Critical Care Medicine-Infections and Immunologic Disease>>>>>Hospital Infection Control, Hospital Acquired Infections
Question 3#

A 32-year-old pregnant woman is admitted to your intensive care unit with severe respiratory distress and hypoxemia requiring supplementary oxygen delivered by high-flow nasal cannula. Computed tomography (CT) of the chest demonstrates bilateral perihilar ground-glass and nodular infiltrates. On physical examination, you notice a diffuse erythematous and vesicular rash, with crops of vesicles in different stages of development. The patient tells you the rash is extremely pruritic.

Which of the following infection control measures is MOST appropriate?

A. Pregnant and nonimmune healthcare workers should not be assigned to care for this patient; mandatory gowns, gloves, and surgical masks should be worn by healthcare workers
B. Pregnant and nonimmune healthcare workers should not be assigned to care for this patient; mandatory gowns, gloves, airborne precautions, and N-95 respirator masks should be worn by healthcare workers
C. Mandatory gowns, gloves, and surgical masks should be worn by healthcare workers
D. Mandatory gowns, gloves, airborne precautions, and N-95 respirator masks should be worn by healthcare workers

Correct Answer is B

Comment:

Correct Answer: B

Disseminated and severe varicella infection, including varicella pneumonia, is more likely to occur in pregnant and immune-compromised hosts. Primary infection is followed by viral replication in regional lymph nodes for 4 to 6 days, followed by secondary viremia and invasion of the skin tissue leading to rash approximately 2 to 3 weeks later. Varicella is highly transmissible, with secondary attack rates approaching 90% among household contacts in the prevaccine era. Varicella is spread both by contact with virus-filled vesicles and through aerosolized droplets or airborne viral particles, mandating strict infection control precautions. Because varicella is a fetal teratogen, it is recommended that pregnant women not be assigned to care for patients with active varicella infection.

References:

  1. Weber DJ, Rutala WA, Hamilton H. Prevention and control of varicellazoster infections in healthcare facilities. Infect Control Hosp Epidemiol. 1996;17:694-705.
  2. Preventing Varicella in Health Care Settings. Centers for Disease Control and Prevention. 2016. Available at https://www.cdc.gov/chickenpox/hcp/healthcare-setting.html.