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Accessible 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: May 2022
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 RAMSEY, Keith M., MD
Centers for Disease Control and Prevention 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: May 2022 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
Joan Blanchard, RN, MSN, CNOR Center
Liaison to Association of periOperative Emily Rhinehart RN MPH CIC CPHQ
Registered Nurses Vice President
Patrick J. Brennan, MD AIG Consultants, Inc.
Liaison to Board of Scientific Counselors Marguerite Jackson, RN PhD CIC
Nancy Bjerke, RN, MPH, CIC Director, Administrative Unit, National
Liaison to Association of Professionals in Tuberculosis Curriculum Consortium,
Infection Prevention and Control Department of Medicine
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: May 2022 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) .................................................................................. 23
I.C.2. Agents of bioterrorism ...................................................................................................................... 24
I.C.2.a. Pre-event administration of smallpox (vaccinia) vaccine to healthcare personnel. ....................... 25
............................................................................................................................................... 25
I.C.3. Prions.
I.C.4. Severe Acute Respiratory Syndrome (SARS) ..................................................................................... 27
I.C.5. Monkeypox ....................................................................................................................................... 29
I.C.6. Noroviruses ....................................................................................................................................... 30
(HFV) ....................................................................................................... 31
I.C.7. Hemorrhagic fever viruses
I.D. Transmission Risks Associated with Specific Types of Healthcare Settings ............................................... 32
I.D.1. Hospitals ........................................................................................................................................... 33
I.D.1.a. Intensive care
units .................................................................................................................... 33
I.D.1.b. Burn units .................................................................................................................................. 33
I.D.1.c. Pediatrics ................................................................................................................................... 34
I.D.2. Non-acute healthcare settings. ......................................................................................................... 35
I.D.2.a. Long-term care .......................................................................................................................... 35
I.D.2.b. Ambulatory care ........................................................................................................................ 37
Last update: May 2022 Page 4 of 206
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