PREPRATION OF ISOLATION

UNIT

PRESENTED BY
SHILA J. VYAS
F.Y.M.Sc.NURSING

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DEFINITION
“Isolation for the control of infection is used to prevent
infected patients from infecting others (source isolation),
and/or prevent susceptible patients from being infected
(protective isolation).”
PURPOSES:-
 To Differentiate between the modes of transmission.
To Determine methods for breaking the chain of infection.
Select and use PPE in healthcare settings.
 Assess the appropriate circumstances for when each type

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THE METHODS OF PHYSICAL PROTECTION :-
1.Barrier nursing - special nursing procedures which
reduce the risks of person to person transmission,
especially by direct contact or by fomites.
2.Segregation into single rooms - which reduces
airborne spread to from patients, and facilitates
nursing techniques.
3.Mechanical ventilation - which reduces the risks of
airborne spread by removing bacteria from the
patient’s room .

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Transmission of Infection
Microorganisms are transmitted in HCF (Health care facility)
by several routes
There are five main routes of transmission:
1.Contact
a) Direct-contact: Direct body surface-to-body surface contact
and physical transfer of microorganisms between susceptible
host and infected.
b) Indirect-contact: Contact of a susceptible host with a
contaminated intermediate object, usually inanimate, such as a
contaminated instrument, needle, or dressing, or contaminated
hands of HCP.
2.Droplet:
Droplets generated by the infected person by cough, sneeze,
talking, or during a procedure such as suctioning.
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3.Airborne
Dissemination of either droplet nuclei (small particle
residue <5 microns) or dust particles containing
microorganisms into the air are then inhaled by a
susceptible host. This can occur over significant
distances via normal air and ventilation systems.
4.Common vehicle
Transmission via contaminated food, water,
medications, blood products, devices, and equipment.
5.Vector-borne
Transmission of microorganisms via mosquitoes, flies,
ticks, etc. Neither common vehicle nor vector-borne
transmission play a significant role in typical hospital-
associated infections (HAI)
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1. Category A.
These infections are spread by;
Hands, Contact with non-sterile equipment, feces,
blood and body fluids, Bedpans/urinals.
 Viruses considered under this category include HIV,
diarrheal viruses and enteroviruses.
A cubicle or private room is required.
All staff should wear a gown or apron and gloves
when attending a patient.
All persons should wash their hands on leaving the
cubicle.
Masks are not necessary but should be used if
indicated.
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2. Category B.
This category covers infections spread from the
respiratory tract via droplets e.g. Chickenpox, measles,
mumps.
 A cubicle or single room is essential.
Masks, gloves, and aprons should be worn when
handling the patient.
 A ventilation system is advantageous for patients with
communicable respiratory infections, especially
chickenpox.

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Category C. (Reverse - Protective Isolation)
This is used for diseases in which there is
increased susceptibility to infection such as
patients with neutropenia, on anti-cancer
chemotherapy, and severely
immunocompromized patients.
 The amount of protection required varies
with the type of patient. Essentially, such
patients should be isolated with a minimum
of dust, dirt, and wet areas.

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4. Category D. (Strict Isolation)
Category D isolation is only found in specialized units for highly
contagious infections such as rabies and viral hemorrhagic fevers.
A cubicle is essential. Gowns, plastic aprons, masks, and eye
goggles should be worn.
Crockery and cutlery should be disposable.
Hospital staff and visitors should be made aware of the risks when
attending such patients.
This is designed to prevent transmission of highly contagious or
virulent infections that may be spread by air or contact.
A private room is required and gowns, masks, and gloves must be
worn before entry.
Hands must be washed after leaving the room and contaminated
articles should be discarded or bagged and labeled before being
sent for decontamination and reprocessing.

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STANDARD PRECAUTIONS
Use standard precautions for the care of all
patients. (This is a combination of universal
precautions and body sub stance
precautions.)Knowledge of standard
precautions is important in preventing
nosocomial Infections. The transmission of
microorganisms is different for each
Infectious process.

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Airborne Precautions
Airborne precautions (AP) are used for
infections which are transmitted by droplet
nuclei. Droplets are generated in the course
of talking, coughing, or sneezing and during
procedures that involve the respiratory tract
such as suction, physiotherapy, intubation,
or bronchoscopy.
Small droplet nuclei size of ≤ 5μ can be
widely dispersed by air currents and can
reach the alveoli of the susceptible host and
cause infection.
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Summary of Airborne Precautions
Location
A single room under negative pressure
ventilation with a wash hand basin and
preferably with an en suite toilet.
The door must be kept closed at all times
except during necessary entrances and exits.
Unnecessary items of equipment must be
removed before the patient occupies the
room.

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Cont…
Disposable paper towels and an
antiseptic/detergent hand cleanser in an elbow
operated pump dispenser should be provided.
Staff When applicable, only personnel that have
immunity against varicella and measles should
care for these patients.
Visitors All visitors must seek advice from the
nurse-in-charge of the ward before visiting the
patient.
Protective clothing

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Summary of Airborne Precautions
A single room under negative pressure ventilation with a
wash hand basin and preferably with an en suite toilet.
The door must be kept closed at all times except during
necessary entrances and exits.
Unnecessary items of equipment must be removed
before the patient occupies the room.
Disposable paper towels and an antiseptic/detergent
hand cleanser in an elbow operated pump dispenser
should be provided.
When applicable, only personnel that have immunity
against varicella and measles should care for these
patients.

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Hand hygiene
Hands must be washed with an antiseptic
preparation and must be dried thoroughly with a
disposable paper towel, or use a waterless alcohol
hand rub/gel
AFTER touching the patient or potentially
contaminated items,
AFTER removing gloves, and
BEFORE taking care of another patient.
No special handling is needed for used or soiled
linen.
Limit the movement and the transport of the
patient to essential purposes only.
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Droplet precautions
In addition to standard precautions, use droplet
precautions for patients known or suspected to have
serious illness transmitted by large particle droplets.
Examples of such illnesses include the following
For those infections which are spread by large
droplets.
Examples
Invasive miningococcal disease (meningitis,
pneumonia meningococcemia etc.)
Diphtheria, pneumonia, Streptococcal pharyngitis,
Influenza, Mumps, Rubella

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Contact precautions
In addition to standard precautions, use contact
precautions for patients known or suspected to
have serious illnesses easily transmitted by direct
patient contact or by contact with items in the
patient's environment.
Ex. Gastrointestinal, respiratory, skin, or wound
infections
Enteric infections with a low infectious dose skin
infections that are highly contagious or that may
occur on dry skin.
 17
Immunocompromized patients

Acquired bacteria from other patients and

environments. Immunocompromized patients vary in
their susceptibility to nosocomial infections.
They are generally at increased risk for bacterial,
fungal, parasitic, and viral infections.
 The use of standard precautions for all patients and
transmission-based precautions.
Leukopenic patients may sometimes require
additional protective measures, other than standard
precautions.
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Enteric

Precautions –
Enteric precautions are designed to prevent
infections that are transmitted by direct or indirect
contact with faeces, Diarrheal viruses, hepatitis A,
and enteroviruses are included in this category.
 A private room is indicated if patient hygiene is
poor and thus at risk of contaminating others.
 Masks are not indicated. Gowns are not indicated
if soiling is likely. Gloves should be used for
touching infective material.
Hands must be washed after touching the patient
or contaminated articles.

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Blood/body fluid precautions
Blood/body fluid precautions are designed to
prevent infections that are transmitted by contact
with blood or other body fluids such as HIV and
HBV.
A private room is indicated if patient hygiene is
poor because of the higher risk to others.
 Masks are not indicated. Gowns are only indicated
if soiling is likely. Gloves should be worn. Hands
must be washed after touching the patient or
contaminated articles, and contaminated articles
should be discarded or bagged and labeled

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Drainage/Secretion Precautions –
These are designed to prevent infections that are
transmitted by direct or indirect contact with
purulent material or drainage from an infected
body site.
 A private room is not indicated.
Masks are not indicated but gloves should be
worn.
 Hands must be washed after touching the
patient or contaminated articles, and
contaminated articles should be discarded or
bagged and labeled.
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Combination of Airborne +
Contact (A+C) Precautions
This type of isolation is used to prevent
transmission of diseases spread both by air and
by contact and is used for patients with highly
transmissible and dangerous infections.
Diseases requiring combination Airborne &
Contact isolation include:
Chicken pox (Varicella). Others as determined
by Hospital Infection Control team.
 

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ISOLATION OFFERING DIFFERENT DEGREES
OF PROTECTION:
1. High security isolation units - These are
usually part of an infectious diseases
hospital. Total environmental control is
usually achieved by the use of negative
pressure.
2. Infectious diseases hospitals - These
units are usually separate from other
hospitals but may be situated in the grounds
of a general hospital with separate
ventilation and nursing staff.
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3. General hospital isolation units - These provide
source isolation facilities for hospital-acquired
infections; they also provide facilities for protective
isolation and for the screening of patients with
suspected infections before admission to a general
ward or transfer to a communicable diseases unit.
4. Single rooms of a general ward - these provide
less secure source isolation than the above because
of the close proximity to other patients and sharing
of nursing and domestic staff with a general ward.
5. Barrier nursing in open ward - this can be
effective in controlling infections transferred by
contact but not by air.

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GENERAL PRINCIPLES
1 .Room or cubicle
APPLY FOR ISOLATION;-
The door should be kept closed at all times. An
extraction fan may be fitted. Any unnecessary furniture
should be removed before admitting the patient. The
room may be equipped with special items needed to
nurse the patient e.g. Pedal bins, plastic bags etc. All
equipment should be kept inside the room and the room
should be kept tidy.
2. Gowns and aprons-
 Disposable aprons are recommended. Cotton gowns
provide limited protection but are acceptable in most
circumstances. Gowns made of water-repellent material
give better protection.
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3. Gloves –
Gloves should be worn when handling infected material and
sites and. Conventional disposable non-sterile plastic gloves
are adequate for most purposes. Long sleeved disposable
gloves may be used.
4. Masks – Masks are necessary for category B and perhaps
some category A infections; which should provide
protection for 10-15 minutes.
5. Hands – Hand washing before and after contact with the
patient is perhaps the most important measure in
preventing the spread of infection. 70% alcohol is more
effective in removing transient as well as residual flora.

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6.Covering Cuts
Cover cuts or areas of broken skin with waterproof
dressings while at work. Health care personnel with
large areas of broken skin must avoid invasive
procedures.
7. Wastes –
 All clinical waste should be disposed of in a color-
coded bag for incineration.
8. Equipment –
 Disposable or autoclavable equipment should be used
whenever possible. Essential items of patient care such
as sphygmomanometers and stethoscopes should be
left in the room and disinfected when the patient is
discharged or before being used on another patient.

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Cont…
9. Needles and syringes –
These should be disposable and placed in a
hardened container which is sealed before
disposal. Avoid sharps usage whenever
possible.
10. Linen –
Avoid vigorous bed-making - linen from
infected patients should be placed in a color-
coded linen bag for transfer to the laundry.
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11. Crockery and cutlery –
Disposable items may be used when a dishwasher heating the
items to over 80’C is not available. Food should be placed in
polythene bags and discarded with ward waste. Patient care
equipment is either single-use disposable or re-usable
12 .Laboratory specimens –
 Some warning should be given to the laboratory staff.
Containers should be placed in a biohazard bag.
13. Charts –
 Patient’s charts should be kept outside the contaminated
areas.
14 .Disposal of personal clothing –
 Clean clothing requires no special treatment. Contaminated
or fouled (spoiled) clothing should be transferred to the
hospital laundry in a sealed water-soluble or alginate-stitched
bag.
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Disposing of Waste Safely
Waste from patients with a known or suspected
infection should not be treated any differently than
waste from patients without known infection..
15. Transporting patients –
 Patients should be sent to other departments only if it is
essential to do so. The department should be notified in
advance so that they may take suitable measures to
prevent the spread of infection.
16. Staff should also take the following precautions when
handling secretion, excretion and exudates.
Cleaning the Environment
Special attention must be given to ensure the
environment is maintained in a clean state and is in line
with good housekeeping practices.
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Monitoring Staff Health
It is important that HCP are appropriately and
adequately immunized against infectious diseases, both
for their own protection and for the protection of others.
Staff who are suffering from a known or suspected
infectious disease must report this to the Occupational
Health Department, which will advise on the
management and on exclusion from work if necessary.
Sharps injuries and any exposure of non-intact skin,
conjunctiva, or mucous membrane to blood or high-risk
body fluids should be recorded and reported to a
responsible person from the Occupational Health
Department.

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17. Disposal of the dead –
When death of a person suffering from any
infectious disease takes place in a hospital.
 provision is made under the Public Health Act
1936 to prohibit the removal of the body from the.
 A justice of the peace has the power to order the
removal or the burial of the body. In practice the
above powers are not generally enforced.
Cremation is the safest method of disposal and
relatives should be encouraged to agree to this
method although it cannot be legally enforced.

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PREPRATION

OF THE PATIENT AND UNIT:
It is important in the care of the patient to consider the
psycho logic or emotional deprivation that may result
from the technique of isolation.
Extra time should be spent with the patient, the room
should be kept clean and pleasant, and the patient
should be taught the rationale for use of this
technique.
Provide sterile clothes and separate articles for the
patient.
Give psychological support to patient to win his
confidence and co-operation.
Keep sterile tray ready for the patient.
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Prior to moving the patient into a room:
Explain the need for isolation to the patient
Remove all unnecessary equipment from the room
Ensure that mattresses and pillows have protective
covers
Place a Source Isolation notice on the door of the room
Consider whether people entering the room should be
immune.
Record in the nursing care plan the reason for isolation.
Inform the Infection Control Team
Alcohol gel for hand rub  

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Before entering the room, staff members should:

Remove white coats or outside clothing (leave on hook outside

room)
Remove wristwatch and jewellery and roll up sleeves
If the patient is to be examined or before any procedure, wash
and dry hands thoroughly or, if hands are clean, use alcohol gel
and put on non-sterile examination gloves
Perform patient task (change disposable gloves if they become
soiled during the procedure).
Do not touch the patient or anything else in the room
unnecessarily
Do not sit on the bed.
Sharps must be disposed of in the sharps box inside the
isolation room
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Before leaving the room or bed space:
Remove gloves and apron and discard into yellow bag
Bag linen in red / clear alginate bag
Wash hands in antiseptic hand wash and dry thoroughly

Outside the room:

Close the door after leaving the room
 Place alginate linen bag into red / clear plastic bag
Wash hands again in antiseptic hand wash, OR
Rub hands using alcohol gel, alcoholic chlorhexidine
hand rub or equivalent

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Visitors of Patients in Source Isolation
The risks to visitors should be assessed (chickenpox). If in
doubt, ask the Infection Control Team before allowing visits.
Visits by children should be discouraged.
Visitors should be reassured by staff as to the risks of
catching infection
Visitors should remove outdoor clothing before entering the
room
There is usually no need for visitors to wear protective
clothing
 Visitors should not sit on the patient's bed
 Visitors should not eat in the patient's room
Visitors should be encouraged to wash their hands

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AFTER CARE OF PROCEDURE
(1) Decontamination of Equipment
If equipment is removed from the room it must be
decontaminated according to the disinfection policy. 
(2) Decontamination of the Room
 The nursing staff should consider the following points
when decontaminating the room after a patient has been
in source isolation:
Deal with spillages of blood and body fluid, and clean and
remove used equipment
Discard any rubbish, disposables into a yellow sack
 

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(3) Domestic Cleaning of the Room
 Domestic staff members should wear protective clothing
(yellow plastic apron and domestic rubber gloves).
Daily cleaning should be done by ward domestic
 staff members after cleaning the rest of the ward. Disposable
cloths will be used and discarded.
 Domestic staff members should use Marigold gloves or
equivalent, not clinical gloves.
(4) The following points should be kept in mind:
If it is necessary to remove equipment, this should be wiped
down with general purpose detergent and then with
disinfectant
 If it is necessary, strip the bed of all linen. Linen should be
placed in an alginate stitched bad and tied, before being
brought out of the room
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 
(5) Additional Action on Discharge of the Patient
 Special Disinfection
After discharge of patients harboring methicillin-resistant
Staphylococcus aureus (MRSA), glycopeptide-resistant
enterococci (GRE) and Streptococcus pyogenes or other diseases
at discretion of the Infection Control Team, special cleaning will
be performed.
Curtains will be taken down and sent for laundering in an
alginate bag.
Paper curtains will be disposed of in a yellow sack.
When the surfaces have been cleaned with detergent, all hard
surfaces must be wiped with fresh chlorine-releasing isolation
On completion of the cleaning, the bucket must be cleaned and
the mop head disposed of or sent for laundering.
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KEY POINTS
 
Gloves should be worn at all times; hands should be
washed for minimum of 10 seconds and gloves changed
when moving fromone patient to another.
Depending on the activity performed on the patient,
the nature of the patient’s illness, and the amount of
exposure to blood and body fluids, other protective
equipment should be worn. e.g. gown and goggles if
patient is coughing, bleeding, or has drainage from
wounds or body orifices.
 Needles should never be capped.

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 All sharps (needles, razors, etc.) should be
disposed of immediately in biohazardous
puncture proof sharps containers located in
each room.
 Never carry needles or sharps from one
location to another.
If necessary to do so, never point toward
another person or yourself. KEEP POINT
TOWARD THE FLOOR OR CEILING.
All unknown spills or waste should be treated
as hazardous.

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