Herpes Zoster Precautions?

[Jen2010]

My fellow classmates and I have been debating this for most of the day. Our professor is just answering our questions with more questions and just creating more confusion between our group. We checked our textbook which states that Herpes Zoster patients should be on Airborne precautions. My Saunder's book says Droplet and Contact precautions. The CDC guidelines say Airborne and Contact precautions. However, in the textbook it says to wear an N-95 respirator mask when in the room with a patient with Herpes Zoster. We have experienced patients in the clinical setting that did NOT require the N95. What do you guys think? Do Herpes Zoster patients need to be in a negative air pressure room and should nurses be wearing N95s? Please let me know what you guys think! We're all going nuts over here, haha Thanks!!

[hodgieRN]

At my hospital, herpes zoster is droplet precautions. It doesn't have the ability to be aerosolized. Since it's not aerosolized, you do not need an N-95 mask in almost all cases. This is mainly for shingles.

If the infection is disseminated (located in various areas besides from the original lesion) or if the pt is immunocompromised, then airborne or contact may need to be initiated because of it's ability to spread.

I would say most cases involving herpes zoster is a localized incidence...like with shingles. It's mainly contained locally within the dermatome. If a pt is immunocompromised, it can be everywhere. If this is the case, it can be located on the face, in the mouth, on or in nose. Throw some coughing and sneezing on top of it and you will see the need for more precautions. But standard cases of shingles only need droplet precautions. The bedside nurse would only need to wear a surgical mask because you would only have to stop direct exposure with a droplet. It's not something that would be floating around in the air as an aerosolized particle, like TB. You can become infected with TB from indirect exposure.

So, you wouldn't need negative air pressure. The only time you need a negative air room is with airborne particles.

[nurseprnRN, BSN, RN]

I'd go with the CDC every time. Their recommendations are updated periodically (check the dates on the ones you referenced) whereas your books (and your faculty) might not be. Evidence-based practice. :)

[Esme12, ASN, BSN, RN]

All of the above is correct......but usually the HZ is not aerosolized and is droplet/contact precautions. As per the CDC.....

Management of Patients with Herpes Zoster

Infection-control measures depend on whether the patient with herpes zoster is immunocompetent or immunocompromised and on whether the rash is localized or disseminated. In all cases, standard infection-control precautions should be followed.

If the patient is immunocompetent with

• localized herpes zoster, then standard precautions should be followed and lesions should be completely covered.
  
• disseminated herpes zoster (defined as appearance of lesions outside the primary or adjacent dermatomes), then standard precautions plus airborne and contact precautions should be followed until lesions are dry and crusted.
  

If the patient is immunocompromised with

• localized herpes zoster, then standard precautions plus airborne and contact precautions should be followed until disseminated infection is ruled out. Then standard precautions should be followed until lesions are dry and crusted.
  
• disseminated herpes zoster, then standard precautions plus airborne and contact precautions should be followed until lesions are dry and crusted. CDC - Shingles - Preventing VZV Transmission in Healthcare Settings - Herpes Zoster
  

I hope this helps

[Brighten]

Airbourne and contact