Should monkeypox be managed with contact or respiratory precautions?

Monkeypox Infection Control: Contact and Respiratory Precautions

Monkeypox requires both contact and respiratory precautions due to its transmission through direct contact with lesions, contaminated materials, and respiratory droplets. 1

Transmission Routes of Monkeypox

Monkeypox virus can be transmitted through multiple routes:

• Direct contact with skin lesions or body fluids 1, 2
• Respiratory droplets during close, prolonged face-to-face contact 2
• Fomites (contaminated objects) such as bedding, towels, and clothing 1, 2
• Contact with contaminated materials from lesions 3

Required Infection Control Measures

Contact Precautions

Contact precautions are essential due to the high likelihood of transmission through direct or indirect contact with the patient or their environment 4:

• Single-patient room or >3 ft spatial separation from other patients
• Appropriate PPE including gloves and gown
• Proper donning upon entry and discarding before exiting
• Limited transport and movement of patient
• Dedicated or disposable patient-care equipment
• Prioritized cleaning and disinfection of the room 4

Respiratory Precautions

Because monkeypox can also spread through respiratory droplets, droplet precautions are necessary 4, 2:

• Single-patient room or >3 ft spatial separation
• Appropriate mask use upon entry to patient room
• Source control: placing a mask on the patient
• Instructing patient in respiratory hygiene/cough etiquette
• Limited transport and movement of patient 4

Isolation Requirements

• Isolation until all lesions have crusted over 1
• Proper handling of contaminated materials:
  • Place used bandages in sealed plastic bags before disposal 1
  • Launder contaminated clothing, towels, and bedding in hot water with bleach 4

Special Considerations

Healthcare Worker Protection

• Healthcare workers should keep vaccination sites covered with gauze or absorbent material with a semipermeable dressing 4
• Meticulous hand hygiene with antimicrobial soap and water or alcohol-based hand rub (>60% alcohol) is critical 4, 1
• Daily assessment of dressings and vaccination sites 4

Documented Transmission Risk

A documented case of monkeypox transmission from a patient to a healthcare worker in the UK occurred through contact with contaminated bedding, highlighting the importance of proper contact precautions 3.

Common Pitfalls to Avoid

1. Inadequate hand hygiene: The most critical measure in preventing transmission is consistent hand hygiene after any contact with lesions or contaminated materials 4, 1

2. Improper handling of contaminated materials: Contaminated bandages should be placed in sealed plastic bags before disposal 1

3. Premature discontinuation of precautions: Isolation should continue until all lesions have crusted over, not just until symptoms improve 1

4. Focusing only on contact precautions: Both contact and respiratory precautions are necessary due to the multiple transmission routes 4, 2

By implementing both contact and respiratory precautions, healthcare facilities can effectively minimize the risk of monkeypox transmission to healthcare workers and other patients.