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Empiric and Syndromic Precautions

Certain clinical conditions carry a sufficiently high risk to call for the practical application of isolation precautions while waiting for a clear diagnosis. Empiric precautions may be initiated while confirmatory tests are pending (eg, laboratory cultures). The Centers for Disease Control and Prevention's (CDC's) document, The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007, includes the following syndromes/conditions that warrant empiric transmission-based precautions (always includes Standard Precautions):
  • Acute diarrhea with a likely infectious cause in an incontinent or diapered patient. Enteric pathogens may include:
    • Enterohemorrhagic Escherichia coli O157:H7
    • Shigella species
    • Hepatitis A virus
    • Noroviruses
    • Rotavirus
    • Clostridium difficile
  • Petechial/ecchymotic rash with fever or suspected meningitis. Pathogens may include:
    • Neisseria meningitidis
    • Enteroviruses
    • Mycobacterium tuberculosis
  • Positive travel history to an area with an ongoing outbreak of viral hemorrhagic fever (VHF) in the ten days before onset of fever. Pathogens may include:
    • Ebola virus
    • Lassa virus
    • Marburg virus
  • Vesicular rash. Possible pathogens include:
    • Varicella-zoster
    • Herpes simplex
    • Variola (smallpox)
    • Vaccinia viruses
  • Maculopapular rash with cough, coryza, and fever. Potential pathogen is rubeola (measles).
  • Cough, fever, and pulmonary infiltrate. Possible pathogens may include:
    • M. tuberculosis
    • Respiratory viruses
    • Streptococcus pneumoniae
    • Staphylococcus aureus
  • History of recent travel (10-21 days) to countries with active outbreaks of SARS or avian influenza. Potential pathogens include:
    • M. tuberculosis
    • Severe acute respiratory syndrome virus (SARS-CoV)
    • Avian influenza
  • Respiratory infections, particularly bronchiolitis and pneumonia, in infants and young children. Possible pathogens may include:
    • Respiratory syncytial virus (RSV)
    • Parainfluenza virus
    • Adenovirus
    • Influenza virus
    • Human metapneumovirus
  • Abscess or draining wound that cannot be covered. Possible pathogens include:
    • S. aureus
    • Group A Streptococcus