isolation

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Isolation

 

Definition

Isolation refers to the precautions that are taken in the hospital to prevent the spread of an infectious agent from an infected or colonized patient to susceptible persons.

Purpose

Isolation practices are designed to minimize the transmission of infection in the hospital, using current understanding of the way infections can transmit. Isolation should be done in a user friendly, well-accepted, inexpensive way that interferes as little as possible with patient care, minimizes patient discomfort, and avoids unnecessary use.

Precautions

The type of precautions used should be viewed as a flexible scale that may range from the least to the most demanding methods of prevention. These methods should always take into account that differences exist in the way that diseases are spread. Recognition and understanding of these differences will avoid use of insufficient or unnecessary interventions.

Description

Isolation practices can include placement in a private room or with a select roommate, the use of protective barriers such as masks, gowns and gloves, a special emphasis on handwashing (which is always very important), and special handling of contaminated articles. Because of the differences among infectious diseases, more than one of these precautions may be necessary to prevent spread of some diseases but may not be necessary for others.
The Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practice Advisory Committee (HICPAC) have led the way in defining the guidelines for hospital-based infection precautions. The most current system recommended for use in hospitals consists of two levels of precautions. The first level is Standard Precautions which apply to all patients at all times because signs and symptoms of infection are not always obvious and therefore may unknowingly pose a risk for a susceptible person. The second level is known as Transmission-Based Precautions which are intended for individuals who have a known or suspected infection with certain organisms.
Frequently, patients are admitted to the hospital without a definite diagnosis, but with clues to suggest an infection. These patients should be isolated with the appropriate precautions until a definite diagnosis is made.

Standard precautions

Standard Precautions define all the steps that should be taken to prevent spread of infection from person to person when there is an anticipated contact with:
  • Blood
  • Body fluids
  • Secretions, such as phlegm
  • Excretions, such as urine and feces (not including sweat) whether or not they contain visible blood
  • Nonintact skin, such as an open wound
  • Mucous membranes, such as the mouth cavity.
Standard Precautions includes the use of one or combinations of the following practices. The level of use will always depend on the anticipated contact with the patient:
  • Handwashing, the most important infection control method
  • Use of latex or other protective gloves
  • Masks, eye protection and/or face shield
  • Gowns
  • Proper handling of soiled patient care equipment
  • Proper environmental cleaning
  • Minimal handling of soiled linen
  • Proper disposal of needles and other sharp equipment such as scalpels
  • Placement in a private room for patients who cannot maintain appropriate cleanliness or contain body fluids.

Transmission based precautions

Transmission Based Precautions may be needed in addition to Standard Precautions for selected patients who are known or suspected to harbor certain infections. These precautions are divided into three categories that reflect the differences in the way infections are transmitted. Some diseases may require more than one isolation category.
AIRBORNE PRECAUTIONS. Airborne Precautions prevent diseases that are transmitted by minute particles called droplet nuclei or contaminated dust particles. These particles, because of their size, can remain suspended in the air for long periods of time; even after the infected person has left the room. Some examples of diseases requiring these precautions are tuberculosis, measles, and chickenpox.
A patient needing Airborne Precautions should be assigned to a private room with special ventilation requirements. The door to this room must be closed at all possible times. If a patient must move from the isolation room to another area of the hospital, the patient should be wearing a mask during the transport. Anyone entering the isolation room to provide care to the patient must wear a special mask called a respirator.
DROPLET PRECAUTIONS. Droplet Precautions prevent the spread of organisms that travel on particles much larger than the droplet nuclei. These particles do not spend much time suspended in the air, and usually do not travel beyond a several foot range from the patient. These particles are produced when a patient coughs, talks, or sneezes. Examples of disease requiring droplet precautions are meningococcal meningitis (a serious bacterial infection of the lining of the brain), influenza, mumps, and German measles (rubella).
Patients who require Droplet Precautions should be placed in a private room or with a roommate who is infected with the same organism. The door to the room may remain open. Health care workers will need to wear masks within 3 ft of the patient. Patients moving about the hospital away from the isolation room should wear a mask.
CONTACT PRECAUTIONS. Contact Precautions prevent spread of organisms from an infected patient through direct (touching the patient) or indirect (touching surfaces or objects that that been in contact with the patient) contact. Examples of patients who might be placed in Contact Precautions are those infected with:
  • Antibiotic-resistant bacteria
  • Hepatitis A
  • Scabies
  • Impetigo
  • Lice.
This type of precaution requires the patient to be placed in a private room or with a roommate who has the same infection. Health care workers should wear gloves when entering the room. They should change their gloves if they touch material that contains large volumes of organisms such as soiled dressings. Prior to leaving the room, health care workers should remove the gloves and wash their hands with medicated soap. In addition, they may need to wear protective gowns if there is a chance of contact with potentially infective materials such as diarrhea or wound drainage that cannot be contained or if there is likely to be extensive contact with the patient or environment.
Patient care items, such as a stethoscope, that are used for a patient in Contact Precautions should not be shared with other patients unless they are properly cleaned and disinfected before reuse. Patients should leave the isolation room infrequently.

Resources

Books

Edmond, M. "Isolation." In A Practical Handbook for Hospital Epidemiologists, edited by L. A. Herwaldt and M. D. Decker. Thorofare, NJ: Slack Inc., 1998.

Key terms

Colonized — This occurs when a microorganism is found on or in a person without causing a disease.
Disinfected — Decreased the number of microorganisms on or in an object.
Latex — A rubber material which gloves and condoms are made from.
Phlegm — Another word for sputum; material coughed up from a person's airways.
Stethoscope — A medical instrument for listening to a patient's heart and lungs.

isolation

 [i″so-la´shun]
1. the process of separating, or the state of being alone.
2. the physiologic separation of a part, as by tissue culture or by interposition of inert material.
3. the extraction and purification of a chemical substance of unknown structure from a natural source.
4. the separation of infected individuals from those uninfected for the period of communicability of a particular disease; see also quarantine.
5. the separation of an individual with a radioactive implant from others to prevent unnecessary exposure to radioactivity.
6. the successive propagation of a growth of microorganisms until a pure culture is obtained.
7. in psychiatry, a defense mechanism in which emotions are separated from the ideas, impulses, or memories to which they usually connect, so that the idea or impulse enters consciousness detached from its unacceptable feeling.
isolation precautions special precautionary measures, practices, and procedures used in the care of patients with contagious or communicable diseases. The centers for disease control and prevention (CDC) provides explicit and comprehensive guidelines for control of the spread of infectious disease in care of hospitalized patients. The type of infectious disease a patient has dictates the kind of isolation precautions necessary to prevent spread of the disease to others.

Isolation practices have evolved over the years. Changes have been based on new epidemiological data, emergence of new or drug-resistant organisms, and the need to protect patients and hospital personnel. The hospital infection control practices advisory committee (HICPAC) advises the CDC on the need to update and revise guidelines and policies related to prevention of hospital acquired infections. Present guidelines distinguish two types of isolation precautions: (1) standard precautions, which synthesize major features of earlier practices of universal precautions and isolation of moist body substances; and (2) transmission-based precautions, based on routes of transmission, designed to be used together with the standard precautions, divided into the three subgroups of airborne, droplet, and contact precautions. These are identified for disorders associated with a high index of suspicion for infection.

The recommendations of the CDC for isolation practices are categorized as follows:

Category 1A: Strongly recommended for all hospitals and strongly supported by well designed experimental or epidemiological studies.

Category 1B: Strongly recommended for all hospitals and reviewed as effective by experts in the field and a consensus of HICPAC based on strong rationale and suggestive evidence, even though definitive scientific studies have not been done.

Category 2: Suggested for implementation in many hospitals; recommendations may be supported by suggestive clinical or epidemiological studies; a strong theoretical rationale or definitive studies may be applicable to some, but not all, hospitals.
General Principles of Patient Care. In addition to the specific measures taken to prevent the spread of certain types of infectious diseases, there are general principles that are basic to the care of any patient who is a source of infection to others or likely to become infected by coming in contact with others. Factors most important in preventing spread of infection are proper disinfection techniques and conscientious hand washing. The hands are used for many tasks in patient care and are therefore likely to be an excellent source of infection if they are not washed properly before and after each contact with the patient or with contaminated articles.
protective isolation (reverse isolation) a formerly common type of isolation designed to prevent contact between potentially pathogenic microorganisms and persons with seriously impaired resistance. The Centers for Disease Control and Prevention deleted this category in 1983, but a few institutions continue to use it. Several studies have demonstrated no significant reduction in infection rates when it was being used.
social isolation a nursing diagnosis approved by the North American Nursing Diagnosis Association, defined as aloneness experienced by an individual as a negative or threatening state. Contributing factors are many and varied and include delay in accomplishing developmental tasks, alterations in physical appearance or mental status, social behavior or social values that are not accepted, inadequate personal resources, and inability to engage in satisfying personal relationships. Negative feelings of aloneness are subjective, existing when the patient/client says they do. When one suspects that a patient/client is experiencing social isolation, the diagnosis must be validated by a thorough assessment. The individual may express feelings of abandonment, rejection, or dread, demonstrate or verbalize a desire for more contact with the nurse or with family members, become more irritable or restless or less physically active, or develop a sleep or eating disorder. See also impaired social interaction.

i·so·la·tion

(ī'sō-lā'shŭn), Do not confuse this word with insolation and insulation.
1. In microbiology, separation of an organism from others, usually by making serial cultures.
2. Separation for the period of communicability of infected people or animals from others, so as to prevent or limit the direct or indirect transmission of the infectious agent from those who are infected to those who are susceptible.

isolation

/iso·la·tion/ (i″sah-la´shun)
1. the process of isolating, or the state of being isolated.
2. the physiologic separation of a part, as by tissue culture or by interposition of inert material.
3. the extraction and purification of a chemical substance of unknown structure from a natural source.
4. the separation of infected individuals from those uninfected for the communicable period.
5. the successive propagation of a growth of microorganisms until a pure culture is obtained.
6. a defense mechanism in which emotions are detached from the ideas, impulses, or memories to which they usually connect.

isolation

(ī′sə-lā′shən)
n.
The act of isolating: ordered the isolation of the sick patients.

isolation

[-lā′shən]
Etymology: L, insula, island
the separation of a seriously ill patient from others to prevent the spread of an infection or to protect the patient from irritating or infectious environmental factors. A patient undergoing radiation therapy may also be isolated to reduce the exposure of hospital personnel to effects of radioactive materials. Types of isolation include airborne, droplet, contact, and infectious.

isolation

Infectious disease The segregation of a Pt, body fluids, and fomites to prevent transmission of an infection to other Pts or hospital personnel. See Biosafety levels, Disinfection, Immunoisolation, Precautions, Sterilization. Cf Reverse isolation, Reverse 'precautions. '.

i·so·la·tion

(ī'sŏ-lā'shŭn)
1. microbiology Separation of an organism from others, usually by making serial cultures.
2. Separation for the period of communicability of infected people or animals from others to prevent or limit the direct or indirect transmission of the infectious agent from those who are infected to those who are susceptible.
Compare: quarantine

isolation

The state of separation from other people of a person suffering from an infectious disease, or carrying infective organisms, so as to prevent spread of infection. Isolation is also used to protect immunocompromized people from organisms carried by healthy people (reverse barrier nursing).

isolation

  1. any geographical separation from other populations of the same organism.
  2. a form of genetic isolation, where gene transfer between populations is limited or entirely prevented by factors which can be behavioural, ecological, seasonal (different breeding seasons) or physiological. The prevention of gene transfer results in new lines of EVOLUTION.

isolation

the act of isolating or state of being isolated, such as (1) the physiological separation of a part, as by tissue culture or by interposition of inert material; (2) the segregation of patients with a communicable disease; (3) the successive propagation of a growth of microorganisms until a pure culture is obtained; (4) the chemical extraction of an unknown substance in pure form from a tissue.

isolation technique
special precautionary measures and procedures used in the care of a patient with a communicable disease.
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Before emergence of influenza A(H7N9) virus, surveillance was conducted by using cell culture-based virus isolation techniques.
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Phigenics Analytical Services Laboratories (PASL) are certified as proficient in the Environmental Legionella Isolation Techniques Evaluation (ELITE) program administered by the Centers for Disease Control and Prevention (CDC).
The vehicles employ a variety of ruggedization and isolation techniques to ensure all telecommunications and power-generation equipment survives and operates with no degradation after thousands of miles of transit, including over roadways of questionable quality.