An 82-Year-Old Woman Comes to the Office Due to a Day

An 82-year-old woman comes to the office due to a day of low-grade fever and rash.  Two days ago, the patient began having stabbing pain in her left flank.  Over the following day, this area became itchy and red.  The patient tried over-the-counter topical hydrocortisone and lidocaine but had no relief.  She has a history of hypothyroidism, type 2 diabetes mellitus, rheumatoid arthritis, and osteoporosis.  She was recently hospitalized for sepsis secondary to a urinary tract infection and discharged on oral ciprofloxacin that she completed yesterday.  The patient has no history of drug allergy but noticed a "strange taste in my mouth" after taking ciprofloxacin.  Her other medications include low-dose aspirin, alendronate, levothyroxine, glipizide, low-dose prednisone, calcium, and vitamin D supplementation.  She does not smoke, consume alcohol, or use illicit drugs.  Temperature is 37.8 C (100 F) , blood pressure is 124/72 mm Hg, pulse is 92/min, and respirations are 14/min.  Examination of her left flank shows bright patchy erythema, excoriations, and several fluid-filled blisters. The appropriate treatment was initiated.  Over the next 24 hours, the patient has progressive pain in the area of the skin lesions and is admitted to the hospital for pain control.  On reexamination, the rash has progressed and now also involves the right flank and lower back.  The rash is patchy with bright red erythema and blisters without crusting.  Which of the following is the most appropriate strategy to reduce the risk of exposure to health care personnel?

A) Follow standard precautions until the lesions are crusted
B) Follow standard precautions until the lesions resolve
C) No infection-control measures are needed
D) Place the patient on contact and airborne precautions
E) Place the patient on droplet precautions