Isolation precautions

Dr. Satti M. Saleh
Chief of Infectious Diseases
Department
Medical Director MGH

ISOLATION PRECAUTIONS
IN HOSPITAL
Rationale for precautions
Infection Transmission Requires :
Microorganism
Source
Susceptible Host
Means of transmission.

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

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 .

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.

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 .

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.

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

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.

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.

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

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

ISOLATION PRECAUTION
IN HOSPITALS
HICPAC Isolation Precautions (1996 )
1 – Standard precautions
a - Blood
b - All body fluids
c - Non intact skin
d - mucous membranes.
( to reduce transmission from organized & unorganized source
of infection.)
2- Transmission based precautions :
( patient documented or suspected to be infectious)
a - Airborne precautions
b - Droplet precautions
c - Contact precautions.
( may be combined for diseases with multiple route of
transmission).

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 .

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

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 .

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 .

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 .

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 .

Phlebotomy Handbook: Blood
Collection Essentials, Seventh
Edition
Pearson Education
Copyright 2005
TB Transmission

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

ISOLATION PRECAUTION
IN HOSPITALS
 Air borne precautions :
 Dissemination of droplet nuclei .
 Small particle residue of 5 micrometers or less of evaporated
droplets.
 Suspended on the air for long time.
 Dust particles containing the infectious agents.
 Special air handling & ventilation required e.g measles ,
varicella , TB .
 Droplet precautions :
 Large particles droplets
Invasive HI type b.
Invasive N Meningitides.
 Diphtheria , Mycoplasma , sterptococcal infection.
 Viral infections : adenovirus , mumps, rubella .

IN HOSPITALS
 Contact precautions :
 Patient known or suspected to have serious illness
transmitted by contact.
a - GIT, Respiratory , skin or wound infection with
multi drug resistant bacteria or colonization.
b – Enteric infections : shigella, HIV, E.coli, O157,
117 .
c – Respiratory viruses .
d – Skin infections Diphtheria , Herpes, Cellulitis
Scabies , VHF.

Phlebotomy Handbook: Blood Collection
Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
Pearson Education
Copyright 2005
Herpes
Neonatal infection with herpes simplex virus
type 1, showing ulcerating and vesicular skin
lesions.
Lesions may be present in small numbers.
The virus was transmitted during birth.

IN HOSPITALS
 Additional Emperic Precautions :
Diarrhea Enteric organism contact
Vesicular rash Varicella air borne
Maculopapular rash measles air borne
cough, fever, upper lobe infilterate TB air borne
Risk of multi drug resistant bacteria contact
Abscess draining wound strept, staph contact
FUNDAMENTAL OF ISOLATION PRECAUTIONS
1- Hand washing
After touching blood , body fluid….etc
After removing gloves
Between pt’s contact.

Edition
Pearson Education
Copyright 2005
Standard Precautions
Figure 5.9 Rinse Hands in a Downward Motion with Water

IN HOSPITALS
2- Gloves :
a – for touching blood, body fluid …etc.
b – Mucous membranes .
c – contaminated items
d- a septic procedures .
3 - Patient placing:
a - Private room.
b - Hand wash & other facilities.
c - With appropriate room mate ( cohorting ).
d - Private room with appropriate ventilation e.g T.B.
4- Transport of infected patients :
a – limit movement .
b – Appropriate measure if needed .

Edition
Pearson Education
Copyright 2005
Figure 5.11 Supplies for Isolation Procedures

Phlebotomy Handbook: Blood Collection
Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
Pearson Education
Copyright 2005

IN HOSPITALS
c – Notify other departments.
d – Patient education.
5 – Mask respiratory, Eye precautions , Eye shields.
6 – Gowns , boots, shoe covers, leg coverings (
remove gown before leaving). .
7 – Environmental control .
8- linen
9- proper waste disposal ( e.g sharp)

Edition
Pearson Education
Copyright 2005
4. Face shields
Figure 5.18 Face shields or goggles
may be worn

Edition
Pearson Education
Copyright 2005
Specific Isolation
Techniques and
Procedural Steps
.2Gowning
Figure 5.13 Gowns should be large
enough to cover all clothing

Edition
Pearson Education
Copyright 2005
5. Completing the
protection
Figure 5.19 Gloves should be pulled over
the ends of gown sleeves

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

Isolation precautions

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