At the beginning the of the 20th century, efforts at isolation moved toward placing individuals together in one hospital infectious disease hospitals or a hospital ward where caregivers used gowns and antiseptic solutions handwashing barriers to disease for transmission Patients who were considered infectious were routinely placed general hospital units in separate rooms or in multiple-patient rooms with other patients who had the same infection by 1970, the Centers for Disease Control.
The Centers for Disease Control (CDC) was actively involved in developing and recommending infection-control practices and procedures for hospitals.
In 2007, the Centers for Disease Control (CDC) updated its specific guidelines for transmission-based precautions.
Still now with health personnel and governments and individuals recognize the need for an organized, systematic approach to the control of infections even that Prevention of infection is a major focus for nurses. As primary caregivers.
The term isolation, a protective procedure that limits the of infectious diseases among hospitalized patients, hospital personnel, and visitors.
Isolation precaution is required for a certain infected patient to prevent the spread of disease to other patient isolation precaution is used to isolate the infection not patient.
· Types of precautions
1. Strict isolation:
Designed for highly contagious infections that are spread by both airborne droplet nuclei and contact transmission. e.g.: varicella, Disseminated herpes zoster, Viral hemorrhagic fevers.
· Private room.
· With negative airflow.
· The use of masks, gowns, and gloves for all persons entering the room.
2. Contact Isolation:
Used for infections, diseases, or germs that are spread by touching the patient or items in the room (examples: MRSA, VRE, diarrheal illnesses, open wounds and RSV).
· Private room.
· Masks for those personnel providing close direct care to the patient.
· Gowns if soiling is likely.
· Gloves for touching infective material.
· Wear a gown and gloves while in the patient’s room.
· Remove them before leaving the room.
· hand washing or use hand sanitizer when entering and leaving the room.
· Visitors must check with the nurse before taking anything into or out of the room.
3. Respiratory Isolation:
designed to prevent transmission of diseases spread over short distances through the air (droplet transmission).
children with Haemophilus influenza, epiglottitis, meningitis, pneumonia, patients with serious meningococcal disease, mumps and pertussis.
· Wear a clean mask when entering the room, and discard it when leaving the room.
1. Reverse isolation:
It protects the patient from the other people, usually because they have a weakened immune system and can’t fight against the bacteria and other infections that live on and around us all the time.
· Private room with a special air ventilation system.
· Require wearing masks, gloves and a gown and to wash hands –thoroughly before putting all that on.
· No gifts like flowers would be allowed in the room.
· Extra precautions would be taken to cleanse or sterilize anything that would be taken in.
2. Airborne Precautions:
· Airborne precautions help keep staff, visitors, and other people from breathing in these germs and getting sick.
· Germs that warrant airborne precautions include chickenpox, measles, and tuberculosis (TB) bacteria.
· People who have these germs should be in special rooms where the air is gently sucked out and not allowed to flow into the hallway. This is called a negative pressure room.
· Anyone who goes into the room should put on a well-fitted respirator mask before they enter.
3. Droplet Precautions
Used when the patient has a type of germ that can be spread to others through large droplets. These droplets are formed and can travel 3 to 6 feet before falling to the ground when the patient coughs, sneezes, talks, laughs, or sings.
· Wear a clean mask when entering the room, and discard it when leaving the room.
1.Preparation of the isolation room or area.
1. availability of the necessary cleaning and disinfection tools and hand-washing facilities
2. Provide sterilization equipment and machines near the care rooms.
3. Ensure that the room has a good ventilation:
negative pressure room these rooms have special technique which take the contaminated air inside the room to outside through large tubes. This kind of rooms is used to isolate airborne infections patients.
4. Post sings outside the room:
indicate that this area is an isolation area.
5. Remove non-essential furniture or items.
because the furniture surfaces are good media microorganisms. Only the important furniture is allowed such; tables. Ensure that they are easy to clean and should be cleaned and dried frequently to be sure that’s retain dirt or moisture inside or on the its surface.
6. Maintain the patient’s requirements
next to him from the drinking utensils and covers and all the necessary personal hygiene.
7. Dedicate non-critical patient-care equipment
Cleaning and disinfection of equipment that can be used for another patient must be done (e.g. stethoscope, thermometer, blood pressure cuff and sphygmomanometer.)
8. Container with cover for equipment needed for sterilization.
Different sizes are available for patient safety and infection prevention so that they are placed externally by the door.
9. Adequate equipment for cleaning and disinfection of the room
1. Eye protection (visor or goggles)
2. Face shield (provides eye, nose and mouth protection)
· reusable vinyl or rubber gloves for environmental cleaning
· latex single-use gloves for clinical care
4. Hair covers (optional)
5. Particulate respirators
6. Medical (surgical or procedure) masks
7. Gowns and aprons
· single-use long-sleeved fluid-resistant or reusable non-fluid-resistant gowns.
· plastic aprons (for use over non-fluid-resistant gowns if splashing is anticipated and if fluid-resistant gowns are not available).
10. Secure communication method
By providing a telephone or similar connection where the isolated person can communicate with people abroad to minimize entry and exit from the isolation area.
2. Wearing and removing personal protective equipment.
Have to prepare your Personal Protective Equipment (PPE) depending on what will do with the patient and what type of infection the patient have. The PPE are gown, goggle, gloves, and face mask these will protect Health care providers from any contaminated such as blood, mucus or air contaminated. PPE should be selected a proper size of PPE not loos and tight.
· The steps for wearing the PPE are:
1- Perform hand hygiene: wash hand
2- Gown: wear the gown by cove the body from neck to knees, and arms to end of wrists, and warp it to the back
3- Mask: you want to put it over nose and the strap around your ears and pull the bottom the mask down chin.
4- Goggle: place it in eyes and the strap behind your head, make sure if it fixed or not.
5- Gloves: wear the gloves, Pull the cuff up over the gown.
As much as can keep hands away from PPT, limit touching areas in patient’s room.
· The steps of removing the PPE are:
1- Gloves: remove it gloves to gloves and skin to skin then discard it in a waste container.
2- Goggle: remove it from the strap then discard it.
3- Gown: remove it from back to front then pull it from inside to outside then discard it
4- Mask: remove it from the straps by fingers then discard it.
5- Wash hand immediately after removing the PPT
3. Checklist for isolation room or area trolley or table.
· Eye protection e.g. (visor or goggles)
· Face shield (provides protection to eye, nose and mouth)
· rubber gloves for environmental cleaning
· latex single -use gloves for clinical care
· Hair covers (optional)
· Particulate respirators e.g. (N95, FFP2)
· Medical (surgical or procedure) masks
· Collection container for used equipment
· Linen bags
· Appropriate clinical waste bags
· Large plastic bags
· Appropriate detergent for environmental cleaning and disinfectant for disinfection of surfaces, instruments or equipment
· Clean single-use towels (e.g. paper towels)
· Plain soap (liquid if possible, for washing hands in clean water)
· Alcohol-based hand rub.
C. the staff precautions
Isolation precautions by staff it is important. it prevents the spread of microorganism in the hospital.
1. Hand washing and Gloving.
2. Patient placement:
Appropriate patient placement is a significant component of isolation precautions. Also, a private room with hand washing and toilet facilities it is important to prevent and reduce opportunities for transmission of microorganisms.
when a private room is not available. an infected patient is pleased with appropriate roommate.
3. Transport of Infected Patients:
In acute care hospitals and long-term care and other residential settings, limit transport and movement of patients outside of the room to medically-necessary purposes. but sometime transport or movement in any healthcare setting is necessary. so, we should be ensuring that infected or colonized areas of the patient’s body are contained and covered. also Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. ask patients to wear medical masks when outside their room or area to prevent transfers infection.
4. Masks, Respiratory Protection, Eye Protection, Face Shields:
During procedures and patient-care activities that are likely sprays of blood, body fluids, secretions and excretions, and for protect ourselves and others we need to Use PPE to protect the mucous membranes of the eyes, nose and mouth. we need to wear masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed.
Wear facial protection, including a medical mask and eye protection (face shield or goggles), to protect the conjunctivae and the mucous membranes of the nose, eyes and mouth. When providing care in close contact with a patient with respiratory symptoms for example: coughing or sneezing, use masks and eye protection, because sprays of secretions may occur.
5. Linen and Laundry:
The patient in the isolation room needs to change his clothes and covers. This task needs a specific procedure to prevent the spread of the disease and not infect others, so follow this point:
· Remove large amounts of solid material like feces from heavily soiled linen, and dispose of the solid waste in a toilet before placing the linen in the laundry bag.
· Avoid sorting linen in patient-care areas. Place contaminated linen directly into a laundry bag in the isolation room or area with minimal manipulation or agitation, to avoid contamination of air, surfaces and people.