Infectious Diseases in Critical Care Medicine

Table 5 Recommended Transmission-Based Isolation Precautions

Pathogen

Recommended

isolation precautions Comments

Class A pathogens
Anthrax (B. anthracis)
Cutaneous Standard, contact. Direct contact with skin lesions can result in cutaneous
disease.
Pulmonary Standard.
Gastrointestinal Standard, contact.
Environmental:
aerosolzable spore-
containing or other
substances

Standard, contact,

droplet, airborne.

Until decontamination, wear respirator (N95 or
powered air-purifying respirator, protective clothing,
and decontaminate those in contact with substance.
Postexposure prophylaxis following environmental
exposure with 60 days of either doxycycline,
ciprofloxacin, or levofloxacin: postexposure
vaccination under investigation. Antibiotic
prophylaxis with active immunization may hold
promise. Minimize aerosol-generating procedures.
Botulism (C. botulinum
toxin)

Standard. Not transmitted person-to-person.

Plague (Y. pestis)
Bubonic Standard, contact
(with draining
lesions)
Pneumonic Standard, droplet,
airborne
(respiratory).

Chemoprophylaxis for heath care workers with close-
contact exposure. Antibiotic treatment rapidly
reduces contagion. Minimize aerosol-generating
procedures.
Smallpox (V. major) Standard, contact,
droplet, airborne.

See Table 4. Postexposure vaccination and
vaccination of health care providers at-risk is
essential for controlling outbreak. Nonvaccinated
health care workers should not provide care when
vaccinated health care workers are available.
Minimize aerosol-generating procedures.
Tularemia (F. tularensis) Standard. Transmitted by inhalation of aerosolized bacteria or
ingestion. Person-to-person spread is rare.
Microbiology laboratory personnel at particular risk.
Minimize aerosol-generating procedures.
Viral hemorrhagic fevers
[filoviruses (e.g., Ebola,
Marburg) and
arenaviruses (e.g., Lassa,
Machupo)]

Standard, contact,

droplet, and

airborne.

Single-patient room preferred. Emphasize sharps
safety, hand hygiene, barrier protection,
impermeable gowns, face/eye protection with
masks, goggles, or face shields, and waste
handling. Use of N95 respirator for any aerosol-
generating procedures. Double gloves, leg, and
shoe coverings also recommended. Minimize
aerosol-generating procedures.
Rabies Standard, contact,
droplet, and
airborne.All
caregivers in
contact with the
patient should
receive
postexposure
rabies prophylaxis
with vaccine and
rabies immune
globulin.

Single-patient room preferred. Emphasize sharps

safety, hand hygiene, barrier protection,

impermeable gowns, face/eye protection with

masks, goggles, or face shields, and waste

handling. Use of N95 respirator for any aerosol-

generating procedures. Double gloves, leg and

shoe coverings also recommended. Minimize

aerosol-generating procedures.

440 Cleri et al.