Spectrum: Local Antimicrobial Stewardship, for CHEO-OCTC

Syndrome-Based Precautions

Syndrome-Based Precautions

Abscess on skin or purulent cellulitis

Empiric Precautions

  • Routine Practices however contact precautions if drainage not contained by dressing

Duration

  • Maintain precautions for duration of drainage

Antimicrobial resistant organism e.g. MRSA or other resistant gram negatives such as ESBL

Empiric Precautions

  • Contact

Duration

  • Maintain precautions as directed by Infection Prevention and Control

Bronchiolitis

Empiric Precautions

  • Droplet/Contact

Duration

  • Maintain precautions for duration of illness.

Cellulitis, non-purulent

Empiric Precautions

  • Routine practices

Comment

  • For purulent cellulitis or abscess see abscess

Conjunctivitis

Empiric Precautions

  • Contact if presumed viral

  • Routine Practices if non-viral

Duration

  • Maintain precautions for duration of symptoms if viral

Cough, fever, acute upper respiratory tract infection

Empiric Precautions

  • Droplet/contact

Duration

  • Duration of illness except pertussis.

  • See precautions for specific pathogens

Croup

Empiric Precautions

  • Droplet/contact

Duration

  • Maintain precautions for duration of illness.

Diarrhea

Empiric Precautions

  • Contact

Duration

  • For duration of precautions, see 'Pathogen or Disease-Specific Precautions' section

  • Contact precautions for duration of hospitalization may be indicated in some circumstances

Encephalitis

Empiric Precautions

  • Contact

Comments

  • If measles, mumps, varicella or M. pneumoniae suspected, also take appropriate precautions for these diseases

  • See 'Pathogen or Disease-Specific Precautions' section

Duration

  • May vary according to specific etiology

  • See precautions for specific pathogens

Epiglottitis

Empiric Precautions

  • Droplet/contact

Duration

  • Maintain precautions until 24 hours of appropriate antimicrobial therapy received

Fever without focus (acute, no focal signs or symptoms) OR “Sepsis or R/O Sepsis”

Empiric Precautions

  • <30 days of age: Routine Practices

  • >30 days of age: Droplet / Contact

Duration

  • Maintain precautions until specific etiology established

  • See 'Pathogen or Disease Related Precautions' section

Hand, foot and mouth disease

Empiric Precautions

  • Contact

Duration

  • Maintain precautions for duration of illness

Hemolytic-uremic syndrome (HUS)

Empiric Precautions

  • Contact

Duration

  • Until E. coli 0157 ruled out; or until 2 negative stools or for 10 days from onset of diarrhea if E. coli 0157

Hemorrhagic fever acquired in appropriate endemic area (Always strongly consider malaria diagnosis)

Empiric Precautions

  • Droplet / Contact plus Airborne

Comments

  • IPAC, local public health authorities and Public Health Agency of Canada (PHAC) should be notified immediately

Hepatitis of unknown etiology

Empiric Precautions

  • Contact

Duration

  • Maintain precautions until hepatitis A and E ruled out; or for 7 days after onset of jaundice for hepatitis A or E

Kawasaki disease (Mucocutaneous lymph node syndrome)

Empiric Precautions

  • Routine practices

Meningitis

Empiric Precautions

  • Droplet /Contact

  • Airborne if measles, varicella, Herpes simplex or tuberculosis suspected

Duration

  • Until etiology established then as for specific organism

  • See 'Pathogen or Disease Related Precautions' section

  • Fungal etiology does not require special precautions

Necrotizing enterocolitis

Empiric Precautions

  • Routine practices

Comments

  • Contact IPAC if outbreak

Necrotizing fasciitis

Empiric Precautions

  • Droplet/contact

Duration

  • Maintain precautions until 24 hours of appropriate antimicrobial therapy received

Orbital or periorbital infection associated with sinusitis

Empiric Precautions

  • Droplet/contact

Duration

  • Maintain precautions until 24 hours of appropriate antimicrobial therapy received.

Osteomyelitis/Septic arthritis

Empiric Precautions

  • Routine practices

Pharyngitis

Empiric Precautions

  • Droplet/contact

Duration

  • Maintain precautions for duration of illness

  • If Strep gr A, until 24 hours of appropriate antimicrobial therapy received

  • If diphtheria, see 'Pathogen or Disease-Specific Precautions' section

Pneumonia

Empiric Precautions

  • Droplet/contact

Duration

  • If viral etiology ruled out and probable bacterial cause, isolation may be discontinued after 24 hours of appropriate antimicrobial therapy.

  • Note: Mycoplasma pneumonia requires isolation for duration of symptoms.

Rash and fever

Empiric Precautions

  • Droplet/contact

  • If measles possible –Airborne

  • If VZV possible – Airborne and Contact

Duration

  • If no specific etiology confirmed, maintain precautions until resolution or alternative non-infectious diagnosis

  • For specific etiologies - see 'Pathogen or Disease-Specific Precautions' section

Urinary Tract infection

Empiric Precautions

  • Routine practices