Isolation Precautions

ISOLATION PRECAUTIONS Isolation – measures to prevent the spread of infections or potentially infectious microorganisms to health personnel, clients and visitors. Guidelines 1. Category – specific Isolation  use seven categories: strict isolation, contact isolation, respiratory isolation, tuberculosis isolation, enteric precautions, drainage/secretions precautions, and blood/body fluid secretions. 2. Disease – specific isolation precautions  provide precautions for specific diseases. 3. Universal precautions (UP)  are techniques to be used with all clients to decrease the risk of transmitting unidentified pathogens  obstruct the spread of bloodborne pathogens 4. the body substance isolation (BSI)  system employs generic infection control precautions for all clients except those with the few transmitted diseases through the air.  BSI system based on three premises 4.a All people have an increase risk for infection from microorganisms placed on their mucous membranes and non-intact skin

4.b All people are likely to have potentially infectious microorganisms in all of their moist body sites and substances. 4.c An unknown portion of clients and health workers will always be colonized or infected with potentially infectious microorganism in their blood and other moist body sites and substances, CDC (HICPAC) ISOLATION PRECAUTIOS (1996) HIPAC - Hospital Infection Control Practices and Advisory Committee 2 tiers of Precaution > Standard Precautions >Transmission – Based Precautions STANDARD PRECAUTIONS ■ Designed for all clients in hospital. ■ Apply to (a) blood (b) all body fluids, excretions, and secretion except sweat (C) nonintact skin (d) mucous membranes ■ Design to reduce the risk of transmission of microorganisms from recognized and unrecognized sources. 1. Perform proper hand hygiene after contact with blood, body fluids, secretions, excretions, and contaminated objects whether or not gloves are worn a. Perform proper hand hygiene immediately after removing gloves.

b. Use a nonantimicrobial product for routine hand cleansing. c. Use an antimicrobial agent or an antiseptic agent for the control of specific outbreaks of infection. 2. Wear clean gloves when touching blood, body fluids, secretions, excretions, and contaminated items a. Clean gloves can be unsterile unless their use is intended to prevent the entrance of microorganisms into the body. b. Remove gloves before touching noncontaminated items and surfaces. c. Perform proper hand hygiene immediately after removing gloves. 3. Wear mask, eye protection, or a face shield if splashes or sprays of blood, body fluids secretions or excretions can be expected. 4. Wear a clean, nonsterile gown if client care is likely to result in splashes or sprays of blood, body fluids, secretions, or excretions. The gown is intended to protect clothing. a. Remove soiled gown carefully to avoid the transfer of microorganisms to others. b. Cleanse hands after removing gown. 5. Handle client care equipment that is soiled with blood, body fluids, secretions, or excretions carefully to prevent the transfer of microorganisms to others and to environment. a. Make sure reusable equipment is cleaned and reprocessed correctly. b. Dispose of single-use equipment correctly.

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Handle, transport, and process linen that is soiled with blood, body fluids, secretions, or excretions in a manner to prevent contamination of clothing and the transfer of microorganisms to others and to the environment. Prevent injuries from used scalpels, needles, or other equipment, and place in puncture-resistant containers.

TRANSMISSON –BASES PRECAUTIONS Airborne Precautions Use standard precautions as well as the following: 1. Place client in a private room that has negative air pressure, 6-12 air changes per hour, and either discharge of air to the outside or a filtration system for the room air. 2. If a private room is not available, place client with another client who is infected with the same microorganism. 3. Wear a respiratory device (N95 respirator) when entering the room of a client who is known or suspected of having primary tuberculosis. 4. Susceptible people should not enter the room of a client who has rubeola (measles) or varicella (chickenpox). If they must enter, they should wear a respirator. 5. Limit movement of client outside the room to essential purposes. Place a surgical mask on the client during transport. Droplet Precautions

Use standard precautions as well as the following: 1. Place client in a private room. 2. If a private room is not available, place client with another client who is infected with the same microorganism. 3. Wear a mask if working within 3 feet of the client. 4. Limit movement of client outside the room to essential purposes. Place a surgical mask on the client during transport. Contact Precautions Use standard precautions as well as the following: 1. Place client in private room. 2. If a private room is not available, place client with another client who is infected with the same microorganism. 3. Wear gloves as described in standard precautions. a. Change gloves after contact with infectious material. b. Remove gloves before leaving clients room. c. Cleanse hand immediately after removing gloves. Use an antimicrobial agent. Note: If the client is infected with C. difficile, do not use an alcohol-based hand rub as it may not be effective on theses spores. Use soap and water. d. After hand cleansing, do not touch possibly contaminated surfaces or items in the room. 4. Wear a gown when entering a room if there is a possibly of contact with infected surfaces or

items, or if the client is incontinent, or has a diarrhea, a colostomy, or wound drainage not contained by a dressing. a. Remove gown in the client’s room. b. Make sure uniform does not contact possible contaminated surfaces. 5. Limit movement of client outside the room. 6. Dedicate the use of noncritical client care equipment to a single client or to clients with same infecting microorganisms. ISOLATION PRACTICES  Use strict aseptic technique when performing any invasive procedure and when changing surgical dressings.  Change intravenous tubing and solution containers according to hospital policy. (4872 hrs)  Check all sterile supplies for expiration date and intact packaging.  Prevent urinary infections by maintaining a closed urinary drainage system with a downhill flow of urine. Keep the drainage bag and spout off the floor.  Implement measures to prevent impaired skin integrity and to prevent accumulation of secretions in the lungs PERSONAL PROTECTIVE EQUIPMENT 1. Gloves

Reasons of wearing:  They protect the hands when the nurse is likely to handle any body substances.  Reduce the likelihood of nurses transmitting their own endogenous microorganisms to individuals receiving care.  Reduce the chance that the nurse’s hands will transmit microorganisms from one client or a fomite to another client. The hands are cleansed each time gloves are removed because:  the gloves may have imperfections or be damaged during wearing so that they could allow microorganism entry  the hands may become contaminated during glove removal 2. Gowns  Clean or disposable impervious gowns or plastic aprons are worn during procedures when the nurse’s uniform is likely to be soiled.  Sterile gowns may be indicated when the nurse changes the dressing of a client with extensive wounds  Sterile-use gown technique 3. Face Masks  mask are worn to reduce the risk for transmission of organisms by the droplet

contact and airborne routes, and by splatters of body substances.  It may be worn: - by those close to the client if the infection is transmitted by large-particle aerosols (droplets) - by all persons entering the room if the infection is transmitted by small-particle aerosols (droplet nuclei) 4. Eyewear > Protective eyewear (goggles, glasses, or face shields) and masks are indicated in situations where body substances may splatter the face.

ISOLATION PRECAUTIONS Isolation – measures to prevent the spread of infections or potentially infectious microorganisms to health personnel, clients and visitors. Guidelines 1. Category – specific Isolation  use seven categories: strict isolation, contact isolation, respiratory isolation, tuberculosis isolation, enteric precautions, drainage/secretions precautions, and blood/body fluid secretions. 2. Disease – specific isolation precautions a. provide precautions for specific diseases. 3. Universal precautions (UP) a. are techniques to be used with all clients to decrease the risk of transmitting unidentified pathogens b. obstruct the spread of bloodborne pathogens 4. the body substance isolation (BSI) a. system employs generic infection control precautions for all clients except those with the few transmitted diseases through the air. b. BSI system based on three premises 4.a All people have an increase risk for infection from microorganisms placed on their mucous membranes and non-intact skin 4.b All people are likely to have potentially infectious microorganisms in all of their moist body sites and substances. 4.c An unknown portion of clients and health workers will always be colonized or infected with potentially infectious microorganism in their blood and other moist body sites and substances, CDC (HICPAC) ISOLATION PRECAUTIOS (1996) HIPAC - Hospital Infection Control Practices and Advisory Committee 2 tiers of Precaution > Standard Precautions >Transmission – Based Precautions STANDARD PRECAUTIONS ■ Designed for all clients in hospital. ■ Apply to (a) blood (b) all body fluids, excretions, and secretion except sweat (C) nonintact skin (d) mucous membranes ■ Design to reduce the risk of transmission of microorganisms from recognized and unrecognized sources.

1. Perform proper hand hygiene after contact with blood, body fluids, secretions, excretions, and contaminated objects whether or not gloves are worn a. Perform proper hand hygiene immediately after removing gloves. b. Use a nonantimicrobial product for routine hand cleansing. c. Use an antimicrobial agent or an antiseptic agent for the control of specific outbreaks of infection. 2. Wear clean gloves when touching blood, body fluids, secretions, excretions, and contaminated items a. Clean gloves can be unsterile unless their use is intended to prevent the entrance of microorganisms into the body. b. Remove gloves before touching noncontaminated items and surfaces. c. Perform proper hand hygiene immediately after removing gloves. 3. Wear mask, eye protection, or a face shield if splashes or sprays of blood, body fluids secretions or excretions can be expected. 4. Wear a clean, nonsterile gown if client care is likely to result in splashes or sprays of blood, body fluids, secretions, or excretions. The gown is intended to protect clothing. a. Remove soiled gown carefully to avoid the transfer of microorganisms to others. b. Cleanse hands after removing gown. 5. Handle client care equipment that is soiled with blood, body fluids, secretions, or excretions carefully to prevent the transfer of microorganisms to others and to environment. a. Make sure reusable equipment is cleaned and reprocessed correctly. b. Dispose of single-use equipment correctly. 6. Handle, transport, and process linen that is soiled with blood, body fluids, secretions, or excretions in a manner to prevent contamination of clothing and the transfer of microorganisms to others and to the environment. 7. Prevent injuries from used scalpels, needles, or other equipment, and place in puncture-resistant containers. TRANSMISSON –BASED PRECAUTIONS Airborne Precautions Use standard precautions as well as the following: 1. Place client in a private room that has negative air pressure, 6-12 air changes per hour, and either discharge of air to the outside or a filtration system for the room air. 2. If a private room is not available, place client with another client who is infected with the same microorganism. 3. Wear a respiratory device (N95 respirator) when entering the room of a client who is known or suspected of having primary tuberculosis. 4. Susceptible people should not enter the room of a client who has rubeola (measles) or varicella (chickenpox). If they must enter, they should wear a respirator.

5. Limit movement of client outside the room to essential purposes. Place a surgical mask on the client during transport. DROLPET PRECAUTIONS Use standard precautions as well as the following: 1. Place client in a private room. 2. If a private room is not available, place client with another client who is infected with the same microorganism. 3. Wear a mask if working within 3 feet of the client. 4. Limit movement of client outside the room to essential purposes. Place a surgical mask on the client during transport. CONTACT PRECAUTIONS Use standard precautions as well as the following: 1. Place client in private room. 2. If a private room is not available, place client with another client who is infected with the same microorganism. 3. Wear gloves as described in standard precautions. a. Change gloves after contact with infectious material. b. Remove gloves before leaving clients room. c. Cleanse hand immediately after removing gloves. Use an antimicrobial agent. Note: If the client is infected with C. difficile, do not use an alcohol-based hand rub as it may not be effective on theses spores. Use soap and water. d. After hand cleansing, do not touch possibly contaminated surfaces or items in the room. 4. Wear a gown when entering a room if there is a possibly of contact with infected surfaces or items, or if the client is incontinent, or has a diarrhea, a colostomy, or wound drainage not contained by a dressing. a. Remove gown in the client’s room. b. Make sure uniform does not contact possible contaminated surfaces. 5. Limit movement of client outside the room. 6. Dedicate the use of noncritical client care equipment to a single client or to clients with same infecting microorganisms. ISOLATION PRACTICES a. Use strict aseptic technique when performing any invasive procedure and when changing surgical dressings. b. Change intravenous tubing and solution containers according to hospital policy. (48-72 hrs) c. Check all sterile supplies for expiration date and intact packaging. d. Prevent urinary infections by maintaining a closed urinary drainage system with a downhill flow of urine. Keep the drainage bag and spout off the floor.

e. Implement measures to prevent impaired skin integrity and to prevent accumulation of secretions in the lungs PERSONAL PROTECTIVE EQUIPMENT 1. Gloves Reasons of wearing: a. They protect the hands when the nurse is likely to handle any body substances. b. Reduce the likelihood of nurses transmitting their own endogenous microorganisms to individuals receiving care. c. Reduce the chance that the nurse’s hands will transmit microorganisms from one client or a fomite to another client. The hands are cleansed each time gloves are removed because: a. the gloves may have imperfections or be damaged during wearing so that they could allow microorganism entry b. the hands may become contaminated during glove removal 7. Gowns a. Clean or disposable impervious gowns or plastic aprons are worn during procedures when the nurse’s uniform is likely to be soiled. b. Sterile gowns may be indicated when the nurse changes the dressing of a client with extensive wounds c. Sterile-use gown technique 8. Face Masks a. mask are worn to reduce the risk for transmission of organisms by the droplet contact and airborne routes, and by splatters of body substances. b. It may be worn: - by those close to the client if the infection is transmitted by largeparticle aerosols (droplets) - by all persons entering the room if the infection is transmitted by small-particle aerosols (droplet nuclei) 9. Eyewear > Protective eyewear (goggles, glasses, or face shields) and masks are indicated in situations where body substances may splatter the face.

PRINCIPLES OF BASIC INFECTION CONTROL 1. Microorganisms move on air currents. 2. Microorganisms are transferred from one when one surface to another whenever objects touch. 3. Microorganisms arte transferred by gravity when one item is held above another. 4. Microorganisms are released into the air on droplet nuclei whenever a person breathes or speaks. 5. Microorganisms move slowly on dry surfaces but quickly through moisture. 6. Proper handwashing removes many of the microorganisms that can be transferred by the hands from one item to another. 7. Blood-borne infections may be spread to another person through contact between blood and body substances contain blood-borne organism and open wounds, sores or mucous membranes and through penetrating injuries with contaminated items. 8. Some body substances, such as feces, urine, nasal secretions, vomitus, and sputum, do not contain blood-borne organisms, but they may contain such large quantities of bacteria that their removal through handwashing is difficult.