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Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)

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Overview

  1. Isolation used to prevent spread of germs
  2. Precautions are minimum standard
    1. More PPE is  acceptable
  3. Nurses should keep each other accountable

Nursing Points

General

  1. Donning PPE
    1. Gown
    2. Mask
    3. Goggles
    4. Gloves
  2. Doffing PPE
    1. Gloves
    2. Goggles
    3. Gown
    4. Mask

Assessment

  1. Determine Required Isolation
    1. Contact
      1. MRSA
      2. VRE
      3. C. Difficile
      4. Scabies/Lice/Bed Bugs
    2. Droplet
      1. Influenza
      2. Meningitis
      3. Pertussis
    3. Airborne
      1. Tuberculosis
      2. Varicella
      3. SARS
    4. Reverse
      1. Post-chemo
      2. Neutropenia
      3. Post-Transplant
      4. Burns

Therapeutic Management

  1. PPE Required
    1. Contact
      1. Gown
      2. Gloves
    2. Droplet
      1. Gown
      2. Gloves
      3. Standard mask
      4. Face shield recommended
    3. Airborne
      1. Gown
      2. Gloves
      3. Particulate Respirator
      4. Negative Pressure Room
    4. Reverse
      1. Gown
      2. Gloves
      3. Hair Bonnet
      4. Standard mask

Nursing Concepts

  1. Safety
    1. Protect staff, patients, and the rest of the facility
  2. Infection Control
    1. Prevent spread of infection
  3. Health Promotion
    1. Family members and visitors should be encouraged to wear PPE

Patient Education

  1. Purpose for precautions
  2. How to apply and remove PPE (visitors)
  3. Handwashing
Want to learn more?
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Nursing Care Plan for Neutropenia

Reference Links

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Video Transcript

So in this lesson we’re going to cover Isolation Precautions. This is something you’ll see from day 1 in nursing school and every day as a nurse on the floor.

So there are 5 types of precautions you need to be aware of so we’ll talk about each one – Standard, Contact, Droplet, Airborne, and Reverse Isolation. The big thing to note here is that the purpose of isolation is to protect from the spreading of organisms or diseases. We don’t want to bring any into other patients or spread it around the hospital. We want to contain it or isolate it to that patient’s room. The other thing to know is that these are MINIMUM standards. This is what you’ll be tested on in nursing school and on the NCLEX. But in the real world you can always wear extra PPE if you feel it is necessary as long as you at least wear the minimum requirements.

The first is Standard precautions – this is what we use on every patient, every time. So any time you go in the room you wash your hands on the way into the room. If you may come into contact with any bodily fluids at all, you need to wear gloves. This confuses people sometimes – you do not have to wear gloves to just help a patient out of bed or bring them something. BUT – if you have a super sweaty patient and just by touching them you’ve touched sweat, you should wear gloves. Then of course anytime you give medications or draw blood, or do any kind of personal care, you must wear gloves. Then, of course, wash your hands on the way out.

Then there’s contact precautions. We use contact precautions for patients with multi-drug resistant organisms like MRSA, VRE, or C.Diff. Contact isolation involves wearing a gown and gloves. Now, these people are wearing masks as well, but again remember you can always do more. You have to gown and glove up every time you walk in the room, even if you won’t touch the patient. This is because all of the surfaces and walls in that room are considered contaminated. You will still wash your hands on the way in and out of these rooms – however, there’s a special caveat with C. Diff – you MUST use soap and water. The alcohol rub won’t cut it.

Then we have Airborne precautions. Diseases like tuberculosis, varicella (which is chickenpox) and SARS are spread with airborne transmission. This means that the organisms escape with every breath, cough, sneeze etc. and those particles are aerosolized. They’re just floating in the air where we can’t see them, but by golly we could breathe them in. So in addition to gown and gloves, we use a particulate respirator – the most common being an N95 respirator. When you get hired you’ll get fit for one to make sure it’s secure and sealed tight. This prevents any unfiltered particulates from getting into your airway. Then, we’ll use what’s called a negative pressure room. What happens is that the air system in the room is set up differently than others. When you open the door, the air flows in instead of out. And the duct system is kept separate from the rest of the hospital as well. Again, the purpose is to prevent the spread of these airborne particles throughout the rest of the hospital.

Then finally there’s something called reverse isolation. The purpose of reverse isolation is to protect the patients from US. We use reverse isolation for patients who are immunocompromised or at super high risk for infection. Examples would be neutropenic patients like after chemo, post-transplant patients, and patients with severe burns – they’ve lost their external protection from infection so those units are kept SUPER clean. We wear a gown and gloves, but also a hair bonnet and a mask. We also enforce strict rules about visitors and hand hygiene and don’t allow any fresh flowers or home-cooked food. The risk for it bringing in organisms is too great. These patients’ immune systems can’t handle it so we’ve got to protect them.

One thing we see being tested on quite frequently both in nursing school and on the NCLEX is the order in which you put on and take off PPE. The fancy words are Donning and Doffing – ON and OFF. When putting PPE on after you wash your hands, you apply your gown first, then your mask, then goggles or face shield over the mask (of course if your mask has a face shield attached this all happens at the same time). Then you put on your gloves and you’re ready to enter the room. When you’re coming out of the room, the proper order is to remove your gloves – remember they’re now soiled, so you want to avoid touching your face or arms with soiled gloves. Then you remove the goggles or faceshield from the back (the front is soiled). Next you remove your gown by untying behind your neck and only touching the back of it – remember the front and sleeves are soiled. Then finally you can remove your mask. An alternative is to remove your gown and gloves at the same time by turning them inside out, then goggles, then mask. Mask is always last to come off. So ON is Gown, Mask, Goggles, Gloves. OFF is Gloves, Goggles, Gown, Mask.

Remember that these standards are your minimum required precautions – you can always add more, but you must do at least this. Make sure you know the organism or disease you’re dealing with so you can use the right precautions. There should be a sign posted outside your patient’s room. And finally remember this is a safety issue, so it’s important that we help each other out and hold each other accountable for these precautions.

Understanding isolation precautions is important because it protects everyone. So go out and be your best SAFE self today and, as always, happy nursing!

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