5-1. CATEGORIES OF ISOLATION

Isolation is the separation of a patient from contact with others in order to control the spread of an infectious or communicable disease. Patients are isolated according to the mode of transmission of the disease.

a. Strict Isolation. Strict isolation is used to prevent the transmission of all highly communicable diseases that are spread by both, contact or airborne routes of transmission. Examples of such diseases are chickenpox and rabies.

b. Respiratory Isolation. Respiratory isolation is used to prevent transmission of organisms by means of droplets that are sneezed or breathed into the environment. Examples of such diseases are influenza and tuberculosis.

c. Protective Isolation. Protective isolation is used to prevent contact between potentially pathogenic microorganisms and uninfected persons who have seriously impaired resistance. Patients with certain diseases, such as leukemia, who are on certain therapeutic regimens are significantly more susceptible to infections.

d. Enteric Precautions. Enteric precautions are used to control diseases that can be transmitted through direct or indirect oral contact with infected feces or contaminated articles. Transmission of infection depends on ingestion of the pathogen. Examples of diseases requiring enteric precautions are dysentery and hepatitis.

e. Wound and Skin Precautions. Wound and skin precautions are used to prevent the spread of microorganisms found in infected wounds (including burns and open sores) and contact with wounds and heavily contaminated articles. Conditions requiring these precautions include infected burns, infected wounds, and infections with large amounts of purulent discharge. Diseases that may require wound and skin precautions include herpes, impetigo, and ringworm.

f. Blood Precautions. Blood precautions are used to prevent acquisition of infection by patients and personnel from contact with blood or items contaminated with blood. Examples of diseases that require blood precautions (refer to Lesson 1) are HBV and HIV/AIDS.

g. Discharge Precautions.

(1) Secretion precautions-lesions. These precautions are used to prevent acquisition of infection by personnel and patients from direct contact with wounds and secretion-contaminated articles. Some examples of diseases requiring these precautions are conjunctivitis, gonorrhea, and syphilis.

(2) Secretion precautions-oral. These precautions are used to prevent acquisition of infection by personnel from direct contact with oral secretions. Some examples of diseases requiring these precautions are herpes areolas and scarlet fever.

(3) Excretion precautions. These precautions are used to prevent acquisition of infection by personnel and patients from direct contact with fecal excretions. Some examples of diseases requiring these precautions are poliomyelitis and staphylococcal food poisoning.

5-2. SIGNS USED TO IDENTIFY TYPES OF ISOLATION

Concise information on isolation in effect is put on signs placed on the door of the isolation room at eye level. Some hospital signs are disease specific, and other hospital signs are category specific. The sign is removed when isolation is no longer required. A checklist is also placed on the door. This list indicates whether masks, gowns, gloves, etc. are required for persons entering the room. Any other pertinent information is also on this sign.

a. Strict Isolation.

(1) Visitors must report to the nurses’ station before entering the room.

(2) Door must be kept closed.

(3) Gowns must be worn by all persons entering the room.

(4) Masks must be worn by all persons entering the room.

(5) Hands must be washed on entering and leaving the room.

(6) Gloves must be worn by all persons entering the room.

(7) Articles must be discarded or wrapped before being sent to Central Supply for disinfection or sterilization.

b. Respiratory Isolation.

(1) Visitors must report to the nurses’ station before entering the room.

(2) Door must be kept closed.

(3) Gowns are not necessary.

(4) Masks must be worn by any person entering the room unless that person is not susceptible to the disease.

(5) Hands must be washed on entering and leaving the room.

(6) Gloves are not necessary.

(7) Articles contaminated with secretions must be disinfected.

c. Protective Isolation.

(1) Visitors must report to the nurses’ station before entering the room.

(2) Door must be kept closed.

(3) Gowns must be worn by all persons entering the room.

(4) Masks must be worn by all persons entering the room.

(5) Hands must be washed on entering and leaving the room.

(6) Gloves must be worn by all persons having direct contact with the patient.

(7) Articles must be handled according to local SOP.

d. Enteric Precautions.

(1) Visitors must report to the nurses’ station before entering the room.

(2) Gowns must be worn by all persons having direct contact with the patient.

(3) Masks are not necessary.

(4) Gloves must be worn by all persons having direct contact with the patient or with articles contaminated with fecal material.

(5) Special precautions are necessary for articles contaminated with urine and feces. Articles must be disinfected or discarded.

e. Wound and Skin Precautions.

(1) Visitors must report to the nurses’ station before entering the room.

(2) Gowns must be worn by all persons having direct contact with the infected wound.

(3) Masks are not necessary except during dressing changes.

(4) Gloves must be worn by all persons having direct contact with the infected area.

(5) Special precautions are necessary for instruments, dressings, and linens.

CAUTION: Only hospital personnel who have been vaccinated with poliomyelitis vaccine should have direct contact with patients who have active poliomyelitis.