Situation: A 72 year old female patient develops a painful rash with fluid filled blisters on the right side of her face, but nowhere else. What should you, the Infection Preventionist do? Consider this a potential case of Shingles; This is the same virus that causes Chicken Pox, a disease that used to be prevalent in childhood until an FDA approved vaccine was developed in 1995 (CDC.gov/vaccines/2009). After Chicken Pox runs its course, the Varicella Zoster Virus remains dormant in the body for life, and in some cases, the virus re-surfaces years later as Shingles. The typical signs and symptoms of Shingles include a painful rash with fluid filled blisters that are limited to one side of the face or body. Headache, malaise and fever may also be present. Anyone who has had Chicken Pox, including children, may develop Shingles, but it is more common in older people, those with impaired immune systems or people on immunosuppressive drugs, such as steroids.
Report your findings in detail to the DON and the patient’s physician. Treatment for a confirmed case of Shingles may include prescriptions for anti-virals such as Zovirax, Acyclovir, or Valtrex. Pain medications may also be prescribed.
Educate patients, staff and family members; explain that Shingles itself cannot be transmitted to anyone else, in other words, you cannot “catch” Shingles, it is a re-activation of the Chicken Pox Virus. Draining blisters are potentially contagious to those who have never had Chicken Pox. If they come in contact with the draining blisters, they could be at risk for developing Chicken Pox. This is important information, especially to women who may be pregnant, because Chicken Pox can cause birth defects.
Standard precautions should be used for all patients in Long-term Care. The CDC’s 2007 Isolation Guidelines recommend Standard Precautions for Shingles. Contact Precautions may be used while the Shingles blisters are draining but once they are dried and crusted over, the patient is no longer considered contagious.
Patients and health care workers who have not had Chicken Pox should not be placed in contact with a patient diagnosed with Shingles while the blisters are draining. See CDC: Shingles