Standard Precautions & Isolation

Peter T. Redona Jr, RN, RM.

Isolation Precautions
Isolation refers to measures designed to prevent the spread of infections or potentially infectious microorganisms to health personnel, clients, and visitors.

Disease-Specific Isolation Precautions

Provide precautions for specific diseases. These precautions delineate use of private rooms with special ventilation having a client share a room with other clients infected with the same organisms, and gowning to prevent gross soilage of clothes for specific infectious diseases.

Universal Precautions
Techniques used with all clients to decrease the risk of transmitting unidentified pathogens. Obstructs the spread of bloodborne pathogens, those microorganisms carried in the blood and body fluids that are capable of infecting other persons with serious and difficult to treat viral infections, namely, hepatitis B & C virus, and the HIV.

Body Substance Isolation (BSI)

Employs generic infection control precautions for all clients except those with few diseases transmitted through the air. The term body substance includes blood, some body fluids, urine, feces, wound drainage, oral secretions, and any others body product or tissue.

Body Substance Isolation (BSI)

Three premises: 1. All people have an increased risk for infection from microorganisms placed on their mucous membranes and non-intact skin. 2. All people are likely to have potentially infectious microorganisms in all of their moist body sites and substances. 3. An unknown portion of clients and health care workers will always be colonized or infected with potentially infectious microorganisms in their blood and other moist body sites and substances.

Standard Precautions
Designed for all clients in the hospital Apply to

Blood All body fluids, excretions and secretions Nonintact (broken) skin and mucous membranes. Designed to reduce risk of transmission of microorganisms from recognized and unrecognized sources.

Standard Precautions
1. Perform proper hand hygiene after 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 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 (i.e. soiled gown). 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 non-contaminated items and surfaces. c. Perform hand hygiene immediately after removing gloves. 3. Wear a mask, eye protection, or face shield if splashes or sprays of blood, body fluids, secretions, or excretions can be expected.

4. Wear a clean, non-sterile 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 a soiled gown carefully to avoid the transfer of microorganism to others (i.e., clients or other health care workers. 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 the environment. a. Make sure reusable equipment is cleaned and processed 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.

Transmission-Based Precautions
Airborne Precautions Use standard precautions as well as the following. 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 room air. If a private room is not available, place client with another client who is infected with the same microorganism. Wear a respiratory device (N95 respirator) when entering the room of a client who is known or suspected of having primary tuberculosis. Susceptible people should not enter the room of a client who has rubeola (measles) varicella (chickenpox). If they must enter, they should wear a respirator. 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: Place client in a private room If a private room is not available, place a client with another client who is infected with the same microorganism. Wear a mask if working within 3 feet of the client. Limit movement of client outside the room to essential purposes. Place a surgical mask during transport.

Contact Precautions
Use standard precautions as well as the following Place client in a private. If a private room is not available, place client with another client who is infected with the same microorganism. Wear gloves as described in standard precautions. Remove gloves after contact with infectious material. Remove gloves before leaving clients room Cleanse hands immediately after removing gloves. Use and antimicrobial agent.

Contact Precautions
Note: If the client is infected with C. difficile, do not use an alcoholbased hand rub as it may not effective on these spores. Use soap and water. Wear a gown when entering a room if there is a possibility 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. Remove gown in the clients room Make sure uniform does not contact possible contaminated surfaces. Limit movement of client outside the room Dedicate the use of non-critical client care equipment to a single client or to clients with the same infecting microorganisms.

Types of Isolation 1. Strict Isolation

Indications

Requirements Private rooms Gowns, mask, gloves, handwashing Double bagged techniques for soiled articles. Private rooms Gowns, mask, gloves, handwashing. Patients with the same organism generally may share room. Labeled plastic bags are used for soiled articles. Private room with negative pressure ventilation so the room air is vented outside Mask Handwashing Bronchoscopy and dental examination generally are postponed until the patient has received approximately 2 weeks of TB medications

-highly transmissible diseases by direct contact and airborne routes of transmission. - droplet transmission

2. Respiratory Isolation

3. TB isolation /AFB - suspected / active TB

Negative pressure ventilation

4. Contact Isolation

- infectious diseases or multiple resistant micro organisms that are spread by close or direct contact. - infectious disease transmitted through direct or indirect contact with infected feces.

Private rooms Gowns, mask, handwashing

gloves,

5. Enteric Precautions

Private room is required if the patient does not practice good hygiene measures. Handwashing Gloves Gowns should only be worn only when handling objects with contaminated feces.

6. Drainage / Secretions patients with Precautions. drainage/infected wounds.

wound

Gloves Gowns are indicated if clothing is likely to be contaminated.

7. Universal Blood and Body Fluids Precautions

- blood-borne, body fluids pathogens (blood, semen, vaginal secretions, CSF, synovial fluid, pleural fluid, peritoneal fluid, and pericardial fluid, amniotic fluid and tissues.

Gloves Mask and protective eye gears Gown Contaminated needles should not be recapped Use puncture resistant containers for used needles and other sharp items.

Strict Isolation

Respiratory Isolation

Contact Isolation

Enteric Precaution

Diptheria Zoster Pneumonia Varicella

H. Influenza Measles Mumps N. meningitis

Diptheria Pediculosis Scabies Syphilis

Diarrhea Gastroenteritis Hepa A Typhoid Fever

Blood & TB/AFB Body isolation fluids precautio ns AIDS TB Hepa B & C

Secretions/ Drainage Precautions

Burns

End of Isolation