Infection Control Manual

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2007 Protective Isolation Policy (71 kB)

 

 

 

 

 

 

 

 

Protective Isolation

Key Points
Perform a risk assessment as to the level of protection required Isolate the patient if necessary Prepare the patient and the room Reduce risks by diligent hand hygiene Post a Protective Precautions (Isolation) Notice on the door No staff member suffering from any infectious disease (including the common cold and active cold sores) can attend an immunosuppressed patient

 

Introduction

Protective isolation aims to protect an immunocompromised patient who is at special risk from environmental organisms or those carried by attending staff and visitors.

Two levels of protective isolation are offered. The majority of cases susceptible to infection are nursed in a separate room with simple precautions to prevent acquisition of attendants' and other patients' micro-organisms. These precautions are listed below. For those profoundly immunosuppressed after total body irradiation and chemotherapy in the bone marrow transplant programme, designated rooms with laminar flow and higher level of precautions may be employed according to a special protocol.

Planning for Protective Isolation

• Explain the need for isolation to the patient
• Remove all unnecessary equipment from the room
• Ensure that all equipment and surfaces in the room are clean
• Contact housekeeping/domestic department for special cleaning of cubicle if required
• Place Protective Precaution Notice on the door
• Record action in nursing care plan (include reason for isolation, date started and any special precautions thought necessary)
• Inform Infection Control Nurse (see lines of communication for your hospital)

REMEMBER: in order to protect the immunosuppressed individual, staff and visitors who are unwell in any way, for example with coughs and colds, sore throat, herpes simplex, diarrhoea or infected skin lesions, must NOT enter the isolation room.

Patients requiring Protective Isolation may also require Source Isolation if they have an infective condition.

 

Equipment Required

Outside room:

• Protective Isolation Notice
• Coat hook
• White disposable aprons
• Yellow plastic bag
• Patient's chartsAlcohol hand rub or alcoholic chlorhexidine hand-rub or equivalent (optional)

Inside room:

• Skin disinfectant for hand hygiene and paper towels
• Foot operated sack holder
• Black disposal bag for domestic waste
• Sterile gloves (for invasive procedures)
• Unsterile disposable gloves
• Sharps box, preferably wall mounted

In the ward:

• Have available on the ward the appropriate chemical disinfectant for decontamination of equipment and for dealing with spillages (e.g. hycolin 2% or chlorine-releasing agent)
• Contact domestic/patient support staff for designated cleaning equipment

 

Protective Isolation Procedure

In the ward:

• Staff should remove white coats, jackets or outside clothing
• Remove wristwatch and costume jewellery
• Wash hands in antiseptic handwash and dry thoroughly, or use alcohol gel. Then put on white apron and gloves if intending to have direct patient contact. (If more convenient, wash hands or use alcohol gel inside the isolation room)

Inside the room or visiting space:

• Wear clean (non-sterile) gloves for patient examination
• Wear sterile procedure gloves when handling intravenous lines, sites and wounds
• On completing task remove clinical waste and linen from the room

On leaving the room:

• Close the door
• Remove gloves and apron outside room and discard into yellow bag
• Wash hands in liquid soap and dry

OR

• Use alcoholic hand rub (or alcoholic chlorhexidine) if moving on to a minor task in another room

NOTE Alcoholic chlorhexidine or alcohol gel can be used as a substitute for thorough hand-washing before performing a patient task providing the hands are not soiled.

 

Domestic Cleaning

Daily cleaning of the room should be completed by the ward domestic preferably before cleaning the rest of the ward/floor.

On discharge of the patient, nurses should:

• Deal with any spillages of blood, secretion or excreta according to the spillage policy
• Clean used medical or nursing equipment with general purpose detergent in hot water, in appropriate manner
• Strip the bed and dispose of linen according to the linen policy

Domestics should then perform ordinary cleaning after patient discharge.

If the patient in Protective Isolation was also infected with, say, MRSA or Streptococcus pyogenes , or glycopeptide-resistant enterococci, even though he was in protective isolation, proper room decontamination should be done before a new patient is admitted. (see policies for Uniforms and Disinfection).

Equipment sent for service or to other units must be accompanied by a Permit to Work Form (see policy for Cleaning Areas used for Source Isolation).