Isolation Precautions: Contact (Ambulatory) - CE/NCPD

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OVERVIEW

Pathogens may be transmitted by one of three routes: contact (including contact with contaminated surfaces), droplet, or airborne. Transmission-based precautions—airborne, droplet, and contact—may be used alone or in combination for diseases that have multiple routes of transmission (e.g., chickenpox) (Table 1).^{undefined#ref2">2} Whether used alone or in combination, these isolation precautions should be done in conjunction with standard precautions (Box 1). Precautions include measures designed for the care of a patient who is known to be or suspected to be infected or is colonized with highly transmissible pathogens for which additional precautions are needed to prevent transmission (Table 1).²

Contact isolation applies to any person with signs of an illness easily transmitted by direct patient contact or by indirect contact with items in the patient’s environment.² Illnesses requiring contact precautions (e.g., gloves, gowns, eye protection) may include those that present with stool incontinence (e.g., norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure injuries, or a generalized rash.

Contact isolation can be divided into two subgroups: direct contact and indirect contact. Direct contact transmission occurs when germs are transferred from one infected person to another without a contaminated intermediate object or person (e.g., cuts or abrasions in skin where blood or body fluids come in contact with a health care team member with ungloved hands).² Indirect contact transmission involves the transfer of a pathogen through a contaminated intermediate object or person (e.g., contaminated patient care devices transferring pathogens if devices are shared between patients; inadequately cleaned instruments, such as endoscopes, used between patients before disinfection; contaminated dressings).²

SUPPLIES

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EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
• Explain the purpose of the contact isolation to the patient and any precautions that the family should take when entering the patient’s room.
• Teach the patient about modes of infection transmission.
• Teach the patient about possible exposure of other individuals before the diagnosis.

PROCEDURE

1. Determine if the patient has health literacy needs or requires tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
2. Review the patient’s previous experience and knowledge of contact isolation precautions and understanding of the care to be provided.
3. Review the patient’s medical record (if available) for indications and risk factors for contact isolation precautions (e.g., stool incontinence, draining wounds, uncontrolled secretions, or the presence of a generalized rash).²

   Rationale: The mode of transmission for an infectious microorganism determines the type and degree of precautions used.

   1. Review the precautions for the specific contact isolation criteria, including the appropriate personal protective equipment (PPE) to apply (Table 1).
   2. Review the patient’s laboratory test results, as applicable.
   3. Determine whether the patient has a known latex allergy.
   4. Put up contact isolation signs on the patient’s room and bathroom doors, as applicable.
4. Collaborate with other health care team members regarding the patient’s emotional state and reaction and adjustment to contact isolation, as applicable.
5. Get the necessary disposable or dedicated equipment, supplies, and labels before going into the patient’s room to reduce the risk of transmitting infectious pathogens.

   Rationale: Using equipment that is disposable or dedicated for use only with the patient on isolation precautions minimizes the risk of infection transmission to other patients.²

6. Be sure to have all the needed PPE in the correct sizes and check that it is intact before putting it on.
7. Clean hands.
8. Put on PPE, as applicable (Figure 1).^1,2
9. Use environmental and transport measures while providing patient care, as applicable (Table 1).
10. Remove PPE in the correct sequence depending on the type of gown used before leaving the patient’s room (Figure 2) (Figure 3).^1,2
11. Clean the patient’s room and reusable patient care items as appropriate (Table 1).

EXPECTED OUTCOMES

• No evidence or suspected breach of contact isolation precautions.
• Health care team members put on and take off PPE correctly.

UNEXPECTED OUTCOMES

• Patient does not cooperate with contact isolation precautions.
• Evidence or suspected breach of contact isolation precautions.
• Health care team members do not put on and take off PPE correctly.

DOCUMENTATION

• Education
• Evidence or suspected breach of isolation precautions, as applicable
• Unexpected outcomes and related interventions

PEDIATRIC CONSIDERATIONS

• Isolation creates a sense of separation from family and a loss of control. A strange environment may add to the confusion that the pediatric patient feels during isolation.
• All PPE should be shown to pediatric patients. Health care team members should let pediatric patients see their faces before applying masks so that patients do not become frightened.

OLDER ADULT CONSIDERATIONS

• Many older adults become confused when they are confronted with a health care team member using isolation precautions or when left in a room with the door closed. The need to close the door should be evaluated, along with the patient’s safety needs.

REFERENCES

1. Centers for Disease Control and Prevention (CDC). (n.d.). PPE sequence. Retrieved December 16, 2024, from www.cdc.gov/healthcare-associated-infections/media/pdfs/ppe-sequence-p.pdf?CDC_AAref_Val=https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
2. Siegel, J.D. and others. (2007, updated 2024). 2007 Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Retrieved December 16, 2024, from https://www.cdc.gov/infection-control/media/pdfs/guideline-isolation-h.pdf?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

Clinical Review: Kerrie L. Chambers, MSN, RN, CNOR, CNS-CP(E)

Published: January 2025