Dr. Satti M. Saleh discusses isolation precautions in hospitals. He outlines the rationale for precautions, which requires an organism, source, mode of transmission, and host. Sources of infection include patients, personnel, visitors, and the inanimate environment. Host factors include age, underlying diseases, and treatments that weaken defenses. Main transmission routes are contact, droplets, airborne, and vectors. Interrupting transmission is aimed at these routes but has disadvantages like added costs and depriving patients of social relationships. Guidelines have evolved from separate facilities in the 1800s to universal, body substance, and new precautions in the 1980s-1990s focusing on standard, contact, droplet and airborne transmission.

1. Dr. Satti M. Saleh
Chief of Infectious Diseases
Department
Medical Director MGH
CBAHI SIT MEMBER

2. ISOLATION PRECAUTIONS
IN HOSPITAL
Rationale for precautions
Infection Transmission Requires :
Organism
Source
Mode of
Transmission
Host

3. SOURCE
Patient , personnel , visitors .
Acute cases in incubation .
Colonized Patients .
Endogenous Flora .
Inanimate Environment ( contaminated )
eg; water , food , equipment .

4. ISOLATION PRECAUTIONS
IN HOSPITALs
HOST
Age
Underlying disease
Treatment :
1 -Antimicrobial.
2 – Corticosteroids.
3 – Immunosuppressive agents.
Weak in first line of defense mechanisms eg;
Surgical operations .
Anesthesia .
Catheters .

5. ISOLATION PRECAUTIONS
IN HOSPITALS
Transmission
Its main routes :
 Contact a -Direct contacts.
b - Indirect contacts.
c - Droplet transmission ( 3 feet ).
 Common vehicle transmission
Water equipment devices.
 Airborne transmission.
Airborne droplet nuclei ( 5 micrometers or small )
Evaporated droplets or dust particles eg TB , Measles ,
chickenpox.
 Vector borne.

6. ISOLATION PRECAUTIONS
IN HOSPITALS
 Interruption of transmission of micro-organisms is
directed primarily at transmission.
Disadvantages of isolation.
 Special equipment, environmental modification ,
more cost.
 Patient care may be affected.
 Deprives patient of normal social relationship.
 Disadvantages to be weighed against prevention
values .
Early isolation practices .

7. ISOLATION PRECAUTIONS
IN HOSPITALS
 1877 Separate facilities.
 1910 Cubical system, separate gown , wash hands, disinfect
objects.
 1950 Infectious disease hospital begin to close.
 1960 T.B Hospitals decreased.
 1970 CDC Isolation manual.
 1983 CDC Guidelines.
1 - Category specific isolation.
Disease specific isolation.
Use guidelines to develop a system .
2- Encourage personnel to make decision on what
precautions to be taken.
3 – Encourage personnel to make decision about the
likelihood of exposure to reduce costs.

8. ISOLATION PRECAUTIONS
IN HOSPITALS
CATEGORY SPCIFIC ISOLATION
 Strict isolation
 Contact isolation.
 Respiratory isolation
 T.B isolation.
 Enteric precaution
 Drainage , secretion precautions.
 Blood & body fluid precautions.
 Protective isolation.
DISEASE SPECIFIC ISOLATION

9. ISOLATION PRECAUTIONS
IN HOSPITALS
 Consider epidemiology of each infectious disease.
Highly educated.
To be updated.
 Universal precautions ( 1985 ) :
 Applying blood & body fluid precautions universally
to all people.
 Prevention of needle stick injuries.
 Traditional barriers e.g gloves .
 Eye coverings in certain procedures . Amniotic ,CSF,
semen, & vaginal secretions.
 Not to feces, nasal secretions, sputum, sweat,
&tears.

10. ISOLATION PRECAUTIONS
IN HOSPITALS
 Body substance isolation ( 1987 ):
 Isolation of all moist &potentially infectious body
substances ( blood, urine, feces, sputum, saliva,
wound drainage, other body fluids regardless of
their presumed infection status ).
 Stop sign alert (( airborne )).
DISADVANTAGES :
 Added costs.
 Overprotection of personnel.
 Difficulty in maintaining routine application.
 Lack of hands washing after gloves removal.
 Droplet infection.

11. ISOLATION PRECAUTIONS
IN HOSPITALS
New Isolation Guidelines ( 1990 ) :
 Problem of multi-drug resistance T.B.
 Multi-drug resistant of micro organisms.
 New guidelines should :
1- Be epidemiologically sound .
2- Recognize importance of all body secretions.
3- Adequate precautions of airborne, droplets
contact routes.
4- Simple.
5- Use new terms to avoid confusions.
6- In expensive

12. New Isolation Precautions,
1996
‘’ Standard’’
And
‘’ Transmission – Based Precautions’’

13. STANDARD PRECAUTIONS
 Consider all patients and their bodily fluids (except sweat) to be
potentially infectious
 Use appropriate barrier precautions when there is a risk of exposure
to blood, body fluids, secretions, excretions, mucous membranes
and non-intact skin.
 Patients with known or suspected infections are NOT to have their
medical records labeled as “infectious”.
 Specimens of patients with known or suspected infections are NOT
to be labeled as “infectious”. All specimens are to be treated in the
same safe manner .
 Used needles and sharps should be disposed of safely ( in puncture
proof sharp boxes ) .
 Needles should NOT be recapped .
 All Health care workers should receive the HBV vaccine .

14. Transmission-Based
Precautions
. Three categories of
Transmission-based Precautions :
- Contact Precautions .
- Droplet Precautions .
- Airborne Precautions .

15. Contact transmission
 Examples of organisms spread by contact:
 Multi-drug-resistant organisms in the
gastrointestinal tract, sputum, or wounds
(MRSA, MDR Gram –ve, VRE).
 Clostridium difficile.
 Herpes simplex virus (mucocutaneous).
 Scabies.

16. Contact precautions
. Wash hands with antimicrobial soap
before leaving the patient's room .
. Minimize risk or environmental
contamination during patient transport
(e.g. patient can be placed in a gown ).
. Patient’s care devices ( e.g. thermometer ,
BP cuffs , stethoscopes ) should be
dedicated to use for a single patient if
possible , otherwise, they should be
rigorously cleansed and disinfected
before use for other patients .

17. Contact precautions
. Private room preferred; cohorting allowed if necessary .
. The door of the room may remain open .
. Gloves :
- upon entering room .
- change gloves after contact with contaminated secretions .
- should be removed before leaving the room .
. Gown:
- if clothing may come into contact with the patient or environmental
surfaces .
- should be removed before leaving the room .

18. DROPLET TRANSMISSION
 Respiratory droplets are large particles (>5 micron)
expelled during .
- Coughing .
- Sneezing .
- Talking.
- During procedures such as suctioning and bronchoscope .
 Droplets travel < 1,5 meter from the source patient .
 Example :
• Neisseria meningitides .
• Haemophilus influenza type b ( invasive ) .
• Streptococcus pyogenes (group A Streptococcus) .
• Mycoplasma pneumonia .

19. DROPLET PRECAUTIONS
 Private room preferred; cohorting allowed
if necessary.
 Special air handling and ventilation are
unnecessary .
 The door of the room may remain open .
 Wear a mask when within 1 meter of the
patient .
 Mask the patient during transport .

20. AIRBORNE TRANSMISSION
 Airborne spreads upon aerosolization of small
particles (=< 5 micron) of the infectious agent
that can then travel over long distances through
the air .
 Most common nosocomial pathogens transmitted
by this route :
- Mycobacterium tuberculosis .
- Varicella-zoster virus (chickenpox) .
- Measles .
- Smallpox.
- ? SARS .

21. AIRBORNE
PRECAUTIONS
 Place the patient in a negative pressure
room with at least 6 – 12 air exchanges
per hour .
 Room exhaust must be appropriately
discharged outdoors or passed through a
HEPA ( high – efficiency particulate
aerator ) filter before recirculation within
the hospital .
 The door of the room should be kept
closed .

22. Hand Hygiene
. Hand hygiene is the single most
important practice to reduce the
transmission or infectious agents in
healthcare settings .
. The term “Hand hygiene” includes :
 -Hand washing with either plain or antiseptic containing
soap and water .
- Use or alcohol-based products ( gals, rinses,
foams) containing an emollient that do not
require the use of water.

23. RATIONALE
TRANSIENT FLORA
(Contaminating or non – colonizing)
 Attached to the superficial layer of skin.
 Microbes isolated from skin not consistently present in
hajority of persons associated with HCAI .
RESIDENT FLORA
 Attached to deeper layer of the skin persistently isolated
from skin of most persons (cons, diptheriods )

24. TRANSMISSIONRequires
1) Pt’s Hands of health care workers .
2) Survive for several minutes .
3) Non or Inadequate hand hygiene .
4) Contaminated Hands Pt’s

25. TYPE OF HAND HYGIENE
1) Intensity of contact .
2) Degree of contamination .
3) Susceptibility of patient to infection .
4) Prove dure to be performed .

26. HAND WASHING
Health care infection control practices
advisory committee (HICPAC) former
recommendations
 Plain soap and water was recommended for
routine hand washing.
 Antimicrobial soaps (e.g. : chlorhexidine) was
recommended for :
- Patients under contact precautions .
- During instances of epidemic or hyperendemic
spread of infections.

27. HAND HYGIENE
 In the absence of visible soiling of hands,
approved alcohol-based products for hand
disinfection are preferred over hand
washing with water and antimicrobial or
plain soap because of their superior
microbiocidal activity, reduced drying of
the skin, and convenience.

28. When to wash hands
 Before and immediately after patient contact
(examination, feeding, bathing, carrying out aseptic
and/or invasive procedures… etc ).
 Between different procedures on the same patient .
 After contact with mucous membranes, blood and
body fluids, secretions and excretions.
 After removing gloves.
 After touching objects or surfaces contaminated with
blood or body fluids.
 Before preparing or serving food.

29. GOWNS AND OTHER
PROTECTIVE APPAREL
(eg-aprons)
 Indications .
 If contact with blood and body fluid is
likely .
 For patients under contact precautions .

30. HAND WASHING STUDY IN
RIYADH MEDICAL COMPLEX-
GENERAL HOSPITAL
 Overall frequency of hand washing .
 23.7% after patient contact .
 6.7% before patient contact .

31. HAND WASHING STUDY
IN RIYADH MEDICAL
COMPLEX-GENERAL
HOSPITAL Frequency of hand washing by profess ion .
 Medical students : 70,0%
 Interns : 69,2%
 Nurses : 18,8%
 Residents : 12.5%
 Consultants : 9,1%

32. HAND WASHING STUDY IN
RIYADH MEDICAL COMPLEX-
GENERAL HOSPITAL
 Frequency of wearing gloves (when
indicated) : 75,5%
 Frequency of hand washing after
removing gloves : 48.8%

33. Precautions Needed for
Cases
 Condition Type Duration
 Pulmonary TB S+A Till sputum Negative
 Chicken Pox S+A Till rash crusted
 M-meningitis S+D 24 Hrs
 HIV S Duration of stay
Clinical Syndromes:
Empiric precautions as per clinical presentation

34. THANK
YOU
Dr. Satti Mohammed