Monkeypox Virus Guidance: Infection Control and Prevention for Patients in a Home Setting

Background

People with monkeypox who do not require hospitalization should isolate at home. Patients with known or suspected monkeypox should be instructed to isolate themselves and avoid contact with other people and animals, including pets, until symptoms have resolved, including full healing of the rash with formation of a fresh layer of skin.¹ Patients should be informed on the expected course of illness and possible complications.

The appropriateness of implementing isolation and infection control measures in a home setting is likely to vary depending on the following factors:

• The presence of additional infected or uninfected people or pets in the home.
• The presence of young children (<8 years of age), people who are pregnant or immunocompromised and individuals with a history of atopic dermatitis or eczema in the home who may be at increased risk for severe outcomes from monkeypox disease.
• The ability of the person with monkeypox and other people in the home to adhere to recommended precautions.

Recommendations for what a patient should do when isolating in their home

People with monkeypox should follow these recommendations until monkeypox infection has resolved¹:

• Friends, family or others without an essential need to be in the home should not visit.
  • Avoid close contact with others, including pets in the home or other animals.
  • Do not engage in activity that involves direct physical contact.
  • Do not share potentially contaminated items, such as bed linens, clothing, towels, wash cloths, drinking glasses or eating utensils.
  • Routinely clean and disinfect commonly touched surfaces and items (such as counters or light switches) using an Environmental Protection Agency (EPA) registered disinfectant (such as List Q) in accordance with the manufacturer’s instructions.
  • Wear well-fitting source control (e.g., medical mask) when in close contact with others at home.
  • Avoid use of contact lenses to prevent inadvertent infection of the eye.
  • Avoid shaving rash-covered areas of the body as this can lead to spread of the virus.
  • Keep lesions clean and dry when not bathing, and cover skin lesions to the best extent possible (e.g., long sleeves, long pants).
  • Gloves should be considered for covering lesions on the hands when not in isolation (e.g., emergencies, medical care).
  • Patients should be discouraged from using contact lenses to prevent inadvertent infection of the eye.

Bathroom usage

If possible, use a separate bathroom if there are others who live in the same household. If there isn’t a separate bathroom in the house, the patient should clean and disinfect surfaces such as counters, toilet seats and faucets using an EPA-registered disinfectant after using any shared space. Consider disposable glove use while cleaning if rash is present on the hands.

Limit exposure to others

• Avoid contact with unaffected individuals until the rash has resolved, the scabs have fallen off and a fresh layer of intact skin has formed.
• Isolate in a room or area separate from other household members (including pets) when possible.
• Limit use of spaces, items and food that are shared with other household members.
• Do not share dishes and other eating utensils. It is not necessary for the infected person to use separate utensils if properly washed. Wash soiled dishes and eating utensils in a dishwasher or by hand with warm water and soap.

Limit contamination within household

Try to avoid contaminating upholstered furniture and other porous materials that cannot be laundered by placing coversheets, waterproof mattress covers, blankets or tarps over these surfaces. Additional precautions such as steam cleaning can be considered if there is concern about contamination.

Considerations for isolating with animals in the home

• People with monkeypox should avoid contact with animals (specifically mammals), including pets.
  • If possible, friends or family members should care for healthy animals until the owner has fully recovered.
  • Keep any potentially infectious bandages, textiles (such as clothes, bedding) and other items away from pets, other domestic animals and wildlife.
  • In general, any mammal may become infected with monkeypox. It is not thought that other animals such as reptiles, fish or birds can be infected.
• If an individual notices an animal that had contact with an infected person appears sick (such as lethargy, lack of appetite, coughing, bloating, nasal or eye secretions or crust, fever, rash) contact the owner’s veterinarian or your local public health authority.

Hand hygiene, source control and personal protective equipment

• Hand hygiene — the use of an alcohol-based hand rub or hand washing with soap and water — should be performed by people with monkeypox and their household contacts after touching rash material, clothing, linens or environmental surfaces that may have had contact with rash material.
• Cover all skin rashes to the extent possible by wearing long sleeves or long pants. Gloves can be considered for covering rash on the hands when not in isolation such as when receiving medical care.
• People with monkeypox should use well-fitting source control (e.g., medical mask) if close contact with others cannot be avoided, such as when receiving medical care.
• Other household members should wear a respirator or a well-fitting mask when in close contact (e.g., within 6 feet) with the person with monkeypox for more than a brief encounter.
• When possible, the person with monkeypox should change their own bandages and handle contaminated linens while wearing disposable gloves, followed by immediate handwashing after removing gloves.
  • As a last resort, if assistance is needed with these activities, a household member should avoid extensive contact and, at a minimum, wear disposable medical gloves and a well-fitting mask or respirator. Any clothing that contacts the rash during dressing changes should be immediately laundered. Gloves should be disposed of after use, followed by handwashing.
• Contain and dispose of contaminated waste, such as dressings, bandages or disposable gloves. See Disinfecting Home and Other Non-Healthcare Settings.

Household disinfection

The Centers for Disease Control and Prevention (CDC) provides general guidance on cleaning and disinfecting non-health care settings, such as homes or cars, where an individual with monkeypox may spend significant time (see Disinfecting Home and Other Non-Healthcare Settings). If cleaning and disinfection is done by someone other than the person with monkeypox, that person should wear, at a minimum, disposable medical gloves and a respirator or well-fitting mask.²

Patients with monkeypox or suspected monkeypox should follow these recommendations until cleared by state or local public health officials.

Linked below are printable PDFs that can be shared with sexually active patients and include safety measures for social gatherings and safer sex guidelines.

• Safer Sex, Social Gatherings, and Mpox | Mpox | Poxvirus | CDC
• Monkeypox facts for people who are sexually active (cdc.gov)
• Disinfecting Home and Other Non-Healthcare Settings | Monkeypox | Poxvirus | CDC

Reporting of possible cases

Patients who may have monkeypox or who might have been exposed to someone with monkeypox should be reported to public health authorities. Contact the appropriate health authority to report potential cases of monkeypox or for clinical consultation.

Health Department	County	Phone Number to Report
Southern Nevada Health District (SNHD)	Clark	(702) 759-1300 (24 hours)
Washoe County Health District (WCHD)	Washoe	(775) 328-2447 (24 hours)
Carson City Health and Human Services (CCHHS)	Carson City, Douglas and Lyon counties	(775) 887-2190 (24 hours)
Nevada Division of Public and Behavioral Health (DPBH)	All other counties	(775) 684-5911 (M-F 8 am to 5 pm) (775) 400-0333 (after hours)

For updated guidance, review the DPBH Technical Bulletin web page. Email stateepi@health.nv.gov for other questions regarding monkeypox.

References:

¹ https://www.cdc.gov/mpox/hcp/infection-control/at-home.html?CDC_AAref_Val=https://www.cdc.gov/poxvirus/mpox/clinicians/infection-control-home.html

² https://www.cdc.gov/poxvirus/monkeypox/specific-settings/home-disinfection.html