What personal protective equipment (PPE) is recommended for healthcare workers caring for patients with meningitis?

PPE for Meningitis

For suspected or confirmed meningococcal meningitis, healthcare workers should use droplet precautions including a surgical mask, eye protection (goggles or face shield), gown, and gloves—N95 respirators are NOT required for routine care but should be used for aerosol-generating procedures like intubation. 1

Standard PPE Requirements by Pathogen Type

Meningococcal Meningitis (Most Critical)

• Droplet precautions are the standard, not airborne precautions, because meningococcal disease spreads via large respiratory droplets over short distances (typically within 3 feet), not through airborne transmission 1
• Required PPE components include:
  • Surgical mask (standard surgical mask is sufficient for routine care) 1
  • Eye protection (goggles or face shield to protect mucous membranes from droplet exposure) 1
  • Gown (impervious surgical gown covering the upper body) 2
  • Gloves (standard gloves; double-gloving may provide extra protection during high-risk procedures) 2

Pneumococcal and Other Bacterial Meningitis

• The same droplet precautions apply as for meningococcal disease 1
• No prophylaxis is indicated for healthcare worker exposure to pneumococcal meningitis 3

When to Upgrade to N95 Respirator

Upgrade from surgical mask to N95 respirator (or PAPR) when performing aerosol-generating procedures, which include: 1

• Endotracheal intubation
• Bag-mask ventilation
• Chest compressions during cardiopulmonary resuscitation
• Positive-pressure ventilation
• Bronchoscopy
• Tracheal suction without closed in-line system 2

During these procedures, use full airborne precautions: N95 respirator, eye protection, gown, and gloves 1

Isolation Room Requirements

• Single room placement is required for all suspected or confirmed meningococcal cases 1
• Negative pressure rooms are NOT necessary—standard single rooms with at least 3 feet spatial separation are adequate 1
• Specialized airborne isolation rooms (AIRs) are reserved for true airborne pathogens like tuberculosis, not meningitis 1
• Isolation can be discontinued after 24 hours of effective antibiotic therapy (ceftriaxone or ciprofloxacin) 1

Critical Timing and Practical Considerations

Do Not Delay Treatment for PPE

• If you lack appropriate PPE when encountering a patient with suspected meningococcal sepsis, immediately don PPE and then begin treatment—do not delay antibiotics 1
• Blood cultures should be obtained, but lumbar puncture should be deferred in patients with severe sepsis and hypotension 1

Proper PPE Use

• Use a "buddy system" with checklists for donning and doffing to prevent self-contamination 2
• PPE should be simple to remove without contaminating the user 2
• Dispose of PPE immediately after removal in appropriate waste containers 2
• Anti-fog measures for goggles may be necessary, as fogging occurs in up to 80% of cases 2

Post-Exposure Prophylaxis

Healthcare workers require prophylaxis ONLY if they had direct exposure to respiratory secretions (e.g., during intubation without appropriate PPE) from a patient with confirmed meningococcal disease 1, 3

Recommended regimens (all equally effective with >95% eradication rates): 3

• Ciprofloxacin 500 mg oral single dose (preferred for ease of administration; contraindicated in pregnancy)
• Ceftriaxone 250 mg IM single dose (preferred during pregnancy)
• Rifampin 600 mg orally twice daily for 2 days (avoid during outbreaks due to resistance concerns)

Healthcare workers have approximately 25 times greater risk than the general population when exposed, though still lower than household contacts 1, 3

Common Pitfalls to Avoid

• Do not use N95 respirators for routine meningitis care—this wastes resources and is not indicated unless performing aerosol-generating procedures 1
• Do not delay prophylaxis waiting for culture confirmation if meningococcal disease is strongly suspected clinically 1
• Do not perform lumbar puncture in hemodynamically unstable patients—give antibiotics immediately after blood cultures 1
• Do not assume all meningitis requires the same precautions—only meningococcal disease requires prophylaxis for exposed healthcare workers 3