NURSING FOUNDATION

UNIT XI INFECTION CONTROL IN CLINICL SETTING

TOPIC:ISOLATION PRECAUTIONS [ BARRIER NURSING ]

Presented By:
Mrs Bemina JA
Assistant Professor
ESIC College of Nursing
Kalaburagi
INTRODUCTION
 Isolation refers to techniques used to prevent or limit the
spread of infection.
 Some forms of isolation has been used for centuries,
whether to protect a high-risk person from exposure to
pathogens or to prevent the transmission of pathogens from
an infected person to others.
 Barrier nursing or isolation technique is intended to
confine the micro-organisms within a given and recognized
area.
 There are a number of isolation techniques and precautions
used to prevent the spread of infection.
Definition
 Barrier nursing is a largely archaic term for a set of
stringent infection control  techniques used in nursing
 It is sometimes called "bedside isolation."
 The nursing technique by which a patient with an

infectious disease is prevented from infecting other

people is called barrier nursing
Purposes

The aim of barrier nursing

 Is to protect medical staff against infection by patients
 To protect patients with highly infectious diseases from

spreading their pathogens to other non-infected people.

Types of Transmission Based Precautions

 Contact Precautions
 Airborne Precautions
 Droplet Precautions
 Protective Isolation
 Three more elements have been added to standard

precautions.
 Respiratory hygiene/cough etiquette
 Safe injection practices
 Use of masks for insertion of catheters or injection into spinal

or epidural areas
Contact Precautions
 Clean, non-sterile gloves are usually adequate for routine care of the
patients
 Use gloves before providing care to patient
 Change gloves after contact with infective material.
 After providing care, remove gloves and wash hands
 Follow proper use of protective gown in case of direct contact with
patient with potentially contaminated environmental surfaces and
observe hand hygiene
 Limit the movement or transport of the patient from the room.
 Make sure any infected or colonized areas are contained or covered.
 Ensure that patient care items, bedside equipment and frequently
touched surfaces receive daily cleaning. 
 Airborne Precautions
 Used to prevent or reduce the transmission of micro-organisms
that are airborne in small droplet nuclei (5 or smaller in size)
or dust particles containing the infectious agent.
 Place the patient in private room that has negative air
pressure, with 6-12 air changes/per hour.
 If not available, cohort with patient with active infection with
same microorganism
 Use of respiratory protection
 Limit movement and transport of the patient.
 Use a mask on the patient if they need to be moved
 Keep patient room door closed.
Droplet Precautions
 Used to reduce the risk of transmission of microorganisms transmitted
by large particle droplets (larger than 5 in size).
 Droplets usually travel 3 feet or less within the air and thus special air
handling is not required, however newer recommendations suggest a
distance of 6 feet be used for safety.
 Place the patient in a private room
 Use of respiratory protection such as a mask when entering the room
recommended and definitely if within 3 feet of patient
 Limit movement and transport of the patient
 Use a mask on the patient if they need to be moved and follow
respiratory hygiene/cough etiquette
 Keep patient at least 3 feet apart between infected patient and visitors
 Room door may remain open
Respiratory Hygiene/Cough Etiquette
 Informing personnel if they have any symptoms of respiratory
infection•
 Health educate patients and visitors to cover their mouth/nose while
coughing and sneezing
 • Proper disposal of used materials, during coughing and sneezing
 • Use of surgical masks on coughing person when appropriate
 • Providing alcohol-based hand-rubbing dispensers and supplies for hand
hygiene and educating patients and staff in their use,
 • Encouraging hand hygiene after coughing or sneezing.
 • Separating coughing persons at least 3 feet away from others in a
waiting room or have separate locality.
 • Instructing patients and providers not to touch eyes, nose, or mouth.
 • Health care workers should use standard precautions with all patients.
Safe injection practices
 Correct disposal in appropriate container
 Avoid re-sheathing needle
 Avoid removing needle
 Discard syringes as single unit
 Avoid over-filling sharps container
 Use of masks for insertion of catheters or injection into

spinal or epidural areas 

Barrier Techniques Infection Control
 1. Aseptic technique[Hand Washing]
 2. Isolation
 3.Personal protective equipments
 4. Decontamination of equipments and unit[Safer Handling of
Sharps, Linen handling and disposal]
 5. Waste disposal
 6. Transportation of infected patients [Handling Biological Spills
 7. Standard safety precautions[Universal precautions]
 7. Environmental cleaning
 8. Risk assessment
 9. Staff health
Aseptic technique[Hand Washing]
 ASEPTIC TECHNIQUE
 • Sepsis - harmful infection by bacteria
 • Asepsis - prevention of sepsis
 • Minimise risk of introducing pathogenic micro- organisms into
susceptible sites
 • Prevent transfer of potential pathogens from contaminated site to other
sites, patients or staff
 • Follow local policy of your hospital
 • Disinfect clean skin with an appropriate antiseptic before insertion and
at the time of dressing changes.
 • A 2% chlorhexidine is preferred.
 Hand hygiene is the single most important measure for control of
nosocomial infections
Hand washing
Introduction
 Hand washing is the single most effective way to prevent

the spread of germs/micro-organism which prevent

communicable diseases.It’s easy to learn how to wash
your hands and how to stop the spread of infection by
washing the germs away. Good hand washing can prevent
diseases such as: Shigellosis,E. Coli, Streptococcal
Disease, Influenza and the Common Cold. We can pick-
up germs from doorknobs, stair railings or anything that
has been touched by others who aren’t good hand washers
Definition of hand washing
 Hand washing or hand hygiene is the act of cleaning
one's hands with or without the use of water or another
liquid, or with the use of soap for the purpose of
removing soil, dirt, and/or micro organisms.
Who should  practice hand hygiene
 Hand hygiene practicing is not important only for

health care Providers, everyone needs to practicing

appropriate & effective hand hygiene to prevent spread
of micro organisms.
MANY PERSONNEL DON’T REALIZE WHEN THEY HAVE MICROBES
ON THEIR HANDS
 • Healthcare workers can get 100s to 1000s of bacteria on their hands
by doing simple tasks like:
 • pulling patients up in bed
 • taking a blood pressure or pulse
 • touching a patient’s hand
 • rolling patients over in bed
 • touching the patient’s gown or bed sheets
 • touching equipment like bedside rails, overbed tables, IV pumps

WHY WE ARE NOT WASHING HANDS ???

 • Working in high-risk areas
 • Lack of hand hygiene promotion
 • Lack of role model
 • Lack of institutional priority •
 Lack of sanction of non-compliers
Where should you perform hand hygiene
   1. Busy health care providers need access to hand
hygiene products where patient or patient environment
contact is taking place.
 2. Hand hygiene is important in all

work settings, including Acute Care, Long Term Care

Facilities, Community and Corporate sites.
 3. Providing alcohol-based hand rub at the point of care

(within arm’s reach) is an important system support to

improve hand hygiene
When do you perform hand hygiene/ Indications

 Hand hygiene is essential :

• 1-When hands are visible soiled
• 2-Before and after caring for a patient
• 3-After contact with organic material ,such as feces ,wound drainage ,and
mucus
• 4-In preparation for an invasive procedure ,such as suction catheterization ,or
injections
• 5-Before changing a dressing or having contact with open wounds
• 6-Befor preparing and administrating medications
• 7-After removing disposable gloves
• 8-Before and after using the toilet
• 9-Before and after eating
• 10-At the beginning and end of the shift.
11-Before initial patient or patient environment contact
Why do we need to learn about Hand
Hygiene
 1. Hand hygiene is the most important way to prevent
the spread of germs.
 2. Hand hygiene helps keep you healthy by reducing

the number of germs on your hands and helps reduce

the spread of germs to your family, friends, co-workers,
patients, residents or clients.
 3. Using appropriate hand hygiene prevents

contamination of the patient’s, client’s, or resident’s

environment.
HAND HYGIENE TECHNIQUES

 1- Routine Hand washing 10-15 seconds

• Washing hands with plain soap and water
 2- Antiseptic hand wash 1 minute
• Washing hands with water and soap or other antiseptic agent
 3- Alcohol-based hand rub
• Rubbing hands with an alcohol-containing preparation (used
after hand washing)
 4- Surgical antisepsis 3-5 minutes
• Hand washing with antiseptic soap or alcohol- based hand
rub before operations by surgical personnel
How to perform hand hygiene
 Proper technique is important when it comes to effective
hand hygiene. Without proper hand hygiene technique, we
can still spread many micro-organisms with our hands. This
section will cover the proper techniques for the following
procedures 1. Wet hands under running water 2. Apply soap
and distribute over hands 3. Rub hands together vigorously
for 15 seconds to create a good lather: Palm to palm 4. Rub
fingertips of each hand in opposite palm
 5. Between and around fingers 6. Rub each thumb clasped

in opposite hand 7. Rub back of each hand with opposite

palm 8. Rinse hands thoroughly under running water.
HAND CARE

 • Nails
 • Rings
 • Hand creams
 • Cuts & abrasions
 • “Chapping”
 • Skin Problems
 Rings and Jewelry Studies have demonstrated that skin
underneath rings is more heavily colonized than
comparable areas of skin on fingers without rings.
 Keep fingernails SHORT! Not excesses
• 1/4 inch – Avoid artificial nails – Avoid nail polish
Fingernails

ISOLATION
 Designed to prevent transmission of microorganisms by common
routes in hospitals.
 Because agent and host factors are more difficult to control,

interruption of transfer of microorganisms is directed primarily at

transmission.
Single room or group
 Source or protective

Source - isolation of infected patient

• mainly to prevent airborne transmission via respiratory droplets
• respiratory MRSA, pulmonary tuberculosis
Protective - isolation of immune-suppressed patient
• Significant psychological effects  
Personal Protective Equipment (PPE)
 PPE is a precautionary step to protect yourself and the people around you.
 PPE is specialized clothing or equipment worn for protection against

dangerous or infectious materials.

 PPE prevents contact with an infectious agent by creating a barrier between

the potentially infectious material and the public health practitioner.

Purpose of PPE
 Public health practitioners should wear PPE to:

 Stop the spread of illness/infection

 Protect their health
 Protect their client's health
 Protect their family's health
 Protect the community's health
PERSONAL PROTECTIVE EQUIPMENT

 PPE when contamination or splashing with blood or body

fluids is anticipated
 Disposable gloves
 Gowns, aprons, coveralls
 Respirators/Masks
 Goggles or Face shields
 Plastic aprons
 Face masks
 Safety glasses, goggles, visors
 Head protection / Hair covers
 Foot protection/ Shoe covers
PPE Gadgets
 Masks
 There are several types of masks to prevent the spread

of infectious disease.
 They vary in shape (rectangular, round) and method of

securing (elastic, ties

 Note that masks are not respirators.
 They do not protect you from airborne transmitted

diseases, just droplet transmitted disease.

 Goggles
 Goggles or face shields protect the mucous membranes

of the eyes, nose and mouth during situations where

blood, body fluid, secretions, or excretions may splash
or spray.
 Eye glasses do not provide an adequate level of

protection.
 Goggles cover the top, front and sides of the eye area,

providing the proper protection from splashes and

sprays that eyeglasses do not.
 Some brands of goggles can be decontaminated and

reused
 GLOVES
 It is important to select the right size gloves to provide

proper protection from infectious agents.

 Remember to change gloves if they become torn or

heavily contaminated during use.

 Gloves are not a substitute for hand hygiene!
RESPIRATORS
 Several types of respirators can be worn to control the spread of infectious

disease.
 Respirators vary in size, shape (oval or round), and level of respiratory

protection offered (N95 versus N100).

 Unlike masks, respirators must be fit-tested before use to ensure they fit

properly.
 Respirators must have a mask-to-face seal and must be checked annually to

make sure they are providing adequate protection.

 Fit-testing is the procedure used to check for a correct mask-to-face seal

and involves testing to ensure there is no air leakage between the mask and
the face.
 Using a respirator that has not been fit-tested for your face provides only

droplet based transmission protection, which only reduces the risk of

transmission via large particle droplets generated by coughing, sneezing or
talking.
 It will not protect you from airborne transmitted diseases.
Donning PPE
 Per CDC guidance, PPE should be donned in the
following order:
 Gown (or apron/coverall)
 Shoe and/or hair covers (if worn)
 Mask/respirator
 Goggles (or face shield in lieu of mask and goggles)
 Gloves (if you are wearing a gown, tuck the gown
cuffs securely under each glove)
Removing PPE
 To Undo ! Recommended sequence of removal of PPE
 Since gloves are considered the most contaminated (compared to masks and gowns) remove first.
 The gown can then be removed by handling the portion of the gown that the gloves were on top
of (i.e. the most distal portion of the sleeves) as this portion would be considered clean. This is the
reason for the order recommended by the CDC.
 After removing PPE, discard immediately and properly to prevent contamination of the clean
area.
 Always remember to perform hand hygiene immediately after removing PPE.
 Remove PPE in an area where you are not in danger of exposure to the infectious agent, such as a
separate room, a porch, a garage, or entryway. Then identify the clean areas and contaminated
areas of the PPE.
 Clean areas: have not been in contact with infectious agent
 Contaminated areas: have been in contact with infectious agent
 TO LIMIT SELF-CONTAMINATION, REMOVE PPE IN THE FOLLOWING ORDER:
 1. Gloves
 2. Goggles (or face shield)
 3. Gown (or apron/coverall)
 4. Shoe and/or hair covers (if worn)
 5. Mask/ respirator
Keys to Workplace Safety
Provide supplies for hand hygiene.
 All rest rooms must have hot water, soap, and paper towels for proper hand washing.

 Hand sanitizer should be available to all visitors and staff; placed at entrances, desks,

hallways, staff lounge and waiting areas.

Post visual alerts
 Place signs and posters at the entrances and in strategic places (e.g., restrooms,

elevators, cafeterias) to provide staff and visitors with instructions (in appropriate
languages) about respiratory hygiene and cough etiquette.
Provide PPE in the Workplace
 Inform staff of the types of PPE that are available in the workplace and where they

are located.
 PPE should be stored in a secure location, but should be easily accessible by staff

when needed.
 A policy should be devised to track PPE use, when to replace PPE supply, and how to

properly dispose of used PPE

Conclusion
 Psychological effects of being separated from healthcare
personnel, family, and friends may occur when isolation
precautions are used.
 Patients may mistakenly feel dirty or untouchable, especially if
they have diseases that are considered socially unacceptable.
 Lack of social interaction can be psychologically injurious.
 Maintaining the patient’s social support before, during, and
after care by being present, listening to the patient’s concerns
and answering questions while adhering to infection control
practices is crucial for the patient’s well-being and healing.
 Answering call lights promptly to alleviate feelings of
abandonment is also important.