Chapter 6, Isolation V
Chapter 6, Isolation V
ONCEPT OF SOLATION
M icrobiology
BSN Semester: I
Unit:6
IFTIKHAR UL HAQ
DEMONSTRATOR
INS-KMU, PESHAWAR
OBJECTIVES
Define Isolation
The separation of a person with infectious disease from contact with other
human beings for the period of communicability.
According to the CDC, isolation is the act of separating a sick individual with a
contagious disease from healthy individuals without that contagious disease in
order to protect the general public from exposure of a contagious disease.
Isolation refers to the precautions that are taken in the hospital to prevent the
spread of an infectious agent from an infected or colonized patient to susceptible
person.
Need Of Isolation
Isolation aimed controlling and preventing the spread of infection.
Isolation helps to protect patients, family members, visitors and health care workers
from the spread of infection.
To protect patients from infection if they have a weak immune system due to certain
diseases or taking certain drugs.
Key points
• The interaction occurs by means of contact between the agent and the host
and is affected by the environment.
Contact spread
Droplet Expelled when sneezing or coughing; less than 2m from the source.
• Direct contact occurs when microorganisms are transferred from one person
to another.
• Droplet spread: Infectious droplets that are expelled, e.g., when sneezing or
coughing, are too heavy to f lo at in air and can be transferred less than 2m
from the source of the droplets.
• Infections spread this way include the common cold, inf lu enza, and
respiratory syncytial viruses.
Standard Precautions
• Based on the concept that body fluids from ANY patient can be infectious.
I. Hand hygiene.
• These precautions are divided into three categories ( contact, droplet & air
born) that reflect the differences in the way infections are transmitted.
I. Contact Isolation
• Place patient in a single room, put on a gown and gloves before entering the
patient’s room.
• Remove gown and gloves just inside the door to the patient’s room and
discard within the room.
• The patient must remain in the isolation room at all times except for
essential tests or procedures that cannot be performed in the room.
• The patient must wear a cover gown and gloves when out of the room.
Recommendations for Contact Enteric Precautions
• The re c o m m e nd a t i o ns fo r pa t i e nt c a re i nc l ud e a l l o f t he a bo v e
recommendations for Contact Precautions, but in addition, hand washing
with soap and water is required when caring for patients with C. dif fic ile-
associated disease. (Clostridium dif ficile is not eliminated by alcohol-based
hand rub products)
II. GOWNS - A gown should be worn for contact with the patient and with patient
items.
IV. TRANSPORT – Activities of the patient may need to be limited and when
transportation is required, the following measures should be undertaken:
• Avoid contact with objects and if necessary use gloves and maintain hand hygiene
• b) Where this is not possible, items should be disinfected after each use.
Procedure for Contact Precautions
• a) Focus on room cleaning and disinfection (e.g., daily bed rails, over bed table,
bedside commode, lavatory surfaces in patient bath rooms, door knobs) and
equipment in the immediate vicinity of the patient.
• b) Housekeeping services need to be done at the end and then change the mops,
dusters, solutions.
Infections which requires contact precautions
• Scabies
Droplet Precautions
• These droplets are relatively large and do not remain suspended in the air,
therefore negative pressure rooms are not necessary.
Recommendations for Droplet Precautions include:
• Wash hands thoroughly before entering and after exiting the room.
• Patients may not leave the room except for essential tests or procedures
that cannot be performed in the isolation room.
• The patient should wear an isolation mask when out of the room.
• Influenza (flu)
• Mumps
• Persons not immune to varicella should not enter the room. Alternate
caregivers should be assigned to the patient.
Recommendations for Airborne Contact Precautions include:
• If susceptible persons must enter the room of a patient with varicella, an isolation
mask should be worn but this may not be completely protective.
• Put on a gown, and gloves before entering the patient’s room. As part of Standard
Precautions, a mask and eye protection are required for close contact (within 3 feet)
with a coughing patient.
• Remove gown, and gloves just inside the door to the patient’s room and discard
within the room.
• Wash hands thoroughly after gown and glove removal.
Airborne Precautions
• Wash hands thoroughly or use alcohol hand gel before entering and after exiting
the room.
• Use a powered air-purifying respirator (PAPR) or N-95 respirator when in the room.
• Patients may not leave the isolation room except for essential tests or procedures
that cannot be performed in the room.
• If possible, the patient wears an isolation mask when out of the room.
Relate isolation to the chain of infection cycle
Patient’s scenario:
An elderly patient, hospitalized with a gastrointestinal disorder caused by (E.coli),
was on bed rest and required assistance for activities of daily living. The patient
had frequent uncontrolled diarrhea stools and the nurse provided excellent care
to maintain cleanliness and comfort. Following one episode of cleaning the
patient and changing the bed linen, the nurse immediately went to a second
patient to provide care with Foleys catheter. The nurse’s hands were not washed
before assisting the second patient.
Cont.
Infectious Agent:
• (Escherichia coli)
Reservoir:
• (Large intestine: E.coli, bacteria in the large intestine of human forms the greater
part of the normal intestinal flora)
Portal of Exit:
• The E.coli organism contaminated the hands of the nurse who then provided
morning care to another patient.
Portal of Entry:
• The second patient receiving care had a Foley catheter.
Susceptible Host:
• The second patient with a Foley catheter. This patient was elderly and had a
chronic illness necessitating complete bed rest. The Foley catheter contaminated
by the E.coli organism provided a direct route into the urinary bladder.
Breaking the Chain of Infection
Patient’s scenario:
A patient assigned for morning care has an open wound on her left lower leg. The
wound is draining and when last cultured, the micro organism MRSA was
identified.
In preparation of bed making, hands of the nurse were washed, clean linen and a
bag for soiled linen were gathered from the linen room and placed on the
patient’s clean bed side stand.
Breaking the Chain of Infection
To remove the soiled linen from the bed, following procedure was followed:
Hands washed
Gloves worn
Each side of the soiled linen ends folded towards the middle of the bed
Hands washed
Breaking the Chain of Infection
Infection Agent: MRSA
• Nurse used proper hand washing techniques, worn protective gloves and properly
handled the linen.