Infection Prevention and Control in Maternal Child Health

Maternal Child Health

Learning objectives December 1, 2013 1. Describe the role of infection prevention and control in maternal child health. 2. Identify potential infection risks in this setting. 3. Explain practices for prevention and control of infection for these patients. 2

Time involved December 1, 2013 60 minutes 3

Key points Infection prevention and control strategies based on the principle of combined care For neonates requiring intensive care, the newborn s environment must be clearly delineated, with spatial separation between incubators Sharing of equipment and supplies must be preceded by thorough cleaning and appropriate disinfection/sterilisation Standard Precautions should be applied for all patient care Prevention strategies include hand hygiene, patient hygiene, environmental cleaning and immunisation December 1, 2013 4

Background The World Health Organization (WHO) estimates that approximately 210 million women become pregnant each year and that 529,000 die from complications In the immediate post-partum period, sepsis and haemorrhage are the commonest causes of maternal death Severe infections cause more than one- third of neonatal deaths December 1, 2013 5

Neonatal risk factors - 1 December 1, 2013 Maternal infections Foetal gestational age at the time of the infection Complications of delivery 6

Neonatal risk factors - 2 Premature infants are at risk for infection due to: Absence of normal microbial flora Increases the risk of colonisation with pathogens Colonisation by gastrointestinal flora Risk differs between breast fed babies versus formula-fed babies Abnormal colonisation that occurs most often in newborns in neonatal intensive care units Fragile, underdeveloped organs that normally provide a barrier to infectious pathogens Such as the skin and lining of the lung A poor immune (antibody) response December 1 2013 7

Neonatal infections December 1, 2013 Occur in the first 28 days of life May be spread: In utero By the transplacental route Intrapartum When in contact with the maternal genital tract, blood or stool Postpartum When in contact with the mother, family and visitors, other neonates in the nursery, health care workers, or contaminated equipment 8

Infant infections For full term newborns - superficial infections of the skin, eye and mucous membranes. Additional infections occur in intensive care Bacteraemia associated with central lines, pneumonia and gastrointestinal infections Microorganisms associated with neonatal infections Staphylococcus aureus, coagulase negative staphylococci, Group B streptococci, Escherichia coli and Candida Other pathogens often associated with outbreaks in the nursery Klebsiella, Serratia, Enterobacter, Citrobacter and Pseudomonas species December 1, 2013 9

Maternal Risk Factors December 1, 2013 Prolonged rupture of membranes (>24 hours) Obesity Interferes with wound healing Diabetes mellitus Invasive tests and procedures 10

Maternal Infections Common infections include: Endometritis Infection of the lining and wall of the uterus (endometrium and myometrium) Mastitis Inflammation and infection of the breast Caesarean surgical site infections Episiotomy site infections Infection at the site of incision of the perineum Sepsis Bloodstream infection which causes a systemic inflammatory response December 1, 2013 11

Prevention Strategies December 1, 2013 Standard Precautions Hand Hygiene Protective barriers Cohorting Additional precautions Single rooms Cleaning 12

Standard Precautions December 1, 2013 Basic hygienic precautions are recommended for all patient encounters 13

Hand Hygiene December 1, 2013 Use soap and running water or alcohol-based hand rubs: before and after contact with the mother with the neonate with their immediate environment before an aseptic procedure after handling blood and body fluids after removal of gloves 14

Protective barriers December 1, 2013 Gloves worn for all contact with mucous membranes, non-intact skin and moist body substances Masks and/or protective eyewear or face shields worn when body substances are likely to splash skin or mucous membrane Gowns and/or plastic aprons worn when body substances are likely to soil clothing or skin Gowns worn for holding infant to the uniform 15

Cohorting December 1, 2013 Cohorting infants with the same infection helps prevent spread of infections in the nursery 16

Additional Precautions December 1, 2013 May be indicated for infants colonised or infected with epidemiologically significant microorganisms Suspected or confirmed infections should be handled according to guidelines developed by the Infection Control Team 17

Single Rooms December 1, 2013 Priority given to mothers who soil articles in the environment with body substances and those colonised or infected with epidemiologically significant microorganisms Infants and/or mothers with diagnosed or suspected infections transmitted by the airborne route must be placed in a single room with negative pressure and the door closed 18

Cleaning December 1, 2013 For labour and delivery suites, post delivery, remove soiled linens using gloved hands The delivery table/bed and the immediate patient environment should be cleaned after each use Use non-toxic disinfectants for cleaning neonatal equipment and incubators Avoid phenolic disinfectants 19

General Infection prevention and control - 1 December 1, 2013 Parent/infant contact encouraged Except for the occasional case when there is a risk of transmitting infection Labouring mothers may shower or bath Post partum, instruct patient on daily perineal care after toileting Reviewing good hygienic policies with parents is vital to protect both mother and infant from acquiring or spreading infections 20

General Infection prevention and control - 2 Prenatal assessment to identify risk factors for maternal/ newborn infection and allow prevention strategies Screen women for Group B streptococcus at 35-37 weeks gestation Screen for human immunodeficiency virus and Hepatitis B HIV positive mothers should refrain from breastfeeding unless alternatives are not available. Antepartum Screen mothers upon admission for symptoms of infection such as new onset of fever and other respiratory symptoms New onset of cough, rash, or diarrhoea If the patient responds yes to the any of these conditions, initiate the appropriate additional precautions and spatial separation from other patients (> 2 metres) December 1, 2013 21

General Infection prevention and control - 3 Breast milk is protective as it provides specific IgA antibody and helps establish normal flora in the neonate Provide post-partum hygiene for the mother and infant immunisations as required For facilities with little room and overcrowding, consider kangaroo mother care This includes skin to skin positioning of the baby on the mother s chest December 1, 2013 22

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism AIDS Maternal Precautions Standard Precautions Standard Precautions VRE/MRSA: Contact Precautions Newborn Precautions Standard Precautions Standard Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding No Amnionitis Permitted Permitted Permitted Permitted Antibiotic Resistant Organisms - Mother Antibiotic Resistant Organisms - Infant Mother uses Standard Precautions Standard Precautions VRE/MRSA: Contact Precautions Standard Precautions Permitted Permitted Candida - Mother Permitted Permitted Candida - Infant Standard Precautions Standard Precautions Permitted Permitted 23 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Chickenpox Maternal Precautions Airborne precautions Newborn Precautions Infant room in with mother Mother/Infant Contact Permitted Breast Feeding Permitted Mother ill healthy term infant Chickenpox Airborne precautions Standard Precautions until day 10. As of day 10 to and including day 28 start Airborne Precautions Airborne precautions Not Permitted Permitted (as expressed breast milk) Mother ill Infant in NICU Mother may not visit the NICU Infant in NICU chickenpox or contact Only parents & visitors who are immune may visit. Permitted if woman is immune. Permitted 24 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Chlamydia Maternal Precautions Standard Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Permitted Mother Chlamydia - Newborn Conjunctivitis and/or pneumonia Conjunctivitis - Bacterial Standard Precautions Standard Precautions Permitted Permitted Standard Precautions Contact Precautions. No sharing of towels, face cloths, pillows, linens Standard Precautions Standard Precautions Permitted Permitted Healthy Term Infant: Room in Extreme care with hand hygiene No sharing of towels, linens Permitted Conjunctivitis - Adenovirus Mother 25 Infant in NICU: Mother NOT to go to NICU Permitted as expressed breast milk.

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Conjunctivitis Maternal Precautions Standard Precautions Newborn Precautions Contact Precautions. No sharing of patient care items. Standard Precautions Mother/Infant Contact As above Breast Feeding As above Adenovirus Infant Cytomegalovirus Standard Precautions Permitted Permitted Mother Cytomegalovirus - Infant Diarrhoea Mother Standard Precautions Standard Precautions Standard Precautions Standard Precautions Permitted Permitted Healthy Term Infant: Permitted with Standard Precautions. Infant in NICU: Not permitted until asymptomatic for 48 hours. Healthy Term Infant: Permitted Single room with toilet Bacterial (suspected or confirmed) Infant in NICU: Permitted as expressed breast milk. 26 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Diarrhoea Mother Antibiotic associated/C. difficile Diarrhoea Mother Maternal Precautions Contact precautions Single room with toilet Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Permitted Contact precautions Contact precautions Single room with toilet Healthy Term Infant: Permitted with Standard Precautions Healthy Term Infant: Permitted Viral (e.g., norovirus) Single room with toilet Infant in NICU: Permitted as expressed breast milk. Infant in NICU: Woman is not permitted in the NICU until asymptomatic for 48 hours 27 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Diarrhoea Maternal Precautions Standard Precautions Newborn Precautions Contact precautions Mother/Infant Contact Permitted Breast Feeding Permitted Infant Bacterial (suspected or confirmed Diarrhoea Standard Precautions Contact precautions Permitted Permitted Infant Viral (e.g. norovirus) Endometritis Standard Precautions Standard Precautions Permitted Permitted 28 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Enterovirus Maternal Precautions Contact precautions Single room Newborn Precautions Contact precautions Single room Mother/Infant Contact Healthy Term Infant: Permitted with Standard Precautions. Breast Feeding Healthy Term Infant: Permitted Mother Infant in NICU: Permitted as expressed breast milk. Infant in NICU: Woman is not permitted in the NICU until asymptomatic. Permitted Enterovirus Standard Precautions Contact precautions Permitted Infant Ensure immediate disposal of diapers into leak proof bag 29 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Gonococcal Infections Maternal Precautions Standard Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Permitted Mother-Untreated or <24 hours of treatment Gonococcal Infections - Infant Standard Precautions Standard Precautions Permitted Permitted Conjunctivitis, scalp abscess, sepsis Hepatitis Mother, Type A Hepatitis Mother, Type B (HbsAg+) Standard Precautions Standard Precautions Standard Precautions Standard Precautions After prophylaxis of infant Permitted After prophylaxis of infant Permitted 30 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Hepatitis Mother, Type C Herpes simplex Mother, Genital delivered by Caesarean section Herpes simplex Mother, Genital vaginal delivery Herpes simplex Mother, Oral or mucocutaneous (i.e., cold sore) Maternal Precautions Standard Precautions Standard Precautions Newborn Precautions Standard Precautions See Infant Asymptomatic Mother/Infant Contact Permitted Breast Feeding Permitted see Comments Permitted Permitted Standard Precautions See Infant Asymptomatic Permitted Permitted Standard Precautions See Infant - Asymptomatic Permitted. Permitted if there are no herpetic lesions on the breast. Total rooming-in preferred. 31 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Herpes simplex Mother , Whitlow Maternal Precautions Standard Precautions Newborn Precautions See Infant Asymptomatic Mother/Infant Contact Direct/hands-on contact is NOT permitted. Breast Feeding May pump and discard milk until lesions are gone or may nurse if the woman does not touch her infant (i.e. someone else holds and positions infant). Permitted Herpes simplex Infant , Asymptomatic Standard Precautions Contact precautions. For duration of incubation period (up to 4 weeks) Contact precautions Permitted Herpes simplex - Infant, Symptomatic Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010 Standard Precautions Permitted Permitted 32

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Herpes zoster(shingles) - Mother localized Maternal Precautions Standard Precautions in single room. Newborn Precautions Standard Precautions Mother/Infant Contact Permitted. Total rooming-in preferred. Mother may not go to nursery until lesions are crusted. Permitted. Total rooming-in preferred. Mother may not go to nursery until lesions are crusted. Breast Feeding Permitted if lesions are not on breast. Only immune staff may care for patient. Herpes zoster(shingles) Airborne precautions Term Infant Rooming- in: Standard Precautions Permitted if lesions are not on breast. Mother disseminated Immune staff only Infant in NICU: Airborne precautions from day 10 from 1st exposure to day 21 of last exposure (or day 28 if infant has been given VarIG). Infant in NICU: Provide expressed milk. Infant in NICU: Woman may NOT go to the NICU until lesions are crusted. 33

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Influenza Maternal Precautions Droplet &Contact Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Healthy Term Infant: Permitted. Woman must wear a surgical mask when within 2 metres of infant. Breast Feeding Healthy Term Infant: Permitted Mother Single room preferred Infant in NICU: Permitted as expressed breast milk. Infant in NICU: Woman is not permitted to go to NICU. Permitted Influenza- Infant Standard Precautions Droplet &Contact Precautions Permitted Listeria Standard Precautions Standard Precautions Permitted Permitted 34 Mother Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Maternal Precautions Newborn Precautions Mother/In fant Contact Permitted Breast Feeding Listeria Standard Precautions Standard Precautions Permitted Infant Measles (Rubeola) Airborne Precautions Immune staff only Only immune family and visitors permitted Standard Precautions Room in with woman Permitted if rooming in with woman. May provide expressed breast milk if not rooming in. Permitted as expressed breast milk only until woman no longer infectious Mother ill Term healthy infant From 8 days from 1st exposure to 12 days from last exposure Airborne Precautions Measles (Rubeola) Airborne Precautions Immune staff only Only immune family and visitors permitted Woman not permitted in NICU until 4 days after the appearance of the rash. Mother ill infant in NICU Immune staff only Only immune family and visitors permitted 35

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Measles (Rubeola) Maternal Precautions Standard Precautions Newborn Precautions Airborne Precautions Mother/Infant Contact Woman immune permitted to see infant Breast Feeding Permitted Infant ill or exposed (i.e. exposed in NICU) Woman susceptible Permitted as expressed breast milk only until infant no longer infectious Immune staff only Woman susceptible woman not permitted to see infant Only immune family and visitors permitted Meningitis Droplet precautions until 24 hrs. after appropriate antimicrobial therapy Neissera meningitidis/ Haemophilus influenzae 36 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Mumps Maternal Precautions Droplet/Contact precaution Immune Staff only Only immune family and visitors permitted Standard Precautions Newborn Precautions Standard Precautions Mother/Inf ant Contact Term Infant: Permitted Breast Feeding Term Infant: Permitted Mother Mumps Infant in NICU Exposed or ill Droplet/Contact precautions starting from 10 days from first exposure to 26 days from last exposure. Single room Immune Staff only Only immune family and visitors permitted Woman immune permitted to see infant Woman immune Permitted Woman susceptible Permitted as expressed breast Woman susceptible woman not permitted to see infant 37

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Pediculosis Head Lice Maternal Precautions Contact Precautions Precautions remain in place until after woman has been appropriately treated. Newborn Precautions Standard Precautions Mother/Infant Contact Healthy Term Infant: Permitted Breast Feeding Healthy Term Infant: Permitted Infant in NICU: Permitted as expressed breast milk until woman has been appropriately treated. Infant in NICU: Permitted once woman has been appropriately treated 38 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Pertussis Mother Maternal Precautions Droplet Precautions Single room Newborn Precautions Standard Precautions Healthy Term Infant: Mother/Infant Contact Breast Feeding Healthy Term Infant: Permitted Permitted. Reinforce hand hygiene and wear a surgical mask when within 2 metres of infant. Precautions remain in place until 5 days of appropriate antibiotic treatment has been completed. Standard Precautions Infant in NICU: Permitted as expressed breast milk. Infant in NICU: Not permitted in NICU until 5 days of appropriate antibiotic treatment has been completed. Permitted Pertussis Contact Precautions Consider cohorting Permitted Infant Precautions remain in place until 5 days of appropriate antibiotic treatment has been completed. 39

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Respiratory Virus Infections Maternal Precautions Droplet/Contact Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Healthy Term Infant: Permitted. Reinforce hand hygiene and wear a surgical mask when within 2 metres of infant Breast Feeding Healthy Term Infant: Infant rooming-in: Permitted Mother ill Single room Infant in NICU: Permitted as expressed breast milk. Infant in NICU: Not permitted in NICU. Permitted Respiratory Virus Infections - Infant ill Infant in NICU chickenpox or contact Standard Precautions Droplet /Contact Precautions Permitted Only parents & visitors who are immune may visit. Airborne precautions Permitted if woman is immune. Permitted 40 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Rubella Maternal Precautions Droplet precautions Immune staff only Newborn Precautions Droplet precautions Immune staff only Mother/Infant Contact Healthy Term Infant: Permitted Breast Feeding Healthy Term Infant: Permitted Mother Infant in NICU: Woman cannot go into the NICU until 7 days after the onset of the rash. Infant in NICU: Expressed breast milk as the woman cannot go into the NICU until 7 days after the onset of the rash. Permitted Rubella Standard Precautions Droplet Precautions Permitted Infant (Congenital) 41 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Scabies Maternal Precautions Contact Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Healthy Term Infant: Permitted once woman has been appropriately treated. Breast Feeding Healthy Term Infant: Permitted once woman has been appropriately treated or may provide expressed breast milk. Precautions remain in place until after woman has been appropriately treated. Infant in NICU: Permitted once woman has been appropriately treated. Infant in NICU: Permitted once woman has been appropriately treated or may provide expressed breast milk. Permitted (see Comments) Staphylococcus aureus - Mother Mastitis Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010 Standard Precautions Standard Precautions Permitted 42

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Staphylococcus aureus - Mother, Breast Abscess Maternal Precautions Standard Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Healthy Term Infant: Permitted Infant in NICU: Permitted on the unaffected breast Permitted Staphylococcus aureus Mother, Minor Wound Infection (contained) or Toxic Shock Syndrome Staphylococcus aureus - Mother, Major Wound (not contained) Standard Precautions Standard Precautions Permitted if draining lesion is adequately contained Contact Precautions Standard Precautions Permitted if draining can be adequately contained Permitted 43 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Staphylococcus aureus Maternal Precautions Standard Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Permitted Infant pneumonia Staphylococcus aureus Standard Precautions Standard Precautions Including gloves and gowns for contact with infant. Standard Precautions Permitted Permitted Infant skin lesions (localized or scalded skin) Staphylococcus epidermidis and other coagulase negative staphylococcal infections Standard Precautions Permitted Permitted 44 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Streptococcal Disease Group A - Mother, Minor Wound Infection (contained) Streptococcal Disease Group A - Mother, Major wound infection or endometritis Streptococcal Disease Group A - Mother, Invasive Disease Maternal Precautions Single room until 24 hours after effective treatment. Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Permitted Single room until 24 hours after effective treatment. Standard Precautions Permitted Permitted Single room until 24 hours after effective treatment. Standard Precautions Permitted after 24 hours of effective treatment. Permitted after 24 hours of effective treatment. 45 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Streptococcal Disease Group A - Mother, Pharyngitis (strep throat) Streptococcal Disease Group A (GAS) - Infant Maternal Precautions Droplet Precautions. Single room . Precautions remain in place until 24 hours after effective treatment Standard Precautions Newborn Precautions Standard Precautions Mother/Infa nt Contact Permitted after 24 hours of effective treatment Breast Feeding Permitted after 24 hours of effective treatment. Contact Precautions Streptococcal Disease Group A (GAS) Standard Precautions Precautions remain in place until 24 hrs. after effective treatment. Standard Precautions Infant Streptococcal Disease Group B (GBS) - Mother, Colonization Standard Precautions Permitted Permitted 46

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Streptococcal Disease Group B (GBS) Mother, Endometritis Streptococcal Disease Group B (GBS) - Infant Colonization Streptococcal Disease Group B (GBS) - Infant Sepsis or Meningitis Maternal Precautions Standard Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Permitted Standard Precautions Standard Precautions Permitted Permitted Standard Precautions Standard Precautions Permitted Permitted 47 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Syphilis - Mother, Mucocutaneous Maternal Precautions Contact Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Permitted after 24 hours effective treatment. Breast Feeding Permitted after 24 hours effective treatment. Until 24 hours effective treatment Standard Precautions Syphilis - Infant, Congenital Contact Precautions Until 24 hours effective treatment Standard Precautions Standard Precautions Permitted Permitted Toxoplasmosis Mother Toxoplasmosis Infant Standard Precautions Standard Precautions Permitted Permitted Permitted Permitted 48 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Tuberculosis - Mother, Positive Skin test asymptomatic Tuberculosis - Mother, Pulmonary or laryngeal on effective treatment Tuberculosis - Mother, Pulmonary or laryngeal newly diagnosed, on inadequate treatment or noncompliant Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010 Maternal Precautions Standard Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Permitted Standard Precautions Standard Precautions Permitted Permitted Airborne Precautions Standard Precautions Not permitted until woman is no longer infectious Mother may provide expressed breast milk. 49

Maternal/Child Infectious Diseases and IPC Management December 1, 2013 Infection/ Organism Tuberculosis Maternal Precautions Standard Precautions Newborn Precautions Standard Precautions Mother/Infant Contact Permitted Breast Feeding Permitted unless the extrapulmonary TB is causing a breast abscess. Not permitted until TB abscess is treated. Permitted Mother Extrapulmonary Urinary Tract Infection West Nile Virus Standard Precautions Standard Precautions Standard Precautions Standard Precautions Permitted Permitted Permitted 50 Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010