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Isolation Precautions in Nursing Care

Nursing Care Guideline Contact, Airborne, and Protective Isolation

Contact Precautions

  • Purpose: Used when a known or suspected contagious disease may be present.

    • **Transmission Routes:
    • Direct Transmission:** Contact with the patient.
    • Indirect Transmission: Contact with equipment or items in the patient's environment.

  • Typical Diseases and Conditions Requiring Contact Precautions:

    • Multidrug-resistant organisms, including:
    • Vancomycin-resistant enterococci (VRE)
    • Methicillin-resistant Staphylococcus aureus (MRSA)
    • Clostridioides difficile (C. diff)
    • Respiratory syncytial virus (RSV)
    • Hepatitis A
    • Scabies and herpes simplex virus
    • Draining wounds in which specific organisms have been cultured.

Airborne Precautions

  • Purpose: Used when known or suspected contagious diseases are transmitted by small droplets or particles suspended in the air for prolonged periods.

  • Transmission Characteristics:

    • Small droplets or particles can cause disease transmission over greater distances and longer timeframes than larger droplets.

  • Precautions:

    • A negative-pressure room with a high-efficiency particulate air (HEPA) filtration system is necessary.
    • A special N95 respirator mask is required.
    • Medical evaluation and measurement for the wearer are required before obtaining the respirator.
    • The respirator must be fit-tested by the facility.
    • Eye protection (goggles or face shield) is worn in certain circumstances.

  • Typical Diseases and Pathogens:

    • Varicella or disseminated varicella zoster (chickenpox)
    • Rubeola (measles)
    • Mycobacterium tuberculosis (pulmonary or laryngeal tuberculosis)
    • COVID-19 (SARS-CoV-2 or coronavirus)
    • Recommended PPE for COVID-19 includes:
      • N-95 respirators
      • Gloves
      • Gown
      • Eye protection and/or face shield

Isolation Precaution Symbol Guide

  • Isolation Type Overview:
    • Each type of isolation requires specific hygiene and protective measures as outlined below:

Hand Hygiene

  • Wash or sanitize hands with alcohol-based gel/foam before entering and upon leaving the room.

Gloves

  • Required upon entry to the room and must be removed prior to exiting the room.

Mask

  • Visitor Requirement: Surgical mask is required when entering the room.
  • Healthcare Worker Requirement: An N-95 Respirator or PAPR is required to enter the room.

Gown

  • Gown is required upon entry and must be removed upon exiting the room.

Room Management

  • Keep Door Closed:
    • The door must be kept closed to maintain negative air pressure.
  • Equipment Use:
    • Use dedicated equipment when possible.
    • Clean shared equipment between patients using hospital-approved disinfectant.

Droplet Precautions

  • Purpose: Used when known or suspected contagious diseases can be transmitted through large droplets suspended in the air.

  • Droplet Generation Mechanisms:

    • Can occur when an infected patient coughs, sneezes, or talks.
    • May also occur during medical procedures, including:
    • Suctioning
    • Tracheal intubation
    • Cardiopulmonary resuscitation
    • Chest physiotherapy.

  • Typical Diseases Include:

    • Pharyngeal diphtheria
    • Mumps, rubella, and pertussis
    • Streptococcal pharyngitis and scarlet fever
    • Pneumonias (streptococcal, mycoplasmal, meningococcal)
    • Pneumonic plague
    • Meningococcal sepsis
    • Influenza

Standard Precautions

  • Documentation: Standard precautions do not require documentation; however, patient and family education regarding these precautions should be documented.
  • Respiratory Etiquette:
    • As outlined by Siegal et al. (2019), respiratory etiquette should be part of standard precautions. This includes:
    • Covering the mouth and nose with a tissue when sneezing or coughing and disposing of the tissue immediately.
    • Washing hands after coughing or sneezing.
    • Wearing a mask if infected.
    • Education:
    • Post signs educating patients and staff about etiquette and social distancing (recommended distance of 3 feet).
    • These steps have been shown to reduce transmission of various organisms and prevent infections in healthcare facilities.

Protective Isolation

  • Purpose: Designed for patients with compromised immune systems; protects the patient from environmental microorganisms.

  • Precautions Vary Depending on the Reason for Compromise:

    • A positive-pressure room with a HEPA filtration system may be required.
    • A mask is required for anyone entering the room, or for the patient if leaving the room.
    • Meticulous Handwashing: Essential to prevent infection.
    • Environmental Restrictions: No live plants, fresh flowers, fresh raw fruit or vegetables, sushi, or bleu cheese may be brought into the room, as they may harbor bacteria and fungi.

  • Conditions Requiring Protective Precautions Include:

    • Allogeneic hematopoietic stem cell transplantation
    • Chemotherapy
    • Diseases or disorders causing immunosuppression, such as:
    • Leukemia
    • Myelodysplastic syndrome
    • Aplastic anemia
    • Systemic lupus erythematosus
    • Rheumatoid arthritis
    • HIV infection
    • Severe sepsis

References

  • Crawford, B.Y. L. (2023). Fundamentals of Nursing (3rd ed.). Elsevier - Evolve. Retrieved from https://pageburstls.elsevier.com/books/9780323828116