A 65 year old male with no past medical history presents to the emergency department with a painful rash on his neck and left shoulder for 2 days. Vitals are within normal limits. Exam is notable for the skin findings shown below with no other abnormal skin findings elsewhere. He is currently being examined in a hallway stretcher. What is the appropriate level of infection control precaution for this patient?
A: airborne
B: contact
C: droplet
D: standard
Answer: standard
This patient is presenting with a vesicular rash on an erythematous base in a dermatomal distribution characteristic of herpes zoster (shingles). Immunocompetent hosts with no signs of disseminated herpes zoster infection should have their skin lesions covered and only require standard infection precautions which is the same for all patients. Immunocompromised patients with localized infection or any patient with signs of disseminated infection should initially be placed on airborne and contact precautions which involves a negative pressure room, gown, and respirator such as N95 mask.
References:
Takhar SS, Moran GJ. Serious Viral Infections. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020.
