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The Need for Isolation Precautions
National Health Care Provider Solutions (NHCPS) published an interesting article about the need for nurses to understand the prevalence and characteristics of common infections as they are often on the front lines in protecting their spread. According to the World Health Organization, up to 7 percent of patients may contract a healthcare-associated infection that could have been prevented with the proper use of isolation protocols.
The fact that so many in the hospital environment are already ill and have weakened immune systems necessitates the use of isolation rooms and isolation carts. Influenza and C. diff may be the most commonly transmitted infectious diseases, but there are many others, such as staph, that can have significant, even deadly ramifications if they aren’t controlled.
Keeping these infections isolated and preventing their spread is paramount. Not only are patients at risk, but every health care worker in the facility and in some cases, the people they come in contact with when they leave the hospital. In an extreme instance such as Ebola, transmission of the disease is so dangerous that the health care workers who treat those infected patients are often quarantined with the patient for 2-21 days.
Depending on the type of infection the patient carries, the isolation protocols will range. Not all infections require significant precautions. Further, each hospital or healthcare facility may have their own set of protocols and stock their isolation carts with different supplies. NHCPS says no matter the disease or infection, however, isolation precautions will fall into one of five categories:
Contact precautions are intended to stop the spread of infections, diseases or germs, such as MRSA, RSV, and VRE, through direct touching the patient or items in the room. To prevent the spread of these infections, it is advised that healthcare workers wear a gown and gloves while in the patient’s room.
Droplet precautions aim to prevent the transmission of diseases or germs through tiny droplets caused by coughing and sneezing, such as pneumonia, influenza, whooping cough, and bacterial meningitis. Droplet contamination requires close contact for transmission. To prevent the spread of these infections, healthcare workers are to wear gloves, gowns, and masks.
Similar to droplet precautions, airborne precautions stops the transmission of microorganisms via airborne droplet nuclei and include infections such as measles, varicella (chickenpox) and Mycobacterium tuberculosis. Again, gloves, gowns and masks are required in patient rooms.
Patients with neutropenia have a decreased number of white blood cells that protect them against infection. Because of their weakened immune systems, certain precautions are needed to prevent them from contracting an illness. Healthcare workers must keep their hands clean, use the same equipment on the patient and keep it in their room, such as blood pressure cuffs and thermometers. Visitors are encouraged to wear masks, gowns, and gloves while in the patient’s room and not bring living plants or produce into the room.
After a patient receives radiation therapy and depending on the dose of radioiodine used, they emit radiation that could harm others. They are often placed in a special isolation room for several days while the radiation wears off.
Hospital facilities must follow best practices to ensure they are minimizing the risk that any infection is spread from patient to patient, from patient to nurse or doctor, or from nurse or doctor to patient. Once the spread of infection begins, it is difficult to contain. By providing the above precautions, facilities can greatly reduce the risk of transmission.
Isolation Carts Provide All Necessary Isolation Supplies
Isolation carts go a long way in helping facilities minimize the risk of spreading germs, pathogens, and infections between rooms. Isolation carts are stocked and kept in the patient’s room as every time the cart is removed from the room, the risk of contamination increases. Healthcare facilities will have their own ways of making sure refilling and sanitizing the isolation carts will not introduce pathogens to other areas of the facility.
Because so many precautionary measures include similar supplies, the isolation carts will most likely contain the following, however, it is ultimately up to the healthcare facility to determine what supplies need to be on which isolation carts:
Gloves are the first line of defense against becoming infected with or transmitting germs. Gloves in various sizes should be stocked on every isolation cart. Many healthcare professionals double-glove in order to further protect themselves. Gloves are not impervious to needles, however, so nurses must take extra precautions when handling needles.
Isolation carts should have various masks, typically surgical masks, to protect nurses from spreading airborne and droplet infections. Plastic face shields may also be used, although these may not provide the same level of protection from all patient illnesses, particularly airborne and droplet infections. Because they are open at the top and not flush with the face, tiny particles may still be inhaled. Keep in mind, the nurse is not only preventing the spread of germs from their last patient’s room, but they are protecting themselves from any germs the patient may emit.
Gowns will be stocked on every isolation cart. Because doctors and nurses travel from patient room to patient room, it is possible for their clothing and skin to be carrying pathogens. By covering their arms and body with the gown, they prevent these germs from contacting the patient or their surroundings. Further, the gowns are removed upon exiting the patient’s room. Any germs the healthcare worker picked up in the room are now properly disposed of and not traveling with them to the next patient room or to common areas where they can be spread.
As the gowns protect the body, the shoe covers protect the shoes and any germs they may carry that can be transmitted from room to room. The key is to remove these covers before exiting each patient’s room and wearing new ones once another patient’s room is entered. These shoe covers will be located on the isolation cart as well.
Airborne isolation precautions may require more substantial face protection than basic surgical masks can provide. Airborne agents can be microscopic and travel through less protective materials. In these cases, the use of an N-95 respirator is recommended. The respirator will ensure even aerosolized nuclei cannot be inhaled.
While most hospital and healthcare facility rooms have hand sanitizers mounted to their walls, an isolation cart often has additional sanitizer in case the hospital worker failed to use it upon entering the room or it was empty. The hand sanitizer can be foam, gel or liquid, just as long as it contains at least 60 percent alcohol.
The isolation cart should be placed near the entrance to the patient’s room or just outside the room. This way, healthcare workers are not walking far into the room before they can protect themselves and the patient. Anyone entering and exiting the patient’s room, including family and visitors, should wash their hands and use hand sanitizer, no matter what type of isolation the patient is under.
Should Visitors Take Precautions?
Visitors do not carry the same risk as healthcare workers who are moving from patient room to patient room. While visitors may carry some germs from the outside environment, they rarely carry the same pathogenic risks as healthcare workers. Those who work inside the hospital or healthcare facility are constantly being introduced to bacterias, viruses and other agents that are more likely to be the cause of cross-contamination.
Still, all visitors should always wash their hands and use hand sanitizer before and after they visit the patient. Gloves, masks, gowns and shoe protectors are typically unnecessary, particularly with contact isolation precautions, however, in some cases, the healthcare facility may determine it is worth the extra effort to ensure patient safety. All visitors should be made aware of the facility’s specific policies and be provided with the required precautionary items from the isolation cart prior to entering the patient room. These items should also be disposed of properly as soon as they exit the patient room so as not to carry any pathogens throughout the hospital.
Most facilities post a sign with the necessary precautions on the door outside of the patient’s room. It should clearly list all of the protective items required and any hygiene protocols, such as washing hands and not bringing plants into the room. In more extreme or sensitive cases, the hospital may require all visitors to check in at the nurse’s station prior to entering the patient room in order to educate them on the isolation protocols and provide them with necessary protective gear.
Keep The Isolation Carts Stocked
It is not recommended that patient nurses refill isolation carts. Because nurses visit multiple patient rooms each day, they can carry germs and pathogens. Even when they take all required precautions, there is still a risk that nurses may contaminate the isolation cart supplies. Instead, isolation carts should be refilled by the unit’s service center. They will not only have the available supplies in bulk, but they are trained in how to refill the cart without posing a risk.
Gloves are likely the most used item on the isolation cart. It is important to have multiple sizes of gloves on each cart and that all healthcare workers who come in contact with the patient wash their hands after treatment, even if they wore gloves while providing care. Gloves may appear to be impervious, however, they contain microscopic holes that can make the healthcare worker vulnerable.
If the isolation cart is running low on any item, it is critical for the service center to be notified immediately. When items are missing, it is common for healthcare workers to cut corners and time by skipping the precautionary protocol to treat the patient. Either they lack the time to find the items elsewhere (such as in an emergency) or they simply want to get through their shift without delays. Alternatively, there may be a delay in care if they have to wait for the necessary items to arrive. In any of these cases, neglecting protocols and precautions puts the entire hospital and even the community at large at risk for the spread of contagious diseases.
Some of the more important features of any isolation cart are its material and design. Isolation carts must be easy to clean and sanitize. The drawers must be smooth, of non-porous material, and with as few nooks and crannies as possible. Once isolation carts are placed in an isolation room, they must be considered potentially contaminated, particularly in the rooms with airborne or droplet isolation precautions.
Isolation carts are an important feature in any hospital or healthcare facility where infectious diseases are common. Hospital staff, including central supply, should work in unison to ensure the isolation carts are where they need to be and constantly stocked with the necessary supplies. When used properly, the isolation cart is an effective way to reduce the spread of infection.