Airborne, droplet, and contact precautions should be used for all suspect, probable, and confirmed cases of monkeypox. Precautions should be used when a patient presents with fever and vesicular/pustular rash (suspected case). Any lesions or respiratory secretions should be considered infectious material.

Routine Practices

Continue to follow routine practices including:

• Point of Care Risk Assessment (PCRA)
• Hand Hygiene
• Patient Placement
• Respiratory hygiene
• Personal Protective Equipment (PPE)
• Injection and Medication Safety
• Cleaning and Disinfection Procedures
• Waste Management

Hand Hygiene

Alcohol-based hand sanitizers and soap and water are acceptable methods for hand hygiene. When hands are visibly soiled, soap and water is the preferred method. Hand hygiene should always be performed after the removal of gloves.

Additional Precautions

As the modes of transmission in this current outbreak are not well understood, airborne, droplet, and contact precautions are recommended.

Patient:

• Patient should perform hand hygiene.
• Patient should wear a medical mask.
• Suspect, probable and confirmed cases should be immediately placed into an Airborne Infection Isolation Room (AIIR) or single room with the door closed, for assessment upon entry to the healthcare setting.
• If the patient must leave the room, a medical mask should be worn, if medically able to tolerate or clinical condition allows.
• Skin lesions should be kept covered with a gown, clothes, sheet or bandage, except during examination.
• Room should be cleaned and disinfected after use (as per directions below).

Health care worker - Personal Protective Equipment (PPE):

• Fit-tested and seal-checked N95 respirator
• Gown (cuffed, long sleeve)
• Gloves
• Eye protection (e.g., face shield or goggles)

All PPE (including respirators) must be discarded after each contact with the patient and hand hygiene performed. All PPE should be donned before entering the patient's room. All PPE should be disposed of prior to leaving the isolation room except for the respirator, which should be removed, outside of the room once the door is closed, and hands should again be cleaned.

Room Selection/Patient Placement

Patient should be placed in an AIIR, when available.

If an AIIR is not available, the patient should be placed in a single room with the door closed. For inpatients, a dedicated patient bathroom is required and a commode can be used if dedicated bathroom not available.

Visitors should be restricted to those necessary for care or compassionate grounds.

Cleaning and Disinfection

Equipment

• Use standard housekeeping cleaning and disinfection protocols.
• Dedicate patient care equipment to a single patient.
• Clean and disinfect all reusable equipment with hospital-approved disinfectants (with Drug Identification Numbers (DIN)), as per manufacturers' recommendations immediately after use.

Environmental surfaces

All patient contact surfaces should be cleaned and disinfected with hospital-approved disinfectants (with Drug Identification Numbers (DIN)), as per manufacturers' recommendations.)** Hospital-grade cleaning and disinfecting agents (with Drug Identification Numbers (DIN)), are sufficient for environmental cleaning for monkeypox.**