ISOLATION Caring for patients on isolation and protecting yourself Crisp & Taylor, Chapter 33: Infection Control

Why are some patients on isolation? Either they are infected with microorganisms that can be harmful to you so you are protecting yourself, OR they have a limited or no immune system and you are protecting them from YOU! The isolation information you will read herein absolutely fits with the infection control information you received when you learned about handwashing and how important it is.

What are some examples of conditions that patients may be placed on isolation? Tuberculosis ESBL MRSA VRE Rubella Varicella Influenza

There are 3 categories of isolation to remember:

How are isolation practices carried out? Either by the use of: 1.Protective environment 2.Personal protective equipment (PPE)

1. Protective Environment Private rooms are used for isolation and may have negative pressure airflow to prevent infectious particles from flowing out of the room (see picture next slide). Positive pressure airflow usually used in operating theatres. The ante-room or prep room contains clean isolation equipment as well as PPE and impervious isolation laundry bag for contaminated linen. Dedicated use of articles such as stethoscopes, BP cuffs, and thermometers should be left in the room of the isolation room as to prevent cross-contamination throughout the ward. If such equipment needs to be used on other patients, they need to be thoroughly cleaned with a hospital grade disinfectant.

The perfect isolation room Ante room aka prep room Pt bathroom

2. Personal Protective Equipment (PPE) The use of PPE protects the clothes and healthcare personnel and visitors from coming in contact with infected material. Gowns are full-arm/knee length and are usually made of a fluid-resistant material, and may either be disposable or reusable. Used gowns need to be removed carefully to minimise contamination of the hands and uniform. Masks or face shields should be worn when it is possible that blood or body fluids may be splashed or sprayed into the health worker’s face. A correctly applied mask fits snugly over the mouth and nose so that pathogens and body fluids cannot enter or escape through the sides. When a mask is work, moisture increased around the mouth and nose, diminishing its effectiveness as a barrier to microorganisms. The mask should be discarded and never reused. Patients with droplet or airborne infections, transported outside their room should wear a mask to protect other patients and personnel. Clean non-sterile glove need to be worn at all times and should be changed between tasks/procedures on the same patient after contact with material that may contain a high concentration of microorganisms.

Putting on PPE 1.Perform handwashing #1 2.Put on gown – Unfold the gown, Hold the gown so that the opening faces you. – Place one arm at a time into the sleeve and down the gown, Pull the gown up over the shoulders, overlapping the gown at the back. – Tie the neck and waist strings in a bow, not a knot. Rationale: Proper application of the gown prevents transmission of infection and protects the nurse when the patient has excessive drainage or discharge.

3. Put on mask – Place either mask (surgical or N95) on. – Position the mask to cover the both the nose and mouth – Bend the nose bar over the bridge of the nose, apply eye protection if required. – Some masks are fastened with ties, others with elastic. If the mask has ties, place the mask over your mouth, nose and chin. Fit the flexible nose piece to the form of your nose bridge; tie the upper set at the back of your head and the lower set at the base of your neck. – If a mask has elastic head bands, separate the two bands, hold the mask in one hand and the bands in the other. Place and hold the mask over your nose, mouth, and chin, then stretch the bands over your head and secure them comfortably as shown; one band on the upper back of your head, the other below the ears at the base of the neck. – Adjust the mask to fit. Remember, you don’t want to be touching it during use so take the few seconds needed to make sure Rationale: Correct application of the correct mask reduces the risk of exposure to airborne microorganisms or exposure to microorganisms from splashing of fluids.

4. Put on Gloves – Select appropriate size and pull the gloves up to cover the cuffs of the gown.

Removing PPE (either at doorway or in anteroom) 1. Remove gloves first – Remember-outside of gloves are contaminated – Grasp outside of one glove with the opposite gloved hand; peel off and hold removed glove in gloved hand. – Slide fingers of ungloved hand under remain glove at wrist and peel glove off over first glove so they form an enclosed ball & discard gloves in isolation waste container Perform hand wash #2 now

Removing PPE 2.Remove gown -Remember, gown sleeves and front are contaminated -Untie the waist strings of the gown first, followed by the neck strings/velcro. -Place a forefinger under the cuff and pull down over the hand and with the hand inside first sleeve, draw second sleeve down over other hand. -Slide gown down & away from body constantly rolling it into itself so the clean inside is now the outside and the contaminated outside is safely on the inside. -Discard into the isolation waste container then… Perform hand wash #3 now.

Removing PPE 3.Remove mask -Remember, front of mask is contaminated -Remove eye protection if used, discard or place in container for sterilization -Depending on the type of mask you are wearing, remove one strap then the other. -Simple rule, if two straps, untie bottom strap first, then the second strap, and pull mask down and away from face and discard in isolation waste container. Perform hand wash #4 now.

Remember: Gloves are task specific, if grossly contaminated, change as necessary. Gowns and masks are single use only. You never want to let anything outside from the inside of the isolation room without being cleaned or sterilized first. Prevent extra trips into and out of the room; gather all needed equipment and supplies before you enter the room. Other equipment that may be used for isolation: -Disposable culinary utensils and plates/cups. -Disposable K-basins, vomit cups -Sharps container if one not already in room -Plastic isolation laundry bags.

A word about the psychological impact of isolation on a patient… Being secluded to a private room can make a patient feel unclean, rejected, lonely or guilty and infection control practices and enforced these beliefs about difference and undesirability. Isolation can cause depression in patients and is particularly hard on children who may not understand the reasons why they are isolated from others and others, especially kin, have to wear isolation gear. As nurses, we are in a prime position to reduce psychological and physical isolation to improve the patients’ emotion state and recovery. A full explanation of the nature of the disease or condition, how infectious organisms are transmitted, the difference between contaminated and clean objects, the purposes of isolation and specific precautions need to be explained. The patient and family/visitors need to be taught proper handwashing and the donning and removal of PPE. The nurse should implement measures to improve the patient’s sensory stimulation, i.e. maintaining a clean, pleasant, and clutter-free environment, curtains open, taking time when in the room providing nursing care, talking, laughing, repositioning, back massage, or even keeping the radio or newspapers/magazine in the room.

Links Australian Government National Health and Medical Research Council healthcare-2010/b1-2-personal-protective World Health Organisation Practical guidelines for infection control in health care facilities Mosby’s Nursing Skills (Go to index, choose “I”, then “Isolation Precautions”) (Go to index, choose “C”, then “Caps, Masks, and Protective Eyewear”)