What is Isolation?
In the hospital setting, isolation refers to additional precautions taken to prevent transmission of infectious agents, such as bacteria or viruses, between people. When a patient is placed in hospital isolation, precautions are followed by healthcare staff and visitors to help protect the patient, individuals that have contact with them, and other patients from contagious diseases.
The term isolation is frequently confused with quarantine or solitary confinement, which can be a frightening consideration for both patients and visitors. However, patients under isolation are rarely blocked from interactions with other people. Instead, isolation means that individuals who enter the patient's hospital room and interact with them need to use additional precautions. These precautions can include washing hands more frequently or wearing gowns, masks, or gloves.
In many cases, a sign on the patient’s hospital door indicates that they are under isolation, and the number of visitors allowed to enter the patient's room may be limited. Although isolation procedures are difficult for patients and staff to endure, they are designed to keep healthcare workers, visitors, and other patients healthy.
What Are the Types of Isolation in Hospitals?
Different isolation protocols are used under different circumstances to prevent transmission of infectious agents. The Centers for Disease Control and Prevention (CDC) identifies two main categories of safeguards, standard and transmission-based precautions. While standard precautions are used with all patients, transmission-based precautions are needed when an infectious disease is suspected or diagnosed. These special transmission-based precautions generally fall into one of three forms of isolation, depending on how the disease spreads. According to the CDC, the three standard categories of transmission-based precautions include contact isolation, droplet isolation, and airborne isolation.
Standard Precautions
These precautions are followed by medical staff when caring for all patients, even those with no known infectious disease. Standard infection control precautions include hand washing or sanitizing upon entering or leaving a patient’s room. Personal protective equipment (PPE) such as gloves, masks, safety glasses, gowns, aprons, and shoe covers may be used when exposure to bodily fluids such as blood, saliva, or urine is possible, or if open wounds are present.
Contact Isolation
Contact isolation is used when a patient has an infectious disease that may be spread by touching either the patient or other objects the patient has handled. Contact precautions usually require medical staff and visitors to wear gowns and gloves when entering the patient’s room.
Droplet Isolation
Droplet isolation is used when a patient has an infectious disease, such as a respiratory infection, that may be spread through sneezing, coughing, or talking. Droplet precautions, such as surgical masks, goggles, or face shields, help prevent contact with nasal or lung secretions containing the infectious agents.
Airborne Isolation
The strictest level of isolation is airborne isolation. Airborne isolation is needed when disease-caused agents can float in the air and be breathed in by surrounding people. In some cases, airborne agents such as viruses can travel into hallways or other rooms, infecting other patients, staff, or visitors. Patients under airborne isolation are typically placed in isolation rooms called negative air pressure rooms, where the air is removed through a specialized filter system and not allowed to flow into other spaces. A closed door is typically required for airborne isolation. In addition to personal protective equipment used under standard precautions, such as gloves, safety glasses, gowns, aprons, and shoe covers, medical staff generally wear specialized respirator masks when they enter airborne isolation rooms. Visitors are often limited during airborne isolation.
What Are Some Isolation Procedures for Hospitals?
Infection control may include one or more sets of isolation precautions, depending on specific patient circumstances. For example, a patient may be placed under both contact and droplet isolation if they carry infectious diseases that can be spread through both touch and coughing. Updated guidelines for disease control and prevention specify that personal protective equipment, such as gowns, gloves, or masks, should be worn upon entry into the room for patients who are under contact or droplet isolation.
Although guidelines for isolation precautions vary between hospitals, standard features for contact, droplet, and airborne isolation include:
- Contact precautions: surgical gown and gloves needed when entering the patient’s room
- Droplet precautions: surgical masks and eye protection such as goggles or face shields required when entering the patient’s room
- Airborne precautions: patient placed in a single room with specialized ventilation; breathing apparatuses such as respirator masks or helmets with a personal air supply are required when entering the patient’s room
Why Would Someone Need to Be Placed in Isolation?
There are many reasons why a patient may be placed under isolation in a healthcare setting. Patients who are infected with contagious diseases that impact the skin, respiratory system, or digestive system are commonly placed in isolation. In some cases, isolation is used even when a patient does not show signs of an infection. For example, if a patient’s skin tests positive for methicillin-resistant Staphylococcus aureus (MRSA) colonization, a type of bacteria resistant to antibiotics, the patient may be placed in isolation to avoid spreading the bacteria to other vulnerable patients or healthcare workers.
Infections that may lead to different isolation types include:
- Contact isolation: MRSA, C. difficile, and norovirus
- Droplet isolation: Influenza, pertussis (whooping cough), and mumps
- Airborne isolation: chickenpox, measles, and tuberculosis (TB)
Considerations for Nursing Staff
Contact precautions significantly impact health care worker satisfaction, particularly that of nursing staff. Nursing staff carries the main burden of isolation procedures due to the increased time and effort required to use PPE. Nursing staff often report fear regarding contracting an infection from isolated patients. In addition, nurses report concern that patients under isolation receive a different level of care and have a higher risk of adverse events than non-isolated patients. For example, health care workers are less likely to examine patients under isolation procedures and tend to spend less time with these patients. Studies also demonstrate that isolated patients are more likely to experience patient care failures, such as not having vital signs measured or supportive care administered. These failures increase the risk of adverse events in isolated patients.
Impact of Isolation on Hospitals
Isolation procedures also impact hospital revenue and patient throughput. Isolated patients typically require single rooms, limiting the total number of patients a hospital can treat. This limitation is of particular concern for hospitals with a limited number of available beds and may negatively impact revenue. The cost of protective equipment which may include gloves, gowns, masks, and eye protection, quickly becomes a significant financial burden. Most PPE is single use, resulting in a vast quantity of accumulated waste and leading to negative environmental impacts and impacting the financial bottom line.
Summary
- Isolation procedures are used in hospitals to prevent the spread of infectious diseases between patients and other people, including other patients, medical staff, and visitors
- Different types of isolation, including contact, droplet, or airborne, are used depending on how an infectious disease may be spread
- Isolation procedures may involve the use of gloves, masks, gowns, eye protection, or specialized breathing apparatuses or ventilation systems
- Common causes of isolation include infection with respiratory or digestive system diseases such as influenza, whooping cough, C. difficile, norovirus, or tuberculosis
- Isolation procedures impact healthcare worker satisfaction as well as hospital revenue and patient throughput
In recent years there has been considerable interest in methods to limit the need for isolation procedures, while still protecting patients, medical staff, and visitors. Limiting isolation procedures helps improve patient satisfaction by making them feel less secluded while also easing the burden on medical staff and hospitals to prevent infection transmission.
As the leader in risk mitigation strategies for MRSA colonization, Nozin® offers programs that can help reduce patient isolation safely, while helping reduce the risk of infection in hospitals. Request a consulation today for a customized cost analysis and to learn more about infection prevention strategies.
References
- Isolation Precautions. Centers for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html. Published July 22, 2019. Accessed February 5, 2020.
- Isolation precautions: MedlinePlus Medical Encyclopedia. Medlineplus.gov. https://medlineplus.gov/ency/patientinstructions/000446.htm. Published 2017. Accessed February 5, 2020.
- Ngam C, Schoofs Hundt A, Haun N, Carayon P, Stevens L, Safdar N. Barriers and facilitators to Clostridium difficile infection prevention: A nursing perspective. Am J Infect Control. 2017;45(12):1363–1368.
- Khan FA, Khakoo RA, Hobbs GR. Impact of contact isolation on health care workers at a tertiary care center. Am J Infect Control. 2006;34(7):408–413.
- Thampi N, Morris AM. Pro/con debate: are barrier precautions cost-effective in improving patient outcomes in the intensive care unit? Crit Care. 2012;16(1):202.
