Isolation systems: More methods

A Isolation

systems:

More methods

ISOLATION/PRECAUTIONS/COMPROMISED HOST: A THREE·SIGN SYSTEM

During the past decade, isolation measures have been one of the most important facets of infection control programs. However, isolation measures still remain a confusing issue for most hospital employees, including the medical staff, as well as for patients and visitors. Because isolation has been such a baffling experience in the past, proposals are now being made to introduce a simplistic, individualized method for patient and staff protection. The principles of isolation remain the same: to interrupt the transmission of infection and to prevent spread of the infectious agent. Knowledge of the contagiousness of a disease and its mode of transmission is required in order to isolate a patient appropriately. Sometimes the word "isolation" is too strong; "precaution" may be a more appropriate classification. The infection control team from the Epidemiology Laboratory at North Carolina Memorial Hospital, Chapel Hill, North Carolina, has developed an innovative approach to the traditional five-card isolation category system. This method utilizes disposable signs for the three categories: "isolation," "precaution," and "compromised host." The signs can be printed in tablet form on two sides, with check-off boxes on the front. A listing of infectious diseases or pathogenic organisms and the recommended degree of isolation can be printed on the back. The check-off boxes are for gown, mask, and gloves and allow individual patient assessment for specific required isolation techniques (Figs. 1 and 2). Because the signs are disposable, the nurse may write on the sheet if particular items are needed only during patient contact or for special procedures (i.e., gloves and mask during suctioning only). It is important to employ isolation measures when needed; however, unnecessary isolation techniques should be avoided. Isolation of the patient may encourage limited contact by 44A

COMPROMISED HOST 00 STRICT HANDWASHING ~ PERSONNEL LIMITED TO 4

AT PATIENT BEDSIDE ~ NO PERSONS WITH

INFECTIONS

[ZJ NO LIVE PLANTS

[J

_

Fig. 1. Door sign for the category "compromised host." Actual size of signs is 8.5 x 11 inches.

ISOLATION ~ WASH HANDS

o o o

GOWN

MASK GLOVES

o Fig. 2. Door sign for the category "isolation."The door sign for the category "precaution"is identical except for the heading.

Volume 9 Number 1

APIC notes

February. 1981

hospital personnel and VIsItors, decrease patient exercise and ambulation, increase patient lonel iness and concern as to whether he or she is improving clinically, and contribute to waste of isolation materials that are costly to the hospital and patient. We should always keep in mind that it is the infectious agent we are isolating and not the patient or the room. Connie Wilson. R.N.* Nurse Epidemiologist North Carolina Memorial Hospital Chapel Hill, N.C.

ISOLATION

o o o

Strict

(gown, mask, door shut)

Respiratory

(mask, door shut)

Protective

(see nurse)

"Present address: Hospital Infection Control, University of California, San Francisco, Calif.

ISOLATION/PRECAUTIONS: A TWO·CARD SYSTEM

At Robert Packer Hospital in Sayre, Pennsylvania, the widely used five-card color-coded system for identifying patients on isolation I has been replaced by a much simpler two-card syst~m.

The new cards measure only 4 x 2 inches, have pressure-sensitive backs, and have been printed to our specifications: the "isolation" card is fluorescent red; the "precautions" card is fluorescent green. When a patient is placed on isolation or precautions, duplicate cards are used: one is attached to the chart cover and the other to the door or over the bed. The nurse checks the type of isolation or precautions to be used and, in the case of wound and skin or enteric categories, what degree of precaution is indicated. A few essentials for each type of isolation appear in parentheses. The conventional five-card system was adopted enthusiastically by our hospital in 1972, but over the years we found that it did not meet the needs of our particular facility. Robert Packer Hospital is a 323-bedcommunity teaching hospital tha t is part ofa rural medical cen terproviding tertiary care to a large area. Keeping each of our 15 nursing stations supplied with cards was surprisingly complicated, and the nurses complained that they were always out of the needed type of card. Even the size (8 x 5 inches) presented a problem: although fine for doors and

45A

Fig. 1

PRECAUTIONS o

o o

Wound/Skin

o

routine

Enteric

o

routine

0 stringent

o

stringent

Serum (use special Serum Handling Set) Fig. 2

walls, they took up too much room on the chart covers. The large card did offer a good deal of information but some of that was less than helpful. We never carried out "protective isolation" as outlined, so there was always a surplus of "blues." The "desirable" private room suggested for wound infections seemed to indicate that the semiprivate accommodation we commonly use was "undesirable." Masks for "susceptible persons" sometimes led to strange theories of immunology based on fear or convenience. The new system does correct some of these flaws. Each nursing unit is supplied with a 250card dispensing roll of both kinds (Figs. 1 and 2), which does away with storage and inventory problems. The fluorescent colors are hard to miss even when placed on the wall over the bed and the

American Journal of

46A

APIC notes

smaller size is convenient for use on the chart cover. Our patients go to many different areas of the medical center, and this is a simple method of alerting other departments and personnel. Perhaps the biggest advantage, however, is that the printed information, although meager, is tailored to our situation: we rarely have a patient who requires strict isolation, and when we do, the" closed door, mask and gown" give us protection while we look up the particulars in the unit isolation manual. Conversely, respiratory isolation, our most frequently used type, is fairly well covered in three words. No attempt is made to be specific about protective isolation; we use it often, especially on the oncology service, but we try to adapt the techniques and procedures to the requirements of the individual patient. The "precautions" card (Fig. 2) is even more individualized. We divide wound and skin categories into routine and stringent precautions: if the exudate is contained by the dressing, little more than handwashing and notouch dressing technique are needed. However, w hen the patient'senvironment is being contaminated by drainage, gown and linen precautions plus other stringent methods are indicated. Similarly, incontinence or uncontrollable diarrhea necessitates stringent rather than routine enteric precautions. Such simple distinctions save time, money, and materials. To our staff, "serum precautions" means hepatitis B, a disease we do not often see in our locale but one that the Infection Control Committee feels could be a special hazard to our employees. At the suggestion of one of our med-

Infection control notification: The standardization of control measures and communication between the infection control department, the nursing staff, and the medical staff are most important when dealing with patients needing strict isolation or when trying to control an epidemic pathogen such as methicillin-resistant Staphylococcus aureus. Ver-

INFECTION CONTROL

ical technology students, we designed a kit containing the essentials for blood collection and this is placed in the room of any patient suspected of having hepatitis B. The label alerts the appropriate personnel without alarming others unnecessarily. The labels were made up by a label company, exactly as we designed them, at a cost of less than $0.06 a label. Introducing our new system was easy. No new terminology was involved, and a simple memo that included a sample of each card seemed to explain the changes adequately. The most difficult task was rounding up the old cards, many of which had been secreted as if in anticipation of future plagues! One deficiency of our new cards is obvious: they make no mention of handwashing. I could have added another line and considered doing so but decided that what I wanted was to differentiate among the various requirements and do it tersely; the cards serve as alerts only. The importance of handwashing is included in all other infection control activities; even so, I suspect that the dictum should have been included. Margaret Aronstam, R.N. Infection Control Nurse Robert Packer Hospital Sayre, Penn.

Reference 1. Center for Disease Control: Isolation techniques for use in hospitals, ed 2., Washington DC, 1975, US Government Printing Office

A communication

system

bal reports and isolation signs do not always guarantee compliance. The Infection Control Department at the University of California, San Francisco, utilizes an "Infection Control Notification" sticker (Fig. 1) that can be placed on the front of the chart or in the physician's progress notes. The ICPs use this sticker to alert the