From the Guidelines
For patients with open shingles and bacterial meningitis in healthcare settings, implement both contact and droplet precautions to minimize the risk of transmission and ensure the best outcomes in terms of morbidity, mortality, and quality of life. When managing patients with these conditions, it's crucial to consider the modes of transmission and the effectiveness of different precautionary measures. For shingles (herpes zoster), the primary concern is the transmission of varicella-zoster virus through direct contact with fluid from vesicles, which necessitates the use of contact precautions until all lesions are crusted over, typically within 7-10 days 1. This includes the use of gloves, gowns, and dedicated equipment when interacting with the patient.
For bacterial meningitis, the focus is on preventing the spread through respiratory droplets. According to the UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults, droplet precautions are recommended until the patient has had 24 hours of effective antibiotic therapy 1. These precautions include nursing the patient in a single room and requiring healthcare workers to wear surgical masks if they will be within close contact (less than 3 feet) of the patient.
Key considerations for managing these patients include:
- Private rooms, preferably with negative pressure for shingles if the patient is immunocompromised or has disseminated disease.
- Hand hygiene with alcohol-based sanitizer or soap and water before and after patient contact.
- Avoidance of patient care by immunocompromised staff for those with active shingles due to the risk of severe infection.
- The use of dedicated equipment and the implementation of standard infection prevention precautions to further reduce transmission risk.
Given the potential for severe outcomes associated with both conditions, particularly in immunocompromised individuals or those with certain underlying health conditions, adhering to these precautionary measures is essential for minimizing morbidity, mortality, and improving quality of life for patients and healthcare workers alike 1.
From the Research
Contact Precautions for Open Shingles and Bacterial Meningitis
- For patients with open shingles, contact precautions are recommended to prevent the transmission of the varicella-zoster virus 2.
- Bacterial meningitis requires contact precautions to prevent the transmission of the bacteria, especially in cases where the bacteria are resistant to certain antibiotics 3.
- The cornerstone of transmission-based precautions, including contact precautions, is the appropriate use of personal protective equipment (PPE) to protect healthcare personnel and patients from infection 4.
- Contact precautions involve the use of PPE, such as gloves and gowns, when caring for patients with infections that can be transmitted through direct or indirect contact 4, 5.
Key Considerations for Healthcare Settings
- Standard precautions should be used for all patients, regardless of their infection status, and include practices such as hand hygiene and the use of PPE when exposure to blood or body fluids is anticipated 4, 5.
- Transmission-based precautions, including contact precautions, should be used in addition to standard precautions when caring for patients with infections that can be transmitted through direct or indirect contact 4, 2, 5.
- Visitors to healthcare facilities should also be considered when implementing transmission-based precautions, and decisions should take into account the organism of concern, means of transmission, and factors related to the visitor and healthcare setting 6.