Since the advent of the measles, mumps and rubella (MMR) vaccine in 1963, the incidence of measles has declined to such low levels that most healthcare workers today have never actually seen a case. Not surprisingly, with recent outbreaks being reported in the U.S.,1 the anxiety levels of staff run high when a suspected or confirmed case has been identified in the hospital.

Image provided by CDC/Allison M. Maiuri, MPH, CHES

Measles is a highly contagious, acute viral illness that can lead to serious complications and death.2 For every 1,000 persons infected, 250 will be sick enough to require hospitalization and one to two will die.3 In 2000, measles was declared eliminated in the U.S., which is defined as interruption of year-round endemic transmission.3 It is spread by the airborne route and through direct contact with infectious droplets when the ill person breathes, coughs or sneezes.3 The virus can remain infectious in the air for up to 2 two hours after an infected person leaves an area.1 The patient should be placed in a single-patient airborne infection isolation room. Healthcare facilities are increasingly requiring healthcare workers to be vaccinated for certain vaccine-preventable diseases, including measles, mumps and rubella (MMR).4 In some instances these requirements are set forth by state laws.4 Completion of two doses of the vaccine is about 97% effective at preventing measles.5 During 2001–2010, the median number of annual cases in this country was 60, most of which were imported from countries where measles is still endemic.2,3

It is important that environmental services (EVS) managers have a basic understanding of the epidemiology of this disease so that they can adequately address any concerns that staff may have.  Below are some key recommendations and information that can be shared with EVS personnel:

  • Confirm personal vaccination status. Employee Health should have a record. Staff not immune to measles should not enter the patient room.
  • Check with the patient’s nurse before entering the room. 
  • Because of the (low) possibility of vaccine failure, even if immunized, staff should observe airborne precautions while in the room, including the use of an N95 mask or other respirator with similar effectiveness (e.g., PAPR).2
  • No special cleaning of the room is required, however, wait two hours after patient has left or wear a respirator to enter the room for terminal cleaning. Follow facility policy using a healthcare-approved disinfectant. 

1 Measles Cases in 2019.
2 Measles (Rubeola): For Healthcare Professionals. Retrieved from 
3 Measles Data and Statistics. Retrieved from
4 Menu of State Healthcare Facility Measles, Mumps, and Rubella (MMR) Vaccination Laws. Retrieved from
5 Measles Vaccination. Retrieved from