Shingles precautions

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When a pt is admitted with shingles we've always put them in a negative pressure room on droplet precautions. I asked a doctor about the necessity of wearing a mask. He states that since I've had chickenpox (and have a titer that demonstrates immunity) I don't need the mask. The idea is that I've already got the virus inactive in me and exposure does not cause a case of shingles. The isolation is to protect the other pts. Any thoughts? Rationales for wearing a mask?

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I'd recommend reading the section on the CDC website that talks about shingles in the healthcare setting and considerations for healthcare workers, there is a good explanation of everything there.

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I agree about the CDC and a rule of thumb always go with what's written in your policy and procedures manual. They are there for a reason. If your policy is negative pressure and droplet go with that regardless of what the doctor says. Now if the CDC or some other scholastic source has new data and it's valid then you could present this to your policy committee and have them research it.

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Specializes in Acute Care, Rehab, Palliative.

We only put patients on contact precautions for shingles.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

According to the CDC.....CDC - Shingles - Preventing VZV Transmission from Zoster in Healthcare Settings - 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.

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Specializes in Emergency, Telemetry, Transplant.

This is a total shot in the dark here...perhaps the concern is that you could inhale shed virus particles in the room, and they are not totally exhaled until you go out of the room and are now near someone susceptible to infection. Again, not sure that is even possible, just a wild guess.

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Thanks all! I'll ask our infection control person whether it is actually the policy or if the other nurses are just doing it this way. Next time I see the ID doc I'll ask him too.

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In all facilities that I've worked, airborne precautions were used whenever the pt is diagnosed with disseminated shingles with at least three dermatomes involved. Pt's with disseminated shingles tend to be significantly immunocompromised as their immune system is unable to keep the infection contained within a single dermatome. It's been explained to me that the amount of herpes zoster is greater with disseminated shingles, and there is a greater chance for aerolization of the virus when the vesicles are oozing. Also interestingly enough, when vesicles were present on the tip of a pt's nose, optic nerve involvement was suspected (shingles opthalamicus) and airborne precautions and IV acyclovir were protocol.

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Specializes in Infection Control, Employee Health & TB.
Thanks all! I'll ask our infection control person whether it is actually the policy or if the other nurses are just doing it this way. Next time I see the ID doc I'll ask him too.

You should have policies in place that mirror the CDC's 2007 Guide for Isolation Precautions (which standards for shingles/herpes zoster have been copied in other posts above). Your institution should have these readily accessible so that if there is a question, no one is relying on what someone remembers doing last time because there can be differences in patient presentation (especially with shingles). It is my experience that when isolation precautions are implemented, all employees are to adhere to them... regardless of evidence of immunity. Most institutions' policies do not state a mask is required for anyone not having immunity, they usually read (for shingles) that Airborne (negative pressure room & N-95 mask)/Contact precautions (depending on the patient's presentation) are to be implemented and adhered to by all employees. As someone that works in our Epidemiology dept (Infection Prevention/Control), I can't even imagine having to monitor adherence to isolation precautions exempting immune individuals. Also, the isolation is to protect everyone, not necessarily only patients. If you have a titer showing immunity, literature shows that you can still become reinfected (see below).

[COLOR=#0066cc]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106231/

If you get a chance to read the article... it is very interesting:nailbiting: (Of course this kind of stuff is always interesting to me!;)

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At my old rehab unit, we'd only put them on contact precautions. Which was only gown and gloves, altho I'd choose to wear a mask. This was also a place that left Tb patients in regular rooms too so... not sure if that's correct protocol or not.

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