Infected Patients

1. If the patient is not immunocompromised and the lesions are localized, (i.e., contained within two contiguous dermatomes) the patient does not need to be placed in a negative pressure room on Airborne and Contact Precautions. Only Contact Precautions are necessary. Non-immunocompromised patients with shingles only have the virus in the ir skin lesions and are only infectious by direct contact.

2. However, immunocompromised patients * with shingles (i.e., localized zoster) must be treated like patients with chickenpox because they may excrete the virus in their respiratory tract as well as in their skin lesions. Additionally, one cannot predict when a localized zoster infection may disseminate. A negative pressure room on Airborne Precautions as well as Contact Precautions are required until all lesions have dried and are crusted over.

   *Immunocompromised patients may include:
   

   	organ transplant patients
   	leukemia/lymphoma or stem cell transplant patients
   	HIV + patients
   	solid tumor patients not in remission
   	patients receiving high dose cortico steroids/other immunosuppressives (i.e., cyclosporine, methotrexate)

3. HCW who have never had a positive history of chickenpox or a positive titer should not enter the room or care for these patients.