| AIDS/HIV positive | Standard | Standard Bathe baby ASAP when stable | Yes | Yes | No HIV may be transmitted through breast milk. | Recommend tuberculosis testing for mother. Due to constant HIV antiretroviral (ARV) treatment option changes, consult with neonatology expert and refer to http://aidsinfo.nih.gov for current ARV treatment options. Report AIDS to health department. |
| Chickenpox (see Varicella) |
| Chlamydia trachomatis | Standard | Standard | Yes | Yes | Yes | Topical prophylaxis is ineffective for Chlamydia ophthalmic disease. Treatment for Chlamydia conjunctivitis and pneumonia is systemic erythromycin for 14 days. |
| Cytomegalovirus (CMV) | Standard | Standard | Yes | Yes | Yes | No additional precautions for pregnant health care workers. |
| Gastroenteritis | Contact precautions for diapered or incontinent persons for the duration of illness or to control outbreaks for gastroenteritis caused by infectious agents such as Clostridium difficile | Contact precautions for the duration of illness to control outbreaks for gastroenteritis/diarrhea caused by infectious agents such as C. difficile | Yes | Yes | Yes | The most effective method to remove C. difficile spores from contaminated hands is through meticulous hand hygiene with soap and water. Alcohol-based hand hygiene products do not inactivate C. difficile spores. Because C. difficile spores are difficult to kill, most surface disinfectants are ineffective. When outbreaks of C. difficile diarrhea are not controlled by other measures, it is recommended to use a disinfectant with sporicidal activity (eg, hypochlorite). |
| Gonococcal ophthalmia neonatorum | Standard | Standard | Yes After 24 hours of maternal treatment with antibiotics | Yes After 24 hours of maternal treatment with antibiotics | Yes After 24 hours of maternal treatment with antibiotics | Prophylactic use of topical 0.5% erythromycin ophthalmic or 1% tetracycline ointment at birth should be performed to prevent ophthalmic neonatorum. Prophylaxis may be delayed for as long as 1 hour after birth to facility parent infant bonding. Newborns born to mothers with active gonorrhea should receive a single dose of ceftriaxone 125 mg IV or IM. For low birthweight neonates, the dose is 25–50 mg/kg of body weight. Cefotaxime (100 mg/kg) in a single does is an alternative. Refer to Perinatal Guidelines (AAP/ACOG), 2012. |
| Group B streptococcal infections | Standard | Standard | Yes | Yes | Yes | Follow Centers for Disease Control and Prevention (CDC) guidelines for laboratory testing and antibiotic treatment recommendations. |
| Hepatitis A, B, C | Standard | Standard | Yes | Yes | Yes | Early hepatitis B immunization is recommended for all medically stable infants with birthweight >2 kg, regardless of maternal status. The American Academy of Pediatrics recommends that infants born to HBsAg-positive mothers, including preterm and low birthweight infants, receive the initial dose of hepatitis B vaccine within 12 hours of birth. Report to health department. |
Herpes simplex virus (HSV) Neonatal infection or positive culture in absence of disease | | Contact gown and gloves | Yes If baby is at low risk of infection. | Yes | Yes If no vesicular herpetic lesion in the breast area and all active skin lesions are covered. | Cultures obtained from mouth swab, nasopharynx, conjunctiva, anus or skin vesicles, CSF, and whole blood samples 12–24 hours after birth are more likely to identify neonatal infection. A positive culture obtained ≥24 hours after birth needs immediate antiviral treatment, even in the absence of symptoms. Neonates with HSV should be managed in a facility that provides level III subspecialty care and consultation. A mother with HSV infection should be taught to wash her hands carefully and use a clean barrier to ensure that the neonate does not come in contact with the lesions. A mother with herpes labialis (cold sore) should wear a disposable surgical mask when touching her newborn and not kiss or nuzzle her newborn infant until the lesions have crusted and dried. Refer to Perinatal Guidelines (AAP/ACOG), 2012 and the Red Book, 2012. |
| Lice (see Pediculosis) |
| Measles (Rubeola) | Airborne Masks for those susceptible. Labor, delivery, and postpartum recovery should take place in a private room with negative pressure, nonrecirculating air with door closed. If mother is transferred to the delivery room for the actual delivery, she should wear mask during transfer and delivery. | Airborne Masks for those susceptible. Private room with negative pressure, nonrecirculating air with door closed. | No | No | No Until mother is noncontagious. | Contagious during prodrome and for 4 days after onset of rash. Report to health department. Maintain isolation for the duration of illness in immune compromised |
| Methicillin-resistant S. aureus (MRSA) | Contact Gown and gloves | Contact Gown and gloves | Yes | Yes Follow contact precautions. | Yes | Apply contact precautions for infection or known colonization. |
| Mumps (infectious parotitis) | Droplet Masks within 3 ft of patient. Private room. | | No | No | No Until mother is noncontagious. | Contagious for 5 days after onset of swelling. Report to health department. |
| Pediculosis (lice) | Contact For 24 hours after treatment, gown and gloves. | Contact For 24 hours after treatment, gown and gloves. | Yes | Yes | Yes | Exposed individuals and household contacts should be examined and treated if infected. Instruct mother to clean breasts before feeding, if medication is applied to that area. Stress good hand hygiene with special attention to area under fingernails. |
Pertussis (whooping cough) | Droplet Masks within 3 ft of patient. Private room. | Droplet Masks within 3 ft of patient. Private room. | No | No | No Until mother is noncontagious. | Contagious for 5 days after start of effective therapy. Treatment with antimicrobial agents if available for newborns <1 and 2 months of age if the risk of developing severe pertussis and life-threatening complications outweighs the potential risk of developing infantile hypertrophic pyloric stenosis. See Red Book, 2012. Depending on the county, it may be reportable to the public health department. |
| Respiratory syncytial virus (RSV) | | Contact Gown, gloves, mask within 3 ft of the patient. | Yes | Yes May visit private room or cohort. | Yes | Parent education is essential to avoid transmission of the virus. The importance of hand hygiene should be emphasized in all settings. Prophylaxis to prevent RSV in newborns at increased risk for severe disease, particularly those with bronchopulmonary dysplasia/chronic lung disease receiving medical management on a long-term basis is available. Refer to Perinatal Guidelines (AAP/ACOG), 2012 and the Red Book, 2012. Contagious for duration of illness. |
| Rubella (German Measles) Postnatal | Droplet | | Yes | No | No | Contagious for 7 days after onset of rash. Susceptible persons stay out of room, if possible. |
| Maternal | Masks within 3 ft of patient. Private room, masks for those susceptible. | | | | | Report to health department. |
| Congenital | | Contact Gown and gloves | Yes | Yes | Yes | Contagious until at least 1 year of age, unless 2 cultures or clinical specimens obtained 1 month apart after 3 months of age are negative for rubella virus. Susceptible persons stay out of room, if possible. Report to health department. |
| Scabies | Contact For 24 hours after treatment, gown and gloves. | Contact For 24 hours after treatment, gown and gloves. | Yes | Yes | Yes | Treatment of exposed individuals and household contacts is recommended. Instruct mother to clean breasts before feeding, if medication is applied to that area. Stress good hand hygiene. |
| Staphylococcus aureus (not MRSA) | Standard | Standard | Yes | Yes | Yes | Two or more concurrent cases of impetigo related to a nursery or a single case of breast abscess in a nursing mother or infant is presumptive evidence of an epidemic; report immediately to attending physician and Infection Control. |
| Syphilis | Standard | Standard | Yes | Yes | Yes | Treatment for congenital syphilis is available for infants in the first month of age. See Red Book, 2012. Health care workers and parents should wear gloves when handling the neonate until 24 hours of treatment with antibiotics. Report to health department. |
Tuberculosis (TB) 1. Mother with recent positive purified protein derivative (PPD) and no evidence of active TB. | Standard | Standard | Yes | Yes | Yes | If the mother is asymptomatic no separation is required. The newborn infant needs no special evaluation or therapy. |
| 2. Mother with minimal disease, or disease has been treated for ≥2 weeks and is determined by Pulmonary or Infectious Disease to be noncontagious at delivery. | Standard | Standard | Yes | Yes | Yes | Management of the newborn infant suspected of congenital TB is based on categorization of the maternal infection. See testing and treatment in the Red Book, 2012. Report to health department. |
| 3. Mother with current pulmonary or laryngeal active TB and suspected of being contagious at time of delivery. | Airborne N95 respirator for health care workers. Labor, delivery, and postpartum care in private room with negative pressure, nonrecirculating air with door closed. If mother is transferred to the delivery room for the actual delivery, she should wear mask during transfer and delivery. | Standard (airborne for intubated neonate with congenital TB) | No Until mother is determined to be noncontagious. | No Until mother is determined to be noncontagious. | No Until mother is determined to be noncontagious. | Management of the newborn infant suspected of congenital TB is based on categorization of the maternal infection. See testing and treatment in the Red Book, 2012. Report to health department. |
| 4. Mother has extrapulmonary spread of TB (ie, miliary, bone, meningitis, etc.) | Standard | Standard | No Until mother is determined to be noncontagious. | No Until mother is determined to be noncontagious. | No Until mother is determined to be noncontagious. | Management of the newborn infant suspected of congenital TB is based on categorization of the maternal infection. See testing and treatment in the Red Book, 2012. Report to health department. |
| Varicella (Chickenpox) or Herpes Zoster in immunocompromised mother or if disseminated maternal infection | Airborne/contact Labor, delivery and postpartum care in private room with negative pressure, nonrecirculating air with door closed. If mother is transferred to the delivery room for the actual delivery, she should wear mask during transfer and delivery. | | No Until mother's lesions have crusted. | No Until mother's lesions have crusted. | No Until mother's lesions have crusted. | Continue airborne/contact precautions minimal 5 days after onset of rash and until all lesions are crusted. In an immunocompromised patient it may take a week or longer. May be contagious 1–2 days before the onset of rash. Hospitalized patients should be discharged prior to the 10th day after exposure, if possible. Exposed susceptible patients should be placed on airborne precautions beginning 10 days after exposure and continue until 21 days after last exposure, or until 28 days if varicella-zoster immune globulin (VZIG) given. Consider immunologic titer for neonates <28 weeks' gestational age. |
| Varicella–newborn or exposure to varicella | | Airborne Masks for those susceptible. Private room with negative pressure, nonrecirculating air with door closed. | Yes | Yes May visit private room or cohort. | Yes Unless mother has lesions. | Hospitalized patients should be discharged prior to the 10th day after exposure, if possible. Begin precautions 10 days after exposure and continue until 21 days after last exposure, or until 28 days if VZIG given. |