Isolation Class 10

Last Class

Preventing the spread of infection

• What do we do when a client has a highly infectious disease?

Specific Infection Control Policies

• Isolation – the principle is to create a physical barrier that prevents the transfer of microorganisms.

What are appropriate barriers? Depending on -

• Organism Transmission• Airborne• Vehicle• Contact

• Direct• Indirect• Droplet

Types of Barriers

• PPE (personal protective equipment)• Gowns• Gloves• Masks• Eyewear

• Each institution is required to have infection control policies and guidelines.

What about when we don’t know?

• 3 systems• Universal precautions• Body substance precautions• Standard precautions

Precautions to guard against the unknown

• Apply to everyone• General public• May or may not carry an infection

History Lesson

• Initially concerned with patient to patient

• Followed by concern for health care professionals

• 1970 – Hepatitis B• 1987 – HIV

• Universal precautions by Center for Disease Control (CDC)

Universal precautions

Stated : All blood & body flds should be

treated as potentially infectious.

Body Substance Isolation (BSI)

• Infection control practitioners in Seattle and SanDiego

• Canada adopted policy but renamed it Body Substance Precautions (BSP)

Standard Precautions

• 1996- newest guidelines by CDC combined the major features of universal precautions & BSP

2 Tier System

• 1996 CDC new guidelines

1st Tier – Standard Precautions• Most important• Universal precautions + BSP• Applies to everyone• Primary strategies for prevention

of infection• Standard precautions

• Blood, body flds., nonintact skin, mucus membranes

2nd Tier

• Specific infections/diagnosis• Droplet, airborne, contact with

contaminated surface

3 Types Transmission Based Precautions

• Airborne, droplet, contact• Some infections combination

(chicken pox)• These extra precautions are in

addition to Standard Precautions

Airborne

• Travels on small particles• Air currents• Portal of entry – nose, mouth,

mucus membranes• Measles, chicken pox, TB

Requirements for Airborne

• Negative pressure room – door closed

• TB = HEPA filter • Do not enter if not immune to

measles/chickenpox• Client wears mask when required

to leave room

Droplet

• Large droplets of moisture• Coughing, sneezing, talking

• Travels 3 ft. or less• Enters nose / mouth• Mumps, pertusis, influenza

• Private room• Staff regular mask for 3 ft. • Client mask for transport

Contact

• Dry skin to dry skin = Direct • Dry skin to object = Indirect• Impetigo, herpes zoster, scabies• Gloves – for direct care or

touching anything in the room• Private room or semi if cohort has

same diagnosis

• Remove gloves prior to exiting and wash hands

• Gown for • patient contact• Changing linen• Handling objects in the room

• Remove gown prior to exiting• Wash hands• Careful clothing does not touch

room surfaces

Protective Isolation / Reverse isolation

• Compromised or suppressed immune system

• Highly susceptible to infections• Protection from environmental

pathogens

Protective Isolation / Reverse isolation

What do you need ?• Private room – door closed• Gown, mask, gloves if direct

contact• Wash hands• No plants / flowers

Procedure

• Before instituting• EXPLAIN to client & family

•Disease•Purpose of isolation•Steps to follow•Time frame

Room Preparation

• Private with BR facilities• Sign on door• Isolation cart outside door• Laundry hamper in room• Waste basket with plastic bag• Thermometer, B/P cuff, stethoscope in

room• Sharps receptacle

• Be organized• Gather equipment prior to entering

room• Remove rings and wash hands• Don PPE• Gown usually disposable• Gloves up over cuff of gown

• Put your watch in a plastic bag if no clock in room

• Linen is placed in a water soluble bag & then cream/yellow bag

• No special treatment for dishes / trays

Exiting Room

• Untie gown at waist • Remove gloves properly• Remove mask• Untie gown at neck, drop over

shoulders, don’t touch outside, fold inwards, and discard

Exiting Room

• Wash hands • Use paper towel on door handle• Wash hands again outside roomImportant to do as much client

care as you can while you are in the room….CLUSTER ACTIVITY.

Basic Principles

• Wash hands prior to entering & exiting room

• Careful disposal of contaminated materials

• Knowledge of disease and mode of transmission

• Protection of client and public during transport

Client Consideration

• Isolation• Loneliness• Self – esteem, body image• Boredom

Sterile Technique / Surgical Asepsis

Purpose – to eliminate all microorganisms from objects that come into contact with the tissues of the body that are normally sterile.

Practice Areas

• Operating room• Labor and delivery• Major diagnostic area• At the bedside in 3 main

situations1. Procedures requiring intentional

perforation of the skin

2. When the skin’s integrity is broken due to surgery or burns

3. During procedures involving insertion of devices into normally sterile body cavities

• Any break in technique could result in contamination increasing clients risk for infection.

Methods of Sterilization

• Steam – most common• Dry heat• Ethylene oxide gas• Chemicals• Indicator of sterility –

• tape on pkg. turns color or forms lines• Expiration Date

Examples of sterilization processes• Moist heat /steam

• Radiation

• Autoclave- instruments, parental solutions, dressings

• Drugs, foods, heat sensitive items

Examples of sterilization processes• Chemicals

• All types microorganisms

• Rapid action• Work with water• Stable in heat &

light• Inexpensive • Not harmful to

body tissue

• Instruments• Glass

thermometers• Ex. Chlorine –

used to disinfect water & for housekeeping purposes

Examples of sterilization processes• Ethylene oxide

gas• Destroys

microorganisms by altering cells’ metabolic processes.

• Rubber • Plastic

Examples of sterilization processes• Boiling water

• Cheap• Imp. – bacterial

spores andsome viruses resist boiling. Not used in hospitals!

• Items should be boiled for at least 15 min.

Practical Exam

• Prepare a sterile field• Add an item• Add a liquid• Don sterile gloves