Varicella and isolation

Q: 34 years old pregnant female is admitted to ICU with active varicella pneumonia. A negative pressure room should be used, and all providers should be required to wear an N95 respirator.

A) True

B) False

Answer: A

Despite vaccination, providers can acquire varicella. Patient requires both airborne and contact precautions. However, staff with evidence of immunity should care for such patients. An N95 respirator mask should be required. All visitors should be considered susceptible and should wear N95.

There is a case report where a provider who never entered the patient's negative pressure isolation room but remained in the outside corridor passing materials in through an open door - and acquired the infection.

For exposed sero-susceptible patients, isolation and all precautions should continue from the 8th day after the first exposure to the 21st day after the date of the last exposure. ID service and hospital's infectious control committee should be consulted.

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References:

1. Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.

2. Tang JW, Eames I, Li Y, et al. Door-opening motion can potentially lead to a transient breakdown in negative-pressure isolation conditions: the importance of vorticity and buoyancy airflows. J Hosp Infect 2005; 61:283.