What PPE should healthcare providers use when addressing a patient with suspected severe infection, such as meningitis or sepsis, presenting with hyperthermia, tachycardia, hypotension, and nuchal rigidity?

PPE for Suspected Bacterial Meningitis with Severe Sepsis

Healthcare providers should immediately don droplet precautions PPE consisting of a surgical mask, gown, gloves, and eye protection (goggles or face shield) when evaluating this patient with suspected meningococcal meningitis and septic shock. 1

Immediate PPE Requirements

Standard Droplet Precautions Equipment

• Surgical mask (not N95 respirator) - adequate for meningococcal disease as it spreads via large respiratory droplets over short distances, not true airborne transmission 1
• Gown - provides better protection than aprons against contamination with body fluids 2
• Gloves - consider double gloving as this reduces contamination risk (RR 0.36; 95% CI 0.16 to 0.78) 3
• Eye protection (goggles or face shield) - protects against droplet exposure to mucous membranes 4

Isolation Placement

• Single room placement with at least 3 feet spatial separation from other patients 1
• Respiratory isolation must be initiated immediately until meningococcal disease is excluded or the patient receives 24 hours of ceftriaxone 1
• Specialized negative pressure airborne isolation rooms (AIRs) are not necessary for meningitis 1

Critical Clinical Context

This patient's presentation (high fever 105.3°F, nuchal rigidity, altered mental status with sluggish pupils, hypotension, and tachycardia) is highly concerning for meningococcal meningitis with septic shock - a medical emergency requiring immediate intervention. 4

Why N95 Respirators Are NOT Required

• Meningococcal and pneumococcal meningitis spread through large respiratory droplets that do not remain suspended in air over long distances 1
• True airborne precautions (N95 respirators, negative pressure rooms) are reserved for organisms like tuberculosis, varicella, and measles that remain infectious over long distances 1
• Standard surgical masks are sufficient for meningitis pathogens 1

Special Considerations for Aerosol-Generating Procedures

If Intubation or Resuscitation Becomes Necessary

Should this patient deteriorate and require intubation or CPR, upgrade to N95 respirator along with gown, gloves, and eye protection, as these are aerosol-generating procedures (AGPs) 4

Key AGPs requiring N95 upgrade include: 4

• Chest compressions
• Bag-mask ventilation
• Endotracheal intubation
• Positive-pressure ventilation

PPE Donning and Doffing Guidance

• Follow CDC doffing recommendations to reduce self-contamination (MD -5.44,95% CI -7.43 to -3.45) 2
• Remove gloves and gown together in one step rather than separately (RR 0.20,95% CI 0.05 to 0.77) 2
• Sanitize gloves with quaternary ammonium or bleach (not alcohol-based hand rub) before removal to decrease contamination 2
• All personnel not wearing appropriate PPE should be immediately excused from the room 4

Duration of Precautions

• Maintain droplet precautions until the patient receives 24 hours of IV ceftriaxone, a single dose of oral ciprofloxacin, or 48 hours of rifampin 1
• If meningococcal disease is deemed unlikely based on clinical assessment or alternative diagnosis is confirmed, precautions may be discontinued earlier 1

Healthcare Worker Prophylaxis Considerations

• Post-exposure prophylaxis is indicated ONLY for healthcare workers with close contact with respiratory secretions (e.g., mouth-to-mouth resuscitation, unprotected intubation) 1, 5
• Healthcare workers have approximately 25 times greater risk of acquiring meningococcal disease than the general population when exposed 1, 5
• Recommended prophylaxis: ciprofloxacin 500 mg oral single dose for adults (ceftriaxone 250 mg IM if pregnant) 5

Common Pitfalls to Avoid

• Do not delay antibiotics to don PPE - if initial responders lack appropriate PPE, they should immediately don it and then begin treatment 4
• Do not use N95 respirators routinely for suspected meningitis without AGPs - this wastes critical PPE resources and provides no additional benefit 1
• Do not perform lumbar puncture in this patient with severe sepsis and hypotension - antibiotics should be given immediately after blood cultures, and LP should be deferred 4
• Do not assume all meningitis requires the same precautions - only meningococcal meningitis requires droplet precautions; pneumococcal and other bacterial meningitis do not require isolation beyond standard precautions once identified 1