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Control of Viruses that Spread by Direct Inoculation

 

1. HSV

Outbreaks of HSV infection have been described in neonates which were confirmed by DNA fingerprinting.

  1. Mothers with either genital or buccal HSV and her infant should be nursed separately from other patients, with gowns and gloves to be worn by attending staff.
  2. Although there is little evidence for postpartum transmission as a cause of neonatal herpes, the mother should be encouraged to wash her hands before handling the patient and to wear a protective gown.
  3. Staff with lesions (oral or whitlows) should cover their lesions and not care for patients at risk of serious infection ie. the young, those who are debilitated, immunocompromised, and those who suffer from eczema.
  4. Patients with herpetic lesions should be nursed separately. Those with widespread lesions should be nursed in standard isolation.
  5. Oral acyclovir should be offered to patients and staff with herpetic whitlows or severe localized lesions. Patients at risk of developing severe herpes infection may need IV acyclovir for 1 week or longer.  

2. Adenovirus

Nosocomial outbreaks of adenovirus pneumonia and URTI, especially caused by types 3 and 7, have been described, as have epidemic conjunctivitis.

  1. Patients with pneumonia should be nursed in standard isolation.
  2. Patients with eye infections should be discharged home as soon as possible.
  3. Staff with eye infections should not have contact with patients for the duration of viral shedding which lasts for 10 days.  

3. CMV

There is no evidence that CMV is acquired nosocomially. Studies in hospital nurses caring for children have not shown any evidence of increased infection rates when compared with women of similar ages working in other occupations. Nonetheless, it would seem prudent to minimize the risks of cross-infection by careful attention to infection control measures in any patient known to be excreting CMV. Gloves and aprons should be worn and careful hand washing implemented. In case of pregnant women in contact with known CMV excretors, the following should be advised.

  1. There is no scientific reason why women of childbearing age or pregnant women should be excluded from contact with known excretors of CMV who constitute only a small part of the pool of infection.
  2. There is no indication for routine serological screening of female staff taking care of children or adults who may be excreting CMV, because there is no evidence that CMV is an occupational hazard.
  3. The most appropriate means whereby pregnant women can protect themselves from acquiring CMV is by attention to good hygiene, especially hand washing. For instance, a pregnant teacher working with disabled children should avoid teaching methods that may involve the transfer of the child’s saliva to her mouth.
  4. Immune status screening may be offered to the worried pregnant women. Those who are seorpositive will be at a far lesser risk of giving birth to a child with cytomegalic inclusion disease should transplacental infection occurs.
  5. Pregnant women known to have had primary infection may be followed up by fetal blood, amniotic fluid, and chorionic villus sampling.

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