Overview: Isolation Precautions
Last week I posted a question regarding transmission of bacterial pneumonia, which sparked some discussion on the meaning of contact, droplet, and airborne transmission and how those transmission affected what isolation precautions were initiated. The question was posted in conjunction with our Featured Course: Chain of Infection.
I thought I’d briefly address the related issue–isolation precautions–in this post.
Isolation precautions have been in development and refinement since the 1970s. Before that time, nurses and other healthcare professionals relied on almost nothing else besides handwashing to reduce the spread of infection. From the 1970s until the 1990s, knowledge about infection control and research about how infections transmit led to multiple revisions of the Center for Disease Control (CDC) guidelines.
Currently, the guidelines’ last revision was in 2007, and the full document of isolation precaution guidelines are found here.
There are four types of precautions: Standard, Contact, Droplet, and Airborne.
The current guidelines combine elements of the formely named “Universal Precautions” and “Body Substance Isolation.” These precautions are to be taken with every patient regardless of diagnosis or lack of diagnosis. They are not only for the protection of the provider, but also for the protection of the patient.
Use of the various elements of personal protective equipment (PPE), such as gloves, masks, and gowns, is largely determined by the healthcare providers at the time of patient interaction under the principles of standard precautions. At a minimum, gloves are used for patient contact, and other items of PPE added based on the assessment judgment of the healthcare provider. Providers are encouraged to wear masks and face shields when inserting invasive lines, intubating, or performing lumbar punctures.
Standard Precautions includes “hand hygiene; use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure; and safe injection practices.” (2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, p. 66).
Respiratory/Cough Etiquette is a new guideline based on the recent SARS epidemic. All people with respiratory symptoms, including family members and guests, should observe the recommendations to cover their mouth/nose during sneezing or coughing, wash hands frequently, and maintain a distance of >3 ft from other persons if possible. Masking may be implemented in certain situations.
Contact isolation is implemented for patients whose body fluids are known or suspected to harbor infectious organisms pread by either direct (person to person) or indirect (person to object) contact.
Contact precautions are in addition to Standard Precautions, but gloves and gown are required during all patient interactions. Gloves and gown should be removed and reapplied with every exit and entry into the patient room.
Patients on contact isolation should be placed in private rooms. If private rooms are not available, the infection control department should be consulted to determine best patient housing options. At minimum, patient beds should be >3 ft apart.
Droplet precautions are implemented for patients whose respiratory secretions are known or suspected to harbor infections organisms spread by droplets through the air. These droplets rarely travel more than 5 ft from a patient, but can contaminate objects around them, as well as infect persons who do not wear a mask when in close proximity to the patient (<5 ft).
Droplet precautions are essentially contact precautions, but with a mask added in to the list of required PPE. Gloves and gown are also essential, especially if the patient is mobile within his/her patient room. Again, privatepatient rooms are recommended for those on droplet precautions. See Appendix A in the CDC document for a list of organisms known to spread via droplets.
Airborne precautions are some of the most extensive precautions observed within a routine hospital environment. These precautions require a negative pressure room (outside air is pulled into the room, filtered, and/or vented to the outside), N95 mask or other similar fine-particulate mask that fits snugly around the mouth and nosex for providers, and all PPE described in previous precautions as needed. If a negative-pressure room is not available, the patient and healthcare providers can both apply masks to reduce likelihood of transmission until adequate facilities are available.
An organism qualifies as an airborne disease if the organism or its infectious particles can travel “long” distances (no specifics, but greater than droplet distances) and survive for quite some time outside a host.
Providers that are not immune to chickenpox, smallpox, or measles should avoid caring for patients with these airborne diseases if possible.
For further research or questions, refer to the CDC 2007 Guidelines in PDF form. We also offer several courses on Infection Control found here for CEU credit! Take advantage of our best sale going on NOW for unlimited access to our courses for the low yearly price of only$19!