes A to person. environment. Page Page Tinea See fungal infections 30

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 30

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Toxoplasmosis Ingestion of > Rarely transmitted contaminated person to person –

Version 2.8 (November 2020) (November 2.8 Version food.  No A > Vertical (mother to baby) or blood transfusion. Trachoma Contact with Chlamydia trachomatis infected eye  No A secretions. Trichomoniasis Sexually  No A Trichomonas vaginalis transmitted.

Tuberculosis Refer to Mycobacterium tuberculosis

Typhoid fever Ingestion of > Infectious (faecal-oral Salmonella Typhi contaminated food      Yes B route) for duration of and water. illness. Vancomycin-resistant Refer to Multi-resistant Organisms (MRO) enterococci (VRE) Varicella Zoster Virus See Chickenpox Vibrio Ingestion of parahaemolyticus contaminated food  (shellfish) and Page Page water. 31

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 31

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Viral haemorrhagic fevers (VHF) –

Version 2.8 (November 2020) (November 2.8 Version Crimean-Congo, Ebola, Blood or body          Marburg substance Yes B (mucosal, parenteral) Lassa fever Aerosols          Viral meningitis Respiratory # Contact & droplet secretions or  # # # # # # # precautions if patient faeces has respiratory, gastrointestinal or rash symptoms

Whooping Cough Respiratory > Infectious until 5 days (Pertussis) droplets. after effective antibiotic treatment. > If no treatment initiated,    *  Yes B then patient is infectious for 21 days from onset of cough. * If <1 metre. Page Page 32

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 32

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

Management of Infectious Diseases Diseases Infectious of Management Type of PPE & Environmental Control Required for Precautions Transmission-based Precautions

A / B

Yes / No – Gown

Negative Pressure P2

Worms – Ingested; can be Echinococcosis person to person –



Version 2.8 (November 2020) (November 2.8 Version (tapeworm) or transmitted due to No A Enterobiasis (pinworm, poor hygiene. threadworm) Zika virus Transmitted by > Vertical transmission specific from mother to baby mosquitoes; during pregnancy or maternal or delivery.  Yes A sexual. > Sexual transmission from infected males to sexual partners is possible.

Page Page 33

For diseases requiring Standard Precautions - gloves, gown/apron, face and eye protection MUST be worn if there is a risk of contact with ANY body fluids 33

Cleaning A - Standard Clean (i.e. detergent & water) Cleaning B - Transmission-based Precaution Clean (i.e. detergent & disinfectant)

For more information

Infection Control Service Communicable Disease Control Branch Telephone: 1300 232 272 www.sahealth.sa.gov.au/infectionprevention OFFICIAL-I1-A2

© Department for Health and Wellbeing, Government of South Australia. All rights reserved Appendix: Infectious disease priority guide for allocation of isolation rooms &/or cohorting On suspicion of, or proven disease, the following guidance will assist with single room allocation & bed management

Highest priority Medium priority Lowest priority Special situations Airborne & droplet infections

• Pandemic influenza • Chickenpox/disseminated • *Clostridium difficile Prioritise as follows: • SARS / MERS shingles • *Diarrhoea / vomiting 4 • Shingles • Viral haemorrhagic fevers • Measles • Influenza-like illness • MRSA (VHF) • Pulmonary tuberculosis • Pertussis 5 • ESBL • Respiratory viral infections • VRE 7 (e.g. influenza, RSV) Negative pressure room Pre-arrange accommodation NOT to wait in common area or Single room or with other patients Single room with ensuite Single room or DO NOT COHORT DOOR CLOSED or Cohort after consultation with 6 Cohort with dedicated IP&C Negative pressure single room bathroom facilities after 6 CONTACT, DROPLET with ensuite consultation with IP&C or DOOR CLOSED AIRBORNE PRECAUTIONS1 CONTACT PRECAUTIONS DROPLET plus CONTACT Depending on current AIRBORNE PRECAUTIONS 1 or recommendations *CONTACT PRECAUTIONS

NOTES • Carbapenem-resistant • Meningococcal disease 1. If a negative pressure room is not available, place patient in a single room with door Gram-negative bacteria with less than 24 hours closed. Ensure air-conditioning is vented to the outside. 2 3 (CR-GNB) antibiotics 2. Includes: Enterobacteriaceae, Acinetobacter sp, Pseudomonas sp. • 3. Isolation is only required for 24 hours following administration of appropriate antibiotics. Single room with ensuite Single room 4. Droplet precautions are required if Norovirus suspected. DO NOT COHORT DOOR CLOSED 5. Single room is required if admitted to an area where babies <12months are housed 6. IP&C – Infection Prevention and Control. 7. Higher priority should be given if the patient is to be admitted to a high risk unit such CONTACT PRECAUTIONS DROPLET PRECAUTIONS as ICU, HDU, burns, transplant, renal or haematology/oncology, or if the patient has faecal incontinence/diarrhoea

Version 2.4 (Feb2017) Public-I1-A2