ISOLATION PRACTICE

S

Goal of Isolation (Protection of / from)

HCWs Other Patients

Environment

Visitors (Commu

nity)

Patient Placeme

nt

PATIENT Barrier nursing

Dr.T.V.Rao MD 3

Chain of Infection

Pathogen

Reservoir

Portal of Exit

Mode of

Transmission

Portal of

Entry

Susceptible Host

Why Isolation?.. because transmission is

easier to control than the source / host!

Fundamentals of isolation precautions

Dr.T.V.Rao MD 6

Our Hands are Threat to LIFEJust Washing can Save Many LIVES

HandwashingMost importantSoap and water OR alcohol based products – when no

visible soiliingLength of fingernails ???

When to wash??

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Hand washing

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/envFailure to change gloves between patient contacts –

INFECTION CONTROL HAZARDNot a substitute to handwashiing

Other Barrier Protection

Masks

Eye protectionGoggles/Face Shields

Gowns and protective apparelWhy gowns???

When to remove??

Respiratory protectionFace 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

Patient Care Equipment and ArticlesDisposal○ Bags

SharpsReusable devices○ Critical - Sterilised / Disinfected○ Non critical – cleaned amd disinfected

after use

Patient placement Private room Patient with highly transmissible or

epidemiologically important microorganisms

With handwashing and toilet facilities Appropriate room mate sharing – same

microorganisms – COHORTINGUseful during outbreaks --- eg??

Airborne transmission – room with appropriate air handling and ventilation

Transport Only for essential purposes With appropriate barriers Precautions in the new area to be

transported Informing patients

Others Linen and Laundary

Common sense storage and processing of soiled linen

Dishes, Glasses, Cups, and Eating UtensilsHot water and detergents

Routine and Terminal cleaning

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

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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.

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Transmission Based Precautions

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AirbornePRECAUTIONS

TuberculosisMeaslesChickenpoxSmall pox

Airborne precautions Patient placement :

monitored negative air pressure 6-12 air changes per hourAppropriate discharge of air outdoorsKeep the room door closed

Respiratory protectionN 95 mask while entering the room /

discard in trash while leaving the room Patient transport

Mask on the patient

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Droplet precautions

Neisseria meningitidisInfluenza, H1N1Adenovirus, rhinovirusPertussis, MumpsGrp A StreptococcusMycoplasma pneumoniae

Droplet Precautiions Patient placement:

Private roomIf not available, spatial separation of atleast 3

ftSpecial air handliing and ventilation – not

necessaryDoor may remain open

Mask while entering the patient room / discard in trash after leaving the room

Masking the patient when transport needed

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Contact precautions

RSVHepatitis -AAntibiotic resistant bacteria

MDRO, MRSA,VRE..

Scabies

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

This is opposite of the other isolations!!

It is to protect the patient from the organisms in the environment. Immunocompromised

patientsBurn patientsPatients receiving

chemotherapy or radiation

REVERSED ISOLATION

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

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?

How would you arrange for a transport of a patient who is under contact isolation?

THANK YOU