Isolation Precautions
1. Explain the rationale for isolation
precautions.
2. Outline the types and indications of
isolation precautions.
3. List the types of personal protective
equipment used in isolation precautions.
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Learning objectives
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• 35 minutes
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Time involved
3
• Microorganisms can be spread from patients to
patients and patients to staff
• Isolation precautions can reduce transmission
decreasing the spread of microbes
• Components: hand hygiene, personal protective
equipment, single rooms, ventilation, and
restriction of movement
• Must be applied according to signs and
symptoms
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Key points
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• Infection results from an
interaction between an
infectious agent and
susceptible host
• The interaction occurs by
means of contact between the
agent and the host and is
affected by the environment
• Breaking the chain of infection
by interrupting transmission is
generally the best way to
prevent infections
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Chain of Infection
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• Contact spread
• Direct: from one person to another
• Indirect: contaminated equipment or surfaces
• Droplet
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Transmission of Infections - 1
• Expelled when sneezing or coughing; less than 2m from the
source
6
• Airborne spread
• Small particles (≤5μm in size) can remain
airborne
• Transferred more than 2m from the source
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Transmission of Infections - 2
• Vehicle spread
• Vector-borne
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• Understand what is to be achieved through
isolation
• Know the route of transmission of an infectious
agent
• Reduce risks
• Emphasise the use of protective barriers
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Principles of Isolation
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• Universal Precautions created in 1985 due to
AIDS epidemic
• Objective was to prevent infections transmitted by
blood and body fluids
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Background
• Concept of Body Substance Isolation published
in 1987
• All fluids from patients handled using gloves
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• Standard Precautions
• Transmission-based Precautions
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Isolation Precautions
10
• Basic precautions recommended for all
patients
• Also called Routine Practices
• Based in the fact that unsuspected agents may
be present in body fluids, non-intact skin and
mucous membranes of all patients
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Standard Precautions - 1
11
• Hand hygiene
• Disposable gloves on contact with secretions,
excretions, or body fluids
• Protective apron or gown for body contact with
patient or patient’s bed
• Appropriate handling of equipment and linen
• Environmental cleaning and spills-management
• No cap, mask, or shoe covers
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Standard Precautions - 1
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Structural Elements
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• Contact precautions
• Droplet precautions
• Airborne Isolation
• Protective Isolation
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Additional transmission-based
precautions
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• PPE when likely to be in contact
with environment contaminated
with agents such VRE, MRSA or
Clostridium difficile
• Single room or room with
another patient infected by the
same pathogen
• Clean gloves when entering the
room
• Clean gown/apron if substantial
contact with the patient or
environment is anticipated
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Contact Precautions
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• Single room or in a room with
another patient infected by
the same pathogen
• Face protection when
working within 1-2 metres of
the patient
• Mask on the patient if
transport is necessary
• Indications: Respiratory
diseases (RSV, Influenza)
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Droplet Precautions
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• Single room most important
• Mask or respirator when entering
room
• Mask on patient if transport
necessary
• Recommended
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Airborne Isolation
• Negative air pressure relative to
corridors
• Air exhausted directly to the outside or
recirculated through HEPA filtration (6 12 air changes per hour)
• Indications: Tuberculosis, rubeola
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• Recommended only for allogeneic hematopoietic
stem cell transplant patients
• Positive room air pressure relative to corridors,
along with HEPA filtration of incoming air at ≥12
air changes per hour
• Appropriate engineering controls
• Consider:
• Single rooms with negative or positive pressure very
difficult to maintain
• Rooms with anterooms have less air movement
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Protective Isolation
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• Hand hygiene
• Especially important after contact with patients and
contaminated equipment or surfaces
• Staff equipment and surfaces
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Essential Components - 1
• Keep clean
• Handle patient equipment with care
• Ensure all reusable equipment is reprocessed
• Linen
• Handle, transport, and process with care
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• Personal protective equipment
• Gloves
• Change between patients
• Remove immediately after use
• Do not reuse
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Essential Components - 2
• Clothes
• Remove if soiled or wet as soon as
possible
• Masks, goggles, visors, respirators
• Protect against blood/ body fluid splashes
• Disinfect as needed
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• Family members providing care to patients MUST
be educated
• Practice good hygiene
• Use appropriate precautions to prevent spread of
infections
• Precautions for family members should be the
same as those used by staff
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Essential Components - 3
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• In most cases, Standard Precautions are sufficient
• Base on clinical signs and symptoms
• Consider:
• Single room when gross contamination of the environment
is likely (e.g., wounds, diarrhoea, bleeding)
• Door closed when contact transfer is likely (e.g., injured
skin)
• Ventilate to the outside when airborne transfer is likely
(e.g., tuberculosis)
• Use airlock when massive airborne transfer is likely (e.g.,
varicella)
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Considerations about Isolation
Precautions
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• Isolation Precautions is associated with
adverse psychological effects
• Discontinued as soon as possible
• Fluids of all patients are potentially
infectious
• Hand Hygiene is a key component
• Use a no-touch technique when possible
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General Recommendations - 1
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• Dispose of faeces, urine, and secretions via
designated sinks, and clean and disinfect
containers
• Clean up spills promptly
• Ensure that patient-care equipment, supplies,
and linen is cleaned and/or disinfected between
each use
• For tuberculosis patients – develop a protocol
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General Recommendations - 2
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• Australian Guidelines for the Prevention and Control of
Infection in Healthcare, 2010.
http://www.nhmrc.gov.au/node/30290
• Hospital infection control guidance (SARS), Health
Protection Agency, UK, 2005.
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_
C/1194947350823
• Routine Practices and Additional Precautions in All
Health Care Settings, 2012, Canada
http://www.publichealthontario.ca/en/eRepository/RPA
P_All_HealthCare_Settings_Eng2012.pdf
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Guidelines
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• Infection prevention and control of epidemic- and
pandemic-prone acute respiratory diseases in health
care. Interim WHO Guidelines, June 2007.
http://whqlibdoc.who.int/hq/2007/WHO_CDS_EPR_
2007.6_eng.pdf
• CDC Guideline for isolation precautions: Preventing
transmission of infectious agents in healthcare settings.
(HICPAC), 2007. http://www.
cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
• Practical Guidelines for Infection Control in Health Care
Facilities. WHO. 2004.
http://www.searo.who.int/entity/emergencies/documen
ts/infectioncontrolfullmanual.pdf
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References
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• Global alert and response: infection prevention
and control in healthcare. WHO. 2011.
http://www.who.int/csr/bioriskreduction/
infection_control/en/
• WHO Interim Infection control recommendations
for care of patients with suspected or confirmed
filovirus (Ebola, Marburg, haemorrhagic fever.),
2008
http://www.who.int/csr/bioriskreduction/filoviru
s_ infection_control/en/index.html
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Further Reading
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1.
2.
In general, Standard Precautions are sufficient to prevent
spread of microorganisms. T/F?
Which of the following is NOT a key component of isolation
precautions:
a)
b)
c)
d)
3.
Hand Hygiene
Separation of beds
Surveillance
Personal protective equipment
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Quiz
In a case of tuberculosis you should use:
a)
b)
c)
d)
Contact isolation
Airborne isolation
Droplet isolation
Protective isolation
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• IFIC’s mission is to facilitate international networking in
order to improve the prevention and control of
healthcare associated infections worldwide. It is an
umbrella organisation of societies and associations of
healthcare professionals in infection control and related
fields across the globe .
• The goal of IFIC is to minimise the risk of infection within
healthcare settings through development of a network of
infection control organisations for communication,
consensus building, education and sharing expertise.
• For more information go to http://theific.org/
December 1, 2013
International Federation of
Infection Control
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