Documentation of isolation precautions is required for insurance reimbursement and includes the type of isolation initiated, patient education, and daily observation of precautions. Isolation can be documented in the problem list, nursing activities, MedAct, or education sections. Proper hand hygiene and use of personal protective equipment are essential to prevent the spread of infection when a patient is in isolation.

1. Isolation
In order to get reimbursed by insurance for isolation
charges, there must be documentation every shift that isolation
precautions are being observed
Document
• Type of isolation initiated
• Education of patient and family on initiation and daily
• Airborne isolation, document fit-testing offered to
family/friends
• Observation of isolation precautions every shift

2. Isolation (continued)
There are many ways to document the observation of isolation
precautions in Point of Care
• Problem List
• Nursing Activities
• MedAct
• Education
Associate MedAct Interventions with the Problem List to
streamline documentation
Always place the appropriately completed Isolation
Communication sheet under doctor’s orders

3. Isolation (continued)
 The number one way to prevent the spread of
infection is through handwashing
 When the hands are not visibly soiled, a hospital
approved alcohol based hand sanitizer (Purell) may
be used
 Chlorhexidine gluconate (CHG, Hibiclens, Calgon
Vestal) is used to wash your hands when your
patient is in isolation precautions
 If patient is on isolation precautions for C-Difficile
remember to wash hands with Chlorhexidine
gluconate in patient’s room. Alcohol based hand
sanitizers do not wash off C-Difficile

4. Isolation (continued)
 When your patient is on airborne precautions, they are placed in a
negative pressure isolation room
 Negative pressure rooms include an anteroom
 Both the interior and exterior door will remain closed – When
entering or leaving the room only one door should be open at a
time
 You must wear a properly fitted N95 respirator mask to enter the
room
 Fit testing is done in Associate Health yearly
 Entering an airborne isolation room without a properly fitted
mask puts you at risk for exposure

5. Isolation (continued)
Isolation carts are obtained by calling Materials Management and
requesting one be brought to the unit
• If Materials Management is closed, the associate can ask the House
Supervisor to get one
When the isolation is discontinued:
• Clean and disinfect the isolation cart - make sure to saturate the
cart with Virex and allow it to sit for at least 10 minutes
• All items used in the patient’s room are thrown away
• Call Materials Management to pick up the cart after it has been
disinfected

6. Isolation (continued)
Isolation carts contain items used in the isolation patient’s
room
 A stethoscope is provided that is disposed of when the
patient is removed from isolation or discharged
 Appropriate personal protective equipment is provided
including gowns, gloves, and masks
 Disposable thermometers are provided (please only take
what you need into the patient’s room)
 Signage for the door is provided
 Calgon Vestal soap is provided – wash with this for all
isolation patients

7. Isolation (continued)
An item must first be cleaned before it is disinfected
 Virex II 256 is used as a general disinfectant
 If an item is contaminated with blood or other
potentially infectious material, Expose must be used
 To disinfect an item, Virex must be sprayed on
liberally and left to sit for ten minutes
 When cleaning an item that has been contaminated
with blood, use Expose allowing it to sit for 10
minutes, clean afterward with Virex to remove any
residue

8. Isolation (continued)
Codes – Isolation codes not only communicate that the patient is
in isolation but also the type:
• A = Airborne
• D = Droplet
• C = Contact
• P = Protective Isolation
These codes are added to the demographics and print to the
following:
Patient summary
Mini Census (I column)
Demographic view on Virtual Chart
Ancillary screens

9. Isolation (continued)
It is the primary nurse’s responsibility to
place the patient in isolation on admission if
necessary by history or if patient is
admitted with abscesses, draining
wounds, or diabetic foot ulcers or other
approved isolation criteria such as:
• Suspected TB
• C-Difficile
• Chicken Pox
• Rubella, Mumps, Diphtheria
• Hepatitis A
(Continued on next slide)

10. Isolation (continued)
 Salmonellosis
 Herpes Zoster (shingles)
 Neonatal herpes simples/Viral infections
 Pediatric respiratory illnesses
 Meningitis
 Staph Aureus/MRSA, VRE
 Multi-drug resistant organisms
*The patients with any of these mentioned isolation criteria;
will have isolation initiated immediately on admission and
Infection Control notified by phone *
If history indicates-cultures of previously infected areas
should be obtained at this time; then if patient is cleared by
acceptable culture, isolation is discontinued

11. Isolation (continued)
 The nurse then notifies infection control of culture results
which clears the isolation status
 Likewise, the infection control nurse should be notified if
patient is placed in isolation on admission
 If patient is placed in isolation after business hours or on the
weekend, leave a message with the infection control nurse at
380-1063
 The admission clerk should notify the receiving unit and
infection control nurse when a patient who is known to have
previously cultured positive for VRE or MRSA is admitted

12. Isolation (continued)
 It is also vital for nursing to check and see if the patient is
positive for VRE or MRSA on admission as well
 This is done by hovering the cursor over the arrow by “Patient
Care” on the virtual chart
 If patient has a history of MRSA or VRE there will be a “Y” in the
respective place
 If this is the case, the patient has not been “cleared” and must
immediately be placed in isolation, infection control notified and
the isolation code “C” placed in demographics screen so it pulls
to the virtual chart
 The “C” does not pull from stay to stay so admissions and
nursing need to be vigilant in looking for these patients on
admission and applying the “C” if indicated

13. Isolation (continued)
Discontinuing Isolation
 When isolation is discontinued the code is removed from
the demographics screen.
 Isolation is discontinued per protocols or once the patient
is cleared
• MRSA is cleared by one negative culture
• VRE is cleared by 3 sets of 3 cultures with each set collected at
least one week apart