Lesson 5-2 Isolation Techniques
The basic purpose of isolation is to minimize the spread of communicable diseases. The physician determines whether or not isolation is needed. Once the need for isolation has been determined, the responsibility for maintaining good isolation techniques belongs to everyone involved--from the physician to housekeeping personnel to the patient himself. Care for the patient in isolation is basically the same as for other patients, but there is an increased emphasis on the principles of medical asepsis.
a. The needs of a patient in isolation should not be ignored just because of the isolation. The needs of the isolated patient are just as important as the needs of other patients.
b. The basic principles that apply to patients in isolation are discussed in the following paragraphs.
A private room should contain hand washing, bathing, and connecting toilet facilities. Connecting toilet facilities make unnecessary the need for portable commodes or special transportation techniques for commodes, bedpans, and urinals. The implementation of isolation can be simplified if special rooms on one or more wards are available for isolation.
a. The room or area should have a minimum ventilation (supply and exhaust) of six air changes per hour. These areas should be constructed so that there is no cross- circulation or recirculation of air, unless passed through high-efficiency filters, between the isolation room and other sections of the hospital.
b. An anteroom between the room and the hall, especially for rooms housing patients in strict isolation or respiratory isolation, will help in maintaining these two categories of isolation by providing storage space for gowns, gloves, and masks. These anterooms also reduce the possibility of airborne spread of infectious agents from the room into the corridor whenever the door of the isolation room is opened. The anteroom should be under slightly negative pressure with regard to the hall. It is preferable for the anteroom, as well as the isolation room, to have its own supply and exhaust for ventilated air.
c. The room design of many, especially older, hospitals may not allow for adequate control of air movement. Therefore, complete control of droplet nuclei and dust particles is not possible. If proper air-handling capabilities are lacking, a commercially available window fan to exhaust air from the room may be used to control airflow. It is far preferable, however, for the hospital to install permanent ventilation systems in an adequate number of rooms specified for isolation. Window fans might be installed in rooms of patients admitted with disease spread by the airborne route, such as staphylococcal pneumonia, or chickenpox. Window fans may be of special use in improving isolation of patients with pulmonary tuberculosis.
5-5. HOSPITAL PERSONNEL
a. Masks. Individual mask technique is recommended. Masks should cover the nose and mouth. The high-efficiency disposal masks are more effective than the standard cotton gauze or paper tissue masks in preventing airborne and droplet spread. Masks should be used only once. They may become ineffective when moist and should be discarded in an appropriate receptacle before the user leaves the contaminated area. Masks must never be lowered around the neck and reused. Supplies of masks should be readily available outside the patient area when isolation procedures require their use.
b. Gowns. Individual gown technique is recommended; that is, gowns should be used only once and then discarded in an appropriate receptacle before the user leaves the contaminated area. Supplies of gowns must be readily available outside the patient area when isolation procedures require their use. Sterile gowns may be used in caring for some patients in protective isolation. In other instances, such as patients with extensive burns or extensive wound infections, it may be desirable to use sterile gowns when changing dressings. Clean, freshly laundered, or disposable gowns may be used for all other categories.
c. Caps and Booties. Caps and booties are not necessary in any of the categories of isolation. When used, the cap should cover all scalp hair, and the booties should cover the open ends of trousers. They should be used only once and then packaged for reprocessing or disposal.
d. Hands. Hand washing before and after contact with each patient is the single most important means of preventing the spread of infection. Hand washing is mandatory even when gloves are used. In addition, personnel must wash their hands after any contact with excretions (feces, urine, or soiled material) or secretions (drainage from wounds, skin infections, and so forth) of the patient before touching that patient again.
e. Gloves. Gloves should be used only once and then discarded into an appropriate receptacle before the user leaves the contaminated area. Supplies of gloves should be readily available outside the patient area when the isolation procedure requires their use. Disposable single-use gloves (sterile or nonsterile, depending on the specific use) are available and may be used.
a. Sphygmomanometer and Stethoscope. When indicated, this equipment should be kept in the isolation area for use with the patient throughout his hospitalization. After the patient is discharged, these instruments should be disinfected in the manner as appropriate based upon the type of agent that required the isolation.
b. Needles and Syringes. Because of the impossibility of knowing which patients' blood may be contaminated with hepatitis virus or other microorganisms, extreme caution must be applied in handling used needles and syringes whether in isolation or not.
c. Urinals and Bedpans. Urine and feces should be flushed down the toilet when the hospital uses a municipal or other safe sewage treatment system. A urinal and/or bedpan, if needed, should be issued to and used by only one patient until decontaminated and resterilized. Autoclaving is the most reliable decontamination system. Steam hoppers do not sterilize these utensils and may even create bacterial or viral aerosols. Disposable urinals and bedpans are available and may be used for patients in isolation. They should be disposed of in the same manner as dressings and paper tissues.
d. Thermometers. Special precautions with nondisposable thermometers are needed for certain categories of isolation. In these instances, the thermometer remains in the patient's room in a container with disinfectant prepared according to local SOP. Every three days, the disinfectant is flushed down the toilet and the container washed, dried, and refilled. Thermometers should be rinsed in cold water before and after use.
5-7. SUPPLIES AND OTHER ITEMS
a. Dressings and Tissues. All dressings, paper tissues, and other disposable items soiled by respiratory, oral, or wound secretions must be considered potentially infective and disposed of accordingly even if the patient is not isolated. Disposal may call for single or double disposable bag techniques. Bags should be impervious. When removed from patient areas, the bags should be closed, sealed, and placed in a larger disposable bag or container. Ultimate disposal is by incineration or placement in a properly supervised and maintained sanitary landfill. Appropriate disposable bags must always be available at the patient's bedside.
b. Linen. All mattresses and pillows for patients in isolation should be covered with impervious plastic. The double-bag technique discussed below should be used when removing linen and other contaminated articles from rooms of patients in isolation.
c. Dishes. Disposable dishes and utensils are available and can be used for patients in isolation.
d. Drinking Water. No special precautions are necessary.
e. Clothing and Personal Effects. Follow established special precautions in strict isolation, enteric precautions, and wound and skin precautions.
f. Laboratory Specimens. When double-bag technique is necessary for transporting specimens, use transparent bags so contents can be seen and handled appropriately.
g. Books, Magazines, Money, Letters, and Toys. In general, any of these articles visibly soiled with potentially infective excretions or secretions should be disinfected or destroyed.
h. Patient's Chart. The patient's chart should not be taken into the isolation room if the patient is under strict isolation.
a. Concurrent Cleaning. Cleaning equipment must be disinfected at the end of each cleaning shift. For example, wiping cloths and mop heads should be laundered and thoroughly dried, dirty water discarded, and buckets disinfected before being refilled.
b. Terminal Cleaning. Terminal cleaning of isolation rooms for isolation areas consists of the following general actions in addition to any specific measures listed in the individual section.
c. Special Instruments. If possible, instruments should be returned to be disinfected or sterilized. They should be either single or double-bagged and marked before they leave the patient's area. All reusable breathing circuits and humidification devices used with inhalation therapy equipment should be wrapped and returned to Central Supply for reprocessing.
d. Special Procedure Trays. Trays should be separated into component parts and handled as indicated.
e. Isolation Carts. Some institutions use special isolation carts prestocked with all necessary equipment for all classes of isolation or separate isolation carts for each class of isolation. These can be wheeled to the area where a patient in isolation is located. They must be cleaned frequently and kept adequately stocked with all necessary supplies.
Visitors should be kept to a minimum since they may become infected. In all instances, visitors should see a floor nurse before entering the isolation area and be instructed in the use of the gown, mask, and gloves. In general, children should not be allowed to visit patients in isolation.
5-10. TRANSPORTING PATIENTS
Patients should be taken out of their isolation area only for essential purposes. Appropriate barriers [masks and impervious (water resistant) dressings] to prevent disease transmission should be provided for the entire period the patient is out of the isolation area. The area to which the patient is to be taken should be notified of his impending arrival and informed of the techniques to be applied to prevent the spread of infection. If appropriate, the patient should be alerted to the potential spread of his disease and informed as to how he can assist in maintaining a barrier against the transmission of his infection to others.
|David L. Heiserman, Editor||
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Revised: June 06, 2015