isolation practices for nurses

2. Goal of Isolation (Protection of / from)
HCWs
Other
Patients
Environment
Visitors
(Community)
Patient
Placement
PATIENT Barrier
nursing

3. Chain of Infection
Pathogen
Reservoir
Portal of
Exit
Mode
of
Transmiss
ion
Portal
of
Entry
Susceptible
Host
Dr.T.V.Rao MD 3

4. Why Isolation?.. because transmission is
easier to control than the source / host!

6. Our Hands are Threat to LIFE
Just Washing can Save Many
LIVES
Dr.T.V.Rao MD 6

7. Handwashing
 Most important
 Soap and water OR
 alcohol based products – when no visible
soiliing
 Length of fingernails ???
 When to wash??

8. Hand washing
8

9. Gloves
 Gloving
 Protective barrier
○ To caregivers
○ To patients
○ Between patients / within the same patient
 When?
○ Anticipated direct contact with non intact skin/body fluids
○ Care of patients colonized with MDRO
○ Handling potentially contaminated patient care
equipments/env
 Failure to change gloves between patient contacts –
INFECTION CONTROL HAZARD

10. Other Barrier Protection
 Masks
 Eye protection
 Goggles/Face Shields
 Gowns and protective apparel
 Why gowns???
 When to remove??

11. Respiratory protection
Face Masks N95 Respirators
 Loose fitting, not
designed to filter out
small aerosols
 Place on coughing
patient (source control)
 HCW should wear mask
to
 protect patient during
certain procedures (e.g.,
surgery)
 protect HCW
○ droplet precautions
○ Mask + goggles for
anticipated
spray/splash
 Tight fitting respirator,
designed to filter the
air
 Protects the wearer
 HCW should wear
when concerned about
transmission by
airborne route

14.  Patient Care Equipment and Articles
 Disposal
○ Bags
 Sharps
 Reusable devices
○ Critical - Sterilised / Disinfected
○ Non critical – cleaned amd disinfected after
use

15. Patient placement
 Private room
 Patient with highly transmissible or
epidemiologically important
microorganisms
 With handwashing and toilet facilities
 Appropriate room mate sharing – same
microorganisms – COHORTING
 Useful during outbreaks --- eg??
 Airborne transmission – room with
appropriate air handling and ventilation

16. Transport
 Only for essential purposes
 With appropriate barriers
 Precautions in the new area to be
transported
 Informing patients

17. Others
 Linen and Laundary
 Common sense storage and processing of
soiled linen
 Dishes, Glasses, Cups, and Eating
Utensils
 Hot water and detergents
 Routine and Terminal cleaning

18. Standard Precautions
 Universal Precautions + Body
Substance isolation
 Principle : All blood, body fluids,
secretions, excretions except sweat, non
intact skin, and mucous membranes
may contain transmissble infectious
agents
 FOR THE CARE OF ALL PATIENTS

19. Standard Precautions .
 Hand washing
 PPE – gloves,mask,goggles ,
gown.
 Proper - handling of soiled
patient care equipments,
environmental cleaning,disposal
of sharps.
 Respiratory hygiene/cough
etiquette
 Minimal handling of soiled linen.19

21. Transmission Based Precautions
21

22. Airborne
PRECAUTIONS
Tuberculosis
Measles
Chickenpox
Small pox
22

23. Airborne precautions
 Patient placement :
 monitored negative air pressure
 6-12 air changes per hour
 Appropriate discharge of air outdoors
 Keep the room door closed
 Respiratory protection
 N 95 mask while entering the room / discard
in trash while leaving the room
 Patient transport
 Mask on the patient

25. Droplet
precautions
Neisseria meningitidis
Influenza, H1N1
Adenovirus, rhinovirus
Pertussis, Mumps
Grp A Streptococcus
Mycoplasma pneumoniae
25

26. Droplet Precautiions
 Patient placement:
 Private room
 If not available, spatial separation of atleast
3 ft
 Special air handliing and ventilation – not
necessary
 Door may remain open
 Mask while entering the patient room /
discard in trash after leaving the room
 Masking the patient when transport
needed

28. Contact
precautions
RSV
Hepatitis -A
Antibiotic
resistant bacteria
 MDRO,
MRSA,VRE..
Scabies
28

29. Contact Precautions
 Private room
 Gloves and Handwashing
 Gown – remove when leaving the room
 Precautions while transport
 Dedicate the use of non critical patient
care equipment to a single patient (or)
clean and disinfect before use for
another patient

31.  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

32.  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

33. QUESTIONS ???
 When do you practice standard precautions?
 Among the mask, gown, gloves which do you
need the most in contact precautions?
 What would you do after using USG machine for a
patient with MRSA?
 When a patient is isolated with contact
precautions, doctor adjusts the ventilator settings
without gloves.. What is your take? What would
you do?
 When a patient with tuberculosis is admitted, what
kind of isolation would you do?
 When there is no private room available for a
patient with swine flu what are your options for
admission?