infection prevention
By Margaret M . Miller , BS , MT ( ASCP ) M CIC FAPIC , and Susan Singh , MPH , CIC
My Patient Has a Diagnosis of Monkeypox , What Do I Need to Know ?
What is Monkeypox ?
Monkeypox is caused by the Monkeypox virus which belongs to the Orthopoxvirus genus in the family Poxviridae . Monkeypox is usually a self-limited disease with the symptoms lasting two to four weeks . There are two distinct genetic clades ( strains ) of the Monkeypox virus : the Central African ( Congo Basin ) clade and the West African clade . The current 2022 outbreak is of the West African clade and is typically associated with less severe illness . More than 99 percent of people who get this form of the disease are likely to survive . However , people with weakened
There are two distinct genetic clades ( strains ) of the Monkeypox virus : the Central
African ( Congo Basin ) clade and the West African clade . The current 2022 outbreak is of the West African clade and is typically associated with less severe illness .” immune systems , children under eight years of age , people with a history of eczema , and women who are pregnant or breastfeeding may be more likely to get seriously ill or die .
What do I need to know about Monkeypox ?
Monkeypox can spread from person-to-person through :
• Direct contact with the infectious rash , scabs , or body fluids
• Respiratory secretions during prolonged , face-to-face contact , or during intimate physical contact , such as kissing , cuddling , or sex
• Touching items ( such as clothing or linens ) that previously touched the infectious rash or body fluids
• Pregnant women can spread the virus to their fetus through the placenta
If you have cared for a Monkeypox patient , be alert to the development of symptoms ( fever , chills , new rash , or lymphadenopathy ) for 21 days after the last date of care , and notify infection control , occupational health , and the health department to be guided about a medical evaluation .
• Healthcare workers who have unprotected exposures ( i . e ., not wearing PPE ) to patients with Monkeypox do not need to be excluded from work duty , but should undergo active surveillance for symptoms , which includes measurement of temperature at least twice daily for 21 days following the exposure . Prior to reporting for work each day , the healthcare worker should be interviewed regarding evidence of fever or rash .
• Healthcare workers who have cared for or otherwise been in direct or indirect contact with Monkeypox patients while adhering to recommended infection control precautions may undergo self-monitoring or active monitoring as determined by the health department .
What do I need to do differently for a patient with Monkeypox ?
Notify the infection prevention and control department that a patient with signs and symptoms of Monkeypox has been admitted .
Have a policy in place that is customized to your facility ’ s needs and outlines the management of patients with suspected or confirmed Monkeypox .
Transmission-based precautions and patient placement
• Patients with suspected or confirmed Monkeypox infection should be placed in a single-person room ; special air handling is not required . The door should be kept closed ( if safe to do so ). The patient should have a dedicated bathroom .
• Transport and movement of the patient outside of the room should be limited to medically essential purposes . If the patient is transported outside of their room , they should use well-fitting source control ( e . g ., medical mask ) and have any exposed skin lesions covered with a sheet or gown .
• Intubation and extubation , and any procedures likely to spread oral secretions , should be performed in an airborne infection isolation room ( AIIR )
• Use of portable fans , dry dusting , sweeping , or vacuuming should be avoided to prevent re-suspending the dried material from lesions
• Ensure signage is posted on patient ’ s door with the appropriate transmission-based precautions
Personal protective equipment ( PPE ) PPE used by healthcare personnel who enter the patient ’ s room should include :
• Gown
• Gloves
• Eye protection ( i . e ., goggles or a face shield that covers the front and sides of the face )
• NIOSH-approved particulate respirator equipped with N95 filters or higher
Waste management
Waste management ( i . e ., handling , storage , treatment , and disposal of soiled PPE , patient dressings , etc .) should be performed in accordance with U . S . Department of Transportation ( DOT ) Hazardous Materials Regulations ( HMR ; 49 CFR parts 171-180 .)
Required waste management practices and classification currently differ depending on the Monkeypox virus clade .
• West African Clade ( current 2022 outbreak ): Waste contaminated with the West African clade should be managed as UN3291 Regulated Medical Waste ( RMW ) in the same manner as other potentially infectious medical waste .
• Congo Basin Clade : Congo Basin clade is classified as Category A under the DOT hazardous materials regulations . See the DOT website for additional information .