C ONCEPT OF I SOLATION

M icrobiology
BSN Semester: I
Unit:6
IFTIKHAR UL HAQ
DEMONSTRATOR
INS-KMU, PESHAWAR
 OBJECTIVES
Define Isolation

Explain the types of isolation

Relate isolation to the chain of infection cycle

Demonstrate the preventive measures during various types of isolation

Perform various nursing interventions professionally in each type of isolation

 Isolation Defined

 Isolation is the separation of a patient from contact with others in order to control the
spread of an infectious or communicable disease.

 The complete separation from others of a person suffering from contagious or infectious
disease; Quarantine.

 The separation of a person with infectious disease from contact with other human beings
for the period of communicability.

 An act or instance of isolating.

 The state of being isolated.

 Isolation Defined

 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 precautions are designed (like-rooms/wards) to minimize the transmission of

infection in the hospital by using updated and skilled technology.

 Isolation helps to protect patients, family members, visitors and health care workers from the
spread of infection.

 To reduce the risk of spreading certain infections or antibiotic resistant germs to other
patients and staff.

 To protect patients from infection if they have a weak immune system due to certain diseases
or taking certain drugs.
 Key points

• Microorganisms can be spread from patients to patients and patients to staff.

• Isolation precautions can reduce transmission, decreasing the spread of microbes.

 Components: hand hygiene, personal protective equipment, single rooms,

ventilation, and restriction of movement.

• Must be applied according to signs and symptoms.

• Microorganisms causing healthcare-associated infections can be spread from

infected or colonized patients to other patients and to staff.
 Key points

• Appropriate isolation/precautions can reduce transmission if they are applied

properly.

• An isolation/precautions policy aims to decrease the spread of infectious agents

between staff and patients to such a level that infection or colonization does not
occur.
 Key points

• Isolation/precautions policies have several parts:

• Hand hygiene, personal protective equipment (protective clothing and other items),
single rooms with more or less sophisticated ventilation, and restrictions for
movement of patients and staff.

• Apply isolation/precautions according to signs and symptoms of the patient; in

general, do not wait for laboratory results.
 Chain of Infection

• Infection results from an interaction between an infectious agent and susceptible

host.

• The interaction occurs by means of contact between the agent and the host and is
affected by the environment.

• Breaking the chain of infection by interrupting transmission is generally the best way
to prevent infections.
 Chain of Infection

• The chain of infection consists of the following components: infectious agent,

reservoir, portal of exit, mode of transmission, portal of entry and susceptible host.

• Isolation precautions focuses on interrupting this chain of infection, especially

transmission.
 Transmission of Infections

 Contact spread

 Direct: from one person to another

 Indirect: contaminated equipment or surfaces

 Droplet Expelled when sneezing or coughing; less than 2m from the source.

 A pathogen may be transmitted by a single route or it can be transmitted in several

ways.
 Transmission of Infections

• Direct contact occurs when microorganisms are transferred from one person to
another.

• It can involve contact with blood, body fluids, excretions, or secretions.

• During patient care by the healthcare worker or a visitor or family member.

• During interactive activities in playrooms between patients.

 Transmission of Infections

• Indirect contact involves the transfer of a microorganism through a contaminated

intermediate object, substance, or person, e.g., contaminated equipment, food, water,
or supplies.

• May occur when Inadequate hand washing is performed by a care provider.

• Equipment is not cleaned, disinfected, or sterilized adequately between patients.

• Blood borne pathogens are transferred by sharps or needle-stick injuries, transfusion,

or injection.
 Transmission of Infections

• Droplet spread: Infectious droplets that are expelled, e.g., when sneezing or
coughing, are too heavy to float in air and can be transferred less than 2m from the
source of the droplets.

• Spread may be direct or indirect.

• Direct droplet transmission: Droplets reach mucous membranes or are inhaled.

• Indirect droplet transmission: Droplets fall on to surfaces or hands and are

transmitted to mucous membranes or food.
 Transmission of Infections

• Indirect droplet transmission is often more efficient than direct transmission.

• Infections spread this way include the common cold, influenza, and respiratory
syncytial viruses.
 Standard Precautions

• Adaptation of uniform precautions for all patients regardless of their diagnosis is

called Standard (Universal) Precautions.

• Guidelines for preventing exposure to blood, body fluids, secretions, excretions,

broken skin, or mucous membranes.

• Based on the concept that body fluids from ANY patient can be infectious.

• Should be used on every patient.

• Use necessary PPE for protection.

 Standard Precautions

I. Hand hygiene.

II. Use of personal protective equipment (e.g., gloves, gowns, masks).

III. Safe handling of potentially contaminated equipment/surfaces/sharp disposal in

the patient environment.

IV. Respiratory hygiene/cough etiquette.

V. Safe injection practices.

VI. Use of mask.

 Transmission Based Precautions

• Transmission based precautions may be needed in addition to standard precautions

for selected patients who are known or suspected to certain infections.

• These precautions are divided into three categories ( contact, droplet & air born) that
reflect the differences in the way infections are transmitted.

• Some diseases may require more than one isolation category.

 Types of Isolation

 Patients are isolated according to the mode of transmission of the disease.

I. Contact Isolation

II. Droplet Isolation

III. Respiratory Isolation

 Contact Precautions

• Direct and indirect contact transmission is the most frequent route of transmission of
hospital acquired infections.

• Direct contact transmission occurs when there is direct body-to-body transfer of

microorganisms between an infected or colonized person and a susceptible host.

• Indirect contact transmission occurs when an inanimate object, such as equipment

used on the infected person or unwashed hands, serves as a vector of transmission
between the susceptible host and the infected person.
 Recommendations for Contact Precautions

• 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.

• Wash hands thoroughly after glove and gown removed.

• Dedicate equipment to the isolated patient.

 Recommendations for contact precautions

• If this is not possible, equipment must be disinfected before being used on another
patient.

• 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

• Used for patients with C. difficile associated disease.

• The recommendations for patient care include all of the above recommendations for
Contact Precautions, but in addition, hand washing with soap and water is required
when caring for patients with C. difficile-associated disease. (Clostridium difficile
is not eliminated by alcohol-based hand rub products)

• Alcohol-based hand rubs may not as effective against spore-forming bacteria

 Procedure for Contact Precautions

 All steps as in STANDARD PRECAUTIONS along with:

I. GLOVES - Gloves should be worn when entering the room.

II. GOWNS - A gown should be worn for contact with the patient and with patient items.

III. PLACEMENT -The patient should be placed in a separate (isolation) room.

 If a separate room is not available, the patient may be placed in a room with another
patient with an identical infectious condition (“cohorting”).
 Appropriate signage to be placed outside the room.
 Limit the number of visitors as appropriate and family or care givers should be educated
on contact precautions and hand hygiene.
 Procedure for Contact Precautions

IV. TRANSPORT – Activities of the patient may need to be limited and when transportation
is required, the following measures should be undertaken:

• Patient’s body is contained or covered

• Avoid contact with objects and if necessary use gloves and maintain hand hygiene

V. PATIENT CARE EQUIPMENT -

• a) Use of dedicated patient care equipment should be considered where possible (e.g.
stethoscope)

• b) Where this is not possible, items should be disinfected after each use.
 Procedure for Contact Precautions

VI. ENVIRONMENTAL MEASURES -

• 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

• MRSA (Methicillin Resistant Staphylococcus Aureus)

• VRE (Vancomycin Resistant Enterococci)

• C. diff (Clostridium Difficile)

• ESBL (Extended Spectrum Beta Lactamase Producing Enzymes Inhibitors)

• MDR (Multidrug Resistant Strains)

• Scabies
 Droplet Precautions

• Droplet transmission occurs when droplets containing microorganisms generated

from the infected person, primarily during coughing, sneezing, or talking, or during
procedures which generate secretions (suctioning, bronchoscopy, etc.) are propelled
a short distance and deposited on the susceptible host’s eyes, nose, or mouth.

• 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:

• Place the patient in a single room.

• Wash hands thoroughly before entering and after exiting the room.

• Put on an isolation mask before entering the patient’s 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.

• Consult with an infection prevention practitioner if this is not possible due to

patient’s age or developmental level.
 Infections that requires Droplet Precautions:

• Influenza (flu)

• Pertussis (whooping cough)

• Mumps

• Respiratory illnesses, such as those caused by coronavirus infections

 Airborne Contact Precautions

• Airborne Contact Precautions are used to prevent transmission of varicella

(chickenpox, disseminated herpes zoster, or localized zoster in an immune
compromised patient).

 Recommendations for Airborne Contact Precautions include:

• A negative pressure, single room is required.

• The door to the room must remain closed at all times.

• 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.

• Persons immune to these viruses need not wear a mask.

• 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

• Airborne Respirator Precautions are used to prevent the spread of TB.

• Airborne transmission occurs by dissemination of airborne droplet nuclei, tiny particles

containing microorganisms that remain suspended in the air for long periods.

• These microorganisms are generated from the infected person, generally by coughing,
sneezing, and talking, or by procedures which generate secretions (suctioning,
bronchoscopy, etc.) and may be inhaled by a susceptible host.
 Negative pressure, single room is required:

• The door to the room must remain closed at all times.

• 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.

• Visitors will be restricted to parents or 2 designated primary caregivers.

• Parents / primary caregivers will be screened for evidence of pulmonary tuberculosis and
will be isolated to the room with the patient until the evaluation is completed.
 Cont.

• 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:

• (E.coli exited the body in feces)

 Cont.
 Mode of Transmission:
•The nurse removed the contaminated linen from the bed.

•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.

•The nurse manipulated the tubing attached to the catheter.

•The E.coli organism on the nurse’s hands contaminated the catheter tubing and ascended to
the patient’s meatus and then into the urinary bladder.
 Cont.

 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
 Soiled linen held away from the nurse’s clean uniform
 Soiled linen placed in the linen bag for later discard
 Protective gloves removed.
 Hands washed
 Breaking the Chain of Infection
 Infection Agent: MRSA

 Reservoir: (Patient’s infected wound)

 Portal of Exit: (Draining from the open wound)
 Mode of transmission: MRSA commonly transferred on hands of the nurse by indirect
contact.
 BREAK IN THE CHAIN:

• Nurse used proper hand washing techniques, worn protective gloves and properly handled
the linen.

• Proper hand washing, gloving and handling of linen.