Isolation Class 10

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Isolation Class 10

• Last Class

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Preventing the spread of infection

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

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Specific Infection Control Policies

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

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What are appropriate barriers? Depending on -

• Organism Transmission
• Airborne
• Vehicle
• Contact
• Direct
• Indirect
• Droplet

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Types of Barriers

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

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

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What about when we dont know?

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

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Precautions to guard against the unknown

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

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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)

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Universal precautions

• Stated
• All blood body flds should be treated as
  potentially infectious.

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Body Substance Isolation (BSI)

• Infection control practitioners in Seattle and
  SanDiego
• Canada adopted policy but renamed it Body
  Substance Precautions (BSP)

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Standard Precautions

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

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2 Tier System

• 1996 CDC new guidelines

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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

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2nd Tier

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

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3 Types Transmission Based Precautions

• Airborne, droplet, contact
• Some infections combination (chicken pox)
• These extra precautions are in addition to
  Standard Precautions

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Airborne

• Travels on small particles
• Air currents
• Portal of entry nose, mouth, mucus membranes
• Measles, chicken pox, TB

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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

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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

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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

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• Remove gloves prior to exiting and wash hands
• Gown for
• patient contact
• Changing linen
• Handling objects in the room

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

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Protective Isolation / Reverse isolation

• Compromised or suppressed immune system
• Highly susceptible to infections
• Protection from environmental pathogens

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Protective Isolation / Reverse isolation

• What do you need ?
• Private room door closed
• Gown, mask, gloves if direct contact
• Wash hands
• No plants / flowers

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Procedure

• Before instituting
• EXPLAIN to client family
• Disease
• Purpose of isolation
• Steps to follow
• Time frame

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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

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• Be organized
• Gather equipment prior to entering room
• Remove rings and wash hands
• Don PPE
• Gown usually disposable
• Gloves up over cuff of gown

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• 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

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Exiting Room

• Untie gown at waist
• Remove gloves properly
• Remove mask
• Untie gown at neck, drop over shoulders, dont
  touch outside, fold inwards, and discard

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Exiting Room

• Wash hands
• Use paper towel on door handle
• Wash hands again outside room
• Important to do as much client care as you can
  while you are in the room.CLUSTER ACTIVITY.

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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

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Client Consideration

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

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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.

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Practice Areas

• Operating room
• Labor and delivery
• Major diagnostic area
• At the bedside in 3 main situations
• Procedures requiring intentional perforation of
  the skin

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1. When the skins integrity is broken due to
   surgery or burns
2. During procedures involving insertion of devices
   into normally sterile body cavities

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

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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

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Examples of sterilization processes

• Moist heat /steam
• Radiation

• Autoclave- instruments, parental solutions,
  dressings
• Drugs, foods, heat sensitive items

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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

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Examples of sterilization processes

• Ethylene oxide gas
• Destroys microorganisms by altering cells
  metabolic processes.

• Rubber
• Plastic

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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.

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Practical Exam

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