ACEP Monkeypox Field Guide

If a patient seeking care is suspected to have monkeypox, infection prevention and control personnel should be notified immediately. Clinicians suspecting monkeypox infection should strictly adhere to infection control practices and immediately contact their local health department to coordinate testing.

Precautions for Preventing Monkeypox Transmission

• Standard Precautions should be applied for all patient care, including for patients with suspected monkeypox. 
• Activities that could resuspend dried material from lesions, e.g., use of portable fans, dry dusting, sweeping, or vacuuming should be avoided.

Patient Placement

• A patient with suspected or confirmed monkeypox infection should be placed in a single-person room; special air handling is not required.
• The door should be kept closed (if safe to do so).
• The patient should have a dedicated bathroom.
• Transport and movement of the patient outside of the room should be limited to medically essential purposes. 
• If the patient is transported outside of their room, they should use well-fitting source control  (e.g. medical mask) and have any exposed skin lesions covered with a sheet or gown.
• Intubation and extubation, and any procedures likely to spread oral secretions should be performed in an airborne infection isolation room.

Personal Protective Equipment (PPE) used by healthcare personnel who enter the patient’s room should include:

• Gown
• Gloves
• Eye protection (i.e., goggles or a face shield that covers the front and sides of the face)
• NIOSH-approved particulate respirator equipped with N95 filters or higher

Waste Management

• Waste management (i.e., handling, storage, treatment, and disposal of soiled PPE, patient dressings, etc.) should be performed in accordance with U.S. Department of Transportation Hazardous Materials Regulations. See the website for more information.
• Facilities should also comply with state and local regulations for handling, storage, treatment, and disposal of waste.

Environmental Infection Control

• Standard cleaning and disinfection procedures should be performed using an EPA-registered hospital-grade disinfectant with an emerging viral pathogen claim. Follow the manufacturer’s directions for concentration, contact time, and care and handling.
• Soiled laundry (e.g. bedding, towels, personal clothing) should be handled in accordance with CDC recommended standard practices (PDF), avoiding contact with lesion material that may be present on the laundry. 
• Soiled laundry should be gently and promptly contained in an appropriate laundry bag and never be shaken or handled in manner that may disperse infectious material.
• Activities such as dry dusting, sweeping, or vacuuming should be avoided. Wet cleaning methods are preferred.
• Management of food service items should also be performed in accordance with routine procedures.

Duration of Precautions

• Decisions regarding discontinuation of isolation precautions in a healthcare facility should be made in consultation with the local or state health department.
• Isolation Precautions should be maintained until all lesions have crusted, those crusts have separated, and a fresh layer of healthy skin has formed underneath.

Additional information on Infection prevention and control recommendations for healthcare settings can be found in the CDC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007).