Does monkeypox require airborne or droplet precautions?

Monkeypox Requires Airborne Precautions for Optimal Infection Control

Monkeypox requires airborne precautions, not just droplet precautions, to minimize transmission risk and protect healthcare workers.

Transmission Characteristics and Precaution Requirements

Monkeypox is transmitted through multiple routes, including:

• Direct contact with infected individuals
• Respiratory droplets
• Contact with contaminated items
• Potential airborne transmission over longer distances

While monkeypox shares some characteristics with diseases requiring droplet precautions, its classification among orthopoxviruses (similar to smallpox) and potential for more distant transmission necessitates airborne precautions 1, 2.

Evidence for Airborne Precautions

Current guidelines classify monkeypox among conditions requiring airborne precautions due to:

1. Its ability to remain infectious over long distances when suspended in air
2. Similarity to other orthopoxviruses that require airborne precautions
3. Documented cases of transmission without direct contact 3

According to the American Journal of Kidney Diseases, airborne precautions are specifically "advocated for the prevention of microorganism spread when they are presumed to remain infectious over long distances when suspended in the air" - with examples including "varicella virus, rubeola virus, Mycobacterium tuberculosis, and SARS" 3. Monkeypox falls into this category of pathogens.

Implementation of Airborne Precautions

When managing patients with suspected or confirmed monkeypox, healthcare facilities should implement:

• Airborne isolation room (AIR) with special air handling and ventilation capabilities
• If AIR is unavailable, place patient in a private room with door closed
• Use appropriate PPE including a fit-tested NIOSH N95 or higher respirator
• Implement a respiratory protection program with education on respirator use
• Limit patient transport and movement 3

When AIR is Unavailable

If an airborne isolation room is not available (common in outpatient settings), alternative precautions should be taken:

• Place a mask on the patient
• Move patient to a private room with door closed
• Provide healthcare personnel with N95 or higher respirators
• Arrange transfer to a facility with AIR capabilities when possible 3

Additional Infection Control Measures

In addition to airborne precautions, comprehensive infection control for monkeypox includes:

• Contact precautions (gloves, gowns)
• Proper hand hygiene
• Dedicated or disposable patient-care equipment
• Prioritized cleaning and disinfection of the room
• Source control by masking the patient
• Limiting transport and movement of patients 4

Special Considerations for Healthcare Workers

Healthcare workers caring for monkeypox patients should:

• Use appropriate PPE including N95 respirators or higher
• Implement strict hand hygiene protocols
• Cover any lesions completely with clean, dry bandages
• Avoid contact with high-risk individuals (pregnant women without immunity, immunocompromised individuals) 5

Common Pitfalls and Caveats

1. Underestimating transmission risk: Assuming droplet precautions are sufficient may lead to healthcare worker infections
2. Inadequate room ventilation: Failing to use negative pressure rooms or appropriate alternatives
3. Improper PPE selection: Using surgical masks instead of N95 respirators
4. Premature discontinuation of precautions: Precautions should be maintained until all lesions are dry and crusted
5. Neglecting contact precautions: Airborne precautions must be implemented alongside contact precautions 3, 5

While some guidelines for other conditions like COVID-19 may suggest droplet precautions for certain scenarios 3, the specific characteristics of monkeypox and its classification among orthopoxviruses warrant the more stringent airborne precautions to ensure maximum protection for healthcare workers and prevent nosocomial transmission.