Isolation (health care)


In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient. Various forms of isolation exist, in some of which contact procedures are modified, and others in which the patient is kept away from all other people. In a system devised, and periodically revised, by the U.S. Centers for Disease Control and Prevention, various levels of patient isolation comprise application of one or more formally described "precaution".
Isolation is most commonly used when a patient is known to have a contagious viral or bacterial illness. Special equipment is used in the management of patients in the various forms of isolation. These most commonly include items of personal protective equipment and engineering controls. Dedicated isolation wards may be pre-built into hospitals, or isolation units may be temporarily designated in facilities in the midst of an epidemic emergency.
Isolation should not be confused with quarantine or biocontainment. Quarantine is the compulsory separation and confinement, with restriction of movement, of individuals or groups who have potentially been exposed to an infectious microorganism, to prevent further infections, should infection occur. Biocontainment refers to laboratory biosafety in microbiology laboratories in which the physical containment of highly pathogenic organisms is accomplished through built-in engineering controls.
When isolation is applied to a community or a geographic area it is known as a cordon sanitaire. Reverse isolation of a community, to protect its inhabitants from coming into contact with an infectious disease, is known as protective sequestration.

Importance

can spread to others through various forms. Four types of infectious disease transmission can occur:
  1. contact transmission, which can be through direct physical contact, indirect contact through fomites, or droplet contact in which airborne infections spread short distances,
  2. vehicular transmission, which involves contaminated objects,
  3. airborne transmission, which involves spread of infectious particles through air,
  4. vector transmission, which is spread through insects or animals.
Depending on the contagious disease, transmission can occur within a person's home, school, worksite, health care facility, and other shared spaces within the community. Even if a person takes all necessary precautions to protect oneself from disease, such as being up-to-date with vaccines and practicing good hygiene, he or she can still get sick. Some people may not be able to protect themselves from diseases and may develop serious complications if they contract the disease. Therefore, disease isolation is an important infection prevention and control practice used to protect others from disease. Disease isolation can prevent healthcare-acquired infections of hospital-acquired infections, reduce threats of antibiotic resistance infections, and respond to new and emerging infectious disease threats globally.

Types of precautions

The U.S. Centers for Disease Control and Prevention created various levels of disease isolation. These precautions are also reviewed and revised by the CDC.

Universal/standard

Universal precautions refer to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The practice was widely introduced in 1985–88. In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions. Use of personal protective equipment is now recommended in all health settings.
One of the most standard practices for all medical professionals to reduce spread of disease is hand hygiene, or removing microorganisms from your hands. Frequent hand hygiene is essential for protection of healthcare workers and patients from hospital-acquired infection. Hospitals have specific approved disinfectants and approved methods for hand washing; defined by the American Nursing Association and American Association of Nurse Anesthetists, proper hand washing with soap and water is defined as, splash water on hands, apply antiseptic soap, and scrub for at least 20 seconds. Approved hand washing with alcohol based sanitizers is, apply sanitizer to middle of hand and rub hands together covering all surfaces and fingernails until dry without touching anything.

Transmission-based

Transmission-based precautions are additional infection control precautions – over and above universal/standard precautions – and the latest routine infection prevention and control practices applied for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens. The latter require additional control measures to effectively prevent transmission. There are three types of transmission-based precautions:
  • Contact precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient's environment.
  • Droplet precautions are intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions.
  • Preventative measures such as personal protective equipment can be worn to prevent direct contact with mucous membrane and respiratory secretion. Many techniques can be applied in order to stop the spread of disease such as gloves. Along with gloves, gowns are also advised to be worn; gowns must be fitted with correct coverage, be tied tightly around the back, and disposed of in the proper receptacles prior to removal of gloves. Eye protection, hair coverings, and surgical masks are also required; all PPE, eye protection, hair coverings, and masks must be properly fitted to the face, covering eyes, nose, hairs, and mouths, be pre-tested in order to assure they are the correct size, and be sanitized or disposed of after contact with patient.
  • Airborne precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air.
  • Airborne pathogens can remain in the air and on objects for long periods of time; one of the easiest ways to prevent this spread is through disinfection and sterilization. The American Nurses Association and American Association of Nurse Anesthesiology set guidelines for sterilization and disinfection based on the Spaulding Disinfection and Sterilization Classification Scheme. The SDSCS classifies sterilization techniques into three categories: critical, semi-critical, and non-critical. For critical situations, or situations involving contact with sterile tissue or the vascular system, sterilize devices with sterilants that destroy all bacteria, rinse with sterile water, and use of chemical germicides. In semi-critical situations, or situations with contact of mucous membranes or non-intact skin, high-level disinfectants are required. Cleaning and disinfecting devices with high-level disinfectants, rinsing with sterile water, and drying all equipment surfaces to prevent microorganism growth are methods nurses and doctors must follow. For non-critical situations, or situations involving electronic devices, stethoscopes, blood pressure cuffs, beds, monitors and other general hospital equipment, intermediate level disinfection is required. "Clean all equipment between patients with alcohol, use protective covering for non-critical surfaces that are difficult to clean, and hydrogen peroxide gas...for reusable items that are difficult to clean."

    Isolation

According to the CDC, isolation is the act of separating a sick individual with a contagious disease from healthy individuals without that contagious disease in order to protect the general public from exposure of a contagious disease.
Special equipment is used in the management of patients in the various forms of isolation. These most commonly include items of personal protective equipment and engineering controls. Dedicated isolation wards may be pre-built into hospitals, or isolation units may be temporarily designated in facilities in the midst of an epidemic emergency.
Many forms of isolation exist.
Contact isolation is used to prevent the spread of diseases that can be spread through contact with open wounds. Health care workers making contact with a patient on contact isolation are required to wear gloves, and in some cases, a gown.
Respiratory isolation is used for diseases that are spread through particles that are exhaled. Those having contact with or exposure to such a patient are required to wear a mask.
Reverse isolation is a way to prevent a patient in a compromised health situation from being contaminated by other people or objects. It often involves the use of laminar air flow and mechanical barriers to isolate the patient from any harmful pathogens present in the external environment.
High isolation is used to prevent the spread of unusually highly contagious, or high consequence, infectious diseases. It stipulates mandatory use of: gloves, protective eyewear, a waterproof gown, and a respirator, not simply a surgical mask. Sometimes negative pressure rooms or powered air-purifying respirators are also used.
Strict isolation is used for diseases spread through the air and in some cases by contact. Patients must be placed in isolation to prevent the spread of infectious diseases. Those who are kept in strict isolation are often kept in a special room at the facility designed for that purpose. Such rooms are equipped with a special lavatory and caregiving equipment, and a sink and waste disposal are provided for workers upon leaving the area.