From the Guidelines
Hospital precautions for patients with shingles should include standard infection-control precautions, as well as airborne and contact precautions when disseminated zoster is suspected or the patient is immunocompromised. This is based on the most recent evidence from 2020, which highlights the importance of preventing the spread of herpes zoster virus infection in healthcare settings 1.
Key Precautions
- Patients with shingles should be placed in a private room with negative air pressure if possible, especially if they have disseminated disease
- Healthcare workers should wear gloves and gowns when providing direct patient care, and those without immunity to varicella should also wear N95 respirators
- Hand hygiene before and after patient contact is essential
- Immunocompromised individuals and pregnant women without varicella immunity should avoid contact with these patients
- Patients can typically be removed from isolation once all lesions have crusted over, which usually occurs within 7-10 days after rash onset
Additional Measures
- Ensure appropriate patient placement, such as a single-patient room or >3 ft spatial separation 1
- Use personal protective equipment (PPE) appropriately, including gloves and gown, and don upon entry and properly discard before exiting
- Limit transport and movement of patient
- Use disposable or dedicated patient-care equipment
- Prioritize cleaning and disinfection of the room
Treatment
- Prompt antiviral treatment with medications like acyclovir, valacyclovir, or famciclovir should be initiated within 72 hours of rash onset to reduce viral shedding and accelerate healing 1
From the Research
Hospital Precautions for Patients with Shingles
- Patients with shingles may be contagious for susceptible children due to the enormous amount of virus particles in vesicle fluid 2
- Hospital precautions should include isolation of the patient to prevent transmission to other patients, especially those with weakened immune systems
- Healthcare workers should wear gloves and masks when interacting with patients with shingles to prevent transmission
- Patients with shingles should be educated on how to prevent transmission, including keeping the rash covered and avoiding contact with others, especially those with weakened immune systems
Management of Shingles in the Hospital
- Antiviral medications such as acyclovir, valacyclovir, or famciclovir may be prescribed to treat shingles, ideally within 72 hours of the development of the rash 3, 4
- Pain management is also crucial, and may include the use of analgesics, tricyclic antidepressants, or anticonvulsants 3, 4
- Patients with postherpetic neuralgia may require additional treatment, including topical lidocaine or capsaicin, and oral gabapentin, pregabalin, or tricyclic antidepressants 4
Special Considerations
- Immunocompromised patients, such as those with HIV infection, may require special consideration and treatment, including the use of antiviral medications and close monitoring for complications 2, 5
- Patients with ocular involvement may require referral to an ophthalmologist to prevent serious complications 3
- Pregnant women with shingles should be closely monitored and treated to prevent complications, including congenital abnormalities 2