Isolation Precautions for CHICKEN POX & HERPES ZOSTER
Place of Isolation: Single room – door to be kept shut. If more than one is involved they can be nursed together in one ward.
Protective Clothing: Plastic Apron – all patient contact. Gloves – handling contaminated articles, contact with infected area, or dressing.
Linen, Crockery, Bedpans: Standard precautions.
Medical Equipment: Use disposable where possible. Ensure adequate decontamination of non-disposable equipment between uses. Wash re-usable with general purpose detergent and disinfect with 0.1% Hypo chloride. Dry thoroughly.
General Waste: No special precautions.
Room Cleaning: Disinfect with 0.1% Hypochlorite solution after cleaning with a detergent solution.
Baths: Disinfect after use, using non-abrasive Hypochlorite powder.
Visitors: Visitors who have not had chicken pox should be warned of the hazard. Instruct in correct hand washing technique. Pregnant women who have not had Chicken Pox should not visit.
All Staff All staff that has not had chicken pox should be excluded from caring for patients with shingles. If staff is not sure whether or not they have had Chicken Pox
an antibody blood test can be performed via the Occupational Health Department.
Nursing Staff Should not look after these patients and patients who are immuno-suppressed during the same span of duty.
Route of Spread Chicken Pox – airborne by droplets. Can be spread from the lesions of Herpes Zoster by contact and cause Chicken Pox in a person who is not immune..
Period of Isolation: Chicken Pox – seven days from start of eruption.
Herpes Zoster – length of illness (when lesions are healed)
Virus is likely to be present in the scabs.
Chicken Pox and Shingles are caused by same herpes virus (varicella – zoster)
Primary Infection Chicken Pox
Chicken Pox is a highly contagious viral illness, which usually occurs in childhood. It has a 10-20 day incubation period and the illness begins with 1-2 days of fever and vomiting prior to the appearance of the rash or eruptions as macules (spots on the skin which are not palpable) which rapidly progress through papule (raised and palpable spots), vesicle (a small collection of serious fluid in the skin) and pustule (containing necrotic white cells and a crust) within a period of 48 hours.
The fever does not abate and fresh lesions appear usually over the next 4-5 days.
The lesions start on the face and trunk and only gradually involve the limbs. The fever eventually abates when no new lesions appear.
In the mouth and respiratory passages, the lesions ulcerate rapidly and release virus into the saliva, which is then aerosolized and is then spread to other persons; the patients are virtually non-infectious when all mucosal lesions have healed.
Complications are uncommon in Chicken Pox, but are more common in older patients, the most being bacterial skin super infections.
The varicella virus can lie dormant in nerve root ganglia, but can re-emerge following systemic disease, particularly Hodgkin’s disease or immune suppressive therapy, resulting in disseminated Herpes Zoster which may be indistinguishable from primary Chicken Pox.
Shingles only occurs in patients who have previously had Chicken Pox. The virus reactivates in sensory nerve cells and erupts in the coetaneous distribution of the nerve.
Herpes Zoster is characterized by vesicular eruption and neuralgic pain in the
cutaneous areas supplied by peripheral sensory nerves arising from the affected root
ganglia. It is due to reactivation of latent virus.
Fever and general malaise, diarrhea and vomiting may be present for 3-4 days before the eruption of vesicles. They begin to dry and scab about 5 days after their appearance, occasionally leaving scarring of the tissue. The area affected can remain very painful (post herpetic neuralgia) for months, most frequently in the elderly.
Contacts of Shingles who have not had Chicken Pox are at risk but they will develop
Chicken Pox not shingles. Virus is present in the vesicular fluid of Shingles until the vesicles have dried.
Respiratory secretions are not usually a source of infection in Shingles.
Treatment with Acyclovir reduces the amount of virus present and shortens the episode of illness but it does not render patient non-infectious until rash has healed.
employees who have already come in contact with Chicken Pox and been admitted for other reasons should, if possible, be discharged home during the incubation period prior to becoming potentially infectious, i.e. within a week after exposure.
Pregnant women who have contact with a patient suffering from Chicken Pox are advised to contact a professional health practitioner.