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The Top 3 Things to Know About Infection Prevention Controls and Waste Management for Mpox

Information on the 2022 mpox outbreak is evolving; for the latest information, refer to the CDC website (CDC, https://www.cdc.gov/poxvirus/monkeypox/about.html, Accessed 5/31/2022).

Outbreaks of the mpox virus have been found on every continent, and to date more than 650 confirmed and suspected cases of mpox have been reported (BNO, https://bnonews.com/monkeypox/, accessed 5/31/22). Mpox is usually associated with travel to central or western Africa, but some of the cases that have been reported outside these countries have no link to travel, underscoring the need to learn more about transmission to prevent mpox infection.

Health care workers who may encounter a case of mpox should familiarize themselves with the symptoms and paths of transmission to limit the spread of the virus. Here are three things you should know about infection prevention controls and waste management for mpox.

EMS Strategies for Mpox

For information on how Emergency Medical Service (EMS) clinicians should respond if they encounter a person infected with mpox, check out our blog post EMS Response to the Current Outbreak of Mpox.

#1: Follow the Identify, Isolate, and Inform Strategy to Prevent the Spread of Mpox

Key Symptoms for Identifying Mpox

• Symptoms typically include fever, headache, chills, muscle aches, and swollen lymph nodes, followed by a rash. ​
• Unlike cases in recent years, the current outbreak of mpox does not always start with flu-like symptoms prior to the onset of a rash. Perianal or genital lesions without a fever have been reported.
• The rash associated with mpox involves vesicles or pustules that are deep-seated, firm or hard, and well-circumscribed; the lesions may umbilicate (resembling a dot on the top of the lesion) or become confluent and progress over time to scabs.
• Lesions typically develop on the face, palms of the hands, and soles of the feet first, and then spread to other parts of the body. However, some recent cases have begun with lesions in the genital and perianal region, which may lead to the infection being confused with sexually transmitted infections, such as syphilis or herpes.
• Lesions are often described as painful until the healing phase when they become itchy.
• For more information, visit the CDC webpages on Clinical Recognition of Mpox (CDC, https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html, Accessed 5/31/2022) and the U.S. Mpox 2022 Situation Summary (CDC, https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html, accessed 5/31/2022).

Travel Risk Factors for Mpox

• If clinicians identify patients with a rash that could be consistent with mpox, especially those with a recent travel history to central or west African countries, parts of Europe where mpox has been reported, or other areas reporting mpox cases, mpox should be considered as a possible diagnosis (CDC, https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html, accessed 5/31/2022).

Isolating Patients Suspected of Having Mpox

• Isolate patients suspected of having mpox in a negative air pressure room. If a negative air pressure room is unavailable, place patients in a private room.
• Keep the patient room door closed and restrict access to the room to designated personnel.
• For more information, visit the CDC webpage on Infection Prevention and Control of Mpox in Healthcare Settings (CDC, https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html, Accessed 5/31/2022).

Watch NETEC’s webinar The I’s Have It: Identify, Isolate, and Inform for more information on how you can stop the spread of illness.

Who to Inform When You Encounter a Case of Mpox

• Possible cases of mpox should be reported to your local hospital epidemiologist and/or infection control personnel, who will contact your state health department (CDC, https://www.cdc.gov/infrastructure/contact/index.html, accessed 5/31/22).
• Review the CDC’s case definition of mpox to help you make a more rapid diagnosis when infection occurs (CDC, https://www.cdc.gov/poxvirus/monkeypox/clinicians/prep-collection-specimens.html, accessed 5/31/2022).
• Establish a plan with your laboratory team to ensure specimen collection, handing, and transportation is aligned with facility and public health expectations (CDC, https://www.cdc.gov/poxvirus/monkeypox/clinicians/prep-collection-specimens.html, accessed 5/31/2022). Check out NETEC’s reference guide on testing, shipping, and managing clinical specimens.
• The CDC has released a new case report form (CDC, https://www.cdc.gov/poxvirus/mpox/health-departments/case-reporting.html, accessed 5/31/2022) for health care professionals to use when evaluating a patient who has been exposed to mpox.

#2: Follow Transmission Based Precautions for Staff Safety

Stop the Spread of Mpox Through Transmission Based Precautions

• Health care personnel should strictly adhere to standard, contact, and airborne precautions. This includes a NIOSH-approved, fit-tested N-95 respirator, gown, gloves, and eye protection with face shield or goggles (CDC, https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html, Accessed 5/31/2022).
• Listen to the Transmission Interrupted podcast episode Back to Basics: PPE and Mpox for guidance on standard and transmission based precautions for infection prevention.
• See the CDC’s guide Standard Precautions for All Patient Care (CDC, https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html, Accessed 5/31/2022) for more information.
• The patient should wear a medical mask and have any exposed lesions covered with a sheet or gown if transported outside of their room (CDC, https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html, Accessed 5/31/2022).

# 3: Handle Mpox Contaminated Waste Carefully

Guide to Handling, Storing, Treating, and Disposing of Waste

• Mpox contaminated waste management practices can differ depending on the strain of mpox virus. The West African clade of mpox viruses can be managed as regulated medical waste. See the Department of Transportation website for more information (DOT, https://www.phmsa.dot.gov/transporting-infectious-substances/planning-guidance-handling-category-solid-waste, accessed 5/31/22)). Facilities should also comply with state and local regulations (Hercenter, Accessed 2025, https://www.hercenter.org/rmw/rmwlocator.php) for handling, storage, treatment, and disposal of waste (CDC, https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html, Accessed 5/31/2022).
• Soiled laundry, including protective clothing, bed linens, etc., should never be shaken or handled in manner that may disperse infectious particles. Laundry should be bagged or contained at the point of use in accordance with Occupational Safety and Health Administration (OSHA) regulations.
• Disposable medical instruments and patient-care devices should be placed in containment for safe handling and discarded as per state regulations for the routine handling of medical waste.
• All reusable medical instruments should be cleaned and sterilized after use.
• Regulated medical waste should be placed in containment, subjected to a decontamination treatment, and discarded in accordance with medical waste regulations of the state or other appropriate jurisdiction.

NETEC Mpox Resources and Support

Visit the NETEC Resource Library for more education and training resources from NETEC and our partners!

Have a question about infection control and prevention or waste management for a mpox case? Get an answer from a NETEC expert: send us your question today!