chelsea & westminster hospital nhs foundation trust

Good communication with all staff involved in the patient’s care is vital, so that staff practise the appropriate precautions at all times. A sign should be displayed on the door of the source isolation room, explaining the special precautions that all staff caring for the patient must follow. The notice must include advice for visitors.

K_

346_

364

DAV

IES,

SH

IRLE

Y72

PO

ES

EELI

TT

TC

HAM

K

K

ING

’S L

YNN

NO

RFO

PE2

4 2N

YD

R

RR

A R

EID

3062

Patient’s notes should be available

SPECIAL PRECAUTIONSALL STAFF MUST

Decontaminate hands before entering the room

Wear a single-use apron and gloves as appropriatee.g. dealing with blood/bodily fluids

Remove protective clothing and discard all hazardouswaste before leaving the room/bed area

Masks are not routinely needed, unless otherwiseadvised by the nurse in charge

Wash hands before leaving the room

Visitors

Wash hands or use alcohol hand rub before enteringand after leaving the room/bed area

The use of gloves, aprons and masks is not routinelynecessary

If in doubt please ask a member of staff for advice

BEDBEDBED

Hands

Door

Protectiveclothing

Beforeleaving

SPECIAL PRECAUTIONS

STOP

All Staff

Visitors

Use alcohol-based hand sanitiser/wash hands with soap and water before clinical contact with the

patient/environment.

Wash hands with soap and water after contact with the patient/environment, before leaving the isolation

room/bay (even if using gloves).

Wear plastic apron and disposable gloves if having direct contact with the patient, bed linen or

equipment (unnecessary if there is no contact or very limited contact).

Remove apron and gloves, discard as hazardous waste (orange or yellow bag) inside the room/bay, unless transporting soiled equipment, e.g. commode, then

remove apron/gloves after decontaminating equipment.Wash hands with soap and water on completion.

DO NOT ENTER. Please speak to a member of the nursing staff before entering the isolation room.

Wash hands or use alcohol-based hand sanitiser when entering.Apron and gloves are generally unnecessary, unless involved in personal

care of the patient while visiting.Wash hands with soap and water before leaving the room/bay.

For any queries, speak to nursing staff.

Keep the door shut as much as possible.

of 3

Infection Control MeasuresAdults

Example of an isolation notice

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

Isolation precautionsEdited by Satu Hakala, Clinical Simulation and Skills Lead Nurse,Chelsea & Westminster Hospital NHS Foundation Trust, London

©2021 Clinical Skills Limited. All rights reserved

Keep the patient’s charts or digital records outside of the room in order to prevent cross contamination.

Isolation precautions are used to protect patients, visitors and healthcare professionals by helping to reduce the spread of microorganisms from person to person and across the healthcare setting (WHO, 2016). These precautions involve isolating infected patients (source isolation) or patients at high risk of infection such as those who are immunocompromised (protective isolation) (PHA, 2020). Standard infection control precautions should be followed at all times to reduce the risk of transmission of infectious agents from known and unknown sources (see procedure “Standard precautions: use of personal protective equipment”).

Source isolation involves physical segregation of patients who pose a known or potential cross infection risk due to organisms such as meticillin-resistant Staphylococcus aureus (MRSA), those that are carbapenem resistant (PHE, 2020a) or those causing potentially infective diarrhoea (such as that associated with Clostridium difficile). Source isolation is often achieved by isolating the individual in a single room although it may also, in a hospital setting, involve isolation of two or more patients who present with the same microorganism (cohort nursing) (Denton & Hallam, 2020; DH, 2007).

The mode of transmission will dictate the required precautions. For infections spread via direct person-to-person contact or contact with the immediate environment and equipment, contact precautions are required. In this case, the person is isolated in a single room and cared for by staff using disposable personal protective equipment (PPE), e.g. gloves and apron, and good hand hygiene (Wilson, 2019). The door to the isolation room must be kept closed. For infections spread by the airborne route or respiratory droplets, for example open pulmonary tuberculosis, influenza or COVID-19, respiratory precautions are required. Staff caring for such patients must use face masks, in addition to the precautions discussed above (Wilson, 2019). Face masks and eye protection should be used in line with local guidance.

For both contact and respiratory isolation, certain fundamental principles apply, to minimise the risk of cross contamination/infection to others. Staff should take only essential equipment into the room; where possible, this should be equipment designed for single-patient use, such as single-use blood pressure cuffs and single-use hoist slings. Where single-use equipment is not available, staff should use dedicated equipment labelled with the individual’s name and, as a minimum standard, decontaminate equipment correctly after use, in line with local policies/guidelines and manufacturer’s instructions, before reuse on other patients. Where an en-suite toilet is not available within the isolation facility, the patient should use a dedicated and labelled urine bottle, bedpan and/or commode. If available, disposable continence equipment must be used.

All waste should be categorised as hazardous waste, in line with national guidance (DH, 2013a) and local guidelines. The waste bin should be located inside the room or bay. It should be foot operated, in good working order, easy to clean (DH, 2013b) and fully enclosed to reduce the risk of accidental inoculation and fire hazard. Treat linen as being infected/contaminated; place this into an inner soluble bag and an outer appropriately marked transport bag (DH, 2013a).

The isolation room should be cleaned at least daily, paying particular attention to areas that are touched frequently. It is important to increase levels of cleaning in circumstances where environmental contamination may increase the risk of cross contamination, for example where individuals are isolated with potentially infective diarrhoea. Once the person has been discharged or the infection has resolved, the room should be cleaned thoroughly and the curtains changed; this is sometimes known as a “terminal clean” (Loveday et al., 2014). In some hospital settings, there is a joint sign-off by the nurse in charge and housekeeping staff, as an assurance that the room is thoroughly clean. The experience of people placed in isolation is often negative. Patients report adverse effects on their physical and emotional wellbeing (Gammon & Hunt, 2018), which can include depression and anxiety (Abad et al. 2010). Good communication will help to reduce the psychological impact of isolation: it is important to explain the reason for isolation and the special precautions to the individual and their visitors, while at the same time maintaining confidentiality.

Consult your local infection prevention and control team for advice about local practice.

Infection Control Measures

Adults

Isolation precautions

Hands

Door

Protectiveclothing

Beforeleaving

SPECIAL PRECAUTIONS

STOP

All Staff

Visitors

Use alcohol hand rub / wash hands with soap and water before clinical contact with the patient/environment.

Wash hands with soap and water after contact with the patient/environment, before leaving the isolation room/

bay (even if using gloves).

Wear plastic apron and disposable gloves if having direct contact with the patient, bed linen, equipment (unnecessary if there is no contact or very limited contact).

Remove apron and gloves, discard as hazardous waste (orange/yellow bag) inside the room/bay, unless transporting soiled equipment, e.g. commode, then remove apron / gloves after decontaminating equipment. Wash hands with soap and water on completion.

DO NOT ENTER.Please speak to a member of the nursing staff prior to entering the isolation room. Wash hands or use alcohol hand rub when entering.Apron and gloves are generally unnecessary, unless involved in personal care of the patient while visiting.Wash hands with soap and water before leaving the room/bay.For any queries speak to nursing staff.


ProtouchExamination Gloves

100 PCS

AmbidextrousRef:Size

Small

350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS

AmbidextrousRef:Size Small

350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS

AmbidextrousRef:Size Med

350


100 PCS

350Ambidextrous

Ref:

Size Med


100 PCS

AmbidextrousRef:

Size Large

350

ProtouchExamination Gloves100 PCSAmbidextrous

Ref:Size Large350


100 PCS

350Ambidextrous

Ref:

Size Large

Hand Rub

500ml

Use to supplement routine

handwashing or when soap

and water handwashing is

not immediately feasible

Dermatologically Tested

Perfume free

REF 190399291M00

Microbiological properties


Lorem ipsum dolor sit amet, consectet

Sit amet, consectet orem ipsum dolor

Ut wisi enim ad minim veniam,

suscipit lobortis nisl ut aliquip ex ea com

Ged diam nonummy nibh euismod tinc


Msed diam nonummy nibh euismod

dolore magna aliquam erat volutpat.


100 PCS


350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS

AmbidextrousRef:Size Large

350


100 PCS

350Ambidextrous

Ref:

Size Large

Hand Rub

500ml






Perfume free

REF 190399291M00











Equipment outside the isolation unit Decontaminate your hands

Hands

Door

Protectiveclothing

Beforeleaving

SPECIAL PRECAUTIONS

STOP

All Staff

Visitors









100 PCS


Small

350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS


350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS


350


100 PCS

350Ambidextrous

Ref:

Size Med


100 PCS

AmbidextrousRef:

Size Large

350


Ref:Size Large350


100 PCS

350Ambidextrous

Ref:

Size Large

Hand Rub

500ml






Perfume free

REF 190399291M00











NHS Trust

ROYAL BECKIHAM

AND VICTORIA

NHS TRUST

INFECTION PREVENTION

AND CONTROL MATRONANN CHOVIES

NHS

Hands

Door

Protectiveclothing

Beforeleaving

SPECIAL PRECAUTIONS

STOP

All Staff

Visitors









100 PCS


Small

350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS


350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS


350


100 PCS

350Ambidextrous

Ref:

Size Med


100 PCS

AmbidextrousRef:

Size Large

350


Ref:Size Large350


100 PCS

350Ambidextrous

Ref:

Size Large

Hand Rub

500ml






Perfume free

REF 190399291M00











Put on an apron Put on a face mask and eye protection


100 PCS

AmbidextrousRef:

Size Small

350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS


350


100 PCS

350Ambidextrous

Ref:

Size Small


100 PCS

Ambidextrous

Ref:Size

Med350


100 PCS

350Ambidextrous

Ref:

Size Med


100 PCS

Ambidextrous

Ref:

SizeLarge

350


Ref:Size Large350


100 PCS

350Ambidextrous

Ref:

Size Large

Hand Rub

500ml






Perfume free

REF 190399291M00











NHS Trust

XYZXYZXYZXYZ

XYZXYZXYZXYZXYZXYZ

NHS

18 5

14

2 1

FP

mask

Put on gloves Communicating with the patient

Page 2 of 3


Appropriate supplies of PPE, such as disposable gloves and aprons, must be available. These should be positioned outside the room, ideally in a wall-mounted holder. Base your selection of protective equipment on an assessment of the risk of transmission of microorganisms. Additional PPE such as masks and goggles/visors may be needed (NICE, 2017). Alcohol-based hand sanitiser should be readily available outside the room.

Decontaminate your hands before putting on PPE. Using the correct technique, either decontaminate hands with alcohol-based hand sanitiser, if hands are visibly clean, or wash hands using liquid soap and running water if hands are visibly soiled or potentially contaminated with body fluids (Loveday et al., 2014; NICE, 2017).

In addition, the use of eye protection and face masks may be indicated for some airborne infections (e.g. open pulmonary tuberculosis, influenza and COVID-19) during aerosol-generating procedures or if bodily fluids are likely to splash (NHS Scotland, 2018; NICE, 2017). Follow local policy.

Wear a disposable plastic apron and gloves if you will have clinical contact with patients, their immediate environment, their equipment or their body fluids. A gown may also be required for some procedures.

When performing the task inside the isolation room, be aware that the person may feel lonely, anxious and stigmatised, and provide support accordingly.

Select disposable gloves of the correct size and put them on before entering the room.

NHS

Victoria and Beckham NHS

Victoriaeckham

Infection Control

STAFF

NHS


Victoriaeckham

Infection Control

STAFF


Victoriaeckham

Infection Control

STAFF

FP

mask

FSM14

FFP3 masEN149:20

Infection Control Measures

Adults

Isolation precautions

After the task, remove gloves first Remove apron

FP

mask

FP

mask

FP

mask

Purell

Remove eye protection and mask Decontaminate your hands

NHS Trust

XYZXYZXYZXYZ

XYZXYZXYZXYZXYZXYZ

NHS

When you must use soap and water Leaving the isolation unit

Page 3 of 3


On completion of the task and before leaving the room, remove personal protective clothing. Remove the disposable gloves first and dispose of them as hazardous/infectious waste (according to local guidelines). Perform hand hygiene using an alcohol-based hand sanitiser.

Decontaminate your hands. Wash basins in isolation rooms should have sensor taps to prevent hands from becoming recontaminated. If your hands appear to be visibly clean, and are not contaminated with body fluids, then you may use either soap and water or an alcohol-based hand sanitiser.

After removing gloves and apron, next remove eye protection (if used) then respiratory mask (if used) (Loveday et al., 2014). (See also clinicalskills.net procedure “Putting on and taking off PPE for COVID-19”.)

Leave the room and ensure the door is kept shut. Perform hand hygiene again after leaving the room.

Do not use alcohol-based hand sanitiser if your hands are visibly dirty, or if the individual has diarrhoea, such as that caused by C. difficile, or diarrhoea and vomiting caused by norovirus. In these cases, you must wash your hands with soap and water (Loveday et al., 2014; NICE, 2017).

CutanAlcohol Gel

Break the neck strap using both hands; do not pull it against your neck. Let the bib of the apron fall down in front of you. Next, without touching your clothing, break the waist straps. Grasping the inner side of the apron, and avoiding touching your clothing or its outer side (which may be contaminated), roll it up into a ball. Dispose of it into the infectious (orange) waste bag (PHE, 2020b).

chelsea & westminster hospital nhs foundation trust

Documents