isolation precautions

2. INTRODUCTION
• Even though, in the early 19th
century, there
was absence of any awareness about the
etiology and spread of the diseases, yet
minimum effective safety measures such as
quarantine and isolation were followed.
• During outbreak of bubonic plague and
cholera pandemic isolation practices were
used as a standard safety precaution.

3. Definition
• Standard precaution:
• Standard precautions are meant to reduce the
risk of transmission of bloodborne and other
pathogens from both recognized and
unrecognized sources. They are the basic level
of infection control precautions which are to
be used, as a minimum, in the care of all
patients.- World heath organization.

4. ISOLATION
• In the context of health care settings, the
isolation is defined as any of the various
interventions usually termed as “isolation
precautions” adopted within a HCF (health
care facility) for the control of infection and
for the prevention of communicable diseases
from a patient to other patients, health care
personnel or visitors.

5. Types of isolation system
• As early as the 20th
century, there have been
evidences of segregating the contagiously
infected patients from others by restricting
them in separate wards. In the current times,
the isolation practices along with the other
preventive strategies are adopted to reduce
the transmission of communicable diseases.

6. Cont..
• The isolation system can be of following two
types:
1. Barrier isolation
- Contact isolation
- Droplet isolation
- Airborne isolation
2. Reverse barrier isolation

7. Cont..
• Barrier isolation:
• the barrier isolation is required when the surrounings
and the people around health care facility need
protection from the infection spread by the patients.
• There types of isolation systems:
• Contact isolation:
• This type of isolation is implemented when the mode of
transmission of infection is by contact only in the form
of the contact precautions.
• The use of PPE is most.

8. Cont..
• Droplet isolation:
• This type of isolation is implemented when the
mode of transmission of the prevailing infection is
the droplet infection that requires the usage of the
droplet precautions to be followed by the healthcare
personnel while handling the patients like:
• Surgical masks
• Surgical googles
• Face sheilds

9. Cont..
• Airborne isolation:
• This type of isolation is implemented when the mode of
transmission of infection is airborne that requires the
isolation of the patient itself in order to ensure the
safety of the healthcare personnel as well as the
surrounding environment. This kind of isolation
includes the following:
- Isolation rooms or negative air pressure rooms
- Respiratory masks while dealing with the patients.
- Breathing apparatus

10. Cont..
• Reverse Barrier isolation:
• In this case the patient who is
immunocompromised requires protection
from the infection prevailing in the
environment. This can be done using the
standard/ transmission based precautions by
the patient itself. So, the isolation adopted is
as per the patient concerned i.e., either
contact, droplet or airborne isolation.

12. Standard precautions
• They are a set of guidelines that helps reduce
the risk of transmission HAI in hospitals and
microorganisms from both recognized and
unrecognized sources of infection in hospitals.

13. Guidelines in standard precautions
• Handwashing
• Gloves
• Personal protective equipments
• Patient care equipment
• Environmental control

14. Handwashing
• Hands of health care workers are often
colonized with pathogens from patients and
environmental surfaces.
• Bacteria that cause hospital-associated
infections (HAI) are most frequently spread
from one patient to another on the hands of
HCW.

15. Cont..
• Some reasons why HCW do not wash their
hands often as they should:
• Heavy workloads
• Sinks are not available or are poorly located
• Skin irritation caused by frequent exposure to
soap and water
• Hands don’t look dirty
• Handwashing takes too long.

16. Indications for handwashing

17. Cont..
• Before touching the patient
• Before clean/aseptic procedure
• After touching the patient
• After body fluid exposure
• After touching patient’s surroundings

18. Handwashing techniques
• Nails must be clean and short
• All jewellery should be removed prior to
handwashing.
• Wet hands under running water
• Apply soap covering all surfaces of the hands.
• Vigorously rub all surfaces of lathered hands
for 10-15 seconds.

20. Handwashing Agents
• Soap
- Liquid soap is better than bar soap.
- If only bar soap is available, use which should
be just adequate
• 2%-4% chlorhexidine gluconate
• 7.5% povidone iodine.

21. Alcohol hand rubs
• Used as an alternative to handwashing with soap and
water or disinfectants.
• Do not use for visibly soiled hands
• Has a good immediate activity.
• Does not require drying with a towel
• Does not require a designated area for hand washing.
• Less time consuming and does not cause drying of skin
• Can be prepared in house
• (97ml of 70% alcohol + 3ml of glycerol)

22. Surgical hand scrub
• Remove all jewellery before scrubbing
• Nail brush should be used only for the first hand
wash of the day to remove debris from
underneath nails.
• Apply 3-5 ml of antiseptic detergent (eg: 4%
chlorhexidine or 7.5% povidone iodine) to
moistened hand and forearms.
• Vigorously rub all surfaces of hands and forearms
for 3-5 minutes.

23. Personal protective equipment (PPE)
• HCW should assess the risk of exposure to
blood, body fluids, excretions or secretions
and should choose their items of PPE
according to the risk.
• Discard used PPE appropriately and wash
hands after attending to patients.

24. Patient care equipment
• Handling of used patient care equipment
soiled with blood, body fluids, secretions and
excretions to prevent.
- Skin and mucous membrane exposures
- Contamination of clothing
- Transfer of microorganisms to other patients
and environment.

25. Cont..
• Single-used items
- Are discarded properly and never re-used.
- However, if such items have to be reused
cleaning and high level disinfection is
recommended.
• Reusable equipment
- Should be cleaned and disinfected or sterilized
appropriately.

26. Cleaning of instruments
• Carried out before disinfection and sterilization.
• Thorough cleaning with detergent and water will
remove most microorganisms.
• Wear Personal protective equipments.
• The sink should be deep enough to completely
immerse the equipment.
• Remove any gross soiling on the instrument by
rinsing in tap water.

27. Cont..
• Immerse all parts in water with detergent.
• Rinse in hot water (45 degree celsius) unless
contraindicated.
• Dry the instrument

28. Environmental Control
• Keep the environment dry, clean, well ventilated
and exposed to sunlight.
• Do not use disinfectants unless indicated eg:
spills, isolation rooms.
• Keep mops and buckets clean, dry and inverted.
• Use different cleaning equipments for clinical
areas and washrooms.
• Routine culture of environment and air should be
done.

29. Management of spills
Blood and body fluid spills
• Wear heavy duty gloves.
• Soak up fluid using absorbent material
• Pour 1% hypochlorite solution till it is well soaked. Leave
for at least 10 minutes.
• Remove the absorbent material and discard as clinical
waste.
• Clean area with detergent and water and dry.
• Discard waste as per BMW protocols.
• Wash hands

30. Linen
• Handle, transport and process soiled linen so as to
prevent skin and mucous membrane exposures and
contamination of clothing.
• Ideally blood and body fluid stained linen and linen
from patients in contact isolation should be washed
in:
- Washing machine with a hot cycle using bleach
- Or should be soaked in 0.5-1% hypochlorite solution for
30 minutes in the wards/ operation theatre before
sending to the laundry.

31. Handling of Sharps
• Sharps such as scalpels, lancets, needles and
syringes should be single use only.
• Take care to prevent injuries when using,
handling after procedures, cleaning and
disposing of sharps.
• Avoid recapping used needles
• Do not remove used needles from disposable
syringes by hand.

32. Cont..
• Discard sharps immediately into the sharps
bin.
• Use clean gloves during procedures like
phlebotomy.