ISOLATION TECHNIQUE

Definition
Isolation Technique, a medical aseptic practice, inhibits the spread and transfer of
pathogenic organisms by limiting the contacts of the patient and creating some kind of
physical barrier between the patient and others.

Overview
The original quarantine of infected patients to infectious disease hospitals occurred in the
late 1800s, but evolved to isolation rooms by the early 1900s due to increasing knowledge about
microorganisms, infectious diseases and epidemiology of infection. With differential modes of
disease transmission, specific categories of isolation became disease-specific precautions, as a
means to a more tailored approach to patient uniqueness. These precautions were further
diversified into a federally mandated Universal Precaution approach focused on minimizing
exposures and disease acquisition. The current tiered system of isolation advocates Standard
Precautions for each patient and transmission-based precautions for special patient needs.
Standard precautions are universally applicable to all patients, are fundamental to patient care
and are the standards of practice by every Health Care Worker. As the epidemiology of
microbes, disease processes and host responses unfold and expand our knowledge, strategies to
prevent, control and reduce widespread infections are built on the foundation of contain and
confine with the goal of protecting others from acquiring these adverse conditions.
The goal of isolation techniques is to prevent the spread of communicable diseases in
hospitals and microorganisms among patients, personnel and visitors. These practical techniques
evolved to control cross infection, namely patient to HCW and HCW to patient. Throughout the
presentation of safe options to contain and confine disease transmission, the guidance states
facilities are encouraged to modify the isolation recommendations to suit the practice setting and
patient needs. This adaptation requires explicit written policies and procedures to ensure the
proper application of the principles in the delivery of services and patient care. Prevention,
control and reduction of infection remain the triad for safe practice. SP offers the safest standard
of practice for patient care when healthcare personnel and providers adhere to its consistent
application in each circumstance.
Isolation techniques evolved from the absence of any barriers to the current practice of
fluid resistant, disposable and reusable barriers. Known as personal protective equipment (PPE)
or personal protective attire (PPA), these barriers minimize the risk of bodily fluid exposures to
healthcare personnel by protecting skin and mucous membranes from potentially infective
materials. PPE/A are numerous in design, type, style, size, color and effectiveness in the
multifaceted arena of patient care. The selection of appropriate protective attire is dependent on
the procedure to be performed and the anticipated exposure that might occur. Gloves, mask,
gowns, eye protection are the most common personal protective equipment.

KINDS OF DISINFECTION PRACTICES

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 In isolation techniques, disinfection procedures are employed to control contaminated items
and areas. These are:
1. CONCURRENT DISINFECTION— Con- current disinfection consists of the daily
measures taken to control the spread of pathogenic organisms while the patient is
still considered infectious.
2. TERMINAL DISINFECTION—Terminal disinfection consists of those measures
taken to destroy pathogenic organisms remaining after the patient is discharged
from isolation. There are a variety of chemical and physical means used to
disinfect supplies, equipment, and environmental areas, and each facility will
determine its own protocols based on the recommendation of an Infection Control
Committee.

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, cubicles, or plastic isolators - 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 and by excluding bacteria present in the outside air from the
room.

TYPES OF ISOLATION
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 plastic
isolators. These units are designed for treating Hazard Group 4 viral pathogens such as
Lassa, Marburg, and Ebola fevers.
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.
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. Their value in protective isolation depends on the
type of patient in the general ward, on the thoroughness of barrier nursing, on whether the
room is self-contained and on the type of ventilation used.

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 5. Barrier nursing in open ward - this can be effective in controlling infections transferred
by contact but not by air.
6. Isolators in open wards - plastic enclosures for individual patients have been shown to
be of value as a form of protective isolation for high risk patients and of source isolation
for infected patients.
7. Ultra-clean wards - experimental units have been set up in special centers for organ
transplantation, treatment of leukemia and other diseases associated with extreme
susceptibility to infection.

CATEGORIES OF ISOLATION
The term strict isolation is used to describe the isolation procedure for highly
transmissible and/or dangerous pathogens. The term standard isolation is used to describe
methods used for other transmissible infections. The term protective isolation is used to describe
methods of isolation for highly susceptible patients. The isolation categories vary from country
to country.

Category A.
These infections are spread by; (1) hands, (2) contact with non-sterile equipment, faees, blood
and body fluids, and (3) bedpans/urinals. Viruses considered under this category include HIV,
HAV, HBV, HCV, 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. The
discipline of the staff is of vital importance, especially in hand-washing, keeping the door closed,
disinfection of toilets and bedpans etc. Enteric precautions are always necessary for diarrheal
diseases and enteric fever. Staff should be protected against TB, polio, rubella and HBV.

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 (consisting of at least an extractor fan) is
advantageous for patients with communicable respiratory infections, especially chickenpox.
The following general principles apply for category A and B isolation;-
1. Room or cubicle - 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. The gown or apron should be left hanging in the room and
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 changed daily or earlier when soiled. Although disposable aprons are preferable, non-
disposable plastic aprons may be used and should be disinfected by heat or alcohol.
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 when protection of the arms is necessary.
4. Masks - masks are necessary for category B and perhaps some category A infections; if
used they should be of the high efficiency filter type, 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. Either a non-medicated soap or a
detergent antiseptic preparation should be adequate for most purposes. 70% alcohol is
more effective in removing transient as well as residual flora and should be used in high
risk situations.
6. Bedpans and urinals - gloves should be worn when handling bedpans and urinals. The
contents should be disposed of directly into the sluice or bedpan disinfector. The bedpan
or urinal should then be heat disinfected and dried. A bedpan washer/disinfector and a
high temperature washing-up machine should be available in the ward.
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. Hard surfaces may be disinfected by wiping with a phenolic or
hypochlorite solution. Other equipment may be disinfected by wiping with 70% alcohol.
Sphygmomanometer cuffs may be disinfected by low temperature steam. Thermometers
should be kept in the isolation room until the patient is discharged.
9. Needles and syringes - these should be disposable and placed in a hardened container
which is sealed before disposal.
10. Linen - avoid vigorous bed-making - linen from infected patients should be placed in a
color-coded linen bag for transfer to the laundry. Linen which may present a hazard to the
laundry staff e.g. hepatitis B should first be sealed in labeled bag.
11. Crockery and cutlery - disposable items may be used when a dishwasher heating the
items to over 80oC is not available. Food should be placed in polythene bags and
discarded with ward waste.
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 clothing should be transferred to the hospital laundry in a sealed
water-soluble or alginate-stitched bag. Clothing from patients with viral hemorrhage
fever require special arrangement.

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 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;-
a. Oral - patients should be encouraged to cough or spit into paper and then
discard into a plastic bag.
b. Exudates - a "non-touch" technique using forceps or disposable gloves
should be used and contaminated material should be placed in sealed paper or
plastic bags.
c. Excretion - for patients with enteric fever, dysentery, cholera and other
infections spread by urine or feces, disposable gloves should be worn to take the
bedpan from the patient to the disposal area. The nurse should don a plastic gown
or apron and the pan should be covered with a disposable paper bag before
transport. Disposable gloves and a plastic apron or gown should be worn to
handle contaminated equipment or linen, and when washing the perineal area.

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 immune-compromised 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. Hands must be washed or
disinfected before entering the room. Sterile gloves, gown or apron, and masks should be worn
and discarded after attending patient. Maximum protection, including sterile linen, food and
other supplies, may be required for immunosuppressed patients, but is not necessary for patients
with eczema and burns. Maximum protective isolation requires the use of a ventilated room or
positive pressure isolator. Mouth and other orifices should be decontaminated, gut and skin may
also have to be decontaminated. Staff should wear sterile protective clothing. If visitors are
admitted to the isolation room, they should be given detailed instructions and if suffering from
any infection, they should be excluded.

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 (a plastic bubble that contains the
patient and all essential patient-care equipment) may be used. Gowns, plastic aprons, masks, and
eye goggles should be worn. Crockery and cutlery should be disposable. Disposable non-clinical
articles should be used and should not be recycled. All other clinical equipment should be
sterilized. Air-borne contamination and patient-handling should be kept to a minimum. Hospital
staff and visitors should be made aware of the risks when tending such patients.

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OTHER ISOLATION PROCEDURE CLASSIFICATION
1. Strict Isolation - this is designed to prevent transmission of highly contagious or virulent
infections that may be spread by air or contact. This is recommended for chickenpox as
well as for viral hemorrhagic fevers. 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.
2. Contact Isolation - this is designed to prevent transmission of highly transmissible or
epidemiologically important infections that do not warrant strict isolation. All diseases
included in this category are spread primarily by close or direct contact such as HSV and
respiratory infections in infants and young children. Private room is indicated although
patients infected with the same organism may share a room. Masks are indicated for
those who come close to the patient. Gowns are indicated if soiling is likely. Gloves are
indicated for touching infective material. Hands must be washed after touching the
patient or potentially contaminated articles and before taking care of another patient.
Articles contaminated with infective material should be discarded or bagged and labeled.
3. Respiratory Isolation - this is designed to prevent transmission of infectious diseases
over short distances through the air. Direct and indirect contact transmission may occur
but is infrequent. Diseases requiring respiratory isolation include measles, mumps, and
rubella. Private room is indicated although patients infected with the same organism may
share a room. Masks are indicated for those who come in close contact with the patient.
Gowns and gloves are not indicated. Hands must be washed after touching the patient or
contaminated articles, and contaminated articles should be discarded or bagged and
labeled.
4. Enteric Precautions - enteric precautions are designed to prevent infections that are
transmitted by direct or indirect contact with feces. 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, and contaminated
articles should be discarded or bagged and labeled.
5. 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 f soiling is likely. 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. Care should be taken to avoid needle-stick injuries. Used needles should not be
recapped or bent; they should be placed in a prominently labeled, puncture-resistant
container designated specifically for such disposal. Blood spills should be cleaned up
promptly with hypochlorite.
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 6. 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. Gowns are only indicated if soiling is
likely. 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.

ISOLATION METHODS FOR INDIVIDUAL VIRAL DISEASES

Chickenpox B In room with extractor fan, non-immune staff must be excluded. Non-
or shingles immune visitors must be warned. SR may be used for shingles

Diarrhea A enteric precautions, should be isolated for duration of illness

Hepatitis A A enteric precautions, isolation probably not required after jaundice has
developed

Influenza, B Isolation not necessary if acquired in hospital or if other patients with the
other disease are in the ward. Cohorting of patients recommended in outbreaks

resp.
infections

Measles B Secretion precautions. If outbreak occurred in pediatric ward, do not admit

non-immune children until 14 days after the last contact has gone home

Meningitis A enteric precautions for enteroviruses

Encephalitis

Mumps B exclude staff who are non-immune

Poliomyelitis A enteric precautions, non-immune staff should be excluded

Rabies D staff should be immunized immediately

Viral HF D special needs

CARING FOR A CLIENT ON ISOLATION

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Definition:
Isolation technique is used for certain patients with infectious diseases to prevent the
spread of the disease to other people.

Purposes:
a. To prevent transmitting the infectious microorganisms from the patient to other patients
and members of the medical team.
b. To avoid contaminating the medical equipment, such as the thermometer and BP
apparatus, being used to monitor the health status of the patient.

Principles:
a. Always do the medical hand washing before and after entering the patient’s room.
b. Always clean the medical equipment before and after patient’s use.
c. Bear in mind the Universal Precautions
d. Always clean from the least contaminated to the most contaminated area.

Equipment:
• BP apparatus
• Stethoscope
• Cotton balls with alcohol
• Cotton balls with soap
• Cotton balls with water
• Dry cotton balls
• Paper lining
• Gown Gloves
• Mask

Procedure:
1. Check physician’s order for type of isolation
and review precautions in infection control
manual.
2. Plan nursing care activities and gather
necessary equipment prior to entering client’s
room. Prepare watch and pen by wrapping it
with paper.
3. Prepare a lining (a piece of paper) for the BP
apparatus, stethoscope, cotton balls with
alcohol, cotton balls with soap, cotton balls
with water, dry cotton balls, a small piece of
Rationale
To be able to determine the recommended type
of isolation and to be familiar with the things to
observe with the particular type of isolation.
Proper planning and gathering of the necessary
equipment saves time and energy. Wrapping
the watch and pen with paper prevents the
microorganisms from harboring on them.
Preparing the equipment saves time and
energy.

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paper for data to be gathered.
4. Provide instructions about isolation For the patient and his significant others to take
precaution to client, family members and the necessary precautions in avoiding possible
visitors. infection.
5. Wash hands Hand washing is one way of preventing the
spread of microorganisms.
6. Put on gowns, mask and gloves if To protect oneself from harboring the
recommended as isolation precaution. microorganism.
a. Put on gown by inserting the hands and a. The inside part of the gown is considered
arms into the sleeves touching only the inside clean.
part of the gown. b. For proper fitting of the gown.
b. Draw the neck of the gown into place, c. To secure the gown to the body.
still touching only the inside part of the gown.
c. Fasten the gown at the back.
7. Enter client’s room with necessary Paper lining is necessary because anything on
equipment. Place paper over table and put on the patient’s room is considered dirty.
equipment.
8. Take vital signs. Follow the procedure in Taking vital signs assesses the health status of
taking the TPR. the patient.
9. When removing the thermometer from the The stem is considered as the least
axilla (rectum or mouth), hold it at its stem. contaminated part; wiping in circular motion
Wipe the thermometer with dry cotton ball promotes better removal of the microorganisms
from the stem to the bulb, in a circular motion.from the thermometer.
10. Read thermometer at eye level. To get the most accurate reading.
11. Clean thermometer with cotton ball with The stem is considered as the least
soap, cotton ball with water, dry cotton starting
contaminated part; wiping in circular motion
from the stem down to the bulb. promotes better removal of the microorganisms
from the thermometer.
o
12. Shake thermometer down to 35 C then To prepare the thermometer for next use,
place the clean thermometer in a container recording the reading immediately prevents the
containing antiseptic solution, at the client’s nurse from forgetting the patient’s temperature.
bedside. Record the data with the use of the
wrapped pen, in a piece of paper provided for.
13. For BP taking, put on, to the client’s left Wrapping the client’s arms with gown prevents
arm, gown (long sleeves) touching only the direct skin-to-skin contact between the nurse
outside portion of the client’s gown. and the patient.
14. Place stethoscope on top of brachial artery To facilitate taking of the patient’s blood
on top of client’s gown and then put on BP pressure level using the safest way in avoiding
cuff on top of client’s gown. the transfer of microorganisms.
15. Take BP (Follow procedure in BP taking). To assess the patient’s hemodynamic status.
16. Record data with the use of a wrapped pen Recording the reading immediately prevents
in a piece of paper prepared for. the nurse from forgetting the patient’s blood

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 pressure level.
17. Remove client’s gown holding only the The outer portion of the patient’s gown is
outer portion of it and hang in patient’s rack considered not contaminated; placing it on a
with contaminated portion exposed in the rack allows for its re-use.
environment.
18. Administer medications, collect specimens To provide the proper and best care possible to
or perform necessary procedures. the patient.
19. Discard lining of the client’s table by After use, the lining should be discarded
grasping the upper middle part of the lining. because it is considered contaminated already.
Put inside waste basket together with the waste
receptacle.
20. Make client comfortable. To make the patient feel at ease.
21. Remove gloves and place in appropriate Proper removal of the gloves prevents the
receptacle. Untie waste strings of gown first. transfer or spread of microorganisms from the
Grasp outside of one glove and turn inside out gloves to the nurse himself.
to remove. Drop in waste container. Insert
fingers of ungloved hand inside the cuff of the
remaining glove. Grasp on inside and remove
by turning inside out. Drop in appropriate
container.
22. Untie mask and drop strings into waste The strings of the mask are considered the least
container. contaminated part.
23. Untie neck strings of gown. Wash hands. To facilitate removal of the whole gown. Hand
washing is one way of preventing the spread of
microorganisms.
24. Draw off the right sleeve by slipping the The nurse is not supposed to touch the outside
index finger under the gown. portion of his gown because it is considered
contaminated.
25. Draw the left sleeve by grasping it with the The inside part of the gown is considered clean
right hand covered with the right sleeve. or least-contaminated.
Remove gown holding the inside part of the
gown.
26. Hang the gown on a stand with the To avoid contaminating the inner portion of the
shoulder seams together and only the gown, which comes into contact with the
contaminated (outer) portion is exposed to the nurse’s body.
environment.
27. If the gown is hung outside the client’s To prevent the spread of microorganisms.
unit, the clean portion is exposed outside the
environment.
28. Wash hands with washing solution, rinse Hand washing is one way of preventing the
then remove covers of pen and watch without spread of microorganisms.
touching the contaminated part. Place paper in

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appropriate container.
29. Place pen and watch inside pocket together To lessen the chances of the microorganisms
with data gathered. harboring on them.
30. Record data gathered and procedures done. For documentation purposes.

UNIVERSAL PRECAUTIONS

Definition:
These are techniques to be used with all clients to decrease the risk of transmitting
unidentified pathogens. These precautions obstruct the spread of blood-borne pathogens, those
microorganisms carried in blood and body fluids that are capable of infecting other persons with
serious and difficult to treat viral infections.
Application for universal infection control precautions means that all patients' body fluids
should be treated as infectious, since it is not known who is infected and carry a virus.
The purpose of these precautions is to prevent the exposure and infection of health care
workers from blood-borne pathogens. The rationale for applying the precautions is that the health
care worker may not know who is and is not infected, thereby making it important to treat all
blood and body fluids as infectious. Infection control precautions are intended to isolate the virus
and the body fluids, not the patient.

 Universal infection control precautions apply to:

Body fluids which may contain HIV or Hepatitis B:
• Blood
• Blood-stained body fluids
• Semen
• Vaginal secretions
• Tissues
• CSF, amniotic, pericardial, pleural fluids etc
Body fluids which may contain other pathogenic micro-organisms:
• Feces
• Urine
• Vomit
• Sputum

 Universal infection control precautions do not apply to:

Body fluids which are unlikely to contain pathogens:
• Tears
• Nasal secretions

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 • Sweat
•Saliva

TRANSMISSION-BASED PRECAUTIONS
Some microbes are so contagious or epidemiologically significant that precautions in
addition to the Standard Precautions should be used when such organisms are recognized. The
CDC recommends a second tier of precautions, called Transmission-Based Precautions.
The additional safety measures are called Airborne, Droplet, and Contact Precautions
(Garner, 1996).

 Airborne Precautions are required for patients with presumed or proven pulmonary TB or
chickenpox. Airborne Precautions are also advised if, as a victim of bioterrorism, a
patient is suspected of having smallpox. When hospitalized, patients should be put in
rooms with negative air pressure; the door should remain closed, and health care
providers should wear an N-95 respirator (ie, protective mask) at all times while in the
patient’s room.
 Droplet Precautions are used for organisms that can be transmitted by close, face-to-face
contact, such as influenza or meningococcal meningitis. While taking care of a patient
requiring Droplet Precautions, the nurse should wear a facemask, but because the risk of
transmission is limited to close contact, the door may remain open. The CDC advises that
negative-pressure rooms should be used in hospitals if available.

 Contact Precautions are used for organisms that are spread by skin-to-skin contact, such
as antibiotic-resistant organisms or C. difficile. Contact Precautions are designed to
emphasize cautious technique for organisms that have serious epidemiologic
consequences or those easily transmitted by contact between health care worker and
patient. The principles of transmission control used in the Standard Precautions are
accentuated. When possible, the patient requiring contact isolation is placed in a private
room to facilitate hand hygiene and protection of garments from environmental
contamination. Masks are not needed, and doors do not need to be closed.

STANDARD PRECAUTIONS
The tenets of Standard Precautions are that all patients are colonized or infected with
microorganisms, whether or not there are signs or symptoms, and that a uniform level of caution
should be used in the care of all patients. The elements of Standard Precautions include hand
hygiene, use of gloves and other barriers (e.g., mask, eye protection, face shield, gown), handling
of patient care equipment and linen, environmental control, prevention of injury from sharps

12
devices, and patient placement. Hand hygiene, glove use, needlestick prevention, and avoidance
of splash or spray of body fluids are discussed in the following sections.

 Hand Hygiene.
The most frequent cause of infection outbreaks in health care institutions is transmission
by the hands of health care workers. Hands should be washed or decontaminated frequently
during patient care. When hands are visibly dirty or contaminated with biologic material from
patient care, hands should be washed with soap and water. In intensive care units and other
locations in which virulent or resistant organisms are likely to be present, antimicrobial agents
(eg, chlorhexidine gluconate, iodophors, chloroxylenol, triclosan) may be used. Effective hand
washing requires at least 15 seconds of vigorous scrubbing with special attention to the area
around nail beds and between fingers, where there is high bacterial burden. Hands should be
thoroughly rinsed after this washing. Nurses should not wear artificial fingernails or extenders
when providing patient care. These items have been epidemiologically linked to several
significant outbreaks of infections. Natural nails should be kept less than 0.25-inch (0.6-cm)
long, and nail polish should be removed when chipped, because it can support increased bacterial
growth.

 Glove Use.
Gloves should be worn when a health care worker has contact with any patient’s
secretions or excretions and must be discarded after each patient care contact. Because hospital
organisms colonizing health care workers’ hands can proliferate in the warm, moist environment
provided by gloves, hands must be thoroughly washed with soap after gloves are removed.
Latex gloves are often preferred over vinyl gloves because of greater comfort and fit and
because some studies indicate that they afford greater protection from exposure.
The nurse who experiences irritation or allergic reaction associated with exposure to latex should
report symptoms to an occupational health specialist or private physician. Suggested methods for
reducing the incidence of such reactions include use of vinyl gloves, powder-free gloves, or
“low-protein” latex gloves.
 Needlestick Prevention.
Extreme care is essential in all situations in which needles, scalpels, and other sharp
objects are handled. Used needles should not be recapped. Instead, they are placed directly into
puncture-resistant containers in the vicinity of their use. If a situation dictates that a needle must
be recapped, the nurse must use a mechanical device to hold the cap or use a one-handed
approach to decrease the likelihood of skin puncture.

 Avoidance of Spray and Splash Exposure.

When the health care provider is involved in an activity in which body fluids may be
sprayed or splashed, appropriate barriers must be used. If a splash to the face may occur, goggles
and facemask are warranted. If the health care worker is handling material that may soil clothing

13
or is involved in a procedure in which clothing may be splashed with biologic material, a cover
gown should be worn.

 Sustained-action disinfectants
Sustained-action disinfectants (e.g. chlorhexidine and povidone iodine) remove organic
contamination and with repeated use, maintain low bacterial hand-counts. They are
recommended prior to an aseptic technique. There is a reported level of allergy to these
disinfectants, although the most common reason for 'allergy' is inadequate drying of the hands.
Hand-creams may be applied after washing and drying the hands.

 Alcohol-based sustained-action disinfectants

Alcohol-based sustained-action disinfectants (e.g. Hibisol) are extremely useful and are
an excellent means of providing hand disinfection in areas where washing facilities are lacking
or where the staff is too busy to disinfect their hands between patients. A container of alcohol-
based disinfectant beside each bed in a high dependency unit results in a significant increase in
compliance with disinfection policy. A container placed on the clinical notes trolley is useful for
hand disinfection between patients during ward rounds.

BLOOD AND BODY FLUID PRECAUTIONS

Overview
Blood and body fluid precautions are recommendations designed to prevent the
transmission of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and other diseases while
administering first aid or other health care that includes contact with body fluids or blood. These
precautions treat all blood and body fluids as potentially infectious for diseases that are
transmitted in the blood. The organisms spreading these diseases are called blood-borne
pathogens.
Blood and body fluid precautions apply to blood and other body fluids that contain
visible traces of blood, semen, and vaginal fluids. They also apply to tissues and other body
fluids, such as from around the brain or spinal cord (cerebrospinal fluid), around a joint space
(synovial fluid), in the lungs (pleural fluid), in the lining of the abdomen and pelvis (peritoneal
fluid), around the heart (pericardial fluid), and amniotic that surrounds a fetus.
Human blood, body fluids, and other body tissues are widely recognized as vehicles for
the transmission of human disease. Although many of these diseases are readily identified and
can be prevented and/or treated successfully by well-accepted measures (e.g. syphilis and
tuberculosis), others are not.
At least three infectious agents transmitted through human blood products and/or body
fluids (BBF) continue to present a serious health problem: hepatitis B virus (HBV), hepatitis C

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virus (HCV) and human immuno-deficiency virus (HIV). Because of difficulties in identifying,
preventing, and treating the diseases they cause, special precautions for minimizing the risk of
exposure to them are warranted. The means of transmission are common to all.
HBV, the more common of the three infectious agents, causes a serious form of hepatitis,
which can lead to a permanent loss of liver function or even death. When suspected, it can be
detected readily in blood or body fluids. Persons exposed can be protected temporarily by the use
of hepatitis B immune globulin. An available vaccine provides long-term protection for those
whose work or travel entails a high risk of exposure. Its cost is high but readily justifiable in
view of the serious consequences of clinical disease.
HCV, once called non-A non-B hepatitis also causes a serious form of hepatitis which
can lead to a permanent loss of liver function and death. There is no vaccine to protect against
this type of hepatitis but this disease can be partially treated in some cases with interferon.
HIV may cause Acquired Immuno-Deficiency Syndrome (AIDS). In addition, once
introduced, it may exist in humans for many years before causing symptoms; during this long
latent period, it can be transmitted through blood products and other body fluids. Unprotected
sexual contact is widely recognized as the most common mode of transmission but transmission
is well recognized via transfusion, shared use of intravenous needles, and pregnancy.
Documented cases have been traced to work related inadvertent contact, such as needle sticks
with infected blood.
HIV appears to be very fragile, hence, unable to survive for substantial periods outside
the body of humans. Efforts to develop a useful vaccine have not been successful; researchers
generally hold out scant hope for success in the near future. Although there is no cure for HIV
disease, it is important to recognize the disease at an early stage so that treatment for the disease
can be initiated. A particularly disturbing feature of the HIV infection is the long latent period
between introduction of the virus into a person's body and clinical symptoms, which may
average five to seven years. There appears to be no bar to transmission during the latent period.
This characteristic poses an especially serious threat to human health since there is neither an
effective cure nor an agent for prevention, such as a vaccine. Disease control must rest solely,
therefore, with behavioral strategies at both the individual and collective levels. Individual
protective behaviors can result from programs to provide information and alter attitudes; the
adoption of collective measures is an institutional and social responsibility.

Definitions
 Infectious body fluids shall include blood, semen, vaginal secretions, cerebrospinal fluid,
synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in
dental procedures, any body fluid that is visibly contaminated with blood, and all body
fluids in situations where it is difficult or impossible to differentiate between body fluids.
 Other potentially infectious materials shall include infectious body fluids, any unfixed
human tissue or organ, HIV, HCV, or HBV containing cell or tissue cultures, organ

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 cultures, culture medium, or blood, organs, or other tissues from experimental animals
infected with HIV,HCV, or HBV.
 Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or
parenteral contact with blood or other potentially infectious materials during the
performance of an employee's duties or assignments of a student in a class.

Levels of Exposure:
• Category I (Exposure): Procedures and activities that involve (known or predictable)
contact with human blood, body fluids, or tissues - including spills or splashes. Risks are
identifiable, since they are inherent in regular job-related tasks. Examples: laboratories,
dental offices, and other health care settings.
• Category II (Non-exposure). Procedures and activities that do not involve regular or
occasional contact with human blood, body fluids, or tissue and in which there is an
extremely low risk of transmission of HBV,HCV or HIV. Examples: sharing wind
instruments (saliva does not transmit HIV), hand shaking, use of public or shared toilets
or phones. (Note: This is not to suggest or imply that other infectious diseases, such as
upper respiratory infections are not transmitted via direct or indirect contact. These
diseases are either self-limited or treatable by available therapeutic agents. Customary
hygienic precautions, based primarily on individually adopted procedures, are adequate
measures of protection.)

Control Measures
• Category I: Appropriate protective measures shall be identified, adopted and required for
every person whose work or activity is classified as Category I.
• Category II: Educational programs shall be introduced to explain lack of risk to persons
active in these settings. In addition, appropriate medical treatment following contacts
with human blood and other potentially infectious materials shall be provided if an
accidental exposure occurs.

Importance of blood and body fluid precautions:

Although skin provides some protection from exposure to potentially infectious
substances, it is strongly recommended that health professionals use blood and body fluid
precautions for further protection when they are providing health care. These precautions also
help protect you from exposure to a potential infection from your health professional in the
unlikely event that you come in contact with the health professional's blood.
Although it is recommended that you use blood and body fluid precautions whenever you
know you may come into contact with nasal secretions, breast milk, stool, sputum, sweat, tears,
urine, or vomit, the precautions are not absolutely necessary unless these fluids contain visible
traces of blood. Blood and body fluid precautions apply to saliva only when it contains blood or
in a dental or oral surgery setting where contamination with blood is likely.

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 The best practice is to always use blood and body fluid precautions, even when there are
no visible traces of blood and no chance of contamination with blood.

Contact Precautions
• To reduce risk of transmitting infectious agents by direct (physical contact) or indirect
contact (through contaminated objects usually inanimate).
• Requires the use of gloves, a mask, a gown, and dedicated patient care equipment
(thermometr, stethoscope, BP cuffs).

Step to reduce the risk for exposure to blood and body fluids:
Blood and body fluid precautions involve the use of protective barriers such as gloves,
gowns, masks, and eye protection. These reduce the risk of exposing the skin or mucous
membranes to potentially infectious fluids. Health care workers should always use protective
barriers to protect themselves from exposure to another person's blood or body fluids.

A. Wear gloves when touching blood and body fluids, mucous membranes or broken skin of
ALL patients, and when performing venipucture and vascular access procedures. Change gloves
for each patient.
• Gloves protect you whenever you touch blood; body fluids; mucous membranes; or
broken, burned, or scraped skin. The use of gloves also decreases the risk of disease
transmission if you are pricked with a needle.
• Always wear gloves for handling items or surfaces soiled with blood or body fluids.
• Wear gloves if you have scraped, cut, or chapped skin on your hands.
• Change your gloves after each use.
• Wash your hands immediately after removing your gloves.
• Wash your hands and other skin surfaces immediately after they come in contact with
blood or body fluids.

B. Wear mask and protective eyewear or face shield during procedures that may generate drops
of blood and body fluids.
• Masks and protective eyewear, such as goggles or a face shield, help protect your eyes,
mouth, and nose from droplets of blood and other body fluids. Always wear a mask and
protective eyewear if you are doing a procedure that may expose you to splashes or
sprays of blood or body fluids.

C. Wear gowns or apron during procedures that are likely to generate splashing of blood or body
fluids.
• Gowns or aprons protect you from splashes of blood or body fluids. Always wear a
gown or apron if you are doing a procedure that may expose you to splashes or sprays of
blood or body fluids.

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D. Do not recap, bend or break, remove from disposable syringes or manipulate needles.
Dispose in puncture resistant containers.
• Giving parenteral medications:
o Use puncture-resistant containers to dispose of needles, scalpels, and other sharp
instruments.
o Do not recap needles.
o Do not bend or handle used needles or disposable syringes.
o If you are pricked by a needle (needlestick), contact your health professional right
away for further advice
o safe removal of hazardous waste, i.e., prompt disposal of contaminated needles or
blood-soaked bandages to containers reserved for such purposes

OTHER CONTROL MEASURES:

• Wash hands immediately after any exposure to blood or body fluids, even if you wear
gloves.
• Avoid touching objects that may be contaminated.
• Prompt removal of wet or soiled dressings
• Prevention of accumulation of bodily fluid drainage, i.e., regular checks and emptying of
receptacles such as surgical drains or nasogastric suction containers
• Avoidance of backward drainage flow toward patient, i.e., keeping drainage tubing below
patient level at all times
• Immediate clean-up of soiled or moist areas

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BIBLIOGRAPHY

Mosby’s Pocket Dictionary of Medicine, Nursing & Health professions, 5th edition.

Nettina, S. (2001). The Lippincott Manual of Nursing Practice, 7th edition.

U.S.A : JB Lippincott Co. pp. 420-425

Smeltzer, Medical-Surgical Nursing, 11th Edition,

U.S.A.:Lippincott Wilkins and Williams, pages 2480-2485.

Ultimate Learning Guide to Nursing Review By: Carl E. Balita p.400

http://www.tpub.com/content/medical/14295/css/14295_104.htm

http://translate.google.com.ph/translate?hl=tl&sl=tl&tl=en&u=

http%3A%2F%2Fwww.google.com.ph%2F

www.webmd.com/a-to-z-guides/blood-and-body-fluid

www.peacehealth.org/kbase/topic/special/tv7778spec/sec1.htm

www.http:Nursingcrib.com

http://www.umass.edu/research/bodyfluid.html

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