conflicting info between docs and patient with varicella

[nadia562002]

I am a little confused. I had a patient this week who was diagnosed with a case of infectious herpes located on the face and over the body. Apparently it is being shed through the lungs as well. At first, everyone had to wear a regular paper mask, gown, and gloves when entering her room. Then an ID doc came through and declared the precautions were unneeded. For the next 8 hours of my shift, I followed standard precautions with this patient. At midnight, another ID doc came through and declared that everyone is return to the previous precautions. Then this particular doc does not use the precautions there after????

Anyways, I followed which ever precautions were in force at the moment. So, if this patient has a basic case of shingles which as we all know is caused by self innoculation, what is with all the precautions? Granted I am not pregnant and had chicken pox, whats with the precautions? Are the precautions just for my other patients or is there really a chance I could have been exposed when the precautions were down for those 8 hours of working with this patient?

[Sharon]

Herpes and Varicella Zoster are two infections that can be present in a singles outbreak. When a patient has an out break of shingles respirator and wound together or strict precautions should be used until either antivirals have been administered for 24 to 48 hours or if not medicated until the last pustule or vesicle is crusted over.

Since Generation X the population of those who have coverage for chicken pox has diminished. We have recognized the morbidity and mortality from chickenpox and shingles. Twenty years ago on the first unit I worked on we saw up to 10 adult deaths a year from shingles and another 2 left in permanent vegetative states. Healthcare workers have stopped encouraging parents to expose their children to chicken pox because of the potential morbidity and mortality from chicken pox and shingles. There is still a gap between children who have been immunized against Zoster and a large in between population that is not protected against Zoster.

I have been through two very bad hospital out breaks of chicken pox with the zero patient had shingles and the attending care provider, a nurse who was later pulled to float, began the transmission spread through out the hospitals. I have seen other outbreaks in which a pharmacist took an unprotected short cut through a pediatric isolation unit and spread it through out the hospital.

I have never relied on physicians to tell me what level of precaution to use with patients. Physicians have been way too late in many cases (especially for those late night admissions) and the recommendations have been wrong as often as right. If I don't know the level of protection off hand I look it up at an authoritative outside resource. I usually use the American Public Health Association's Control of Communicable Diseases Manual (17th Edition) Edited by James Chin, MD, MPH http://www.apha.org/media/science.htm

For every communicable disease there is a Method of Control and a Patient Control section that usually includes the type of isolation.

ID doctor's can be very "do as I say and not as I do" in clinical settings. Also he is probably much more current on his own immunizations and/or antibody status.

When was the last time you had your titer checked? My primary who is Internal Medicine and Occupational Health checks patients who are health care workers titers on joining his practice and periodically after that to ensure his healthcare worker patients are not at risk to contract these infections. He also does more preventive checking and immunizing his general population based on occupation, hobbies and travel.

To me there are no "basic case of shingles" or with any disease that has a fomites or respiratory transmission potential.