Accessable version: https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Last update: July 2019 Jane D. Siegel, MD; Emily Rhinehart, RN MPH CIC; Marguerite Jackson, PhD; Linda Chiarello, RN MS; the Healthcare Infection Control Practices Advisory Committee Acknowledgement: The authors and HICPAC gratefully acknowledge Dr. Larry Strausbaugh for his many contributions and valued guidance in the preparation of this guideline. Suggested citation: Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html Page 1 of 206 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) Healthcare Infection Control Practices Advisory Committee (HICPAC): Chair PERROTTA, Dennis M. PhD., CIC Patrick J. Brennan, MD Adjunct Associate Professor of Epidemiology Professor of Medicine University of Texas School of Public Health Division of Infectious Diseases Texas A&M University School of Rural Public University of Pennsylvania Medical School Health Executive Secretary PITT, Harriett M., MS, CIC, RN Michael Bell, MD Director, Epidemiology Division of Healthcare Quality Promotion Long Beach Memorial Medical Center National Center for Infectious Diseases Centers for Disease Control and Prevention RAMSEY, Keith M., MD Professor of Medicine Members Medical Director of Infection Control BRINSKO, Vicki L., RN, BA The Brody School of Medicine at East Carolina Infection Control Coordinator University Vanderbilt University Medical Center SINGH, Nalini, MD, MPH DELLINGER, E. Patchen., MD Professor of Pediatrics Professor of Surgery Epidemiology and International Health University of Washington School of The George Washington University Children’s Medicine National Medical Center ENGEL, Jeffrey, MD STEVENSON, Kurt Brown, MD, MPH Head General Communicable Disease Control Division of Infectious Diseases Branch Department of Internal Medicine North Carolina State Epidemiologist The Ohio State University Medical Center GORDON, Steven M., MD SMITH, Philip W., MD Chairman, Department of Infections Diseases Chief, Section of Infectious Diseases Hospital Epidemiologist Department of Internal Medicine Cleveland Clinic Foundation University of Nebraska Medical Center Department of Infectious Disease HARRELL, Lizzie J., PhD, D(ABMM) Research Professor of Molecular Genetics, HICPAC membership (past) Microbiology and Pathology Robert A. Weinstein, MD (Chair) Associate Director, Clinical Microbiology Cook County Hospital Duke University Medical Center Chicago, IL O’BOYLE, Carol, PhD, RN Jane D. Siegel, MD (Co-Chair) Assistant Professor, School of Nursing University of Texas Southwestern Medical Center University of Minnesota Dallas, TX PEGUES, David Alexander, MD Michele L. Pearson, MD (Executive Secretary) Division of Infectious Diseases Centers for Disease Control and Prevention David Geffen School of Medicine at UCLA Atlanta, GA Last update: July 2019 Page 2 of 206 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) Raymond Y.W. Chinn, MD Lorine J. Jay MPH, RN, CPHQ Sharp Memorial Hospital Liaison to Healthcare Resources Services San Diego, CA Administration Alfred DeMaria, Jr, MD Stephen F. Jencks, MD, MPH Massachusetts Department of Public Health Liaison to Center for Medicare and Medicaid Jamaica Plain, MA Services James T. Lee, MD, PhD Sheila A. Murphey, MD University of Minnesota Liaison to Food and Drug Administration Minneapolis, MN Mark Russi, MD, MPH William A. Rutala, PhD, MPH Liaison to American College of Occupational and University of North Carolina Health Care System Environmental Medicine Chapel Hill, NC Rachel L. Stricof, MPH William E. Scheckler, MD Liaison to Advisory Committee on Elimination of University of Wisconsin Tuberculosis Madison, WI Michael L. Tapper, MD Beth H. Stover, RN Liaison to Society for Healthcare Epidemiology of Kosair Children’s Hospital America Louisville, KY Robert A. Wise, MD Marjorie A. Underwood, RN, BSN CIC Liaison to Joint Commission on the Accreditation Mt. Diablo Medical Center of Healthcare Organizations Concord, CA Authors’ Associations HICPAC Liaisons Jane D. Siegel, MD William B. Baine, MD Professor of Pediatrics Liaison to Agency for Healthcare Quality Department of Pediatrics Research University of Texas Southwestern Medical Center Joan Blanchard, RN, MSN, CNOR Liaison to Association of periOperative Emily Rhinehart RN MPH CIC CPHQ Registered Nurses Vice President AIG Consultants, Inc. Patrick J. Brennan, MD Liaison to Board of Scientific Counselors Marguerite Jackson, RN PhD CIC Director, Administrative Unit, National Nancy Bjerke, RN, MPH, CIC Tuberculosis Curriculum Consortium, Liaison to Association of Professionals in Department of Medicine Infection Prevention and Control University of California San Diego Jeffrey P. Engel, MD Linda Chiarello, RN MS Liaison to Advisory Committee on Elimination of Division of Healthcare Quality Promotion Tuberculosis National Center for Infectious Diseases, CDC David Henderson, MD Liaison to National Institutes of Health Last update: July 2019 Page 3 of 206 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) TABLE OF CONTENTS Updates ................................................................................................................................................................ 7 Executive Summary .............................................................................................................................................. 8 Parts I - III: Review of the Scientific Data Regarding Transmission of Infectious Agents in Healthcare Settings .......................................................................................................................................... 9 Tables, Appendices, and Other Information ................................................................................................... 10 Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions . 10 Pre- Publication of the Guideline on Preventing Transmission of MDROs ..................................................... 11 Summary ........................................................................................................................................................ 11 Part I: Review of Scientific Data Regarding Transmission of Infectious Agents in Healthcare Settings.......... 13 I.A. Evolution of the 2007 Document .............................................................................................................. 13 Changes or clarifications in terminology. .................................................................................................. 14 Scope. ........................................................................................................................................................ 14 I.B. Rationale for Standard and Transmission-Based Precautions in healthcare settings .............................. 15 I.B.1. Sources of infectious agents. ............................................................................................................ 15 I.B.2. Susceptible hosts. ............................................................................................................................. 15 I.B.3. Modes of transmission. .................................................................................................................... 16 I.B.3.a. Contact transmission. ................................................................................................................ 16 I.B.3.a.i. Direct contact transmission. ............................................................................................... 16 I.B.3.a.ii. Indirect contact transmission. ........................................................................................... 17 I.B.3.b. Droplet transmission. ................................................................................................................ 18 I.B.3.c. Airborne transmission. .............................................................................................................. 19 I.B.3.d. Emerging issues concerning airborne transmission of infectious agents. ................................ 20 I.B.3.d.i. Transmission from patients. ............................................................................................... 20 I.B.3.d.ii. Transmission from the environment. ................................................................................ 21 I.B.3.e. Other sources of infection. ....................................................................................................... 21 I.C. Infectious Agents of Special Infection Control Interest for Healthcare Settings ....................................... 21 I.C.1. Epidemiologically important organisms. .......................................................................................... 22 I.C.1.a. C. difficile. .................................................................................................................................. 22 I.C.1. b. Multidrug-resistant organisms (MDROs). ...............................................................................