What precautions are recommended for patients with meningitis?

Infection Control Precautions for Meningitis

Patients with suspected meningococcal meningitis should be placed under respiratory isolation with droplet precautions until meningococcal disease is excluded, or they have received 24 hours of effective antibiotic therapy. For non-meningococcal meningitis, standard precautions only are required. 1

Types of Precautions Based on Pathogen

Meningococcal Meningitis (Neisseria meningitidis)

• Droplet precautions required for the first 24 hours of effective antibiotic therapy 1
• Precautions include:
  • Placing patient in a single room or maintaining >3 feet spatial separation from other patients
  • Healthcare workers wearing surgical masks when in close contact (<3 feet) with the patient
  • Standard infection prevention precautions (gowns, gloves) alongside droplet precautions
  • Proper hand hygiene before and after patient contact

Non-meningococcal Meningitis

• Standard precautions only are required 1
• This applies to meningitis caused by:
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Viral pathogens
  • Other bacterial causes

Implementation of Precautions

Personal Protective Equipment (PPE)

• Surgical masks (not N95 respirators) when within 3 feet of patients with meningococcal meningitis 1
• N95 respirators should be reserved only for aerosol-generating procedures or suspected COVID-19 co-infection
• Goggles or face shields to protect mucous membranes of the eyes during procedures that might generate splashes
• Protective clothing (disposable or reusable gown) that covers personal clothing and skin

Duration of Precautions

• Maintain droplet precautions for meningococcal meningitis until:
  • Patient has received 24 hours of effective antibiotic therapy (such as Ceftriaxone) 1, OR
  • Meningococcal disease has been ruled out

Antibiotic Prophylaxis for Healthcare Workers

• Only required for healthcare workers with direct exposure to respiratory secretions 1
• Primarily those involved in airway management without wearing a mask
• Options include:
  • Rifampin
  • Ciprofloxacin (single dose)
  • Ceftriaxone
• Not needed for all staff caring for the patient

Special Considerations

Critical Care Management

• Intensive care teams should be involved early in patients with 2:
  • Rapidly evolving rash
  • Evidence of limb ischemia
  • Cardiovascular instability
  • Altered mental state (GCS ≤12 or drop of >2 points)
  • Frequent seizures
  • Respiratory compromise

Common Pitfalls to Avoid

1. Unnecessary isolation: Not all forms of meningitis require droplet precautions - only meningococcal meningitis does
2. Delayed antibiotic administration: Antibiotics should be started promptly, as they not only treat the infection but also reduce transmission risk
3. Over-prescribing prophylaxis: Prophylactic antibiotics should be limited to healthcare workers with direct exposure to respiratory secretions, not all staff
4. Inadequate PPE removal: All PPE should be properly removed before leaving the patient's room to prevent environmental contamination

By following these evidence-based precautions, healthcare facilities can effectively prevent the transmission of meningococcal meningitis while avoiding unnecessary isolation measures for patients with other forms of meningitis.