ISOLATION PROCEDURE

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Janet J. Nelson RN,CMA

Define transmission-based isolation & other key words

Identify requirements for ◦ Airborne precautions◦ Droplet precuations◦ Contact precautions◦ Reverse Isolation

Recognize the difference between clean and contaminated during isolation

Objectives:

To prevent the spread of a communicable disease to YOU or to others.

A variety of infection control measures are used for decreasing the risk of transmission of microorganisms.

Included in isolation are:◦ Handwashing and gloving◦ Patient placement◦ Transportation precautions◦ Masks, respiratory protection, eye protection, face shields◦ Gowns and protective apparel◦ Patient care equipment and articles e.g. sharps, bio-bags,

laundry bags, &disposable eating utensils

Why Transmission Based Isolation?

Transmission precautions is Standard Precautions PLUS.◦ Techniques to provide extra protection against

specific disease or pathogens based on how the organism is transmitted.

◦ The severity of the disease◦ And/or if the pathogen is antibiotic resistant or

not

REMEMBER

Direct Contact

Indirect Contact Fomite:

Transmission of Disease

Clean vs Contaminated Contaminated items will

have organisms from patient. HCW does not touch these items unless using PPE.

Clean items have not been exposed to patient.

Different view on:

Is the most important and frequent mode of transmission of nosocomial infections.◦ Direct-contact (direct care to patient)◦ Indirect-contact (contact with contaminated object)

Examples of disease requiring contact Isolation:◦ MRSA (or other multidrug resistant organisim), in a

wound, respiratory, or GI tract◦ E-Coli infection◦ Hepatitis A◦ Impetigo◦ Herpes Simples◦ Staphylococcal infections◦ RSV

Contact Precautions

TYPES OF ISOLATION (TRANSMISSION-BASED

PRECAUTIONS)

~ Contaminated surfaces increase cross-transmission ~

Airborne transmission < 5 microns Stay suspended in air for long periods of

time. The organism can travel from patient by air currents a long distance.

Negative pressure room sucks air outside Use N-95 respirator or PAPR Door always closed

Airborne Precautions

Air-Mate™ High Efficiency

Powered Air Purifying

Respirator (PAPR) (or HEPA)

N95 Respirator

Disease requiring Airborne IsolationGerman measles (Rubella)Varicella (Chickenpox)Tuberculosis (TB)Herpes Zoster

Airborne Isolation

Droplets are generated from the source person primarily during coughing, sneezing and talking (& special procedures e.g. bronchoscopy or suctioning)

The droplets are transmitted a short distance (3 feet) to the hosts mucous membranes (nose,eye,mouth).

Droplets do NOT stay suspended in the air and must not be confused with airborne isolation.

Droplet Precautions

Droplet Precautions Diseases that require Droplet Precautions:

Haemophilus influenzae (HIB) meningitis, pneumonia

Pertussis (whooping cough)

Strept (group A) throat, pneumonia, scarlet fever

Neisseria meningitis or pneumonia

Limit the times the patient must leave his room.

When patient transport is necessary to:◦ Have patient use approtopriate barriers ( e.g.

mask, impervious dressings)◦ Notify the HCW in new area◦ Inform patient of ways he can assist in preventing

the transmission of his infectious microorganism.

Transporting the patient

This is opposite of the other isolations!!

It is to protect the patient from the organisms in the environment. ◦ Immunocompromised

patients◦ Burn patients◦ Patients receiving

chemotherapy or radiation

REVERSED ISOLATION

Sterile gloves, gowns, masks are used by HCW and visitors.

Frequent disinfecting of the room All equipment and supplies are sterile and

at best disinfected before entering room Positive pressure in the room. Filtered, clean

air is brought into the room and allowed to vent out of the room to the surrounding corridors.

Protect the patient

Inside of gown Outside of gown Inside of gloves Outside of mask Waist ties of gown Ties of mask Neck tie of gown Inside of cap

Review: When leaving an isolation unit what is

considered clean/contaminated?

‣ IV Pump ‣ Faucet of sink‣ Outside of gloves

Isolation precautions are burdensome on the HCW and visitors

Facilities policy may vary The emotional impact of isolation for the

patient is enormous.

Conclusion