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To isolate or not to isolate in the ED: That is the question

Redness, itchy, fluid filled, crusty, fever or no fever. So many rashes, so many decisions. Do I isolate the patient? Is the condition emergent or can the patient safely wait for care? Knowing how fast to act and when to isolate a patient comes as a challenge for many healthcare providers.

In Fast Facts for the Triage Nurse, 2ndEd., Anna Sivo Montejano DNP, RN, PHN, CEN, and I share insights into some medical conditions requiring patient isolation.


Many presentations require isolation to prevent exposure of other patients, visitors, and staff. The following discussion is not all encompassing but provides information that may help the triage nurse understand rash progression, determine when to initiate isolation, and guide triage decision-making. For additional information, see www.cdc.gov.

  • Chickenpox: Occurs in individuals with a recent exposure to someone with chickenpox; patient may or may not present with a rash since patient is contagious 48 hours before rash erupts and remains contagious until lesions crust over; incubation period is 10 to 21 days after exposure to chickenpox (CDC, 2016); rash appears first on the face, back, or abdomen and then spreads; rash starts as small red bumps (pimples) that develop into blisters and has varying stages of eruption; may have signs of dehydration from sores in mouth (due to difficulty swallowing fluids)
  • Impetigo: Exposure to a person with impetigo; contagious until lesions crust over; rash to the lips, face, legs, or arms and spreads easily; itchy blisters filled with yellowish fluid
  • Lice: Rash mostly found on the scalp and behind ears, and patient feels movement on scalp (head lice); rash presents on waist, thighs, and groin (body lice)
  • Measles (Rubeola): Recent exposure to a person with measles; incubation period is 10 to 12 days with rash appearing approximately 14 days after exposure; patient is contagious 4 days before rash erupts and it continues for 4 days after the rash appears (CDC, 2017); rash starts on the head before spreading to most of the body, including hands and feet; three Cs include cough, conjunctivitis, coryza (runny nose); Koplik (white) spots inside the mouth; causes itching; rash is said to “stain” the skin, changing from red to dark brown before disappearing (easier to see in light-skinned people) can be life threatening, which is spread from person to person in a variety of ways, such as sharing food, coughing, or kissing; risks are large groups of people (college campuses), traveling out of the country to certain locations, and certain medical conditions; signs and symptoms are nausea, vomiting, confusion, photophobia, and so on; if you suspect meningitis, notify a medical provider immediately, in only a few hours, death can occur (CDC, 2018a)
  • Rubella: Recent exposure to a person with rubella; incubation period for 14 days after exposure; rash is first identified on the face and spreads to the chest, back, and limbs; lesions are in different stages of development; begins with fever, runny nose, and cough followed by characteristic rash; itchy
  • Scabies: Rash often found in the webs of fingers, wrists, belt or bra line, and buttocks; small black dot at the center of rash; severe itching; symptoms may not develop for 4 to 6 weeks after an exposure to scabies; patient can be contagious even before symptoms develop (CDC, 2018b)
  • Shingles: Occurs in individuals with a history of chickenpox; patient is contagious until the lesions crust over, rash does not cross the midline (follows a dermatome), extremely painful
Reproduced with permission from Springer Publishing Company from Fast Facts for the Triage Nurse (2ndEd.). New York, NY: Springer Publishing.

Still feeling confused or uncertain of how to respond if faced with such clinical presentations? Always err on the side of safety.

Does your intuition tell you that the patient has a potentially emergent condition? Then act on that. Even if you’re wrong, you’ll know that you made the decision based on what was in the best interest of the patient.

Not sure if you should isolate the patient? Consult with colleagues or the treating provider. When in doubt, isolate. Your actions could be the difference in saving many others from exposure to a communicable disease.


Lynn Sayre Visser is the author of Fast Facts for the Triage Nurse (2ndEd.) and Rapid Access Guide for Triage and Emergency Nurses. She has devoted her career to emergency nursing, triage education, and mentoring others.

*This blog is the fourth in a series. Read the first blog here.


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