Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

ABSCESS Minor: Pus Direct & indirect Variable Duration of drainage Duration of Minor: Drainage is contained by Staphyloccus aureus Routine contact drainage dressing. Group A Streptococcus Major: Drainage not contained by Major: Other bacteria dressing. Contact ACQUIRED IMMUNE DEFICIENCY Routine Blood, body fluids Mucosal or Weeks to From onset of For life Follow the WRHA Post Exposure SYNDROME containing visible percutaneous years infection Blood & Body Fluid Post Exposure AIDS, ARC, or HIV blood, CSF, pleural exposure to Protocol Management Policy. Report an exposure to infective Antibody Positive, peritoneal, infective pericardial, amniotic material material e.g., needle-stick or blood Suspected Human fluids, semen, & Breastmilk spill/splash immediately to the Immunodeficiency vaginal secretions ingestion Occupational Health Department. Virus (HIV) Infection Refer to Specific Disease Protocol: AIDS/HIV.

ACTINOMYCOSIS Routine Not person to Normal flora: infection usually Actinomyces species person secondary to trauma.

ADENOVIRUS Routine Eye drainage Direct & indirect 2-14 days Until symptoms Duration of Different strains can be responsible for Conjunctivitis Children <6 yrs: contact cease illness respiratory and gastrointestinal disease. Contact Minimize exposure of immunocompromised patients, children with chronic cardiac or lung disease, and neonates.

Diarrhea Routine* Feces Direct & indirect 3-10 days Until symptoms Until feces *Consider Contact Precautions for Children<6 yrs: contact cease normal incontinent patients if feces cannot be contained or for patients who Contact contaminate their environment. Refer to Specific Disease Protocol: Diarrhea – Viral.

6.1

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

ADENOVIRUS (cont’d) Routine Respiratory Droplet, 2-14 days Until symptoms Until 48 hours Respiratory infection Pediatric: secretions direct & indirect cease after resolution Droplet & contact of symptoms Contact AMEBIASIS Routine* Feces, pus Direct & indirect Days to Duration of cyst Duration of *Consider Contact Precautions for Entamoeba Histolytica Children <6 yrs: contact weeks excretion illness incontinent patients if feces cannot be Abscess Contact (Fecal/oral) contained or for patients who contaminate their environment. Refer to Specific Disease Protocol: Diarrhea Feces Diarrhea – Other.

ANTHRAX Routine* Lesion drainage Not person to Few hours to *Contact Precautions required only if Bacillus Anthracis person 7 days wound drainage cannot be contained Cutaneous by dressing. Acquired from infected animals and animal products. Cutaneous Anthrax is not usually fatal.

Pneumonia Routine Respiratory Usually fatal secretions Anthrax is a possible agent of bioterrorism.

ANTIBIOTIC RESISTANT Contact Infected or colonized Direct & indirect Variable Variable As directed by Includes MRSA, VRE, ESBL, other ORGANISMS (ARO) secretions or contact Infection resistant Gram Negative bacilli and excretions Prevention and other bacteria. Control Refer to Specific Disease Protocol: Antibiotic Resistant Organisms. (ARO)

ARTHROPOD BORNE VIRAL Routine Mosquito or tick Variable Variable ENCEPHALITIS bite (Arboviruses) Not person to Eastern or Western person

6.2

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

ARTHROPOD BORNE VIRAL ENCEPHALITIS (cont’d) Equine Encephalitis St. Louis/California Encephalitis Powassan Encelphalitis Venezuelan Equine Encephalomyelitis West Nile Virus

ARTHROPOD BORNE VIRAL Routine Insect-borne Variable Variable FEVERS/RASH Mosquito or tick Colorado Tick Fever bite Dengue Fever Not person to Yellow Fever person

ASCARIASIS Routine Not person to Ova must hatch in soil to become Roundworm person infective.

ASPERGILLOSIS Routine Not person to Spores in dust; infections in Aspergillus species person immunocompromised patients may be associated with construction.

ASTROVIRUS Routine* Feces Direct & indirect 1-4 days Duration of illness Until feces *Consider Contact Precautions for Diarrhea Children <6 yrs: contact normal incontinent patients if feces cannot be Contact (Fecal/oral) contained or for patients who contaminate their environment. Refer to Specific Disease Protocol: Diarrhea - Viral. AVIAN INFLUENZA Droplet & Respiratory Droplet, 14 days after onset of As directed by Refer to Specific Disease Protocol: Contact secretions direct & indirect symptoms Infection Severe Respiratory Infection & contact Prevention & Influenza. Control Human-to-human transmission inefficient and rare, but risk of 6.3

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

AVIAN INFLUENZA (cont’d) reassortment with human influenza strains and emergence of pandemic strain serious concern.

BABESIOSIS Routine Tick or blood Transmission from person to person is Babesia microti transfusion unlikely except by blood transfusion. Other Babesia species

BED BUGS Contact Parasite Not person to Until parasites are Refer to Specific Disease Protocol: Climex lectularius person* eliminated from Bed Bugs. resting/sleeping *Frequent association with transport of space personal belongings.

BLASTOMYCOSIS Routine Not person to Acquired from spores in soil. Blastomyces dermatitidis person Pneumonia Skin lesions

BOILS Routine Pus Direct & indirect Variable Duration of drainage Duration of Staphylococcus aureus contact drainage Group A Streptococcus Other bacteria

BOTULISM Routine Foodborne Variable Clostridium botulinum Not person to person BRONCHIOLITIS Routine Respiratory Droplet, Variable Variable Until 48 hours May cohort if infected with the same Adenovirus Pediatric: secretions direct & indirect after resolution virus. Influenza Droplet & contact of symptoms Minimize exposure of Parainfluenza Virus Contact immunocompromised patients & Respiratory Syncytial Virus (RSV) children with chronic cardiac or lung disease, neonates.

6.4

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

BRUCELLOSIS Brucella species Routine* Lesion drainage Possibly direct Weeks to Duration of *Contact Precautions required only if Draining lesions contact months drainage wound drainage cannot be contained Rare cases of by dressings Mediterranean Fever Routine person to Undulant Fever person transmission

BUBONIC PLAGUE Routine Direct contact 1-7 days Close contacts may need Yersinia pestis with infected chemoprophylaxis. rodents and/or their fleas

BURKHOLDERIA CEPACIA Contact Respiratory Direct & indirect Variable Variable As directed by Minimize contact with other CF Resistant to all antibiotics tested secretions contact Infection patients in the hospital who are not Antibiotic sensitive or resistant Prevention & colonized or infected with B. cepacia. strains in Cystic Fibrosis (CF) Control Do not place in the same room as a patient patient with Cystic Fibrosis (CF) who is not infected or colonized with B. cepacia. Persons with CF who visit or provide care and are not infected or colonized with B. cepacia may elect to wear a mask when within 1 metre (3 feet) of a colonized or infected patient who is coughing or undergoing chest physiotherapy.

BURNS . Patients with burns depending on MINOR severity may be referred to the Burn Less than total 25% body surface Routine Units at HSC or Children’s Hospital. area MAJOR Contact More than 25% total body surface area

6.5

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

BURNS (cont’d) Minor: Pus Direct & indirect Variable Duration of drainage Duration of Minor: Drainage is contained by INFECTED Routine contact drainage dressing. Major: Major: Drainage not contained by Contact dressing.

CALICIVIRUSES Routine* Feces Direct & indirect 24-48 hours Duration of excretion Until feces *Consider Contact Precautions for Calicivirus Children <6 yrs: contact range 10-50 normal incontinent patients if stool cannot be Norovirus Contact (Fecal/ oral) hours contained or who contaminate their Other small round- structured environment. viruses Refer to Specific Disease Protocol: Diarrhea - Viral.

CAMPYLOBACTER JEJUNI Routine* Feces Direct & indirect 1-10 days Duration of excretion Until feces * Consider Contact Precautions for Children < 6 yrs: (Fecal/ oral) normal incontinent patients if feces cannot be Contact contained or for patients who contaminate their environment Refer to Specific Disease Protocols – Diarrhea – Bacterial.

CANDIDIASIS Routine Infected secretions Variable Normal flora. Candida species. and excretions Moniliasis Thrush

CAT SCRATCH FEVER Routine Cat scratch, bite Acquired from animals (cats and Bartonella henselae or lick to others) nonintact skin. Not person to person.

CELLULITIS Minor: Pus Direct & indirect Variable Duration of drainage Duration of Minor: Drainage is contained by Draining: Routine contact drainage dressing. Staphylococcus aureus, Major: Major: Drainage not contained by Group A Streptococcus Contact dressing Other bacteria 6.6

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

CELLULITIS (cont’d) Droplet if Respiratory Droplet & direct Variable Variable Until 24 hours Periorbital or other with intact skin: Haemophilus secretions contact after startt of Haemophilus influenzae type b in influenzae appropriate non immune child <5 years type b is antibiotic Streptococcus group A possible cause, therapy Other bacteria otherwise Routine

CHANCROID Routine Genital ulcer Sexually 3-10 days As long as the Haemophilus ducreyi drainage transmitted infectious agent persists

CHICKENPOX: Varicella Zoster Virus (VZV)

Active Chickenpox Airborne & Respiratory Airborne, direct 10-21 days 2 days before rash Until all vesicles Roommates and HCWs should be contact secretions, & indirect and until all skin dry & crusted immune to chickenpox. Non-immune lesion drainage contact vesicles are crusted HCWs should not enter room if & dry (usually 5-7) immune caregivers are available. If days non-immune persons enter room they must wear N95 respirator. Susceptible high-risk contacts should receive VZIG as soon as possible, within 96 hours of exposure. VZIG may extend the incubation period to 28 days.

Newborns: Airborne precautions Susceptible Contact Airborne Respiratory Potentially From 8 days should be taken with neonates born to secretions communicable during after first contact mothers with varicella onset < 5 days last 2 days of until 21 days before delivery. Prevent exposure of incubation period after last contact susceptible persons & with rash (28 immunosuppressed patients. days if given Refer to Specific Disease Protocol: VZIG) Chickenpox.

6.7

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

CHLAMYDIA PSITTACI Routine Not person to 1-4 weeks Acquired from contact with infected Psittacosis person birds. Ornithosis CHLAMYDIA TRACHOMATIS Routine Sexually Variable Genital ulcers transmitted Pneumonia Trachoma

Neonatal Conjunctivitis Routine Mother to Newborn

CHOLERA Routine* Feces Direct & indirect 1-5 days Duration of shedding Until feces *Consider Contact Precautions for Vibrio Cholera 01 Children< 6 yrs: contact normal incontinent patients if feces cannot be Contact (Fecal/oral) contained or for patients who contaminate their environment. Refer to Specific Disease Protocols: Diarrhea - Bacterial.

CLOSTRIDIUM DIFFICILE Contact Feces Direct & indirect Variable Duration of shedding Until feces Refer to Specific Disease Protocol: Diarrhea contact normal for 48 Diarrhea – C. difficile. Pseudomembranous Colitis (PMC) (Fecal/ oral) hours Bacterial spores persist in the environment Pay special attention to cleaning.

CLOSTRIDIUM PERFRINGENS Routine Not person to 6-24 hours Food poisoning person Foodborne

Abscess Routine Wound drainage Direct & indirect Variable Found in normal gut flora, soil. Gas gangrene contact Myonecrosis

COCCIDIOMYCOSIS Routine Not person to 1-4 weeks Inhalation of spores in contaminated Coccidioides immitis person soil.

6.8

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

COLD (COMMON) Adult: Respiratory Droplet, Variable Variable Until 48 hours May cohort if infected with the same Adenovirus Routine secretions indirect contact after resolution virus. Coronavirus Pediatric: of symptoms Minimize exposure of Influenza Droplet & immunocompromised patients, children Parainfluenza Contact with chronic cardiac or lung disease, Rhinovirus neonates. Respiratory Syncytial Virus (RSV)

COLORADO TICK FEVER Routine Tickborne 4-5 days Arbovirus Not person to person

CONGENITAL RUBELLA Droplet & Respiratory Droplet, direct & Prolonged shedding Until 1 year of Refer to Specific Disease Protocols: Contact secretions, urine indirect contact in respiratory tract age, unless Rubella. and urine, can be up nasopharygeal to 1 year & urine cultures done after 3 months are negative

CONJUNCTIVITIS Adult: Eye discharge Direct & indirect Until 24 hours after Until 24 hours Routine contact startt of appropriate after startt of Acute Bacterial Children < 6 yrs: antibiotic therapy appropriate Pink Eye Contact until antibiotic viral etiology therapy ruled out

Chlamydia Routine Eye discharge Mother to Gonococcus newborn

Viral Routine Eye discharge Direct & indirect Duration of Adenovirus Children < 6 yrs: contact drainage and Enterovirus Contact symptoms

6.9

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

CORONAVIRUS Adult: Respiratory Direct & indirect 2-4 days Until symptoms Until 48 hours Common cold Routine secretions contact, cease after resolution Pediatric: possible droplet of symptoms Droplet & Contact

COUGH Adult: Respiratory Droplet, Variable Until symptoms Until infectious May cohort if infected with same virus. Rhinovirus Routine secretions direct & indirect cease cause ruled out Minimize exposure of RSV Pediatric: contact or 48 hours after immunocompromised patients. Parainfluenza Droplet & resolution of Adenovirus Contact symptoms Coronavirus Pertussis

COXSACKIEVIRUS Routine Feces Direct & indirect 3-5 days During the acute For duration of If patient has diarrhea – Refer to Children < 6 yrs: Respiratory contact stage of the illness illness Specific Disease Protocols – Diarrhea: Contact secretions and perhaps longer Viral.

CREUTZFELDT-JAKOB DISEASE Routine* Central nervous Unknown** Months to CNS tissues are Duration of *Special precautions for instruments (CJD) system tissues, years infectious throughout illness contaminated with CSF or CNS CSF illness (months to tissues, neurosurgical procedures, years) autopsy and handling deceased body required. **Transmission has been documented following human pituitary hormone therapy, human dura mater grafts, corneal grafts and linked to neurosurgical instruments. Refer to Specific Disease Protocols: CJD.

CROUP Adult: Respiratory Droplet, direct & Variable Variable Until infectious May cohort if infected with same virus Adenovirus Routine* secretions indirect contact cause ruled out Minimize exposure of Influenza Pediatric: or 48 hours after immunocompromised patients, Parainfluenza Droplet & resolution of children with chronic cardiac and lung Respiratory Syncytial Virus (RSV) Contact symptoms disease, neonates. 6.10

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010

Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Disease Precautions Transmission Communicability Precautions

CRYPTOCOCCOSIS Routine Not person to Acquired from spores in soil. Cryptococcus neoformans person CRYPTOSPORIDIOSIS Routine* Feces Direct & indirect 1-12 days From onset of Until feces *Consider Contact Precautions for Cryptosporidium parvum Children < 6 yrs: contact symptoms until normal incontinent patients if feces cannot be Contact several weeks after contained or for patients who resolution contaminate their environment. Refer to Specific Disease Protocol: Diarrhea – Other.

CYSTICERCOSIS Routine Feces Direct contact Weeks to 10 Transmissible only if patient has Taenia solium larvae (Fecal/oral) years Taenia solium adult tapeworm in Tapeworm gastrointestinal tract. Ova in feces. CYSTIC FIBROSIS (CF) Contact Respiratory Ongoing All persons with CF to wear a secretions surgical/procedure mask when in Droplet/Contact if common areas of the hospital. known or suspected Private room, no room mates. If respiratory infection. cohorting must occur, patients may be cohorted with a suitable roommate, Airborne/Contact if provided measures are taken to known or suspected minimize their exposure to patients airborne infection. with transmissible infections such as E.g. tuberculosis respiratory and gastrointestinal viruses, and antibiotic resistant organisms NOTE: A ‘suitable roommate’ is a patient who does not have an infection or is not at high risk for infection (i.e., roommate should not be a patient with wounds, diarrhea, and/or respiratory symptoms or recent known exposure to infectious diseases). A suitable roommate is not someone with CF In clinic settings and if shared rooms, maintain a separation of ideally 2 metres; minimally 1 metre between patients. Draw curtains Reference: Infection Control and Hospital Epidemiology, Vol. 35, No. S1, Cystic Fibrosis Foundation Guideline (August 2014), pp. S1-S67

6.11 DATE ISSUED: February 1, 2006 REVISION DATE: June 2015

Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

CYTOMEGALOVIRUS (CMV) Routine Saliva, Genital Sexual contact, Unknown Secreted in urine and Requires intimate sexual or direct personal secretions, Urine, direct contact saliva for months contact for transmission. Respiratory secretions may be in symptomatic congenitally infected infants DECUBITUS ULCER Minor: Routine Pus Direct & indirect Variable Duration of drainage Duration of Minor: Drainage is contained by dressing. Staphylococcus aureus, Group A contact drainage Major: Drainage not contained by dressing. Streptococcus, Other bacteria Major: Contact DENGUE FEVER Routine Mosquito-borne Arbovirus Not person to person

DERMATITIS Minor: Routine Skin exudates Direct & Variable Variable Until infectious Bacteria, Virus, Fungus Major: Contact indirect contact etiology ruled out DERMATOPHYTOSIS Routine Direct contact Variable May be acquired from animals, close Ringworm person to person contact, shared combs, Tinea brushes, sheets. DESQUAMATION, EXTENSIVE Contact Skin exudates Direct & indirect Variable Variable Until skin Staphylococcus aureus contact exudates contained or infection ruled out DIARRHEA Contact Feces Direct & indirect Variable Variable Until feces normal Refer to Specific Disease Protocols: Acute diarrhea or dysentery contact (fecal/oral) or until specific Diarrhea. unknown etiology possible infectious agent identified or infectious etiology ruled out Bacterial Routine* Feces Direct & indirect Variable Variable Until feces normal *Consider Contact Precautions for Campylobacter Children <6 yrs: contact (fecal/oral) incontinent patients if feces cannot be Cholera Contact contained or for patients who contaminate Escherichia coli 0:157 H:7 their environment. Salmonella Shigella Refer to Specific Disease Protocols: Vibrio parahaemolyticus Diarrhea - Bacterial Yersinia enterocolitica

Clostridium difficile Contact Feces Direct & indirect Variable Duration of shedding Until feces normal Refer to Specific Disease Protocols: contact (fecal/oral) for 48 hours Diarrhea – C. difficile.

Viral Routine* Feces Direct & indirect Variable Variable Duration of virus *Consider Contact Precautions for Calicivirus Children <6 yrs: contact (fecal/oral) detectable in incontinent patients if feces cannot be Coxsackievirus Contact feces contained or for patients who

DATE ISSUED: February 1, 2006 6.12 REVISION DATE: May 1, 2010

Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

DIARRHEA (cont’d) contaminate their environment. Viral Norovirus Refer to Specific Disease Protocols: Rotavirus Diarrhea – Viral. Small round enteric Virus (SREV)

Other Routine* Feces Direct & indirect Variable Variable Until feces *Consider Contact Precautions for Amebiasis Children < 6 yrs: contact normal incontinent patients if feces cannot be Crytosporidium Contact (fecal/oral) contained or for patients who Dientamoeba fragilis contaminate their environment. Dysentry Giardia Lamblia Refer to Specific Disease Protocols: Diarrhea – Other.

DIPHTHERIA Contact Lesion drainage Direct or indirect 2 to 5 days. If untreated, 2 weeks Until 2 cultures Cultures should be taken at least 24 Corynebacterium diphtheriae contact to several months. from skin hours apart and at least 24 hours after Cutaneous disease lesions are cessation of antimicrobial therapy. negative. Close contacts should be given antibiotic prophylaxis.

Pharyngeal Droplet Respiratory Droplet, 2-5 days Until 2 cultures secretions direct contact from both nose & throat are negative.

EBOLA VIRUS Airborne & Blood and bloody Direct & indirect, 2-21 days Unknown possibly Until symptoms Manitoba Health & WRHA Medical Viral Hemorrhagic Fever Contact body fluids, possibly several weeks resolve Officer of Health should be notified respiratory secretions airborne if immediately of a suspected case. pneumonia Notify Infection Prevention & Control, Infectious Diseases Physician on Call, and Administrator on Call. Add eye protection, double gloves, leg and shoe coverings, and impermeable

6.13

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

EBOLA VIRUS (cont’d) gowns. Viral Hemorrhagic Fever Special precautions for handling of deceased body. Contact Infection Prevention & Control for direction.

ECHINOCOCCOSIS Routine Not person to 12 months to Acquired from contact with infected Hydatidosis person years animals. Echinococcus granulosus Echinococcus multiocularis

ECHOVIRUS Routine Feces Direct & indirect Variable Variable Duration of DISEASE Children < 6 yrs: Respiratory contact illness Contact secretions Eye discharge

ENCEPHALITIS Routine Feces Direct & Variable Variable Until specific Although specific etiologic agents can Arbovirus Children < 6 yrs: Respiratory Indirect contact etiology include enteroviruses, arthropod borne Enterovirus Contact secretions (Fecal/oral) established viruses, and herpes simplex, Herpes Simplex Virus precautions for enteroviruses are Unknown etiology generally indicated until a definitive diagnosis can be made. May be associated with measles, mumps, varicella, Mycoplasma pneumoniae, Epstein-Barr. If so, take appropriate precautions for associated disease.

ENDOMETRITIS Routine Group A Streptococcus Other bacteria

ENTEROBIASIS Routine Ova in perianal Direct contact 1-2 months Close household contacts may need Pinworms region treatment. Enterobius vermicularis Oxyuriasis

6.14

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

ENTEROCOCCUS Vancomycin Resistant Routine Direct & indirect Variable *Contact Precautions if patient has: Enterococcus VRE Modified (Alert) contact loose stool, diarrhea or fecal/urinary incontinence or not able to practice good hand hygiene, or does not have good personal hygiene practices or not cognitively able to follow directions.

Vancomycin Resistant Contact Feces Direct & indirect Variable Most individuals As directed by Refer to Specific Disease Protocols: Enterococcus (VRE) Positive Infected or colonized contact colonized for life Infection Antibiotic Resistant Organisms – secretions, or Prevention & Vancomycin Resistant Enterococcus excretions Control

VRE Suspect Routine Direct & indirect Variable Contact of positive VRE contact

ENTEROVIRAL INFECTION Routine Feces Direct & indirect Variable Variable Duration of Echovirus Children < 6 yrs: Respiratory contact illness Coxsackievirus Contact secretions Poliovirus Eye discharge Enterovirus

EPIGLOTTITIS Routine Respiratory Droplet, direct Variable Variable Until 24 hours of Streptococcus group A Pediatric: secretions contact appropriate Staphylococcus aureus Droplet antimicrobial Haemophilus influenzae type b therapy received until Haemophilus influenzae type b ruled out

6.15

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

EPSTEIN-BARR VIRUS Routine Saliva 30-50 days Infectious mononucleosis Glandular fever

ERYSIPELAS Routine Drainage Streptococcus group A

ERYTHEMA INFECTIOSUM Fifth Disease: Respiratory Droplet, 4-21 days Fifth Disease: no Aplastic or For patients with transient aplastic or Fifth Disease Routine secretions direct contact longer infectious by erythrocyte erythrocyte crisis, precautions should Parvovirus B-19 Aplastic crisis: the time the rash crisis be maintained for 7 days. Aplastic Crisis Droplet appears See comments For immunosuppressed patients with chronic infection, maintain for duration of hospitalization.

ESCHERICHIA COLI Routine* Feces Direct & indirect 1 to 8 days From onset of Until stools *Consider Contact Precautions for Pathogenic strains Children < 6 yrs: contact symptoms until normal. incontinent patients if feces cannot be Diarrhea Contact (Fecal/oral) several weeks after If HUS: until two contained or for patients who Hemolytic-uremic syndrome (HUS) resolution stools negative contaminate their environment. Thrombotic Thrombocytopenic for E. coli Refer to Specific Disease Protocol: purpura 0157:H7 or 10 Diarrhea – Bacterial. days from onset of diarrhea.

EXTENDED SPECTRUM LACTAMASES (ESBL) ESBL Alert Routine* Direct & indirect Variable *Contact Precautions if patient has: contact loose stool, diarrhea or fecal/urinary incontinence, or not able to practice good hand hygiene or does not have good personal hygiene practices or not cognitively able to follow directions.

ESBL Positive Contact Feces Direct & indirect Variable Until negative As directed by See Specific Disease Protocol: Infected or colonized contact Infection Antibiotic Resistant Organisms – excretions, or Prevention & Extended Spectrum Lactamases secretions Control (ESBLS).

6.16

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

EXTENDED SPECTRUM LACTAMASES (ESBL) (cont’d) ESBL Suspect Routine Direct & indirect Variable contact

FEVER: Routine* Respiratory Direct or indirect Variable Variable Until enteroviral * If findings suggest a specific UNKNOWN ORIGIN Children < 6 yrs: secretions, contact infection ruled transmissible infection, take Suspected Enterovirus Contact Feces (Fecal/oral) out or 48 hours precautions for that infection pending (June-December) after resolution diagnosis. of symptoms

FIFTH DISEASE Fifth Disease: Respiratory Droplet, 4-21 days Fifth disease: Aplastic or For patients with transient aplastic or Erythema infectiosum Routine secretions direct contact No longer infectious erythrocyte erythrocyte crisis precautions should Parvovirus B-19 Aplastic crisis: by the time the rash crisis: be maintained for 7 days. For Aplastic Crisis Droplet appears See comments immunosuppressed patients with chronic infection, maintain for duration of hospitalization.

FOOD POISONING Routine Not person to 0.5 to 24 Contaminated food, soil or dust. Bacillus cereus person spread hours Food borne

Clostridium botulinum Routine Food containing Food borne Variable *Food in which neurotoxin has formed Botulism neurotoxin* Not person to usually due to inadequate heating person during canning Presents as flaccid paralysis, cranial nerve palsies.

Clostridium perfringens Routine Food borne 6-24 hours Food & water contaminated by soil or Not person to feces. person

6.17

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

FOOD POISONING (cont’d) Routine* Feces Direct & indirect 1 to 8 days From onset of Until feces is *Consider Contact Precautions for Escherichia coli 0157:H7 Children <6 yrs: contact symptoms until normal. incontinent patients if feces cannot be Contact (Fecal/oral) several weeks after If HUS: until two contained or for patients with poor Food borne** resolution feces negative hygiene who contaminate their for E. coli environment. 0157:H7 or 10 **Food & water contaminated by soil or days from onset feces. of diarrhea

Salmonella Routine* Feces Contact Diarrhea: Variable Until feces *Consider Contact Precautions for Children < 6 yrs: (fecal/oral) 6-72 hours normal incontinent adults if feces cannot be Contact Food borne Enteric fever: contained or for adults who 3-60 days contaminate their environment. Refer to Disease Specific Protocol: Diarrhea – Bacterial.

Staphylococcus aureus Routine Direct & indirect 30 minutes to **Water and food products containing contact several hours staphylococcal toxins Food borne**

Vibrio parahaemolyticus Routine Feces Food borne** 5-92 hours **Contaminated fish and shellfish Probably not person to person

FURUNCULES Minor: Pus Direct & indirect Variable Duration of drainage Duration of Minor: Drainage is contained by Staphylococcus aureus Routine contact drainage dressing. Major: Contact Major: Drainage not contained by dressing.

6.18

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

GANGRENE Routine Wound Direct & indirect Variable Found in normal gut flora, soil. Gas gangrene: drainage contact Infection related to devitalised tissue. Clostridium species Not person to Fournier’s gangrene: person Polymicrobial GASTROENTERITIS Contact Feces Direct & indirect Variable Variable Until stools Refer to Specific Disease Protocols: Acute gastroenteritis or dysentery contact normal or until Diarrhea. unknown etiology possibly (fecal/oral) specific agent infectious identified or infectious etiology ruled out Bacterial Routine* Feces Direct & indirect Variable Variable Until feces *Consider Contact Precautions for Campylobacter Children < 6 yrs: contact normal incontinent patients if feces cannot be Cholera Contact (fecal/oral) contained or for patients who Escherichia coli 0:157 H:7 contaminate their environment. Salmonella Refer to Specific Disease Protocols: Shigella Diarrhea - Bacterial Vibrio parahaemolyticus Yersinia enterocolitica

Clostridium difficile Contact Feces Direct & indrect Variable Duration of shedding Until feces Refer to Specific Disease Protocols: contact normal for 48 Diarrhea – C. difficile. (fecal/oral) hours Viral Routine* Feces Direct & indirect Variable Variable Duration of virus *Consider Contact Precautions for Calicivirus Children < 6 yrs: contact detectable in incontinent patients if feces cannot be Coxsackievirus Contact (fecal/oral) feces contained or for patients who Norovirus contaminate their environment. Rotavirus Refer to Specific Disease Protocols: Small round enteric virus (SREV) Diarrhea – Viral.

Other Routine* Feces Direct & indirect Variable Variable Until feces *Consider Contact Precautions for Amebiasis Children < 6 yrs: contact normal incontinent patients if feces cannot be Crytosporidium Contact (fecal/oral) contained or for patients who 6.19

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

GASTROENTERITIS (cont’d) contaminate their environment. Other Refer to Specific Disease Protocols: Dientamoeba fragilis Diarrhea – Other. Dysentry Giardia Lamblia

GERMAN MEASLES Droplet Respiratory Droplet, direct 14-23 days 1 week prior to rash – Until 7 days Droplet Precautions should be Acquired Rubella secretions contact for 7 days after onset after onset of maintained for exposed susceptible of rash. rash patients for 7 days after first contact through to 21 days after last contact.

Congenital Rubella Droplet & Urine Droplet, direct & Prolonged shedding Until 1 year of Contact Respiratory indirect contact in respiratory tract age, unless secretions and urine; can be up nasopharyngeal to 1 year and urine cultures done after 3 months of age are negative GIARDIASIS Routine* Feces Direct & indirect 1-4 weeks May persist for Until feces *Consider Contact precautions for Giardia lamblia Children < 6 yrs: contact months normal incontinent patients if feces cannot be Contact (Fecal/oral) contained or patients with who contaminate their environment. Refer to Specific Disease Protocol: Diarrhea – Other.

GINGIVOSTOMATITIS Routine* *Consider Contact Precautions if Herpes Simplex Virus extensive disease.

GONORRHEA Routine Drainage Sexually 2-7 days May extend for Neisseria gonorrhoeae transmitted months if untreated, Direct contact 6.20

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

GONORRHEA (cont’d) Neisseria gonorrhoeae

Ophthalmia Routine discharge Mother-to- 1-5 days Until 24 hours after neonatorum newborn effective treatment

Arthritis, Routine Drainage Sexually 2-7 days May extend for Pelvic inflammatory disease transmitted months if untreated.

GRANULOMA INGUINALE Routine Sexually 8-20 days Donovanosis transmitted Klebsiella granulaomatous

GUILLAIN-BARRE SYNDROME Routine* *Take precautions as appropriate for known or suspected associated infection.

HAEMOPHILUS INFLUENZAE Droplet Respiratory Droplet, Variable Most infectious in the Until 24 hours Close contacts less than 48 months of TYPE b (HIB) secretions direct contact week prior to the after startt of age and who are not immune may Invasive disease onset of illness and appropriate require chemoprophylaxis. during the illness until antibiotic Household contacts of such children treated therapy should also receive prophylaxis. Refer to Disease Specific Protocol: Meningitis: Haemophilus Meningitis. HAND, FOOT & MOUTH DISEASE Routine Feces Direct & indirect 3-5 days During the acute For duration of Coxsackie enterovirus Children < 6 yrs: Respiratory (Fecal/oral) stage of the illness illness Contact secretions contact and perhaps longer

HANSENS DISEASE Routine Nasal secretions Direct contact One to many Transmitted between persons following Leprosy years very prolonged and extensive close Mycobacterium leprae personal contact. Household contacts Lepromatous leprosy should be given prophylaxis.

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DATE ISSUED: February 1, 2006 REVISION DATE: August, 2012 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

HANTAVIRUS Routine Rodent feces Not person to 2-4 weeks Infection acquired from rodents. person

HELICOBACTER PYLORI Routine

HEMOLYTIC UREMIC SYNDROME Routine* Feces Direct & indirect If E. coli If E. coli *Consider Contact Precautions for (HUS) Children < 6 yrs: contact 0:157:H7: :from 0:157:H7: Until incontinent patients if feces cannot be May be associated with Contact (Fecal/oral) onset of symptoms 2 stools contained or for patients who Verotoxigenic until several weeks negative or 10 contaminate their environment. Escherichia coli after resolution days from onset If E. coli 0:157:H7: Refer to Specific of diarrhea Disease Protocol: Diarrhea – Bacterial.

HEMORRHAGIC FEVERS (VIRAL) Airborne & Blood & Direct & indirect Variable Unknown possibly Duration of Manitoba Health & WRHA Medical (VHF) Contact bloody contact, possibly several weeks illness Officer of Health should be notified Ebola Fever body fluids airborne hemorrhagic immediately of a suspected case. Lassa Fever Respiratory if pneumonia Notify Infection Prevention & Control , Marburg Fever secretions Infectious Diseases Physician on Call, Others and Administrator on Call immediately. Add eye protection, double gloves, leg and shoe coverings and impermeable gowns. Special precautions for handling of deceased body. Contact Infection prevention & Control for direction.

HEPATITIS Routine* Blood Direct & indirect Variable Variable For 7 days after If specific etiology is established, refer Unknown etiology Children < 6 yrs: Certain body fluids. contact onset of to specific disease in table. Contact Feces (Fecal oral) jaundice or until *Consider Contact Precautions for for Hepatitis A, diagnosis incontinent patients if feces cannot be E established or contained or for patients with poor infectious hygiene who contaminate their etiology ruled environment. out 6.22

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

HEPATITIS ( cont’d) Hepatitis A, E Routine* Feces Direct & indirect A: 15-50 Hep A: 2 weeks 1 week after *Consider Contact Precautions for Children < 6 yrs: contact, days before to 1 week onset of incontinent patients if feces cannot be Contact (Fecal/oral) E 15-64 days after onset of symptoms contained or for patients with poor symptoms; shedding Newborn: hygiene who contaminate their prolonged in new- duration of environment. born. hospitalization Post-exposure prophylaxis indicated Hep E: fecal for non-immune contacts with shedding at least 2 significant exposure to Hepatitis A if weeks within 2 weeks of exposure. Refer to Specific Disease Protocol: Viral Hepatitis A.

Hepatitis B, C, D Routine Blood and certain Mucosal or B:45-180 From onset of Follow the WRHA Post Exposure other body fluids percutaneous days infection Prophylaxis Care Map/Blood & Body exposure to C: 2 weeks to Fluid Exposure Management Policy. infective blood 6 months Report an exposure to infective material e.g., needlestick or blood and/or body D: 2-8 weeks fluids spill/splash immediately to Occupational Health. Refer to Specific Disease Protocol: Viral Hepatitis B & C.

HERPANGINA Routine* Feces Direct & indirect 3-5 days During the acute Duration of *Consider Contact Precautions for Enterovirus Children < 6 yrs: Respiratory contact stage of the illness illness incontinent patients if feces cannot be Contact secretions (Fecal/oral) and perhaps longer contained or for patients with poor hygiene who contaminate their environment. If diarrhea: Refer to Specific Disease Protocol: Diarrhea – Viral.

HERPES SIMPLEX Routine Encephalitis

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DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

(no lesions elsewhere)

HERPES SIMPLEX (cont’d) Mucocutaneous: Localized Routine Skin or mucosal Direct contact 2 days to 2 While lesions Until lesions Disseminated or primary and Contact lesions weeks. present. resolve extensive Neonatal Contact Skin lesions or Direct contact Birth to 6 Duration of Contact Precautions are also indicated mucosal lesions; weeks illness for infants delivered vaginally (or by c- possibly all body section if membranes have been secretions and ruptured more than 4-6 hours) to excretions women with active genital infections, until neonatal HSV infection has been ruled out.

6.24

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

HERPES ZOSTER Shingles

Disseminated: Airborne & Respiratory Airborne, Variable Until all lesions are Until all lesions Roommates & HCWs should be More than one dermatomal Contact secretions, direct & indirect crusted and dried. have crusted immune to chickenpox. Non-immune distribution lesion drainage contact and dried HCWs should not enter room if immune caregivers are available. If non-immune persons enter room they must wear N95 respirator. Susceptible high-risk contacts should be given VZIG as soon as possible; within 96 hours of exposure. Refer to Specific Disease Protocol: Herpes Zoster – Shingles.

Localized: Airborne & Lesion drainage Direct & indirect Variable Until all lesions are Until 24 hours Localized zoster may disseminate in Immunocompromised host Contact contact, possibly crusted and dried. after antiviral immunocompromised host if not airborne therapy startted; treated. then as for Refer to Specific Disease Protocol: localized zoster Herpes Zoster – Shingles. in normal host

6.25

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

HERPES ZOSTER: Routine Lesion drainage Direct & indirect Variable Until all lesions have Until all lesions *Consider for cases of extensive Localized: Or contact, possibly crusted and dried have crusted localized zoster that cannot be Normal Host Airborne and airborne and dried covered, in situations where there are Contact* Varicella (chickenpox) susceptible patients. Refer to Specific Disease – Protocol: Herpes Zoster – Shingles.

HISTOPLASMOSIS Routine Not person to 3-17 days Acquired from spores in soil Histoplasma Capsulatum person spread

HOOKWORM Routine Not person to Larvae must hatch in soil to become Necatar americanus person infectious Ancyclostoma duodenale

HUMAN HERPES VIRUS 6 Routine Saliva (Presumed) Direct contact 9-10 days Transmission requires intimate Roseola personal contact. HHV-6

HUMAN IMMUNO-DEFICIENCY Routine Blood, body fluids Mucosal or Weeks to From onset of For life Follow the WRHA Post Expsoure VIRUS (HIV) INFECTION containing visible percutaneous years infection Prophylaxis Care Map/Blood & Body AIDS, ARC, or HIV blood CSF, pleural exposure to Fluid Exposure Management & Policy. Antibody positive peritoneal, infective Report an exposure to infective Suspected Human pericardial, synovial, material material, e.g. needle – stick or blood Immunodeficiency Virus Infection & amniotic fluids, spill/splash immediately to the semen, & vaginal Occupational Health Dept. secretions Refer to Disease Specific Protocol: AIDS/HIV.

HUMAN T-CELL LEUKEMIA Routine Blood, body fluids Mucosal or Weeks to From onset of VIRUS containing visible percutaneous years infection Human T-lymphotropic Virus blood, CSF, pleural exposure to HTLV-I peritoneal, infective HTLV-II pericardial, synovial, material & amniotic fluids, semen, & vaginal secretions 6.26

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

IMMUNOCOMPROMISED Refer to Disease Specific Protocols: Immunocompromised Condition. IMPETIGO Routine Lesions Direct & indirect Variable, but Until 24 hours of Until 24 hours of *Lesions not covered by dressings Staphylococcus aureus Contact if Skin exudates contact usually appropriate antibiotic appropriate Streptococcus group A extensive* develop therapy received antibiotic within therapy 4-10 days INFECTIOUS MONONUCLEOSIS Routine Saliva 30-50 days Epstein-Barr virus

INFLUENZA Droplet & Respiratory Droplet, 1-4 days 5 days, shedding Until 48 hours Patient should not share room with Contact secretions direct & indirect maybe longer in after resolution high risk patients. Minimize exposure Type A or B contact infants of symptoms of immunocompromised patients, children with chronic cardiac or lung disease, neonates. Refer to Disease Specific Protocols: Influenza.

JAUNDICE Routine* Blood Direct & indirect Variable Variable For 7 days after If specific etiology is established, refer Children < 6 yrs: Certain body fluids contact onset of to specific disease in table. Suspected viral etiology Contact Feces (Fecal/oral) for jaundice or until *Consider Contact Precautions for e.g., Hepatitis Hepatitis A, E diagnosis incontinent patients if feces can not be established or contained or for patients with poor infectious hygiene who contaminate their etiology ruled environment. out KAWASAKI DISEASE Routine Not known to be transmissible. Mucocutaneous lymph node syndrome

LASSA FEVER Airborne & Blood & Direct & indirect 6-21 days Until 3-9 weeks after Duration of viral Manitoba Health & WRHA Medical Viral Hemorrhagic Fever Contact bloody body fluids contact, possibly onset shedding Officer of Health and Health Canada Respiratory airborne if should be notified immediately of a secretions pneumonia suspected case. 6.27

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

LASSA FEVER (cont’d) Notify Infection Prevention & Control, Viral Hemorrhagic Fever Infectious Diseases Physician on Call, and Administrator on Call. Add eye protection, double gloves, leg and shoe coverings and impermeable gowns. Special precautions for handling of deceased body. Contact Infection Prevention & Control for direction.

LEGIONNAIRE'S DISEASE Routine Not person to Legionellosis person spread

LEPROSY Routine Nasal secretions Direct contact One to many For 3 months after Transmitted between persons following Hansen’s Disease Lesion drainage years effective treatment very prolonged and extensive close Mycobacterium leprae personal contact. Household contacts should be given prophylaxis.

LEPTOSPIROSIS Routine Not person to Acquired from contact with animals. Leptopirosis species person spread

LICE Routine* Direct & indirect 7-10 days Until 24 hours after Until effective *Glove for direct patient contact only. (Pediculosis) contact initiation of treatment treatment to kill Apply pediculicides as directed on Pediculus humanus lice & ova label. If live lice found after therapy, Phthirus pubis Usually until 24 repeat. hours after Refer to Disease Specific Protocol: initiation of Pediculosis. treatment

LISTERIOSIS Routine Respiratory Foodborne Average 21 Mothers of infected Listeria monocytogenes secretions Mother to fetus days. newborn infants may Feces or newborn shed in vaginal discharge and urine for 7-10 days

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DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

LYME DISEASE Routine Tickborne Rash: Borrelia burgdorferi Not person to 3-31 days person spread

LYMPHOCYTIC Routine Acquired from 15-21 days CHORIOMENINGITIS VIRUS contact with rodents Not person to person spread

LYMPHOGRANULOMA Routine Sexually VENEREUM transmitted Chlamydia Trachomatis

MALARIA Routine Blood Mosquito-borne Can be transmitted via blood Plasmodium species Mosquito-borne Not normally transfusion. person to person

MARBURG VIRUS Airborne & Blood and bloody Direct & indirect 2-21 days Duration of virus Until symptoms Manitoba Health & WRHA Medical Viral Hemorrhagic Fever Contact body fluids contact, shedding resolve Officer of Health and Health Canada Respiratory possibly should be notified immediately of a secretions airborne if suspected case. pneumonia Notify Infection Prevention & Control, Infectious Diseases Physician on Call and Administrator on Call. Add eye protection, double gloves, leg and shoe coverings & impermeable gowns. Special precautions for handling of deceased body. Contact Infection Prevention & Control for direction.

6.29

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

MEASLES Rubeola Active Measles Airborne Respiratory Airborne 7-18 days 5 days before onset For 4 days after Roommates & HCWs should be secretions of rash, (1-2 days startt of rash. immune to measles. before onset of Duration of illness Immunoprophylaxis is indicated for initial symptoms), in immunocom- susceptible contacts. Precautions until 4 days after promised should be taken with neonates born to onset of rash patients mothers with measles infection at (longer in delivery. immunocompromised Non-immune HCWs should not enter patients) room if immune caregivers are available. If non-immune persons enter room they must wear N95 respirator. Susceptible Contact Airborne Respiratory Airborne Potentially From 5 days after secretions communicable during first exposure last 2 days of through 21 days incubation period after last exposure MELIOIDOSIS Routine Organism in soil in South-East Asia. Burkholderia pseudomallei Rare cases of person-to-person transmission. MENINGITIS Droplet Respiratory Droplet Variable Variable Until infectious Refer to Disease Specific Protocol: Suspected until etiologic agent Pediatric: secretions (Fecal/oral) etiology ruled Meningitis. diagnosed Droplet & Feces out or specific Contact agent is identified Arthopodborne viruses Routine

Bacterial Meningitis other than listed Routine Respiratory Droplet Until infectious below Children < 6 yrs: secretions etiology ruled Contact out or specific agent is identified. 6.30

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

MENINGITIS (cont’d) Fungal Meningitis Routine

Haemophilus influenzae type b Droplet Respiratory Droplet, Variable Most infections in the Until 24 hours Close contacts less than 48 months of secretions direct contact week prior to the onset after startt of age and who are not immune may of illness & during the appropriate require chemoprophlaxis. Household illness until treated antibiotic contacts of such children should also therapy receive prophylaxis. Refer to Disease Specific Protocol: Meningitis: Haemophilus Meningitis.

Herpes simplex Routine

Listeria monocytogenes Routine Respiratory Food borne Mean 21 days Mothers of infected Secretions Mother to fetus newborn infants may Feces or newborn shed in vaginal discharge and urine for 7-10 days.

Neisseria meningiditis Droplet Respiratory Droplet, 2-10 Days Until 24 hours after Until 24 hours Close contacts may require Meningococcus secretions direct contact startt of appropriate after startt of chemoprophylaxis. antibiotic therapy appropriate Refer to Disease Specific Protocol: antibiotic Meningitis – Meningiococcal. therapy Pneumococcal Routine Respiratory Droplet 2-10 days Refer to Disease Specific Protocol: secretions Meningitis – Pneumococcal.

Streptococcus group B Routine Respiratory Droplet Variable Refer to Disease Specific Protocol: secretions Meningitis – Pneumococcal.

Tuberculous Routine *Rule out associated pulmonary TB.

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DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Route of Period of Duration of Microorganism, Infectious Infective Material Incubation Comments Precautions Transmission Communicability Precautions Disease MENINGITIS (cont’d) Routine Feces Direct & indirect Duration of Refer to Disease Specific Protocol: Viral: Children < 6 yrs: contact illness or 7 days Meningitis – Viral. Enteroviruses Contact after onset, whichever is less

METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) MRSA Positive Contact Infected or colonized Direct & indirect Variable Variable As directed by Refer to Disease Specific Protocols: secretions, contact Infection Antibiotic Resistant Organisms - excretions Prevention & MRSA. Control

MRSA Suspect Routine Direct & indirect Variable Variable contact

MOLLUSCUM Routine Contents of papules Direct contact 2 weeks to 6 Unknown Requires intimate direct personal CONTAGIOSUM months contact for transmission.

MUCORMYCOSIS Routine Not person to Acquired from spores in dust, soil Mucor person Phycomycosis transmission Zygomycosis Zygomycetes

MUMPS Droplet Saliva Droplet, 12-25 days 7 days before to 5 Until 5 days Droplet precautions for exposed Paramyxovirus direct contact days after onset of after onset of susceptible patients should begin 10 swelling of salivary swelling of days after first contact and continue glands (parotitis). salivary glands through 26 days after last exposure.

MYCOBACTERIUM NON- Routine Not person to Acquired from soil, water, animal, and TUBERCULOSIS (ATYPICAL) person reservoirs. Mycobacterium avium complex

6.32

DATE ISSUED: February 1, 2006 REVISION DATE: July 5, 2011 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

MYCOBACTERIUM Airborne* Respiratory Airborne Weeks to While organisms in In consultation *Tuberculosis in young children is TUBERCULOSIS secretions years sputum with attending rarely contagious, assess visiting Also: physician and family members for cough. Mycobacterium africanum IP & C Refer to Disease Specific Protocol: Mycobacterium bovis Tuberculosis. Multi-drug resistant TB (MDRTB)

Non respiratory: Routine Lesion drainage Direct & indirect Variable Variable In consultation Assess for concurrent pulmonary Bone & joint infection contact with attending tuberculosis. Avoid procedures that Draining lesions physician and may generate aerosols from drainage. PPD skin test positive with no IP & C evidence of current pulmonary disease

MYCOPLASMA Routine Respiratory Droplet, 1-4 weeks. Unknown Duration of Mycoplasma pneumoniae Pediatric: secretions direct contact illness Droplet

NECROTIZING ENTEROCOLITIS Contact* Feces P Probably *Unknown if transmissible. Take indirect contact precautions if outbreak suspected.

NECROTIZING FASCIITIS Minor: Drainage Direct & indirect Variable As long as organism Until 24 hours Minor: Drainage is contained by Streptococcal Routine contact is the after startt of dressing Clostridial Major: exudate/drainage appropriate Major: Drainage not contained by Polumicrobial Contact antibiotic dressing therapy for Streptococcal or until negative for other organisms

6.33

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

NEISSERIA GONORRHEA Neisseria gonorrhoeae Routine Drainage Sexually 2-7 days May extend for transmitted months if untreated, Direct contact Effective treatment ends the communicability

Ophthalmia neonatorum Routine Eye discharge Mother-to- 1-5 days Until 24 hours after newborn startt of appropriate antibiotic therapy

Arthritis Routine Drainage Sexually 2-7 days May extend for Pelvic Inflammatory Disease transmitted months if untreated Effective treatment ends the communicability NEISSERIA MENINGITIDIS Droplet Respiratory Droplet 2-10 days Until 24 hours after Until 24 hours Close contacts may require Meningitis secretions direct contact start of appropriate after start of chemoprophylaxis. Refer to Disease Known or Suspected antibiotic therapy appropriate Specific Protocol: Meningitis – antibiotic Meningiococcal. therapy NOCARDIOSIS Routine Not person to Unknown Acquired from organisms in dust, soil. Nocardia species person spread

NOROVIRUS Routine* Feces Direct & indirect 10-50 hours Duration of excretion Until feces *Consider Contact Precautions for Children <6 yrs: contact normal incontinent patients if feces cannot be Contract (Fecal/oral) contained or for patients with poor hygiene who contaminate their environment. Refer to Specific Disease Protocol: Diarrhea – Viral.

ORF Routine Not person to Unknown Unknown From infected animals Poxvirus person

6.34

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

OSTEOMYELITIS Routine Until 24 hours Staphlococcus aureus Pediatric: after start of Haemophilus influenzae type b. Droplet appropriate Other bacteria If Haemophilus antibiotic influenzae type therapy b possible, otherwise Routine OTITIS Routine Pus Direct & indirect Variable Duration of drainage Duration of Draining contact drainage Staphylococcus aureus Group A Streptococcus Other bacteria

PARAINFLUENZA VIRUS Routine Respiratory Direct & indirect 2-6 days 1-3 weeks Until 48 hours May cohort if infected with same virus. Pediatric: secretions contact, after resolution Minimize exposure of Contact and droplet of symptoms immunocompromised patients, children Droplet with chronic cardiac or lung disease, neonates. PARVOVIRUS B-19 Fifth Disease: Respiratory Droplet, 4-21 days Fifth Disease: Aplastic or For patients with transient aplastic or Erythema infectiosum Routine secretions direct contact No longer infectious erythrocyte erythrocyte crisis, precautions should Fifth Disease Aplastic crisis: by the time the rash crisis: be maintained for 7 days. For Aplastic Crisis Droplet appears See comments immunosuppressed patients with chronic infection, maintain for duration of hospitalization.

PEDICULOSIS (LICE) Routine* Direct & indirect 7-10 days 24 hours after Until effective *Glove for direct patient contact only. Head Lice contact initiation of treatment treatment to kill Apply pediculicides as directed on * Pediculosis humanus lice and ova. label. If live lice found after therapy, Usually until 24 repeat. Body Lice hours after Refer to Disease Specific Protocol: Phthirus pubis initiation of Pediculosis. treatment

6.35

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

PERTUSSIS Droplet Respiratory Droplet 6-20 days To 3 weeks after To 3 weeks after Close contacts may require Bordatella pertussis secretions onset of paroxysms if onset of chemoprophylaxis. Whooping Cough not treated paroxysms if not Non-specific respiratory tract treated; infection in infants Or until 5 days of appropriate therapy received

PHARYNGITIS Routine Respiratory Direct & indirect Duration of Corynebacterium diptheriae Pediatric: secretions contact, illness; if Group Group A Streptococcus Droplet and droplet A Streptococcus Viral Contact until 24 hours after start of antibiotic therapy received

PHYCOMYCOSIS Routine Not person to Acquired from spores, in dust, soil. Mucor person Mucormycosis, transmission Zygomycosis Zygomycetes

PINWORMS Routine Ova in perianal Direct contact 1-2 months Close household contacts may need Enterobiasis region treatment. Enterobius vermicularis Oxyuriasis

6.36

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

PLAGUE Routine Direct contact 1-7 days Yersinia pestis with infected Bubonic lymphadenitis rodents and/or their fleas

Pneumonic Droplet Respiratory Droplet 2 to 4 days Until 48 hours of Until 48 hours of Close contacts may require secretions appropriate antibiotic appropriate prophylaxis therapy antibiotic therapy

PLUERODYNIA Routine Feces Direct & indirect Variable Variable Duration of Enterovirus infection Children < 6 yrs: Respiratory contact illness Contact secretions

PNEUMONIA Routine Respiratory Droplet, Variable Variable Duration of Minimize exposure of Bacterial: Pediatric: direct & indirect illness immunocompromised patients, children not listed below or elsewhere Droplet & contact with chronic cardiac or lung disease, contact neonates

Haemophilus influenzae type b Routine Respiratory Droplet, Variable Most infections until Until 24 hours Close contacts less than 48 months of Pediatric: secretions direct contact the week prior to the after start of age and who are not immune may Droplet onset of illness and appropriate require chemoprophlaxis. Household during the illness until antibiotic contacts of such children should also treated therapy receive propylaxis

Legionella Routine Not person to person spread

6.37

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

PNEUMONIA (cont’d) Droplet Respiratory Droplet, 2-10 days Until 24 hours after Until 24 hours Close contacts may require Meningococcal secretions direct contact start of appropriate after start of chemoprophylaxis Neisseria meningitidis antibiotic therapy appropriate antibiotic therapy

Pneumococcal Routine Respiratory Droplet, Variable Until 24 hours after Until 24 hours Streptococcus pneumoniae Pediatric: secretions direct contact start of appropriate after start of Droplet antibiotic therapy appropriate antibiotic therapy

Staphylococcal Routine Respiratory Possibly droplet Variable Staphylococcus aureus secretions

Streptococcal Routine Respiratory Droplet, Variable Until 24 hours Group A Streptococcus Pediatric: secretions direct contact after start of Droplet appropriate antibiotic therapy

Other: Chlamydia Routine Respiratory Droplet, Variable Duration of Pediatric: secretions direct & indirect illness Droplet contact

Mycoplasma Routine Respiratory Droplet, 1-4 weeks Unknown Duration of Pediatric: secretions direct contact illness Droplet

Pneumocystis carinii Routine Unknown Unknown Ensure roommates not immunocompromised.

Viral Routine 6.38

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

POLIOMYELITIS Routine Respiratory Direct & indirect 9-12 days Duration of shedding Until 6 weeks Close contacts who are not immune Enterovirus Children < 6 yrs: secretions contact from onset of should receive chemoprophylaxis. Contact Feces illness or feces Staff must have current immunization. culture negative

PSEUDOMONAS Contact Infected or colonized Direct & indirect Variable Variable As directed by aeruginosa: secretions or contact Infection Resistant to all excretions Prevention & antibiotics tested Control

Other than aeruginosa: Contact Infected or colonized Direct & indirect Variable Variable As directed by Resistant to all antibiotics tested secretions or contact Infection excretions Prevention & Control

PSEUDOMEMBRANOUS Contact Feces Direct & indirect Variable Duration of shedding Until feces Refer to Specific Disease Protocol: COLITIS contact normal for 48 Diarrhea – Clostridium difficile. (PMC) (Fecal/oral) hours Bacterial spores persist in the Clostridium difficile environment.

PSITTACOSIS Routine Not person to 1-4 weeks Acquired from contact with infected Chlamydia psittaci person spread birds Ornithosis

Q FEVER Routine Not person to 4-21 days Acquired from contact with infected Coxiella burnetii person animals or from raw milk.

RABIES Routine Saliva Mucosal or 3-8 weeks up Acquired from contact with infected percutaneous, to years animals. exposure to Post-exposure prophylaxis saliva, person to recommended for percutaneous or person not mucosal contamination with saliva of documented rabid animal or patient.

6.39

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

RASH Airborne Respiratory Airborne 7-18 days 5 days before onset If confirmed Roommates & HCWs should be Maculopapular: secretions of rash, (1-2 days measles, until 4 immune to measles. Non-immune Measles before onset of initial days after onset HCWs should not enter room if symptoms) until 4 of rash. immune care providers are available. days after onset of Duration of Non-immune persons must wear N95 rash (longer in illness – respirator. immunocompro- immunocom- Immunoprophylaxis is indicated for mised patients) promised susceptible contacts. patients Precautions should be taken with neonates born to mothers with measles infection at delivery. Refer to Specific Disease Protocol: Measles. Petechial: Droplet if Respiratory Droplet, If N. Until 24 hours after If N. meningitidis Close contacts may require Neisseria Meningitis Neisseria secretions direct contact meningitidis start of appropriate confirmed, until chemoprophylaxis. meningitidis 2-10 days antibiotic therapy 24 hours after suspected start of otherwise appropriate Routine antibiotic Pediatric: therapy Droplet

Scabies Contact Direct & indirect 4-6 weeks, if Until 24 hours after If confirmed Refer to Specific Disease Protocol: contact re-infected 1- initiation of scabies, until 24 Scabies. 4 days appropriate therapy hours after initiation of appropriate therapy. Vesicular with fever: Airborne and Respiratory Airborne 10-21 days 2 days before rash If varicella Roommates & HCWs should be Varicella Contact secretions, lesion Direct & indirect and until all skin confirmed, until immune to chicken pox. drainage contact vesicles are crusted all vesicles dry Newborn: Airborne Susceptible high- & dry (usually 5-7 & crusted risk contacts should receive VZIG as days) (usually 5-7 soon as possible, within 96 hours of days) exposure. VZIG may extend the incubation period to 28 days. 6.40

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

RASH (cont’d) Non immune HCWs should not enter Vesicular with fever: room if immune caregivers are Varicella available. Non immune persons must wear N95 respirator. Newborn: Airborne Precautions should be taken with neonates born to mothers with varicella onset <5 days before delivery. Prevent exposure of susceptible persons & immunosuppressed patients. Refer to Disease Specific Protocol: Chickenpox.

RAT BITE FEVER Routine Not person to S. moniliformis: rats and other Streptobacillus moniliformis person animals, contaminated milk. Spirillum minus S. minus: rats, mice only.

RESPIRATORY Routine Respiratory Droplet, 2-8 days Until symptoms Until 48 hours May cohort if infected with same virus. SYNCYTIAL VIRUS Pediatric: secretions direct & indirect cease after resolution Minimize exposure of (RSV) Droplet & contact of symptoms immunocompromised patients, children Contact with chronic cardiac or lung disease, neonates

RESPIRATORY INFECTION Airborne Respiratory Airborne, direct Variable Unknown Precautions Unknown etiology, emerging Contact secretions & indirect until symptoms pathogen Droplet contact, droplet cease and/or a diagnosis is confirmed

REYE'S SYNDROME Routine* *May be associated with viral infection, especially influenza, varicella. Implement precautions for known or suspected associated viral infection.

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DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

RHINOVIRUS Routine Respiratory Droplet, 2-3 days Variable Until 48 hours Common Cold Pediatric: secretions direct & indirect after resolution Droplet & contact of symptoms contact

RICKETTSIAL POX Routine Miteborne Transmitted by mouse mites. Vesicular rickettsiosis Not person to person

RINGWORM Routine Direct contact Variable Fungus persists as May be acquired from animals, close Tinea long as lesions are person to person contact, shared Trichophyton present combs, brushes, sheets. Microsporum Epidermophyton Malessezia furfur

RITTER'S DISEASE Minor: Drainage, skin Direct or indirect Variable As long as organism Until drainage Minor: Drainage is contained by Scalded skin syndrome Routine exudates contact is in the resolved or dressing. Major: exudates/drainage contained by Major: Drainage not contained by Contact dressings dressing.

ROCKY MOUNTAIN SPOTTED Routine Tickborne FEVER Not person to person

ROSEOLA INFANTUM Routine Saliva (Presumed) Direct contact 9-10 days Transmission requires intimate direct Human herpes virus 6 personal contact.

ROTAVIRUS Routine* Feces Direct & indirect 1-3 days Duration of illness Duration of *Consider Contact Precautions for Children < 6 yrs: contact illness minimum incontinent patients if feces cannot be Contact (Fecal/oral) of 7 days** contained or for patients who contaminate their environment. **Prolonged fecal shedding may occur in immunocompromised patients after 6.42

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010

Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

ROTAVIRUS (cont’d) recovery; Contact Precautions for duration of hospitalization may be justified. Refer to Specific Disease Protocol: Viral. ROUNDWORM Routine Not person to Ova must hatch in soil to become Ascariasis person infective. RUBELLA Droplet Respiratory Droplet, 14-21 days 1 week prior to rash Until 7 days Droplet precautions should be German Measles secretions direct contact for 7 days after onset after onset of maintained for exposed susceptible Acquired Rubella of rash rash patients for 7 days after first contact through to 21 days after last contact. Refer to Disease Specific Protocol: Rubella. Congenital Rubella Syndrome Droplet & Urine Droplet, direct & Prolonged shedding Until 1 year of Contact Respiratory indirect contact in respiratory tract age, unless secretions and urine; can be up nasopharygeal to one year and urine cultures done after 3 months of age are negative

RUBEOLA Airborne Respiratory Airborne 7-18 days 5 days before onset For 4 days after Roommates & HCWs should be Measles secretions of rash, (1-2 days onset of rash. immune to measles. Non-immune before onset of initial Duration of illness HCWs should not enter room if symptoms), until 4 in immuno- immune care providers are available. days after onset of compromised Non-immune persons must wear N95 rash (longer in patients respirator. immunocompro- Immunoprophylaxis is indicated for mised patients) susceptible contacts. Precautions should be taken with neonates born to mothers with measles infection at delivery. Refer to Disease Specific Protocols: Measles.

6.43 DATE ISSUED: February 1, 2006 REVISION DATE: June 2012 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

RUBELOA (cont’d) Airborne Respiratory Airborne Potentially From 5 days after Susceptible Contact secretions communicable during first exposure last 2 days of through 21 days incubation period after last exposure

SALMONELLA Routine* Feces Contact Diarrhea: 6- Variable Until normal *Consider Contact Precautions for including Samonella typhi Children < 6 yrs: (Fecal/oral) 72 hours; feces incontinent patients if feces cannot be Contact Foodborne Enteric fever: contained or for patients who 3-60 days contaminate their environment. Refer to Disease Specific Protocol: Diarrhea – Bacterial.

SCABIES Contact Mite Direct & indirect 4-6 weeks. If Until 24 hours after Until 24 hours Refer to Specific Disease Protocol: Sarcoptes scabiei contact re-infected, initiation of after initiation of Scabies. 1-4 days appropriate therapy appropriate therapy

NORWEGIAN SCABIES Contact Mite Direct & indirect 4-6 weeks, if Until mites and eggs Until the skin Severe case contact re-infected, 1- are destroyed by lesions have 4 days treatment resolved and skin scrapings are negative

SCALDED SKIN SYNDROME Minor: Drainage, Direct or indirect Variable As long as organism Until drainage Minor: Drainage is contained by Staphylococcus aureus Routine Skin exudates contact is in the resolved or dressing. Major: exudates/drainage contained by Major: Drainage not contained by Contact dressings dressing. SCHISTOSOMIASIS Routine Not person to Contact with larvae in contaminated Schistosoma species person water. Bilharziasis SEPTIC ARTHRITIS Routine Until 24 hours after start of effective 6.44

DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

SEPTIC ARTHRITIS (cont’d) Pediatric: treatment Haemophilus infuenzae type b in Droplet if non-immune infant < 5 years of age Haemophilus Staphylococcus aureus, influenzae type Streptococcus pneumoniae, B possible, Group A Streptococcus otherwise Other bacteria Routine

SEVERE ACUTE RESPIRATORY Droplet Respiratory Droplet, indirect Maximum Unknown but thought Duration of *High risk aerosol – generating SYNDROME Contact Secretions & direct contact incubation to start when the hospitalization procedures also require Airborne Cornovirus (SARS Co-v) period is 10 respiratory symptoms Precautions. days start Refer to Disease Specific Protocol: Severe Respiratory Infection.

SHIGELLOSIS Routine* Feces Direct & indirect 1-7 days Usually 4 weeks if Until normal Consider Contact Precautions for Shigella Children < 6 yrs: contact not treated feces * incontinent patientss if feces cannot Contact (Fecal/oral) be contained or for patients who contaminate their environment. Refer to Specific Disease Protocol: Diarrhea – Bacterial. Treatment with effective antibiotics shortens period of infectivity.

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DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

SHINGLES Airborne & Respiratory Airborne, Variable Until all lesions are Until all lesions Roommates & HCWs should be Varicella Zoster Contact secretions direct & indirect crusted & dried have crusted & immune to chickenpox. Non immune Disseminated: Lesion drainage contact dried HCWs should not enter room if More than one dermatomal immune caregivers are available. Non distribution immune persons must wear N95 respirator. Susceptible high-risk contacts should be given VZIG as soon as possible, within 96 hours of exposure. Localized: Airborne & Lesion drainage Direct & indirect Variable Until all lesions are Until 24 hours Localized zoster may disseminate in Immunocompromised Contact contact, possibly crusted & dried. after antiviral immunocompromised host if not Host airborne therapy started, treated. then as localized zoster in normal host

Localized: Routine or Lesion drainage Direct & indirect Variable Until all lesions have Until all lesions *Consider for cases of extensive Normal Host Airborne & contact, possibly crusted & dried have crusted & localized zoster that cannot be Contact* airborne dried covered, in situations where there are varicella (chickenpox) susceptible patients. Refer to Specific Diseases Protocol: Herpes Zoster – Shingles.

SKIN INFECTIONS Minor: Pus Direct & indirect Variable Duration of drainage Duration of Minor: Drainage is contained by Routine contact drainage dressing. Major: Major: Drainage not contained by Contact dressing

SMALL ROUND VIRUS (SRV) Routine Feces Direct & indirect 24-48 hours, Duration of excretion Until feces *Consider Contact Precautions for Children < 6 yrs: contact range 10-50 normal incontinent patients if feces cannot be Contact (Fecal/oral) hours contained or for patients who contaminate their environment. Refer to Specific Disease Protocol: Diarrhea – Viral. 6.46

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

SPOROTRICHOSIS Routine Not person to Acquired from spores in soil, on Sporothrix schenckii person vegetation.

STAPHYLOCOCCAL INFECTIONS

Respiratory: Lung Abscess Routine

Pneumonia Routine* Respiratory Possibly droplet Variable *Transmissibility and need for masks secretions controversial. Consider mask for close contact until 24–48 hours of antibiotic received.

Toxic Shock Syndrome Routine Vaginal discharge Variable Drainage

Stomatitis Routine Respiratory Direct & indirect Variable Variable secretions contact Wound & Skin: Minor: Routine Drainage, skin Direct or indirect Variable As long as organism Until drainage Minor: Drainage is contained by Burns Major: Contact exudates contact is in the resolved or dressing (Ritters Disease) exudate/drainage contained by Major: Drainage not contained by Scalded skin syndrome dressings dressing. Skin – Impetigo Refer to Methicillin Resistant Wounds Staphyloccocus aureus if patient has MRSA.

STENOTROPHOMONAS Contact Infected or colonized Direct & indirect Variable Variable As directed by MALTOPHILIA secretions or contact Infection Resistant to all antibiotics tested excretions Prevention & Control

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DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

STREPTOCOCCAL INFECTION Streptococcus pyogenes

Necrotizing Fasciitis Minor: Drainage Direct & indirect 1-3 days As long as organisms Until 24 hours Minor: Drainage is contained by Routine contact is in the after start of dressing. Major: exudate/drainage appropriate Major - Drainage not contained by Contact antibiotic dressings. therapy Respiratory: Adult: Respiratory Droplet, Variable Until 24 hours Pneumonia Routine secretions direct contact after start of Pharyngitis Pediatric: appropriate Droplet antibiotic therapy Scarlet Fever Routine Respiratory Droplet, Variable Until 24 hours Pediatric: secretions direct contact after start of Droplet appropriate antibiotic therapy

Wound & Skin: Minor: Drainage, skin Direct & indirect Variable As long as organism Until 24 hrs of Minor: Drainage is contained by Burn infection Routine exudate, pus contact is in the appropriate dressing. Cellulitis Major: exudate/drainage antibiotic Major: Drainage not contained by Impetgo Contact therapy dressing. Skin infection Wound infection Erysipelas

Group B Streptococcus agalactiae Routine Drainage Variable Septic meningitis

Streptococcus pneumonia Routine Variable

6.48

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

STRONGYLOIDES Routine Rarely Infective larvae in soil. May cause Strongyloides stercoralis transmitted disseminated disease in person to immunocompromised host. person

SYPHILIS Routine Genital secretions Sexual Mother- Requires intimate direct contact for Treponema pallidum Lesion exudates to-fetus or transmission. newborn Mother-to-fetus or newborn.

TAPEWORM Routine Not Consumption of larvae in raw or Taenia saginata transmissible undercooked beef or pork or raw fish; Taenia solium person to larvae develop into adult tapeworms in Diphyllobothrium latum person gastrointestinal tract. Hymenolepsis nana Foodborne

TETANUS Routine Not person to Acquired from spores in soil which Clostridium tetani person germinate in wounds, devitalized tissue.

TINEA Routine Direct contact May be acquired from animals, close Dermatophytes person to person contact, shared Trichophyton combs, brushes, sheets. Microsporum, Epidemophyton, Malassezia furfur

TOXIC SHOCK SYNDROME Routine Vaginal discharge, Variable Staphylococcus aureus drainage Group A Streptococcus

TOXOCARIASIS Routine Not person to Ova in dog/cat feces. Acquired from Toxocara canis person contact with dogs, cats. Toxocara cati

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DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

TOXOPLASMOSIS Routine Not person to Acquired by contact with infected Toxoplasma gondii person except felines or soil contaminated by felines, mother to fetus consumption of raw meat, contaminated raw vegetables or contaminated water.

TRACHOMA Routine Eye discharge Mother to Chlamydia trachomatis newborn Conjunctivitis

TRENCH MOUTH Routine Usually normal flora. Vincent Angina Multiple bacteria

TRICHINOSIS Routine Not person to Acquired from consumption of infected Trichinella spiralis person meat.

TRICHOMONIASIS Routine Vaginal and urethral Sexually Trichomonas vaginalis discharges of an transmitted infected person

TRICHURIAS Routine Not person to Ova must hatch in soil to become Trichuris trichiura person infective Whipworm

TUBERCULOSIS Airborne Respiratory Airborne Weeks to While organisms are In consultation Tuberculosis in young children is Mycobacterium tuberculosis secretions years in the sputum with attending rarely contagious, assess visiting Also: physician and family members for cough. Mycobacterium africanum IP & C. Refer to Specific Disease Protocols – Mycobacterium bovis Tuberculosis. Multi-drug resistant TB (MDRTB)

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DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

TUBERCULOSIS – (cont’d)

Non-respiratory Routine Lesion drainage Direct & indirect Variable Variable Duration of Assess for concurrent respiratory Draining lesions contact drainage tuberculosis. Avoid procedures that may generate aerosols from drainage. Refer to Specific Disease Protocols – Tuberculosis.

PPD skin test positive with no Assess for concurrent respiratory evidence of current pulmonary Tuberculosis. disease Refer to Specific Disease Protocols – Tuberculosis.

TULAREMIA Routine Not person to Acquired from contact with infected Francisella tularensi person animals.

TYPHOID/PARATYPHOID Routine* Feces Contact Diarrhea: Variable Until normal *Consider Contact Precautions for Salmonella Children < 6 yrs: Foodborne 6-72 hours feces incontinent patients if feces cannot be Contact (Fecal/oral) Enteric fever: contained or for patients with poor 3-60 days hygiene who contaminate their environment. Refer to Disease Specific Protocol: Diarrhea – Bacterial.

TYPHUS FEVER Routine Not directly Endemic: fleas. Rickettsia typhi transmitted from Epidemic: lice. Rickettsia prowazeki person to person

URINARY TRACT INFECTION Routine

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DATE ISSUED: February 1, 2006 REVISION DATE: February 1, 2008 May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

VANCOMYCIN INTERMEDIATE Contact Infected or colonized Direct & indirect Variable Duration of As directed by Notify Infection Prevention & Control RESISTANT excretions, contact colonization Infection immediately. STAPHYLOCOCCUS secretions Prevention & Refer to Disease Specific Protocol: AUREUS Control Antibiotic Resistant Organisms - VISA Vancomycin Intermediate Resistant Staphylococcus aureus.

VANCOMYCIN RESISTANT ENTEROCOCCUS VRE

VRE Modified Alert Routine* Direct & indirect Variable * Contact Precautions if patient has: contact loose stool, diarrhea or fecal/urinary incontinence, or not able to practice good hand hygiene or does not have personal hygiene practices or not cognitively able to follow directions.

VRE Positive Contact Feces Direct & indirect Variable Most individuals As directed by Refer to Specific Disease Protocol: Infected or colonized contact colonized for life Infection Antibiotic Resistant Organisms - VRE. excretions or Prevention & secretions Control

VRE Suspect Routine Direct & indirect contact

VANCOMYCIN RESISTANT Contact Infected or colonized Direct & indirect Variable Duration of As directed by Notify Infection Prevention & Control STAPHYLOCOCCUS AUREUS excretions, contact colonization Infection immediately. VRSA secretions Prevention & Refer to Disease Specific Protocol: Control Antibiotic Resistant Organisms - Vancomycin Resistant Staphylococcus aureus.

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DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

VARICELLA ZOSTER Airborne & Respiratory Airborne 10-21 days 2 days before rash Until all vesicles Roommates & HCWs should be VIRUS INFECTIONS Contact secretions, direct & indirect and until all skin dry & crusted immune to chickenpox. Non-immune Chickenpox Lesion drainage contact vesicles are crusted HCWs should not enter room if Varicella Zoster Virus (VZV) & dry (usually 5-7 Newborns: immune caregivers are available. Non- Active Chickenpox days) Refer to immune persons must wear N95 comments respirator. Susceptible high-risk contacts should receive VZIG as soon as possible, within 96 hours of exposure. VZIG may extend the Susceptible contact Airborne Respiratory Potentially From 8 days incubation period to 28 days. secretions communicable during after first contact Newborns: Airborne precautions last 2 days of until 21 days should be taken with neonates born to incubation period after last contact mothers with varicella onset < 5 days with rash (28 before delivery. Prevent exposure of days if given susceptible persons & VZIG) immunosuppressed patients.

Herpes Zoster Airborne Lesions drainage Airborne, Variable Until all lesions are Until all lesions Roomates & HCWs should be immune Shingles and Respiratory direct & indirect crusted and dried. have crusted to chickenpox. Non-immune HCWs Disseminated: Contact secretions contact and dried should not enter room if immune More than one dermatomal caregivers are available. Non-immune distribution persons must wear N95 respirator. Susceptible high-risk contacts should be given VZIG as soon as possible; latest within 96 hours of exposure. Refer to Specific Disease Protocol: Herpes Zoster – Shingles.

Localized: Airborne Drainage from Direct & indirect Variable Until all lesions are Until 24 hours Localized zoster may disseminate in Immunocompromised Host and lesions contact, possibly crusted and dried. after antiviral immunocompromised host if not Contact airborne therapy started; treated. then as for localized zoster in normal host.

6.53

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

Herpes Zoster (cont’d) Routine* Drainage from Direct & indirect Variable Until all lesions have Until all lesions *Consider for cases of extensive Localized: Or lesions contact, possibly crusted and dried have crusted localized zoster that cannot be Normal Host Airborne and airborne and dried covered, in situations where there are Contact* varicella (chickenpox) susceptible patients. Refer to Specific Disease – Protocol: Herpes Zoster – Shingles.

VIBRIO PARAHEMOLYTICUS Routine Feces Food borne 5-92 hours Contaminated fish & shellfish. Gastroenteritis Probably not Refer to Specific Disease Protocol: person to Diarrhea – Bacterial. person

VINCENTS ANGINA Routine Usually normal flora. Trench mouth

VIRAL HEMORRHAGIC FEVERS Airborne & Blood/ Airborne, direct Variable Variable Duration of Manitoba Health & WRHA Medical (VHF) Contact bloody body fluids & indirect illness or until Officer of Health should be notified Arenavirus family: Respiratory contact hemorrhagic immediately of a suspected case. Lassa Fever secretions fever virus is Notify Infection Prevention & Control, Junin Excretions ruled out Infectious Diseases Physician on call Sabia Tissues and Administrator on call immediately. Machupo Add eye protection, double gloves, leg Bunyavirus family: and shoe coverings and impermeable Crimean-Congo gowns. Special precautions for Rift-Valley handling of deceased body. Contact Filovirus family: Infection Prevention & Control for Marburg direction. Ebola Ebola Reston Flavivirus family: Yellow fever

6.54

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

WEST NILE Routine Not person to West Nile Virus person Rarely by organ transplant, by breast milk or transplacentally

WHIPWORM Routine Not person to Ova hatch in soil to become infective. person

WHOOPING COUGH Droplet Respiratory Droplet 6-20 days To 3 weeks after To 3 weeks after Close contacts may require secretions onset of paroxysms if onset of chemoprophylaxis. not treated paroxysms if not treated; Or until 5 days of appropriate therapy

WOUND INFECTION Minor: Routine Pus Direct & indirect Variable Duration of drainage Duration of Minor: Drainage is contained by Major: Contact contact drainage dressings.

Major: Drainage not contained by dressings.

YERSINIA Routine* Feces Direct & indirect 1 to 14 days Duration of excretion Until feces *Consider Contact Precautions for Gastroenteritis Pediatric: contact, food normal incontinent patients if feces cannot be Yersinia pseudo-tuberculosis Contact borne contained or for patients who Yersinia enterocolitica contaminate their environment. Refer to Specific Disease Protocol: Diarrhea – Bacterial.

6.55

DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010 Winnipeg Regional Health Authority Infection Prevention & Control Manual

Clinical Presentation, Type of Infective Material Route of Incubation Period of Duration of Comments Microorganism, Infectious Precautions Transmission Communicability Precautions Disease

ZOSTER Airborne Drainage from Airborne, Variable Until all lesions are Until all lesions Roommates & HCWs should be Herpes Zoster and lesions Respiratory direct & indirect crusted and dried. have crusted immune to chickenpox. Non-immune Contact secretions contact and dried HCWs should not enter room if Disseminated: immune cargivers are available. Non- More than one dermatomal immune persons must wear N95 distribution respirator. Susceptible high-risk contacts should be given VZIG as soon as possible; latest within 96 hours of exposure. Refer to Specific Disease Protocol: Herpes Zoster – Shingles.

Localized: Airborne Drainage from Direct & indirect Variable Until all lesions are Until 24 hours Localized zoster may disseminate in Immunocompromised and lesions contact, possibly crusted and dried. after antiviral immunocompromised host if not contact airborne therapy started; treated. then as for localized zoster in normal host.

Localized: Routine * Drainage from Direct & indirect Variable Until all lesions have Until all lesions *Consider Airborne/Contact Normal Host lesions contact, possibly crusted and dried have crusted Precautions for cases of extensive airborne and dried localized zoster that cannot be covered, in situations where there are varicella (chickenpox) susceptible patients. Refer to Specific Disease – Protocol: Herpes Zoster – Shingles.

ZYGOMYCOSIS Routine Not person to Acquired from spores in dust. Phycomycosis person Mucormycosis transmission

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DATE ISSUED: February 1, 2006 REVISION DATE: May 1, 2010