Introduction to Isolation Practices
All clients in healthcare facilities expect those caring for them will protect
them from a healthcare-associated infection (HAI). Hand hygiene and
Standard Precautions are the first line of defense for healthcare workers,
patients, and visitors.
For individuals with known infections, transmission-specific isolation
guidelines—such as contact, droplet, and airborne precautions—are available.
The Centers for Disease Control and Prevention (CDC) offers disease-specific
infection control recommendations on their website.
As you complete this concept, you will gain the knowledge and skills needed
to:
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Differentiate between standard, contact, droplet, and airborne
precautions.
Identify the personal protective equipment used with each precaution.
Identify specific diseases that need isolation precautions.
What Are Isolation Precautions?
The Centers for Disease Control and Prevention (2019) outlines the
fundamentals of infectious disease transmission in healthcare settings. It
takes commitment from the administration to:
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Support infection control professionals and nurses.
Provide adequate staff (nursing and laboratory).
Create a culture of safety in the organization by adhering to guidelines.
Monitor healthcare-associated infections (HAI).
Provide education and personal protective equipment.
Promote safe work practices.
By abiding by these fundamentals, healthcare settings can work towards and
meet a key goal of The Joint Commission—decrease HAI.
Standard Precautions
Tom is a 32-year-old male who was in a motor vehicle accident. He has
multiple rib fractures, a broken clavicle, and a damaged spleen that was
surgically removed. He is at risk of infection but is sharing a room with
another client.
As with all clients, standard precautions should be used. This type of
precaution acknowledges that all blood, body fluids, non-intact skin, and
mucous membranes may contain infectious agents.
Standard precautions are the minimum level of protection to protect clients
and healthcare workers. Staff need to wash their hands and use personal
protective equipment, such as gloves, a gown, and/or a mask if there is a risk
for contamination.
Standard precautions also include using safe needle practices, dedicating
multi-dose vials to a single client, cleaning contaminated surfaces, and using
respiratory hygiene like covering coughs.
For more information, see the concepts on hand hygiene and personal
protective equipment.
Image Transcript
Contact Precautions
Eve, a 58-year-old healthy female, was admitted to the
hospital for a left knee replacement. She was given antibiotics after surgery
but began to show signs of infection in her knee. The incisional drainage was
cultured and she was positive for methicillin-resistant Staphylococcus aureus
(MRSA).
Since MRSA can be spread by direct or indirect contact with the patient or the
patient’s environment, Eve is placed on contact precautions. She is placed in a
private room and the door can be open. Before patient contact, staff need to
wash their hands and don clean, nonsterile gloves and gown. Common
equipment, like vital sign machines, is left in the room and not shared with
other patients.
When Eve has visitors, they have to wear gloves and gowns as well.
Contact Precautions Mnemonic: Mrs. Wee
Diseases:
M – Multi-drug resistant infection
R – Respiratory infection (RSV)
S – Skin infection
W – Wound infections
E – Enteric infections* (Clostridium difficile)
E – Eye infections (conjunctivitis)
*Contact Enteric Precautions require hand hygiene with soap and water only.
Droplet Precautions
Lee is a 68-year-old male admitted to the
hospital with complications with chronic obstructive pulmonary disease
(COPD) due to influenza. He is having difficulty breathing and is on 7 L of
oxygen via a mask. He has a fever, a cough, and is fatigued. Lee is placed on
droplet precautions since transmission of influenza is by droplets (> 5
microns) through contact with respiratory secretions via coughing, sneezing,
talking, or droplet-inducing procedures.
Lee is in a private room, but the door can be open. Employees must perform
hand hygiene along with wearing a mask. Per standard precautions, a gown
and gloves may be a requirement. Equipment cannot be shared with other
patients and must remain dedicated to Lee's room.
When Lee has visitors, they have to wear masks.
Droplet Precautions Mnemonic: Spiderman
Diseases:
S – Sepsis, scarlet fever, streptococcal pharyngitis
P – Parvovirus B19, pneumonia, pertussis
I – Influenza
D – Diphtheria
E – Epiglottitis
R – Rubella
M – Mumps, meningitis, mycoplasma, meningeal pneumonia
An – Adenovirus
Airborne Precautions
Dalton is a 7-year-old boy with a severe case of
chickenpox (varicella). His parents chose not to vaccinate and he is homeschooled. He has a fever, fatigue, and loss of appetite to the point he is
refusing to eat. His pox are in the weeping stage. He is placed on airborne
precautions to prevent transmission via airborne droplets (≤ 5 microns) that
are suspended in the air for long periods of time over long distances and can
be widely dispersed by air currents.
Dalton needs a monitored negative pressure private room in which the air is
discharged outside or through a HEPA filter before recirculation. He feels very
lonely since all doors and windows must be kept closed at all times. The staff
look very scary in N95 masks, gowns, and gloves. He also misses his siblings
because they cannot visit since they are not immune to varicella.
Airborne Precautions Mnemonic: “My Chicken has TB”
Diseases*:
My – Measles (rubeola)
Chicken – Chickenpox (varicella)
Has – Herpes zoster
TB – Tuberculosis
* COVID also requires airborne precautions.
Neutropenic Isolation
Peggy is a 60-year-old female who is
undergoing chemotherapy and radiation for breast cancer. Neutropenia, low
levels of neutrophils that fight off infection, occur about 7-12 days after
treatments. Peggy was admitted 8 days after her last dose due to high fevers
and a cough.
Since Peggy is susceptible to infection, she was placed on neutropenic
precautions. Staff need to wash their hands and don a mask, gown, and
gloves before entering her room. Her door must be shut and no one who is ill
may enter. She has her own equipment in the room. She is sad since she
cannot have any fresh flowers, fruits, or vegetables. They may contain
bacteria that could make her sick.
The nurse must perform hand hygiene by washing their hands with only soap
and water after providing care to clients with C. diff. Hand sanitizer is not
sufficient in these conditions.
For conjunctivitis, MRSA, and RSV, healthcare workers can use hand sanitizer.
Standard precautions are used with every client. Standard precautions also
include properly handling equipment, using safe needle practices, dedicating
multi-dose vials to a single client, cleaning contaminated surfaces, and using
respiratory hygiene like covering coughs.
Wearing a surgical mask, gown, and gloves demonstrates droplet and
neutropenic precautions. These precautions are in addition to standard
precautions.
Contact precautions do not require a mask.
Airborne precautions require a N95 mask.
Clients on neutropenic precautions cannot have any fresh flowers, fruits, or
vegetables. They may contain bacteria.
The rest of the items/foods do not place the client at risk.
Performing hand hygiene, covering a cough, and donning a mask, a gown, gloves, and a face
shield demonstrate standard precautions when at risk of contact with bodily fluids.
A surgical scrub is not part of standard precautions.
Doffing or removing your personal protective equipment (PPE) is also done in
a particular order. You can remember that doffing is taking off your PPE
because it has the word “off” in the middle. When removing PPE:
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Remove the gown first, being careful to turn it inside out to contain
any infectious materials.
Remove gloves, turning inside out to contain any infectious materials.
Both the gown and glove should be disposed of in the trash after being
removed.
Wash your hands to get rid of any contamination that may have
occurred during care or removing the gown and gloves.
Remove your face mask pulling from the straps and taking care not
to touch the part of the face mask that was away from your face while
wearing it. It may be infectious.
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Remove your goggles or eye wear by grabbing the arms of the
goggles near the ear and pulling them off. Face mask or the face shield
will be taken off like the mask by pulling on the strap on your head.
After all PPE is removed, wash your hands one last time.
Clients on airborne precautions (e.g., with COVID) require a negative pressure
room with the door closed. Clients on droplet precautions (e.g., with
pertussis) should have a private room with the door open. Clients on
neutropenic precautions need a private room with the door closed. Clients on
standard precautions (e.g., with a broken femur) may room with another
client (CDC, 2019).
Enteric infections - contact precautions
Eye infections - contact precautions
Measles - airborne precautions
Varicella - airborne precautions
Tuberculosis - airborne precautions
Pertussis - droplet precautions
Influenza - droplet precautions
Epiglottitis - droplet precautions