Communicable diseases exclusion

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide PCH ED staff to determine communicable diseases exclusion criteria.

Background

  • While it is often difficult to prevent the transmission of common respiratory (colds / flu) and gastroenteritis infections that occur, every effort should be made to minimise the spread of infection.
  • Adults and children should stay at home in the early stages of illness as at this stage they can be infectious and shed the virus, bacteria or parasite through coughing, sneezing, contaminating surfaces and personal contact.

Management

Disease  Exclusion  Infectious periods 
Acute febrile respiratory illness  Exclude until afebrile Usually for duration of symptoms
Campylobactor sp Until asymptomatic 2-3 days treated
2-3 weeks untreated
Chicken Pox  Exclude from at least 5 days after rash appears and
until vesicles have formed crusts. Crusted lesions alone do not warrant exclusion
2 days before rash until all vesicles have formed crusts
Conjunctivitis  Exclude until discharge from eyes has ceased Whilst eye discharge is present
Cryptosporidiosis  Exclude until 24 hours after diarrhoea has ceased 2-4 weeks
Diarrhoea  Exclude until 24 hours after diarrhoea has ceased Days to weeks  
Glandular fever  Do not exclude  Months 
Hand, foot and mouth disease  Exclude until vesicles have formed crusts  As long as there is fluid in the vesicles. Faeces remain infectious for several weeks 
Head lice  Exclude until  after treatment has commenced and live lice removed Until lice and eggs are killed
Haemophilus influenzae Type B  Exclude until antibiotic treatment finished usually 48 hours Infectious until treated with antibiotics
Hepatitis A  For 14 days after onset of illness if not jaundiced or 7 days after jaundice appears  2 weeks before onset of symptoms to 7 days after jaundice appears
Hepatitis B  Do not exclude  Weeks before to months after the onset. Carriers may be infectious for life
Hepatitis C  Do not exclude  Weeks before to months after the onset. Carriers may be infectious for life
Herpes Simplex I and II  Young children unable to comply with good oral care hygiene practices should be excluded until dry. Sores should be covered with a dressing where possible
2-7 weeks
HIV  Do not exclude  As long as HIV infection persists
Human Herpes virus 6  Do not exclude  Unknown 
Impetigo  Exclude for 24 hours after antibiotic treatment commenced. Lesions on exposed skin surfaces should be covered with water proof dressing. Young children unable to comply with good hygiene practices should be excluded until the sores are dry As long as there is discharge from untreated lesions
Influenza  Do not exclude  Usually 1 day before onset of symptoms until 7 days after
Measles  Exclude for 4 days after onset of rash. Unvaccinated contacts should be excluded until 14 days after onset of rash of the last case
4 days before to 4 days after rash appears. 
Meningococcal Disease  Exclude for 24 hours after antibiotic commenced. Contacts will be managed by WA Public Health
 
Until bacteria are no longer present in nose and throat secretions
Molluscum Contagiosum  Do not exclude  As long as lesions persist
Mumps  Exclude for 5 days after onset of symptoms  2 days prior to 5 days after parotitis (swollen salivary glands) 
Parainfluenza  Until asymptomatic  4 days to 3 weeks
Parvovirus B19 (Slapped Cheek Syndrome) Do not exclude  Not infectious after rash appears
Pertussis  Exclude for 21 days from onset of cough, or 5 days after starting antibiotic treatment. Contacts will be managed by WA Public Health  From onset of runny nose to 3 weeks after onset of cough. 
Pin Worm  Do not exclude  As long as eggs are excreted. Eggs remain infective for up to 2 weeks
Pneumococcal disease  Exclude until 24 hours after commencement of antibiotics Until Streptococcus pneumoniae are no longer present in nose and throat secretions
Ring worm  Exclude until 24 hours after treatment has commenced As long as lesions are present
Rotavirus  Until asymptomatic  10 days
Rubella  Exclude for 4 days after onset of rash  From 7 days before to at least 4 days after onset of rash
RSV (Respiratory Syncytial Virus)  Until asymptomatic  3 days to 4 weeks. 
Scabies  Exclude until the day after treatment has commenced  Until mites and eggs are destroyed
Shigella  Until asymptomatic  4 weeks
Shingles  Do not exclude unless rash is uncovered and weeping  Up to 1 week after appearance of the lesions
Tuberculosis  Exclude until medical certificate of recovery is obtained. Contact management by WA Public Health  As long as bacteria are present in respiratory secretions
Typhoid  Discussion exclusion with your local public health staff as clearance testing may be required Infectious as long as Salmonella typhi are present in faeces or urine
Warts  Do not exclude  As long as the wart remains

Bibliography

  1. Department of Health Communicable Disease Control Guidelines http://www.public.health.wa.gov.au/2/243/3/infectious_diseases_az_for_health_professionals.pm  
  2. Australian Immunisation Handbook (current edition). http://www.health.gov.au/internet/immunise/publishing.nsf/content/handbook/10home 
  3. Department of Health WA fact sheets and case definitions https://ww2.health.wa.gov.au/Articles/F_I/Infectious-disease-guidelines

Endorsed by:  Director, Emergency Department  Date:  Jun 2018


 Review date:   Jun 2021


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