Isolation Precautions: Contact
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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Perform hand hygiene with soap and water or use an alcohol-based hand rub (ABHR) immediately after removing all PPE.undefined#ref5">5
Infection prevention and control measures help ensure the protection of individuals in a range of settings who may be vulnerable to acquiring an infection.
Infection-control practices that reduce and eliminate sources of infection transmission help protect patients and health care team members from disease. The health care team member is responsible for educating a patient about infection control. Knowledge of the infectious process, disease transmission, and critical thinking skills associated with the use of aseptic techniques and barrier protection is essential for both health care team members and patients.1
Contact isolation can be divided into two subgroups: direct contact and indirect contact. Direct contact is when direct transmission occurs because microorganisms 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 bodily fluids come in contact with mucous membranes, scabies-infested patient transfer to a health care team member with ungloved hands).4 Indirect contact transmission involves the transfer of an infectious agent through a contaminated intermediate object or person (e.g., patient care devices transmitting pathogens if devices contaminated with blood or bodily fluids are shared between patients; inadequately cleaned instruments used between patients before disinfection, such as endoscopes).4
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. Illnesses requiring contact precautions may include those present with stool incontinence (e.g., norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure injuries, or a generalized rash.
Standard precautions, or tier one precautions, assume that every patient is potentially infected or colonized with an organism that could be transmitted in the health care setting. The health care team member should apply standard precautions when caring for all patients regardless of risk or presumed infection status (Box 1).5 Standard precautions are the primary strategies for preventing infection transmission and apply to contact with blood, bodily fluids, nonintact skin, and mucous membranes, as well as contact with equipment or surfaces contaminated with potentially infectious materials.
Tier two 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 or epidemiologically important pathogens for which additional precautions are needed to prevent transmission (Table 1).5 Organisms may be transmitted by one of the three routes: contact (including contact with contaminated surfaces), droplet, or airborne. The 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).5 Whether used alone or in combination, these isolation precautions should be employed in conjunction with standard precautions.
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Rationale: The mode of transmission for an infectious microorganism determines the type and degree of precautions used.
Rationale: Using equipment that is dedicated for use only with the patient on isolation precautions minimizes the risk of infection transmission to other patients.5
Rationale: Donning a gown properly prevents the transmission of infection and provides protection if the patient has excessive drainage or discharge.
Rationale: Donning eye protection properly reduces the risk of exposure to microorganisms that may occur from splashing fluids.
Rationale: Single-use medication containers minimize the transfer of microorganisms.
Rationale: Gloves act as a barrier to reduce the risk of exposure to blood.
Ensure that linens or waste are totally contained to protect health care team members from exposure to infectious organisms.
Rationale: Disinfecting equipment after use decreases the risk of infection transmission.5
If hands become contaminated during PPE removal, immediately perform hand hygiene with soap and water or use an ABHR.
Do not touch the outer surface of the gloves; it is considered contaminated.
Do not touch the outer surface of the eye protection or face shield; it is considered contaminated.
Do not touch the front surface or sleeves of the gown; it is considered contaminated.
Do not touch the outer surface of the mask or mask with face shield; it is considered contaminated.
If hands become contaminated during any part of the PPE removal, immediately perform hand hygiene with soap and water or use an ABHR.
Do not touch the front surface or sleeves of the gown or outside of the gloves; it is considered contaminated.
Do not touch the front of the mask or mask with face shield; it is considered contaminated.
Clinical Review: Kerrie L. Chambers, MSN, RN, CNOR, CNS-CP(E)
Published: November 2023
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