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Vol. 2, No. 5 October 1994 |
Infection Control Precautions for Pneumonic Plague
Although plague occurs worldwide, most of the human cases are reported from the developing countries of Asia and Africa. Plague was estimated to have killed one-fourth of Europe's population in the middle ages. In the first half of the century India was severely affected by plague epidemics. Recent reports indicate that the Indian subcontinent is again having another outbreak of the plague.
Yersinia pestis, a gram-negative bacillus is the causative agent of plague. It is transmitted among natural animal reservoirs, mainly rats, by flea bites or by ingestion of contaminated animal tissues. Fleas may remain infective for months under favourable temperature and humidity.
The most common form of plague is called bubonic plague. Infected persons experience sudden onset of fever, chills, weakness, and headache, and usually the following day sudden swelling occurs in the lymph nodes of the groin, axilla or neck. Another form and one of the most feared is secondary pneumonia (pneumonic plague) where the infection reaches the lungs through the blood.
Pneumonic plague is of special significance since droplets of sputum that contain plague bacilli are highly contagious. Person to person spread is a potential threat following exposure to a patient who has a cough. Pneumonic and septicemic plague are fatal when antibiotic therapy is delayed.
Although the odds that the plague could arrive here from India are low, a patient with a possible pneumonic plague who is admitted to our Hospital should have the following precautions implemented.
Infection Control Precautions for Patients Admitted to The TorontoHospital with Pneumonic Plague
Single Room:
Single room under negative pressure with > 6 air exchanges per hour. The door should be closed.
Handwashing: Use antiseptic handwashing solution (eg. 2% chlorhexidine or betadine 7.5%).
Gloves, Gowns, Masks:
Required.
Isolation Duration:
Maintain for three days after the start of effective therapy.
Equipment:
Maintain single patient use of stethoscopes, thermometers, and blood pressure cuffs.
Environment:
Rid patients and their clothing and luggage of fleas using an insecticide effective against local fleas and proven to be safe for health care providers. Utilize single use disposable equipment where possible.
References:
1) Paton S. Infection control precautions for persons admitted to hospital with Yersinia pestis. Bureau of Communicable Disease Epidemiology, LCDC.
2) Benenson A. Control of communicable diseases in man. 13th Edition. pp. 250-255, 1980.
3) Butler T. Yersinia pestis. In: Mandell G.L., Douglas R.G., Bennett J.E. (eds.). Principles and practices of infectious diseases. New York: Churchill Livingstone Inc., 3rd Edition; 1990: 1748-1755.
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