The document outlines the importance of reverse barrier nursing (protective isolation) in preventing infections in immunocompromised patients, particularly in oncology settings. Key strategies include rigorous hand hygiene, use of personal protective equipment, and careful environmental cleaning. It also emphasizes dietary restrictions and specific visitor protocols to minimize infection risk within isolation areas.

1. Reverse Barrier Nursing
(Protective Isolation)
Mrs. Dilnasheen Safdar
Director Nursing and Infection Control and Prevention
NIBD BMT Lahore Campus

3. Introduction:
• Implementation of isolation precautions from the Centres
for Disease Control and Prevention (CDC) has been justified
through research and clinical evidence
• Infectious diseases are the second leading cause of death in the field
of oncology including HSCT. Around 60% of deaths are infection
related to cancer patients, especially with underlying hematological
malignancies.
https://doi.org/10.1200/JCO.2019.37.15_suppl. e2309 Journal of clinical oncology

4. Why do we need to Isolate/barrier nurse?
• Barrier nursing is one way of preventing the spread of infection from
one person to another in hospital.
• To reduce the risk of spreading certain infections or antibiotic
resistant germs to other patients and staff.

5. Isolation
• There are two types of isolation – Source Isolation (barrier nursing)
where the patient is the source of infection
• Protective Isolation (reverse barrier nursing) where the patient
requires protection i.e. they are immunocompromised.
• Neutropenic precautions are used when a patient has a low
number of neutrophils in their immune system, making
them immunocompromised.
• Patients may need to be nursed in “isolation” or “barrier”

6. According to Center of Disease Control
Mode of Spread Example Condition Example Pathogens
Contact Diarrhoea,
Infectious rashes, antibiotic resistant
organisms, skin and soft tissue infections
Clostridium difficile, Escherichia coli
0157, Staphylococcus Aureus including
Methicillin resistant strains, Viral
Diarrhoea and Vomiting (Can also
spread by aerosol’s), Streptococcus A,
(until 48 hours of antibiotics)
Droplet Meningitis, infectious rashes, respiratory
tract infections
Respiratory Syncytial virus Haemophilus
Influenza, Influenza virus, Mumps,
Rubella virus
Airborn Infectious rashes, respiratory tract
infections
Varicella virus (chicken pox), Respiratory
Syncytial virus (RSV), Mycobacterium
tuberculosis

7. Reverse Barrier Nursing/Protective Isolation
• Protective isolation is intended to prevent a more susceptible patient acquiring infection e.g. patients
with lowered immune systems. As
• Post Bone Marrow Transplant.
• After chemotherapy.
• On certain medications like immunosuppressants.

8. Important Strategies for prtective Isolation
• This is best achieved in a positive pressure side room.
• The European Heating, Ventilation and Air Conditioning Association
(REHVA) has postulated that adequate ventilation is the first step in
engineering infection prevention and control.
• In a positive air pressure isolation room, the air pressure is
higher than that in the adjoining areas. Therefore, positive
pressure isolation prevents airborne pathogens from
entering the room to avoid the air becoming contaminated.

9. Hand Hygiene

10. Personel Protective Equipments
• When you are caring for immunocompromised patients strict on
isolation protocol as.
• Perform hand hygiene
• Wear Mask, nursing cap and gown before enter the room.
• Perform hand hygiene in patient zone wear gloves if required.
• Use surgical gloves if handle central line or IV line.

11. Environmental Cleaning
• Use single room Dry mop,wet mop use recommended disinfectant.
• Individual room disopsable damp dusting with surface disinfectant.
• Hepafiltrational for air cleaning.
• Special concideration on highly touched area e.g remote, call bell, bed
side rails.
• Proper disposal of waste at the point of care

12. Neutropenic Diet
• This diet helps protect them from bacteria and other
harmful organisms found in some food and drinks.
• Avoid all fresh fruits and vegetables except thick peeled
fruits
• Well cooked food is allowed preferably home cooked
• Avoid fresh raw salad
• Use boiled water

13. • Avoid raw nuts.
• Make sure all of the dairy products you eat are pasteurized.
• Avoid yogurt and yogurt products with live and active
cultures.
• Wash your hands before handling food.
• Wash all surfaces, cutting boards and cutting utensils
thoroughly.
• Keep hot food hot and cold food cold.

14. Attendent Policy
• In reverse Barrier precation attends are not allowed in special cases of
pediatric patients one attendent allowed after proper screening and
education.
• He/She will wear proper PPE during stay.
• If any sign of infection change her immedialely.
• Emphasized on proper hand hygiene.

15. Other Alerts
• No entery if you have flu,dermatitis,sore throat or itching.
• Remove dirty shoes outside the isolation and wear clean shoes inside.
• Remove Coats, Dupata, over coat at bufferzone area or at enterance.
• Keep bags, Laptop outside the isolation.
• Fresh flowers, plants are not allowed .
• Stuff toys stuff cloths are prohibited ( Pediatric Patient can use Plastic
toys with smooth surface and video games are also allowed).
• Avoid trafficking in isolation

16. Thanks