Precautions for Patients with Herpes in Hospital Settings
For patients with herpes infection, implement standard precautions plus specific transmission-based precautions based on the type and location of herpes infection, with contact precautions for all forms and airborne precautions for disseminated zoster in immunocompromised patients. 1, 2
Type-Specific Precautions
Herpes Zoster (Shingles)
Localized zoster in immunocompetent patients:
- Implement standard precautions
- Cover all lesions completely
- Restrict from care of high-risk patients (including pregnant women, neonates, and immunocompromised persons)
- Maintain precautions until all lesions are dry and crusted 1
Disseminated zoster or localized zoster in immunocompromised patients:
Genital Herpes
- Implement standard precautions
- Cover lesions when possible
- Emphasize hand hygiene before and after patient contact 4
- Educate patient about preventing transmission during active lesions 5, 6
Oral Herpes (Cold Sores)
- Implement standard precautions
- Emphasize hand hygiene before and after contact with the patient or their environment 4
- Cover lesions if possible 7
Key Components of Precautions
Hand Hygiene
- Decontaminate hands before and after each patient contact
- Use alcohol-based hand rub if hands are not visibly soiled
- Use soap and water when hands are visibly dirty or contaminated with body fluids
- Perform hand hygiene after removing gloves 4
Personal Protective Equipment (PPE)
Gloves
- Wear gloves when contact with lesions or potentially contaminated items is anticipated
- Change gloves between clean and contaminated procedures on the same patient
- Remove gloves and perform hand hygiene before touching environmental surfaces 8
Gowns
- Wear gowns when entering the room of patients with disseminated herpes zoster
- Change gowns after contact with infectious material and before caring for another patient 8
Masks and Eye Protection
- Wear surgical mask and eye protection when performing procedures that might generate sprays of secretions
- For herpes zoster (disseminated or in immunocompromised patients), use N95 respirator or equivalent 8, 9
Patient Placement
- Private room: Required for patients with disseminated herpes zoster or localized zoster in immunocompromised patients
- Negative pressure ventilation: Recommended for disseminated zoster to prevent airborne transmission 1, 3
- Cohorting: Patients with the same type of herpes infection may share a room if necessary 8
Patient Transport
- Limit transport to essential purposes only
- If transport is necessary, ensure lesions are covered
- For patients with disseminated zoster, place a surgical mask on the patient during transport 8
Special Considerations
Healthcare Personnel Exposure
- Healthcare workers without evidence of varicella immunity who are exposed to herpes zoster should:
- Receive varicella vaccine within 3-5 days of exposure if possible
- Be excluded from duty from the 8th day after first exposure through the 21st day after last exposure 1
Immunocompromised Patients with Herpes
- Implement more stringent precautions
- Maintain precautions until all lesions are completely crusted
- Consider antiviral therapy to reduce viral shedding 2, 10
Patient Education
- Instruct patients about the nature of their infection and transmission risks
- Emphasize the importance of hand hygiene and covering lesions
- Provide information about antiviral medications when appropriate 5, 6
Common Pitfalls to Avoid
- Failure to recognize atypical presentations of herpes infections, especially in immunocompromised patients 6, 7
- Premature discontinuation of precautions before lesions are fully crusted 1
- Inadequate protection of susceptible patients (neonates, pregnant women, immunocompromised individuals) from exposure 1, 2
- Inconsistent hand hygiene which remains the most important measure to prevent transmission 4