What type of isolation is recommended for patients with shingles?

From the Guidelines

Standard contact precautions are recommended for patients with shingles, and for immunocompromised patients with disseminated shingles, airborne precautions should be added to contact precautions. These precautions should be maintained until all lesions have crusted over 1. The isolation measures are necessary because shingles is caused by the reactivation of the varicella-zoster virus, which can be transmitted through direct contact with fluid from the vesicular lesions. Some key points to consider when implementing isolation precautions for patients with shingles include:

• Contact precautions involve wearing gloves and a gown when entering the patient's room and during patient care 1
• Proper hand hygiene before and after patient contact is essential 1
• Using dedicated equipment when possible can help prevent transmission 1
• Airborne precautions, such as negative air-flow rooms, should be employed for immunocompromised patients with disseminated shingles 1
• If negative air-flow rooms are not available, patients should be isolated in closed rooms and should not have contact with persons without evidence of immunity to varicella 1 The virus can cause chickenpox in susceptible individuals who have not had chickenpox or received the varicella vaccine, and immunocompromised patients, pregnant women, and newborns are at particularly high risk for severe disease if infected 1.

From the Research

Isolation for Shingles

• The type of isolation recommended for patients with shingles is not explicitly stated in the provided studies, but it can be inferred that isolation is necessary to prevent the transmission of varicella-zoster virus (VZV) to susceptible individuals, such as immunocompromised patients, pregnant women, and neonates 2.
• Airborne precautions should be taken when caring for patients with herpes zoster, as the virus can be transmitted through the air or by direct contact with the index case 2, 3.
• Patients with shingles should be placed in a private room with airflow that minimizes the dispersal of airborne pathogens, and healthcare workers should wear personal protective equipment (PPE) when entering the room 3.
• The Centers for Disease Control and Prevention (CDC) recommends that patients with shingles be isolated from susceptible individuals until the rash has crusted over, which usually occurs within 7-10 days of the onset of the rash 3.
• In healthcare settings, it is essential to verify the immunization status of healthcare workers and patients, and to take measures to prevent the transmission of VZV, such as furloughing unimmunized staff after exposure to herpes zoster, and offering postexposure prophylaxis with vaccination or varicella zoster immunoglobulin (Varizig) 3.

Prevention of Transmission

• Preventing the transmission of VZV in healthcare settings requires a multifaceted approach, including:
  • Verifying the immunization status of healthcare workers and patients
  • Implementing infection control measures, such as airborne precautions and PPE
  • Furloughing unimmunized staff after exposure to herpes zoster
  • Offering postexposure prophylaxis with vaccination or Varizig
  • Documenting patients' immunity to varicella at the time of hospital admission 3.

Treatment and Management

• The treatment and management of shingles typically involve antiviral medications, such as valaciclovir, which can help alleviate symptoms and reduce the risk of complications 4.
• Valaciclovir has been shown to be effective in controlling the symptoms of acute herpes zoster and reducing the duration of postherpetic neuralgia 4.
• The recommended regimen for the treatment of herpes zoster is valaciclovir 1000 mg three times daily for 7 days, which has been shown to be well tolerated and effective in immunocompetent patients 4.