1. ISOLATION PRECAUTION
Dr.Saeed.kalantari

2. Learning Objectives
Discuss chain of infection and different types of mode of transmission
Define isolation precautions and describe different types isolation precautions.
Describe standard precautions procedures and conditions under which to use standard precautions
Describe contact precautions and conditions under which to use contact precautions.
Describe conditions under which to use droplet precautions.
Describe conditions under which to use airborne precautions.

3. Chain of infection
infectious diseases result from the interaction of agent,
host, and environment. More specifically, transmission occurs
when the agent leaves its reservoir or host through a portal of
exit, is conveyed by some mode of transmission, and enters
through an appropriate portal of entry to infect a susceptible
host. This sequence is sometimes called the chain of infection.
The reservoir of an infectious agent is the habitat in which the
agent normally lives, grows, and multiplies. Reservoirs include
humans, animals, and the environment. The reservoir may or may
not be the source from which an agent is transferred to a host.
Human reservoirs. Many common infectious diseases have human
reservoirs. Diseases that are transmitted from person to person
without intermediaries include the sexually transmitted diseases,
measles, mumps, streptococcal infection, and many respiratory
pathogens. Because humans were the only reservoir for the
smallpox virus, naturally occurring smallpox was eradicated after
the last human case was identified and isolated.
Human reservoirs may or may not show the effects of illness. As
noted earlier, a carrier is a person with inapparent infection who is
capable of transmitting the pathogen to others. Asymptomatic or
passive or healthy carriers are those who never experience
symptoms despite being infected.

4. Mode of transmission
A microorganism may be spread by a single or multiple routes.
Contact, direct or indirect
Droplet
Airborne
Vector-borne (usually arthropod) and
Common environmental sources or vehicles - includes food-borne and waterborne, medications e.g., contaminated IV fluids
Several main routes of transmission of microorganisms.
A microorganism may be spread by a single or multiple routes.
Types of mode of transmission:
Contact, direct or indirect
Droplet
Airborne
Vectorborne (usually arthropod) and
Common environmental sources or vehicles - includes foodborne and waterborne, medications e.g., contaminated IV fluids

5. Contact transmission Direct-contact
Direct body surface-to-body surface contact and
Physical transfer of microorganisms between a susceptible host and an infected or colonized person
Indirect-contact
Contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated hands or gloves
The most important and frequent mode of transmission of nosocomial infection
Two subgroups:
Direct-contact
Direct body surface-to-body surface contact and
Physical transfer of microorganisms between a susceptible host and an infected or colonized person
Indirect-contact
Contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated hands or gloves

6. droplet transmission Droplet generation Droplet transmission
coughing,
sneezing,
talking,
procedures such as suctioning and bronchoscopy
Droplet transmission
Droplet deposited on the host’s conjunctivae, nasal mucosa, or mouth.
Droplets – generated from the source person primarily during coughing, sneezing, and talking, and during the performance of certain procedures such as suctioning and bronchoscopy
Droplet transmission occurs when droplets containing microorganisms generated from the infected person are propelled a short distance through the air and deposited on the host’s conjunctivae, nasal mucosa, or mouth.

7. Airborne transmission
Small-particle residue {5µm or smaller} of evaporated droplets containing microorganisms
Suspended in the air for long periods of time
Dispersed by air currents
Inhaled by a susceptible host within the same room or over a longer distance
Occurs by dissemination of either airborne droplet nuclei (small-particle residue {5µm or smaller in size) of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent
Microorganisms can be dispersed by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environment factors
Therefore, special air handling and ventilation are required to prevent airborne transmission.
E.g. Mycobactarium tuberculosis and the rubeola and varicella viruses

8. Definition of Isolation Precautions
Special precautionary measures, practices, and procedures used in the care of patients with contagious or communicable diseases

9. Fundamentals of isolation precautions
Handwashing and gloving
Personal protective equipments:
Masks, respiratory protection, eye protection, face shields, gowns Patient-care equipment and articles
Linen and laundry
Routine and terminal cleaning
Patient placement
Transport of infected patients

10. Isolation Precautions
Unit 6 - Infection Control Measures
Isolation Precautions
Hand hygiene
Patient
placement
PPE
Isolation
Precautions
Patient
Transport
Routine and
Terminal Cleaning
In HA hospitals, isolation precautions should be implemented to break the transmission of infections. The elements includes hand hygiene, PPE, patient placement, decontamination, waste management, linen and laundry, and patient transport.
Each of them will be discussed in the following presentation.
Reference:
HA Infection Control Plan for Avian Influenza Jul 2006
Linen & laundry
Patient care equipment
And articles
Unit 6 - Infection Control Measures

11. Types of Isolation Precautions
Standard precautions
Transmission-based precautions
Contact precautions
Airborne precautions
Droplet precautions

12. Definition of standard precautions
Apply to all patients receiving care in hospitals regardless of their diagnosis or presumed infection status.
Apply to (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood; (3) nonintact skin; and (4) mucous membranes.
Designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals.
Apply to all patients receiving care in hospitals regardless of their diagnosis or presumed infection status.
Apply to (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood; (3) nonintact skin; and (4) mucous membranes.

13. Standard Precaution - Hand hygiene
Handwashing with either plain or antiseptic
containing soap and water, and use of alcohol-based
products (gels, rinses, foams) that do not requre the
use of water
Perform hand hygiene:
Before and after patient contact
After removing gloves or any other PPE item
After touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn
Handwashing is the single most important procedure for preventing the spread of communicable diseases.
Perform hand hygiene:
Before and after patient contact
After removing gloves or any other PPE item
After touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn
2. Improved hand hygiene practices associated with a sustained decrease of MRSA and VRE infections primarily in ICU.
Unit 6 - Infection Control Measures

14. Standard precautions – Gloves (PPE)
Exposure to blood, body fluids, secretions, excretions, mucous membranes and non-intact skin, and contaminated items
Change gloves when heavily contaminated
Perform hand hygiene immediately after glove removal
Personal Protective Equipment - Gloves
The primary design of personal protective equipment (PPE) is to protect healthcare workers (HCWs) and reduce opportunities for transmission of microorganisms in Healthcare facilities.
Gloves
Wear gloves when the procedure may expose you to blood, body fluids, secretions, excretions, mucous membrane and non-intact skin, and contaminated items
Change gloves after contact with material that may contain a high concentration of microorganisms, e.g. it may happen between tasks and procedures on the same patient
Wash hands immediately after gloves are removed.
Do not disinfect clean gloves after donning and disposable gloves should not be reused
References:
Centers for Disease Control and Prevention. (1996). Guidelines for Isolation Precautions in Hospitals Hospital Infection Control Advisory
Committee. Retrieved September 30, 2006, from
HA Infection Control Plan for Avian Influenza Jul 2006
4. Disposable glove should not be reused
Unit 6 - Infection Control Measures

15. Standard precautions – Mask and eye protection (PPE)
Surgical masks and eye protection:
When splashes or sprays of blood
and body fluid, secretions and excretions
are likely
Sterile technique
Respiratory etiquette
Change PPE promptly if heavily
contaminated during the procedure
Personal Protective Equipment – Mask & eye protection
Masks are used for 3 primary purposes in healthcare facilities:
Placed on HCW to protect them from contact with infectious material from patients e.g., resp. secretions and sprays of blood or body fluids, consistent with Standard precautions
Placed on HCW when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents carried in a HCW’s mouth or nose.
Placed on coughing patients to limit potential dissemination of infectious resp. secretions from patient to others.
Surgical masks and eye protection:
Wear surgical mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood and body fluids, secretions and excretions are likely
.Health care workers should change PPE promptly if it is heavily contaminated during the procedure.
Unit 6 - Infection Control Measures

16. Standard precautions - prevent hcws exposure to bloodborne pathogens
Prevent needles and other sharps instrument injuries
Prevent mucous membrane exposures
Safe work practices and PPE to protect mucous membranes and non-intact skin
Needles and other sharps instrument injuries associated with transmission of HBV, HCV, HIV to HCW
Prevention of mucous membrane exposures has been an element of standard precautions for routine patient care
Safe work practices and wear PPE to protect mucous membranes and non-intact skin from contact with potentially infectious material.

17. TRANSMISSION-BASED PRECAUTIONS

18. TRANSMISSION-BASED PRECAUTIONS - Patient Placement
Single patient rooms - always indicated for patients placed on airborne precautions and preferable for those who require contact of droplet precautions
Cohort patients with same organism
Unit 6 - Infection Control Measures

19. TRANSMISSION-BASED PRECAUTIONS - Contact Precautions
Infections spread by direct or indirect contact with patients or patient-care environment – shigellosis, C. difficle, MRSA
Limit patient movement
Private/SINGLE room or cohort with patients with same infection
Wear disposable gown and gloves when entering the patient room
Remove and discard used disposable gown and gloves inside the patient room
Wash hands immediately after leaving the patient room
Clean patient room daily using a hospital disinfectant, with attention to frequently touched surfaces (bed rails, bedside tables, lavatory surfaces, blood pressure cuff, equipment surfaces)
Use dedicated equipment if possible (e.g., stethoscope)
TRANSMISSION-BASED PRECAUTIONS - Contact Precautions
Consists of standard precautions (see previous frames) plus precautions for direct and indirect contact
Infections spread by direct or indirect contact with patients or patient-care environment – shigellosis, C. difficle, MRSA
Limit patient movement
Private room or room shared with patients with same infection status
Wear disposable gown and gloves when entering the patient room
Remove and discard used disposable gown and gloves inside the patient room
Wash hands immediately after leaving the patient room
Clean patient room daily using a hospital disinfectant, with attention to frequently touched surfaces (bed rails, bedside tables, lavatory surfaces, blood pressure cuff, equipment surfaces)
Use dedicated equipment if possible (e.g., stethoscope)

20. Contact Precautions cont.
GLOVES
Use gloves when entering the room.
Change gloves after contact with infective material.
Remove gloves before leaving the room.
Wash hands or use appropriate gel after glove removal.
Do not touch infective material or surfaces with hands.
Clean, non-sterile gloves are usually adequate.
GOWN
Use protective gown when entering the room if
direct contact with patient or
potentially contaminated surfaces or
equipment near patient is anticipated or
if the patient has diarrhea or
colostomy or wound drainage that is not covered by a dressing.
GLOVES
Use gloves when entering the room.
Change gloves after contact with infective material.
Remove gloves before leaving the room.
Wash hands or use appropriate gel after glove removal.
Do not touch infective material or surfaces with hands.
Clean, non-sterile gloves are usually adequate.
GOWN
Use protective gown when entering the room if
direct contact with patient or
potentially contaminated surfaces or
equipment near patient is anticipated or
if the patient has diarrhea or
colostomy or wound drainage that is not covered by a dressing.
Remove gown and observe hand hygiene prior to leaving room, and do not come in contact with potentially contaminated environmental surfaces

21. Contact precautions signs

22. Droplet Precautions
Reduce the risk of transmission by large particle droplets (larger than 5 m in size).
Requires close contact between the source person and the recipient
Droplets usually travel 3 feet or less
E.g., influenza, rubella, parvovirus B19, mumps, H. influenzae, and N. meningitidis
Consists of standard precautions plus specifics for droplet precautions
Ues to reduce the risk of transmission of microorganisms transmitted by large particle droplets (larger than 5 m in size).
Droplet transmission requires close contact between the source person and the recipient because droplets do not remain suspended in the air.
Droplets usually travel 3 feet or less within the air and thus special air handling is not required.
Droplet transmission involves contact of the conjunctiva of the eyes or the mucous membranes of the nose or mouth of a person with the microorganism generated from the infected source person during coughing, sneezing or talking, or during the performance of procedures such as suctioning and bronchoscopy.

23. Droplet Precautions cont.
A private/single room or
Cohort with patient with active infection with same microorganism
Use a mask when entering the room 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 at least 3 feet between infected patient and visitors
Place the patient in a private/single room or if not available
Cohort with patient with active infection with same microorganism
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 repiratory hygiene/cough etiquette
Keep patient at least 3 feet apart between infected patient and visitors
Room door may remain open

24. Droplet precautions signs

25. Airborne Precautions Tuberculosis, measles, varicella
Place the patient in an airborne infection isolation room (AIIR)
Pressure should be monitored with visible indicator
Use of respiratory protection (e.g., fit tested N95 respirator)
Limit movement and transport of the patient. Use a mask on the patient if they need to be moved
Keep patient room door closed.

26. Airborne precautions signs

27. Terminology
Cleaning
general removal of debris (dirt, food, feces, blood, saliva
and other body secretions).reduces amount of organic matter that contributes to proliferation of bacteria and viruses
Disinfection
removes most organisms present on surfaces that can
cause infection or disease
Sterilization
the killing or removal of all organisms

28. Spaulding Classification

29. Critical
Semicritical
Noncritical

30. Resistance of Microorganisms
Sterilization
Spores
bacterial, fungal
Bacillus stearothermophilus
Bacillus subtilis
Clostridium sporogenes
High Level Disinfection
Mycobacteria, TB bacilli
Intermediate Disinfection
Hydrophilic viruses
Polio, Coxsackie, Rhino
Low Disinfection
Vegetative fungi & bacteria
Lipophilic viruses
Trichophyton, Cryptococcus,Candida
Pseudomonas, Staphylococcus,Salmonella
HSV, CMV, RSV, HBV, HIV

31. ضد عفونی کننده های high level:
پراکسید هیدروژن
پراستیک اسید
گلوتارالدهید
فرمالدهید

32. ضد عفونی کننده های intermediate level:
کلر و ترکیبات کلره
ید و ترکیبات یده
الکل ها

33. ضد عفونی کننده های low level:
فنل و ترکیبات فنلی
ترکیبات آمونیوم

34. Resistance of Microorganisms
Sterilization
Spores
bacterial, fungal
Bacillus stearothermophilus
Bacillus subtilis
Clostridium sporogenes
High Level Disinfection
Mycobacteria, TB bacilli
Intermediate Disinfection
Hydrophilic viruses
Polio, Coxsackie, Rhino
Low Disinfection
Vegetative fungi & bacteria
Lipophilic viruses
Trichophyton, Cryptococcus,Candida
Pseudomonas, Staphylococcus,Salmonella
HSV, CMV, RSV, HBV, HIV

35. Ultraviolet Radiation
Dependent on strength and duration of exposure to light, line of sight‟, how well microorganism can withstand UV imited to destruction of airborne organisms, inactivation of microorganisms on surfaces, and water purification

36. References
2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings:
CDC guidelines for isolation precautions in hospitals 1996, Hospital Infection Control Practices Advisory Committee (HICPAC):
Principles of Epidemiology in public health practice, 3rd edition