COURSE: NURSING PRACTICE
TOPIC: ISOLATION TECHNIQUES (barrier nursing)
Introduction
Isolation represents one of the measures that can be taken to implement infection controls.
The prevention of infections/contagious diseases from spreading from one patient to
another; or from health care workers to visitors; or from visitors to patients; or from
patients/hospital to healthcare workers is a fundamental responsibility of nurses. Various
forms of isolation exist - some of which contact procedures are modified while others
involve taking the patients away from all others. Infection that is acquired in the hospital or
any other health care facility is termed nosocomial infection or healthcare-associted
infection (HTI).
Definition
Isolation techniques are a medically aseptic method to limit spread of infectious
diseases. They are voluntary or compulsory measures of separation and
confinement of those known or suspected to be infected with a contagious disease
agent (whether ill or not) to prevent further infection.
Purposes
− Block the contact with the infectious organisms
− Protect the nurse from self-contamination
− Prevent spread of infection between patients.
− Prevent the transfer of pathogen to visitors
− To segregate immunosuppressive patients from acquiring exogenous
infection, e.g. patient with leukemia.
Types of isolation techniques
Isolation can be done at ward or unit level called ward or unit isolation and it can done in a
special hospital called disease isolation. But generally isolation can be classified into:
a. Isolation Protective
b. Isolation Sources
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a. Isolation protective
It is a form of isolation designed to prevent contact between potentially pathogenic
microorganism and the person with seriously impaired resistance.
Indication for protective isolation
− Burn patients
− Patients with immunodeficiency disease, e.g. AIDS, leukaemia etc
− Patient receiving bone marrow transplanting
− Patient on cytotoxic and steroid drugs that cause severe immunosuppression
− Extremely aged (geriatric) patient
− Patient on strong antimicrobial therapy
Isolation protective environment
The prevention of exogenous transmission of infection is important and can be
achieved by:
− Careful monitoring of environment to remove items which could predispose
to infection
− Adequate bed spacing between patients and between floors and beds
− Strictly maintaining patient’s hygiene at standard level
− Adhering to infection control measures (standards precautionary measures).
− Hand washing. Strict hand washing can be said to be the most important
means of infection control measures.
− Reducing patient’s anxiety by assisting patient to learn about their situation
− Strictly using gloves, special gowns, face masks, etc
− Performing procedures and treatments in the appropriate rooms.
− Minimizing visitors to the patient’s environment.
b. Isolation sources
Isolation sources or source isolation is designed to prevent the spread of pathogenic
microorganisms from an infected patient to other patients, hospital workers and
visitors. The patient and any other material in contact with him/her or eliminated by
him or her should be isolated.
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Indications for source isolation
It is done to a patient with highly contagious or communicable disease in order to
prevent spread of disease to others. Examples include patient with multidrug resistance
tuberculosis (MDR TB), Ebola, Lassa Fever etc.
Source isolation environment
− The place can be a purposely built as infectious disease ward/unit, e.g. TB
patients wards/units.
− It can be single room in a general ward. A Negative pressure room can be
used in dealing with patient that has highly contagious disease.
− The patient should be provided with hand washing facilities, toilets facilities,
and an anteroom area for protective clothing like gown, gloves, mask, caps,
apron etc.
− All instruments that are required for nursing needs should be kept with the
patient e.g. vital sign instruments.
− Disposable eating materials should be used.
− Strict precautionary measures should be maintained in all affairs related to
the patient e.g. feeding the patient, medication, transporting e.t.c.
ASEPSIS
Definition
Asepsis means the absence of microorganisms such as bacteria, viruses and other
pathogenic microorganisms.
Types of asepsis
a. Medical asepsis (clean technique)
Medical asepsis is the term used to describe the technique of preventing the transfer
of disease by stopping the infection at its source or by reducing the number of
pathogenic microorganisms after they have left the source as well as breaking their
chain of transmission.
Examples of medical aseptic practices
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− Disinfection (cleaning using chemical compounds to reduce or inactivate
microorganisms from items or surfaces)
− Daily change of patient bed linen
− Hand washing before and after each procedure
− Separating infected patients from the non-infected patients (isolation
patients)
− Hospital ventilation
− Maintenance of general cleanliness of the hospital
− Safe disposal of excreta and refuse
− Destruction of rodents and insects
− Maintenance of personal hygiene of the patient
− Use of masks, gowns and gloves
− Keeping toilet articles separate for each person
− Minimizing the number of visitors
− Hygiene health education to the patients and relatives
b. Surgical asepsis (sterile technique)
Surgical asepsis refers to procedures used to keep objects or areas sterile and
completely free from all microorganisms. The techniques are used in any invasive
procedure or areas where aseptic technique is to be followed, e.g: operating room,
labour room burn units etc.
Examples of surgical aseptic practices:
− Sterilization
− Use of disposable sterile supplies, such as syringes, personal protective
equipment (PPE), surgical gloves and the use of reuseable sterile items such as
surgical instruments (e.g. forceps) in performing surgical procedures
(appendectomy, caesarian section, etc), suturing wounds, dressing wounds,
inserting IV line, administering injection, vaginal examination with
instrument, delivering babies etc.
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Principles of surgical asepsis
− Always face the sterile field. Do not turn back or side on a sterile field
Rationale: Sterile objects which are out of vision are considered questionable
and their sterility cannot be guaranteed
− Keep sterile equipment above your waist level or above table level
Rationale: Waist level and table level are considered margins of safety and
will promote maximum visibility of the sterile field
− Do not speak, sneeze and cough over a sterile field
Rationale: To prevent droplet infection
− Never reach across sterile field
Rationale: when a non-sterile object is held above a sterile object, gravity
causes microorganisms to fall into the sterile field
STERILIZATION
It is a surgical aseptic method involving complete destruction of microorganisms including
viruses and bacterial spores.
Methods
Chemical method – this method uses chemical agents such as alcohol, aldehydes, halogens,
etc.
Physical method – this involves the use of physical apparatus/equipment. The techniques
include:
a. Heat
− Dry heat (flaming, incineration, red heat, hot air oven)
− Moist heat (steam under pressure/autoclaving, boiling, pasteurization)
b. Radiation (infrared, ultraviolet, X-rays etc)
c. Filtration (membrane filter, air filter, depth filter)
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Note: it is always necessary to clean items with detergents or disinfectants after use
to make sure they are free from visible stains of blood and other bodily fluids before
sterilizing them using the heat methods for effectiveness.