Isolation Precaution

1970 – Isolation Techniques for Use in
Hospitals 1st Edition
1975 – Isolation Techniques for Use in
Hospitals 2nd Edition
1983 – CDC Guidelines for Isolation
Precautions in Hospitals
1985-1988 – Universal Precaution
1990 – Body Substance Isolation
1996 – Guidelines for Isolation Precautions in
Hospitals
2004 - Standard Precaution & Isolation Policies
2007 - updates and expands the 1996 Guidelines
for Isolation Precautions in Hospitals.

1.The transition of healthcare delivery from primarily
acute care hospitals to other healthcare settings (e.g. home
care, ambulatory care, free-standing specialty care sites,
long-term care) created a need for recommendations
that can be applied to ALL healthcare settings while
adhering to common principles of infection control
practice
2. The revised guidelines addresses the spectrum of
healthcare delivery and the term “nosocomial
infections” is replaced by “healthcare-associated
infections (HAIs) to reflect the changing patterns in
healthcare delivery.

3. The emergence of new pathogens (e.g. severe acute respiratory
syndrome [SARS], Avian influenza in human) and new therapies
(e.g. gene therapy) and increasing concern for the threat of bio-
weapons attacks established a need to address a broader scope
of issues than in previous isolation guidelines
4.The experience with Standard Precautions since it
was recommended in the 1996 guideline, has led to
the reaffirmation of this approach as the foundation
for preventing transmission of infectious agents in all
healthcare settings

“At any given time, over 1.4
million patients worldwide
suffer from infectious
complications associated with
health care.”

Recommendations of the
Healthcare Infection Control
Practices Advisory Committee
(HICPAC) 2007
Preventing Transmission
of Infectious Agents in
Healthcare Settings

TWO TIERS:
 Standard Precautions
 Transmission-based Precautions

 Standard precautions synthesizes the major
feature of Universal Precautions (1988) and
Body Substance Isolation (1990)
 Includes infection control practices and use of
PPE recommended for healthcare personnel
when having contact with ALL patients wherever
healthcare is delivered, regardless of patient
diagnoses or presumed infection status.
 Standard precaution is designed to protect
HCWs and patients from contact with infectious
agents in a recognized and unrecognized sources
of infection

 Standard precaution applies to:
• blood
• all body fluids, secretions and excretions
except sweat, regardless of whether they
contain visible blood
• Non-intact skin
• mucous membranes

COMPONENT RECOMMENDATION
S
Hand Hygiene  After touching blood,
body fluids, secretions,
excretions, contaminated
items;
 immediately after
removing gloves;
 between patient
contacts

Considered to be one of the most important
procedures in the prevention of hospital-
acquired infection.
Vigorous, brief rubbing together of all
surfaces of lathered hands, followed by
rinsing under a stream of water for at least
30 seconds

 Healthcare Workers’ Hands
The greatest transmitter
of GERMS !!!!!
The most common means
of spread of INFECTION.
Healthcare Workers’ Hands

COMPONENT RECOMMENDATIONS
Personal Protective Equipment (PPE)
GLOVES For touching blood, body fluids,
secretions, excretions, contaminated
items
 For touching mucous membranes
and non-intact skin
Mask,
Eye Protection,
Face Shield
 During procedures and patient-care
activities likely to generate splashes or
sprays of blood, body fluids, secretions
Gown  During procedures and patient-care
activities when contact of clothing/exposed
skin with blood/body fluids, secretions, and
excretions is anticipated

Soiled patient-care equipment  Handle in a manner that
prevents transfer of
microorganisms to others and
to the environment
 wear gloves if visibly
contaminated
 Perform hand hygiene

Environment Control  Develop procedures for
routine care, cleaning and
disinfections of environment
surfaces, especially
frequently touched surfaces
in patient-care areas

Textiles and Laundry  Handle in a manner that
prevents transfer of
microorganisms to others and
to the environment

Needles and Other
Sharps
 Do not recap, bend, break, or hand-
manipulate used needles
 If recapping is required, use a one-
handed scoop technique only
 Use safety features when available
 Place sharps in puncture-resistant
container

Patient Resuscitation  Use mouthpiece,
resuscitation bag, other
ventilation devices to
prevent contact with
mouth and oral
secretions

COMPONENT RECOMMENDATIO
NS
Patient Placement  Prioritize for single-
patient room if the
patient is at increased
risk of transmission, is
likely to contaminate
the environment, does
not maintain
appropriate hygiene, or
is at increased risk of
acquiring infection or
developing adverse
outcome following
infection

1. Education of healthcare facility staff, patients and
visitors
2. Posted signs in language appropriate to the
population served with instructions to patients and
accompanying family members and friends
3. Source control measures (e.g. covering the mouth /
nose with a tissue when coughing and disposing of
used tissues, using surgical masks on the coughing
person when tolerated and appropriate
4. Hand hygiene after contact with respiratory
secretions
5. Spatial separation, ideally > 3 feet , of persons with
respiratory infections in common waiting areas when
possible

TARGET:
 Patients and accompanying family members or friends but
applies to any person with signs of a cold or other respiratory
infection (e.g. cough, congestion, rhinorrhea, increased
production of respiratory secretions) who enters any
healthcare facility
 Absence of fever does not always exclude a respiratory
infection (e,g. pertussis and colds)
 Patients who have asthma, allergic rhinitis, or chronic
obstructive lung disease also may be coughing and sneezing,
although these patients are not infectious, cough etiquette
measures ALSO APPLY

Respiratory hygiene / Cough Etiquette
(Source containment of infectious
respiratory secretions in symptomatic
patients, beginning at initial point of
encounter e.g., triage and reception areas
in emergency departments and physician
offices)
 Instruct symptomatic persons
to cover mouth/nose when
sneezing/coughing
 Use tissue paper and dispose
in no-touch receptacle
 Observe hand hygiene after
soiling of hands with respiratory
secretions
 Wear surgical mask if
tolerated or maintain spatial
separation , > 3 feet if possible

CORRECT SEQUENCE FOR DONNING PERSONAL
PROTECTIVE EQUIPMENT (PPE)
GOWN:
Wear long sleeved cuffed gown if contamination of skin, uniform or
clothing is anticipated. Fully cover your body from neck to knees.
The opening of the gown should be at the back secure the gown at
the neck and waist. Remove immediately if wet. Use only once.
.
MASKS
Wear mask to protect nose and mouth from splashes and sprays of
blood or body fluids. Wear within 2 meters of a coughing
client/patient/resident.
Place over nose, mouth and chin.
Secure ties or elastic bands at the middle of head and neck.
Fit flexible band to the bridge of your nose.
Adjust the mask to fit.
Disposable use only once.

N95 MASKS
Wear fit tested N95 respirator to protect against airborne diseases i.e.
TB, or when performing aerosolizing procedures i.e. intubation,
nebulized medications.
Fit snug to face and below chin
Secure on head with elastic band
Perform a fit check:
Inhale – respirator should collapse
Exhale – check for leakage around face
Disposable – use only once.
EYE PROTECTION AND FACE SHIELDS
Wear to protect the mucous membranes of the
eyes, nose and mouth.
Use face shields or safety goggles
Prescription eye glasses are not suitable eye
protection (face shield or safety glasses must fit over
prescription glasses).
Place over face and eyes and adjust to fit.
Can be reusable, must be cleaned and disinfected
between use i.e. disinfectant wipes.

GLOVES
 Wear to protect skin.
 For adequate protection must have a good fit.
 May use a good quality vinyl, latex or nitrile
glove.
 Insert each hand into glove and adjust as
needed for comfort and dexterity.
 Extend to cover wrist of isolation gown.
 Disposable – use only once.

GLOVES
Remove gloves first.
Do not touch the outside of gloves as they are contaminated.
Grasp outside of glove with opposite gloved hand; peel off.Hold removed glove
in gloved hand.
Slide fingers of ungloved hand under remaining glove at wrist.
Peel glove off over first glove.
Discard gloves in waste container.
Perform hand hygiene.
Disposable – use only once.

 EYE PROTECTION AND FACE SHIELDS
Next remove eye protection
Do not touch the outside of eye protection and face
shield as it is contaminated.
To remove, handle by head band or ear pieces.
Place in a designated receptacle for cleaning and
disinfection or dispose in a waste container.

GOWNS
 Next remove gown
 Do not touch the outside of the gown front and sleeves as they are
contaminated.
 Unfasten ties at neck (waist ties can be unfastened with gloved
hand).
 Pull away from neck and shoulders, touching inside of gown only.
 Turn gown inside out
 Fold or roll into a bundle and discard or if reusable place in laundry
bin.

PROCEDURE / N95 MASKS
 Next remove mask.
 Do not touch the front of mask/respirator as it is
contaminated.
 Grasp bottom, then top ties, or elastics and remove.
 Discard in waste container.
 Never reuse.
 Perform hand hygiene.

“Transmission-Based Precautions” used to reflect
infection control measures, in addition to STANDARD
PRECAUTIONS that are needed to prevent
transmission of highly transmissible or
epidemiogically important infectious agents.
 designed for patients who are known or suspected to
be infected with epidemiologically important
pathogens that require additional control measurers
to prevent transmission.

 Contact Precautions
 Droplet Precautions
 Airborne Infection Isolation (AII)
 Protective Environment (PE) for allogeneic
HSCT patients
More than one category may be used for diseases that
have multiple routes of transmission (e.g. SARS)
When used either singularly or in combination, they
are always to be used in addition to STANDARD
PRECAUTIONS

 Direct contact- occurs when microorganisms are
transferred from one infected person to another
person
 Indirect contact- involves the transfer of infectious
agents through a contaminated intermediate object
or person.
 Use contact precautions for patients with known or
suspected infections or evidence of syndromes that
represent an increased risk for contact transmission,
including colonization or infection with MDROs

 Acute care setting: single patient room
 Long Term Care Setting : make decisions regarding
patient placement on a case-by-case basis, balancing
infection risks to other patients in the room and the
potential adverse psychosocial impact on the infected
or colonized patient
 Ambulatory settings : place patients who require
Contact Precautions in an examination room or
cubicle as soon as possible

 Observe hand hygiene practices and wear gloves according to
Standard Precautions and whenever touching the patient’s
intact skin or surfaces and articles in close proximity to the
patient (e.g., medical equipment or bed rails)
 Wear gown if you are anticipating direct contact of
clothing with the patient or potentially contaminated
environmental surfaces or items in the patient’s room.
Remove the gown and observe hand hygiene before
leaving the patient’s environment
 After gown removal, ensure that clothing and skin do not
contact potentially contaminated environmental surfaces to
avoid transfer of microorganisms to other patients or
environmental surfaces.

 Limit transport and movement of patients outside
of the room to medically necessary purposes.
When transport is required, ensure that infected
or colonized areas of the patient are contained
and covered.
 Remove contaminated PPE and perform hand
hygiene prior to transporting patient on Contact
Precautions.
 Don clean PPE to handle the patient when the
transport destination has been reached.

Manage patient care equipment
according to Standard Precautions
Use disposable patient care items (e.g.
blood pressure cuffs) wherever possible
or implement patient-dedicated use of
non-critical equipment to avoid sharing
between patients.
 If use of common equipment or items is unavoidable,
clean and disinfect them before use on another patient.

 Clostridium difficile
 Rotavirus
 Congenital Rubella
 Decubitus ulcer
 Hepatitis A, diapered or incontinent patients
 Herpes simplex, mucocutaneous, disseminated or
primary, severe (until lesions dried and crusted)
 Impetigo,
 Lice (head, body, pubic)
 Poliomyelitis
Scabies,

 Use Droplet Precautions for patients known
or suspected to be infected with
microorganisms transmitted by respiratory
droplets (large-particle droplets {>5 um in
size} that can be generated by the patient
during coughing, sneezing, talking, or the
performance of cough-inducing procedures)

 Acute care setting: single patient room
 Residence care settings : place patients who may require
Droplet Precautions in an examination room or cubicle
as soon as possible. Instruct patients and accompanying
individuals to follow recommendations for Respiratory
Hygiene / Cough Etiquette.
 Ambulatory settings : place patients who may require
Droplet Precautions in an examination room or cubicle
as soon as possible. Instruct patients and accompanying
individuals to follow recommendations for Respiratory
Hygiene / Cough Etiquette.

 Limit movement and transport of the patient outside
of the room to medically necessary purposes.
 Instruct patient to wear a surgical mask and follow
Respiratory Hygiene / Cough Etiquette during
transport.
 No mask is required for person handling transport.
 Discontinue Droplet Precautions after signs and
symptoms have resolved or according to pathogen-
specific recommendations.

 Diphtheria, Pharyngeal
 Influenza
 Mumps
 Pertussis
 Pneumonic plague
 Haemophilus influenza type b in children
 Meningococcal
 Group A Streptococcal infection in children
 Rubella

 Use AII for patients known or suspected to be
infected with infectious agents transmitted person-
to-person via airborne route
 e.g., tuberculosis, measles, chickenpox,
smallpox, viral hemorrhagic fevers, SARS.

Acute Care Hospitals or Residential Setting: Place the patient in an
AII that should be a single patient room equipped with the
following:
= Continuous, monitored negative pressure (2.5 Pa [0.01 inch water
gauge]) in relation to the air pressure in the corridor.
= Monitor air pressure daily with visual indicators (e.g., smoke
tubes, flutter strips) placed in the room with the door closed.
= At least 6 (existing facility) or 12 (new construction) air exchanges
per hour.
= Direct exhaust of air to the outside. If it is not possible
to exhaust the air from an AII room directly to the
outside, the air may be returned through HEPA filters
to the air-handling system serving exclusively the
isolation room.

4. Keep the room door closed when not required for
entry and exit
5. When a private room is not available or in the event of
an outbreak or exposure where large numbers of
patients require AII precautions, consult infection
control professionals before patient placement to
determine the safety of alternative rooms that do not
meet engineering requirements for AII and/or
cohorting patients together based on clinical diagnosis
in areas with the lowest risk of airborne transmission

Ambulatory Setting:
1. Develop systems (e.g. triage, signs) to identify and
segregate patients with known or suspected
infections that require AII precautions as soon as
possible after entry into a healthcare setting,
including emergency departments.
2. Place a surgical mask on the patient immediately
and maintain until the patient has been placed in an
AII room.

Ambulatory Setting:
3. Place patients in appropriately ventilated AII rooms when
available.
If such rooms are not available, place these patients in an
examination room at the farthest distance from other
patient rooms, preferably one that is at the end of the
ventilation circuit and place a portable HEPA filter in the
room. Once the patient leaves, the room should remain
vacant for the appropriate time according to the number of
air changes per hour, usually one hour, to allow full
exchange of air.
4. When hospital admission is indicated, place patients with
confirmed or suspected airborne-transmitted infections in
AII rooms/ If AII rooms are not available, transfer to
another facility that has AII rooms.
HEPA = High-efficiency particulate air filter

 Restrict susceptible health-care personnel from
entering the rooms of patients known or suspected
to have measles, chickenpox, smallpox if other
immune health-care personnel are available.

 Wear nose/mouth protection upon entering the
room or home of a patient known or suspected of
having measles (rubeola), varicella, or
disseminated zoster (immune and susceptible) for
consistency and because of the difficulties in
establishing definite immunity in all health-care
personnel.
 No recommendation for the type of protection to
use (e.g., N95 respirator or surgical mask) for
exposure to measles and varicella viruses.
Unresolved Issue.

 Limit movement and transport of patients who
require AII precautions to medically necessary
purposes.
 If transport or movement outside an AII room is
necessary, place a surgical mask on the patient. For
patients with skin lesions associated with varicella or
smallpox or draining skin lesions caused by
Mycobacterium tuberculosis, cover the patient to
prevent aerosolization or contact with the infectious
agent present in the skin lesions.
 Wear respiratory protections when transporting
patients who require AII precautions

 Discontinue AII Precautions after signs and symptoms
have resolved or according to pathogen-specific
recommendations.

Measles (Rubeola)
Varicella Zoster
Pulmonary or Pharyngeal
Tuberculosis, confirmed or
suspected

 Adenovirus in children – D,C
 Aerosolizable Anthrax – AII, C
 Avian Influenza – AII, D, C (14 days after onset of
symptoms)
 Disseminated Herpes zoster – AII, C
 Monkey pox – AII, C (until lesions crusted)
 SARS – AII, D, C (DI plus 10 days after resolution of
fever, provided respiratory symptoms are absent or
improving)
 Smallpox – AII, C
 Tuberculosis, extrapulmonary, draining lesion – AII, C
 Varicella – AII, C (Until lesions dried and crusted)
 Viral Hemorrhagic Fevers due to Ebola, Lassa,
Marburg, Crimean-Congo Fever viruses – AII, C

 Differ from other categories in that the goal of
placing a high-risk patient in a PE to prevent the
patient from acquiring fungal infections from the
environment whereas the goals of the other
categories are to protect HCWs, visitors, and other
patients from acquiring infectious agents from
infected patients.
Place allogeneic hematopoietic stem cell
transplant (HSCT) patients in a PE to reduce
exposure to environmental fungi (e.g.,
Aspergillus sp.)

Surface:
 Daily wet-dusting of horizontal surfaces using cloths
moistened with disinfectant/detergent
 Avoid dusting methods that disperse dust
 No carpeting in patient rooms or hallways
 No upholstered furniture and furnishings
 No flowers (fresh or dried) or potted plants in PE rooms
or areas
 Use vacuum cleaner equipped with HEPA filters when
vacuum cleaning is necessary

TODAY, NURSES ARE THE
KEY PLAYERS IN THE FIGHT
TO ENSURE THE SURVIVAL
OF INFECTION CONTROL
PRACTICES…….

ROOM 101 ROOM 102 ROOM 103 ROOM 104
If you have 8 admissions, how will you assign the room assignments
of these patients ?
1. HIV case with drug reaction to sulfonamides
2. measles
3. Pulmonary Tuberculosis, suspect
4. Uncomplicated Malaria
5. DHF Grade II
6. Meningococcemia
7. Typhoid Fever
8. Stroke in Evolution

If you have 8 admissions, how will you assign the room
assignments
of these patients ?
1. HIV case with drug reaction to sulfonamides
2. measles room 101 or 102
3. Pulmonary Tuberculosis, suspect room 101 or 102
4. Uncomplicated Malaria
5. DHF Grade II
6. Meningococcemia
7. Typhoid Fever
8. Stroke in Evolution
ROOM 101 ROOM 102 ROOM 103 ROOM 104

Isolation Precaution

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