What is the management of transmissible conditions?

Management of Transmissible Conditions

The management of transmissible conditions requires implementation of appropriate transmission-based precautions based on the mode of transmission, combined with standard precautions for all patients regardless of their infectious status. 1, 2

General Principles of Management

• Standard precautions should be universally applied for all patients, including hand hygiene, use of personal protective equipment when exposure to blood, body fluids, or potentially infectious materials is anticipated 1, 2
• Transmission-based precautions should be added based on the specific pathogen and its mode of transmission (contact, droplet, or airborne) 1, 2
• All transmissible conditions must be reported to appropriate public health authorities according to local, state, and national requirements 1
• Early identification and isolation of infected individuals is critical for controlling outbreaks of highly contagious diseases 3, 4

Specific Transmission-Based Precautions

Contact Precautions

• Implement for pathogens transmitted by direct or indirect contact with the patient or their environment 1
• Use single rooms when available, wear gloves and gowns upon room entry, and limit patient transport 1, 2
• Examples: Clostridium difficile, multidrug-resistant organisms, viral hemorrhagic fevers 1

Droplet Precautions

• Implement for pathogens transmitted through respiratory droplets (typically within 1-2 meters) 1
• Use single rooms when available, wear surgical masks when working within 1-2 meters of the patient 1
• Examples: Influenza, Bordetella pertussis, Yersinia pestis 1

Airborne Precautions

• Implement for pathogens transmitted through airborne route (small particles that remain suspended in air) 1
• Require negative pressure rooms with closed doors, special high-filtration particulate respirators (N95 or FFP2 masks) 1
• Examples: Tuberculosis (especially multidrug-resistant), measles, varicella 1

Management of Specific Transmissible Conditions

Hand, Foot, and Mouth Disease

• Patients remain contagious until all blisters have dried and crusted over (7-10 days from symptom onset) 5
• Children should not return to school until fever has resolved without medications and all blisters have crusted over 5
• Thorough handwashing with soap and water is essential as alcohol-based sanitizers are insufficient against enteroviruses 5

Pinworm Infections

• Treat with Albendazole 400 mg as a single oral dose, repeated after 2 weeks to address reinfection from eggs that may have hatched after initial treatment 6
• Implement strict hand hygiene and environmental cleaning to prevent fecal-oral transmission 6

Influenza

• Oseltamivir can be used for post-exposure prophylaxis in household contacts of infected individuals 7
• Post-exposure prophylaxis has been shown to reduce laboratory-confirmed influenza from 12% to 1% in household contacts 7

Herpes Infections

• Patients should avoid contact with lesions or intercourse when lesions/symptoms are present to avoid infecting partners 8
• Patients should be informed that genital herpes can be transmitted even in the absence of symptoms through asymptomatic viral shedding 8

Special Populations

Sexual Assault Victims

• Offer prophylactic treatment for STDs after sexual assault 1
• Use condoms for sexual intercourse until STD prophylactic treatment is completed 1
• Offer HIV counseling and testing after assault, though prophylactic treatment for HIV is not generally recommended in most cases 1

Children with Suspected Sexual Abuse

• The identification of sexually transmissible agents in children beyond the neonatal period strongly suggests sexual abuse 1
• Evaluate children for STDs when there is a high risk for STDs, including when a suspected offender has an STD or is at high risk, when the child has symptoms/signs of an STD, or when there is high STD prevalence in the community 1
• Report suspected child sexual abuse according to state requirements 1

Pregnant Healthcare Workers

• Pregnant healthcare workers face additional risks when caring for patients with transmissible conditions due to potential exposure of their unborn children 9
• Risk assessment should be performed for each infectious disease, and temporary reassignment may be advisable for high-risk exposures 9

Immunocompromised Patients

• Immunocompromised patients may require special consideration for prophylaxis against certain infections 7
• Prophylactic strategies have been shown to be effective in preventing influenza in immunocompromised transplant recipients 7

Prevention of Transmission in Healthcare Settings

• Healthcare facilities should have protocols for identifying and managing patients with highly infectious diseases 1
• Emergency departments should have at least one isolation room with a dedicated route and direct access 1
• Special training should be provided to emergency department teams for managing highly infectious diseases 1
• Laboratory sampling should be done in appropriate isolation settings, with preference for point-of-care bedside tests when available 1

Common Pitfalls to Avoid

• Failing to implement transmission-based precautions early in the course of illness 2, 4
• Relying solely on clinical symptoms without considering the incubation period and pre-symptomatic transmission 4
• Neglecting environmental cleaning, especially for pathogens that can survive on surfaces for extended periods 5
• Returning patients to school/work settings prematurely before they are no longer contagious 5
• Overlooking the need for repeated treatment in certain parasitic infections to prevent reinfection 6