Preventing the spread of monkeypox for health care workers


Monkeypox is a viral disease that previously occurred mostly in central and western Africa and is called “monkeypox” because it was first identified in laboratory monkeys, though it can infect people and other animals. Monkeypox cases are very rare in the United States and, in the past, were usually associated with international travel or importing animals from areas where the disease is more common. Recently, cases of monkeypox have been identified in the U.S., including Washington state, that were transmitted through person-to-person contact. Health care workers should take precautions to protect themselves if a patient presents with symptoms of monkeypox.

Monkeypox can easily be mistaken for other rash causing diseases, including sexually transmitted infections. Patients may seek care in outpatient clinics and other healthcare settings, so health care workers should consider a patient presenting with a rash may have monkeypox and take appropriate precautions. Refer to the CDC information on clinical recognition of monkeypox for more information.


After exposure it generally takes one to two weeks for symptoms appear, but may appear in as little as five days or up to three weeks.
Initial symptoms may include:

  • Fever;
  • A general sense of being unwell or tired;
  • Headache;
  • Sore throat or cough; and
  • Swollen lymph nodes in the neck, armpits, or groin occurring on both or one side of the body.

Typically, within one to three days of experiencing a fever, a rash appears. Lesions typically begin to develop simultaneously and evolve together on any part of the body, however, cases in the recent outbreak have presented with lesions in multiple stages in the same area of the body and sometimes before or in absence of other symptoms. Traditionally, lesions progress through four stages—macular (flat and discolored), papular (raised), vesicular (fluid-filled), to pustular (pus-filled)—before scabbing over and healing. This process happens over a period of two to three weeks.

Refer to the CDC information on clinical recognition of monkeypox for more information.


Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, body fluids, or respiratory secretions during prolonged, face-to-face contact. Monkeypox may also spread through materials or clothing contaminated by an infected person’s body fluid or sores.


Health care workers should follow CDC’s recommendations for isolation precautions in all health care settings when caring for patients who present with fever and vesicular/pustular rash. If a patient is suspected of having monkeypox, notify infection control personnel immediately.

A patient with suspected or confirmed monkeypox should be placed in a single-person room with the door closed (if safe to do so). Any procedures likely to spread oral secretions should be done in an airborne infection isolation room. Avoid activities that could suspend dried material from lesions, such as use of portable fans, dry dusting, sweeping, or vacuuming.

Personal Protective Equipment (PPE)

All PPE must be used in accordance with WAC 296-800-160. Employers must provide health care workers with the required PPE and train them how to use it. Recommended PPE when caring for a patient with suspected or confirmed monkeypox includes:

  • Gown;
  • Gloves;
  • NIOSH-approved N95 or other NIOSH-approved respirator. Respirator use must be in the context of a comprehensive respiratory protection program in accordance with Chapter 296-842 WAC. Employers of healthcare workers who will need to wear respirators must ensure workers are medically-cleared, trained, and fit-tested for respirator use; and
  • Eye protection (face shields or goggles).

Additional Actions

Other actions to limit the transmission of monkeypox includes:

  • Washing hands with soap and water for at least 20 seconds or use alcohol-based hand sanitizer (with at least 60% alcohol) after each contact with a patient or their environment.
  • Disposing contaminated waste (for example, dressings) properly.
  • Taking care when handling soiled laundry to avoid contact with potentially contaminated material. Do not shake or handle dirty laundry in a manner that may disperse infectious particles.
  • Cleaning and reprocessing used equipment appropriately.
  • Cleaning and disinfecting surfaces with a hospital-grade disinfectant that is effective against orthopoxviruses (for example, monkeypox or smallpox).


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