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Contents.. Page No. Introduction 2 Assessment Activities 3 Aim and Learning Outcomes 4 Topic Sequencing Diagram 5 Section 1: What is Source Isolation? 6 Assessment Activity 1 8 Section 2: Principles of Isolation Care 9 Assessment Activity 2a 13 Assessment Activity 2b. 15 Section 3: Isolation Precautions Protective Clothing 16 Assessment Activity 3 18 Section 4: Risk Assessment 19 Assessment Activity 4 23 Section 5: The Patient Experience 24 Assessment Activity 5 (Optional) 26 Summary 27 References 28 Bibliography 29 Appendix 1: Components of Standard Precautions 30 Resources 31 1
Introduction.. Welcome to this Learning Resource Pack (LRP) on Source Isolation. The LRP is designed for you to undertake with the purpose of developing and enhancing your knowledge in order to facilitate safe, effective, evidence based isolation care and so prevent the spread of infection. The following topics are covered as components of Source Isolation: What is Source Isolation? Principles of Isolation Care Isolation Precautions (Protective Clothing) Risk Assessment The Patient Experience. In addition hospital policy will be focused on throughout the pack as a basis for guiding your practice of source isolation within Southampton University Hospitals Trust. How to use the LRP Whether you undertake the Learning Resource Pack as a whole, in one go, or in individual sections over a short period of time is up to you. However, it should be remembered that despite being divided into 5 sections, each section must be seen as integral with the others to view Source Isolation as a whole. The suggested progression for completing the pack is shown on page 5. It is recommended that you spend a little time looking through the pack before you start, to familiarise yourself with the layout. Content The LRP contains a variety of materials text, activities and reading that have been developed to facilitate your learning and progression through the pack. Many of the in text activities promote you to think and reflect on your own knowledge and experience and are a key component of the LRP. At the back of the pack you will find a list of resources required to complete the LRP. It is essential that you obtain a copy of the Southampton University Hospitals NHS Trust Isolation Policy (2002). 2
Assessment Activities.. In order to demonstrate that the learning outcomes have been met, an assessment activity is included at the end of each section. The completed assessments can be checked against the assessment activity answer pack. Section What is Source Isolation? Principles of Isolation Care Isolation Precautions Risk Assessment The Patient Experience Assessment Activity Summary of Understanding Isolation Care Checklist Action Plan for Isolation Care. Isolation Precautions Table Isolation scoring Quiz Optional: Questions on experiences of patient in Isolation. If you require any further information or have any queries regarding this learning resource pack please contact the. 3
Aims and Learning Outcomes.. Aim: To develop and enhance knowledge and practice of source isolation, in order to facilitate the implementation of safe, effective isolation care in accordance with hospital policy. Learning Outcomes On completion of this LRP you will be able to: 1. Justify the need for Isolation Care. 2. Discuss the basic principles of isolation care. 3. Identify appropriate isolation precautions based on specific modes of transmission of infection. 4. Undertake risk assessment to identify and prioritise isolation facilities. 5. Describe the impact of isolation care on the patient. 6. Ask relevant questions in relation to source isolation care and practice. Mapping of LRP Content against learning outcomes. Section Learning Outcome 1 2 3 4 5 6 What is Source Isolation? Principles of Isolation Care Isolation Precautions Risk Assessment The Patient Experience 4
Topic Sequencing Diagram.. This diagram outlines the suggested route of progression through the pack. However, it should be remembered that despite being divided into 5 sections, each section must be seen as integral with the others to view Source Isolation as a whole. What is Source Isolation? Principles of Isolation Care Isolation Precautions Risk Assessment The Patient Experience 5
1. What is Source Isolation? The practice of Isolation nursing will not be new to you and is a regular occurrence within the hospital setting. Indeed, you may have current or recent experience of nursing patients in isolation. Let us first begin by clarifying your understanding of isolation care. Activity Spend a few minutes thinking about your current or recent experiences of isolation nursing, and then attempt to describe what you understand by the term isolation care. ----------------------------------------------------------------------------------------------------------------- Did you find this easy? You may have a wealth of experience in the practice of isolation nursing. Did you mention preventing the spread of infection? Did you think about isolation of patients with infections (source isolation) and isolation of susceptible patients (protective isolation)? Isolation Care may be implemented for two reasons: 1. To reduce the risk of spread of infection, from patients with infections to susceptible individuals (SOURCE ISOLATION). 2. To prevent those patients at risk e.g. immunocompromised patients, from becoming infected (PROTECTIVE or REVERSE ISOLATION) For the purpose of this Learning Resource Pack we will focus on SOURCE ISOLATION. Micro-organisms such as bacteria, viruses and fungi can cause a range of infections. In many cases the spread of micro organisms from patient to patient, patient to staff, and staff to patient can be reduced by the use of the basic principles of infection control known as STANDARD PRECAUTIONS (appendix 1). Please refer to SUHT Infection Control Standard Precautions Policy (2005) for more information. You will be very familiar with the concept of Standard Precautions as these are the basic principles that should be applied to all patients at all times regardless of whether they have an infection or not. However, in some cases, such as for some pathogens (micro-organisms that cause infection) spread by the airborne, droplet or contact route, it is considered necessary to take additional precautions in order to minimise the risk of transmission. This is 6
most relevant in the hospital setting where the frequency of contact with staff and the presence of other vulnerable patients may facilitate spread (Wilson 2003). These additional precautions are known as SOURCE ISOLATION and the associated principles and practices. Source Isolation is the term used to describe the physical isolation of patients with infections. It indicates the patient is the source of infection (Wilson 2003). Hospital Policy. In order to facilitate safe, effective isolation practice in hospitals, policies and guidelines are in place for staff to follow. At this point you are required to undertake some reading in order to familiarise yourself with the Southampton University Hospitals Trust (SUHT) policy on Source Isolation. Activity Locate a copy of the SUHT Isolation Policy (2002) and spend some time reading through the policy. (The policy can be located in the ward/unit infection control folder or downloaded from the SUHTranet). Assessment Activity In order to clarify your understanding of Source Isolation you should now undertake the assessment activity on page 8. Now that we have clarified what we mean by Source Isolation we will now go on to explore this concept in practice by looking at: Principles of Isolation Care Isolation Precautions Risk assessment The patient experience 7
Assessment Activity 1: What is Source Isolation?.. Briefly summarise why some patients require Source Isolation Care. Name.. Date:. 8
2. Principles of Isolation Care The purpose of Source Isolation is to minimise the risk of micro-organisms being transferred from an infectious, or potentially infectious, patient to others. This may also include patients who are colonised with resistant organisms, e.g. MRSA. Activity Consider occasions when patients you are nursing have required isolation. List where these patients have been isolated.. You will be familiar with isolation of patients in single room accommodation, the Infectious Diseases Unit (IDU) or the cohorting together of a group of patients with the same infection. Is simply separating an infectious, or potentially infectious, patient away from others, by physically isolating them in a single room, sufficient to minimise the risk of spread of these micro-organisms that cause infection? The physical isolation of patients alone, without additional infection control precautions, is not sufficient to minimise the spread of micro-organisms. As discussed in the previous section, in many cases the spread of micro organisms can be reduced through the use of standard precautions (appendix 1). This basic set of principles should be universally applied to all patients at all times regardless of whether they have an infection or not. In addition, when patients are being nursed in isolation, some basic principles of isolation care and specific isolation precautions should be followed in order to minimise the risk of the spread of micro-organisms to both patients and health care workers. Let s look at some basic principles of isolation care. Activity Spend some time reviewing a patient in isolation and the practice that is occurring in your clinical area. Look in the isolation room and reflect on the facilities and isolation care that is in place for this patient. Use the Isolation Care guidelines on p.21/22 of the SUHT isolation policy (2002) to guide you. Now complete the isolation checklist on page 13 in this pack. This will form part of the assessment activity for this section. 9
Did the isolation facilities and practice meet all of the requirements included in the Isolation Care guidelines? Well done if they did. We will revisit this checklist later on in the section. Now let s look at the significance of the isolation care guidelines. Activity Spend a few minutes thinking about the significance of the guidelines set out in the isolation policy. For each aspect listed below write down your thoughts of why it is important in relation to infection control and isolation care. Accommodation with ensuite toilet. Hand hygiene Protective clothing Disposal of waste Dedicated equipment Disposal of linen Communication with the patient. 10
The Isolation Care guidelines included in the SUHT Isolation Policy (2002) are in fact basic principles of isolation care that should be followed in order to minimise the transmission of micro-organisms from the patient in isolation. We will now summarise and expand on these for you. Accommodation Appropriate patient placement is a component of isolation precautions (Centres for Disease Control and Prevention, CDC, 1996). The purpose of single room accommodation is to prevent the transmission of micro-organisms spread by the airborne route and to prevent contamination of the environment outside of the room with particular micro-organisms spread by the contact route. Facilities, e.g. toilet and hand washing facilities, should be available in the room again to reduce the opportunities for transmission of micro-organisms. A notice should be displayed on the door of the room to indicate to staff and visitors that special precautions are being observed. Hand hygiene The Single most important measure to reduce the spread of infection. Must be carried out after contact with the patient, on leaving the room. Should also be carried out in between different aspects of care for the same patient. Protective clothing Should be worn to reduce the risk of acquiring pathogens on hands or clothing and when contact with material likely to transmit infection is anticipated (Wilson 2003). May need to change protective clothing during an episode of care for an individual patient. Protective clothing should be removed before leaving the room and hand hygiene performed. An exception to this is if equipment, such as a bedpan, needs to be taken out of the room. Protective clothing should be removed once the bedpan has been disposed of and hand hygiene performed. The choice of protective clothing is explored further in section 3. Cleaning and decontamination: Equipment Micro-organisms can be transmitted on equipment. Whether a patient is in isolation or not, equipment must be cleaned between patient use in accordance with the SUHT Cleaning and Decontamination Policy. Ideally a patient in isolation should have dedicated equipment, which must be cleaned following discharge, prior to use on another patient. Room Some micro-organisms survive for long periods in dust. Isolation rooms should be cleaned daily to keep dust to a minimum. Each room should have dedicated cleaning equipment. A thorough clean of the room must be undertaken when the patient is discharged. The next patient can be admitted into the room as soon as it is dry. (See cleaning procedures for Single Isolation room, pp.18/19 SUHT Isolation policy). 11
Disposal of waste Waste from an infected patient may be contaminated with infectious material and therefore must be disposed of safely in a yellow clinical waste bag, located inside the room. A black domestic waste bag should be available by the sink for disposal of hand towels, newspapers etc. Disposal of linen Linen from any patient may pose a risk to laundry workers if contaminated with blood or body fluids. Local policy should be followed for the care of linen from infectious patients (See SUHT Care of Used Linen policy 2004). Care of deceased Deceased patients with infections may pose a risk to mortuary staff and it may be necessary to place the patient in a body bag, rather than a body liner, and place a Danger of Infection notice on the outside. The SUHT Last Offices Policy (2003) should be referred to for the correct procedure. Specimens For some infections it is necessary to alert the laboratory of the increased risk that may be posed to them. It may therefore be necessary to label request cards and specimen containers with a Danger of Infection sticker e.g. for ACDP (Advisory Committee on Dangerous Pathogens) Category group 3 or 4(see Isolation Policy Table 2: Common Conditions & pathogens, p.10) Communication/information. The patient should be informed of the reason for isolation and the practices and precautions that will be observed. The impact of isolation for the patient will be explored further in section 5 Visitors If applicable, visitors should be advised of any particular risks that the infection might pose to them. In most cases they will not need to wear protective clothing as are unlikely to come into contact with infectious material and are unlikely to have contact with other patients on the ward. There are exceptions for some infections. If contributing to patient care, visitors must follow the same precautions as staff. Visitors must be advised on the importance of hand hygiene when leaving the room. Assessment Activity To complete the assessment activity for this section, using your checklist that you completed earlier, create an action plan, using the template provided on page 15. This action plan should address deficits highlighted in your checklist where facilities and practice are not meeting the isolation care guidelines. It is recommended that you discuss both the completed checklist and action plan with your ward/unit manager to aid in addressing the required actions in order to facilitate isolation care. 12
Assessment Activity 2a: Isolation Care Checklist Isolation Care Guidelines Current Practice Yes No Accommodation Single room Toilet facilities Hand washing facilities Check room is clean before patient is isolated Unnecessary furniture / equipment removed. Inside Room: Soap Paper towels Alcohol hand gel Protective clothing Yellow clinical waste bag Black domestic Waste bag Yellow bucket and mop handle Outside Room: Yellow Isolation sign Observation Charts Supply of Protective clothing Door kept closed Hand hygiene Soap and water Paper Towels Alcohol hand gel Hand hygiene guidelines available on ward Hand hygiene performed on exit from room. Protective clothing Yellow aprons Disposable gloves Gowns Masks if appropriate. Goggles if appropriate Communication/information Patient informed of reason for isolation. Visitors Visitors informed of importance of hand hygiene 13
Isolation Care Guidelines Current Practice Yes No Cleaning and decontamination: 1. Equipment Keep equipment limited Dedicated equipment, used for that individual patient only, (BP cuff and Hoist slings). Kept in room Equipment cleaned on patient discharge before return to general use. e.g. Clean PAT slides and hoist frame. Hoist slings sent to laundry or single patient use disposable used. Cleaning & Decontamination Policy available 2. Room Cleaned daily Domestic services contacted for cleaning of room on patient discharge. Disposal of waste Clinical Waste - yellow bag inside room. Domestic Waste - black bag by sink for hand towels etc. Waste bags for disposal are secured with the correct coded tape. Sharps sharps bin available inside room. Disposal of Linen Linen contaminated with blood or body fluids treat as infected (white water-soluble bag then into red plastic bag). Care of Deceased Last Offices guidelines for dealing with infectious patients are referred to (SUHT Last Offices guidelines). Specimens Request cards and sample containers from patients with a risk of ADCP Category Group 3 or 4 are labelled with a biohazard label - Danger of Infection Sticker. Name Date 14
Assessment 2b: Action Plan for Isolation Care. Isolation Care Deficit Action Required. Name Date 15
3. Isolation Precautions Protective Clothing Having discussed the basic principles of Isolation Care we will now focus specifically on the use of protective clothing. Let us first consider why the wearing of protective clothing is important? Gould and Broker (2000) cite three reasons for the use of protective clothing: 1. Protect clothing from contamination by pathogens that could subsequently be transferred to other people, from patient to nurse and vice versa. 2. Prevent the direct transfer of pathogenic organisms from patient to nurse or vice versa. 3. Prevent clothing becoming soiled, wet or stained. (p.120). Put simply, protective clothing should be used to prevent the spread of microorganisms. from the patient to you, or you to the patient. It should be used to reduce the risk of acquiring pathogens on hands or clothing and worn when contact with material likely to transmit infection is anticipated (Wilson 2003). Activity Consider the area in which you practice. What protective clothing is available to you?... Hopefully, the following protective clothing is available: Gloves Aprons Gowns Eye protection (goggles/visors) Masks (SUHT Infection Control: Standard principles for the Use of Personal Protective Clothing Policy 2005). In the sections 1 and 2 we discussed the use of standard precautions, which should be used routinely for contact with blood and body fluids. We have already discussed the need to take additional precautions on top of standard precautions for some infections, and highlighted the use of protective clothing as a principle of isolation care. Protective clothing is an important isolation precaution. The choice and use of protective clothing should be based on how pathogens are spread in order to minimise that spread, to both other patients and yourself. 16
Let us now consider how infections are spread. Micro-organisms are transmitted in hospitals by several routes (CDC, 1996). What are these routes? Activity List the routes by which micro-organisms / infection are spread. Micro-organisms can be transmitted by a number of routes: Blood borne transmission Contact transmission Air borne transmission Droplet transmission Vector borne transmission Food/ water borne transmission. According to the CDC (1996) vector borne and food/water borne transmission are of less significance in hospitals. Focus is therefore placed on blood borne, contact, air borne and droplet transmission. (It is recommended that you refer back to the SUHT isolation policy for the definitions of these routes, if you are unclear) It is therefore necessary to take precautions based on how micro-organisms are transmitted to prevent spread, e.g. contact precautions for infection spread via the contact route. An assessment should therefore be undertaken to ensure that the appropriate protective clothing is chosen when caring for patients with infections. For example for someone with an infection spread by the airborne route, e.g. TB, you may need to wear a mask, whereas for a patient with an infection spread by the contact route you will only need to wear a mask during procedures likely to cause contamination with blood or body fluids. In order for you to decide on what protective clothing you need to wear, it is important to know the mode of transmission of the pathogen and the required precautions for that mode of transmission. This information is provided in the SUHT Isolation Policy (2002) on pages 11 and 12. The following assessment activity requires you to utilise this information. 17
Assessment Activity 3: Isolation Precautions.. Using the SUHT Isolation Policy 2002 and your existing knowledge complete the following table. Condition Pathogen Hepatitis B Mode of Transmission Infection Control Precautions. Scabies Mycobacterium Tuberculosis Rubella MRSA Influenza virus Neisseria meningitidis Staphylococcus aureus. Clostridium difficile Name Date 18
4. Risk Assessment Having looked at the principles and precautions associated with source isolation care we will now focus on how we make decisions regarding who needs isolation and how isolation facilities are utilised Activity Think back to your recent experiences on the ward. Consider whether there were any patients being nursed in the open ward that should have been in dedicated isolation facilities. Why were they not in isolation? Were the patients in isolation rooms of a higher infection risk than those on the open ward? Who made the decision concerning which patients were isolated and how was that decision reached? Jot your thoughts down below You may have recalled occasions when patients requiring isolation were not isolated. Reasons for this may have included factors related to a lack of single isolation rooms or the patient requiring close observation due to medical condition etc. Were you able to determine whether patients on the main ward were of less risk to others than those in single rooms? Hopefully the decision regarding the risk and priority for isolation was based on a risk assessment, as incorporated in SUHT Isolation Policy (and Guidelines for Management of MRSA on Medical Unit, 2003), undertaken by you on the ward, or on advice of the. If this is not the case was the decision evidence based? We will now go on to examine Isolation Risk Assessment. Why Risk Assessment? As you may have experienced in your own practice, demand on isolation facilities is often greater than availability. It is therefore important to ensure that the appropriate patients are being nursed in these limited isolation facilities. How is this achieved? Over a number of years, Isolation facilities in hospitals in the UK have decreased, but demand on these decreasing facilities has never been greater e.g. due to the emergence of new infections, re-emergence of old infections and the widespread occurrence of antibiotic resistant bacterial infections. Decisions regarding who gets isolated are often inconsistent and not evidence based. A prioritisation system developed by Dr. Gopal Rao has been adapted by SUHT and is an integral part of its current Isolation Policy (2002). For more Information you may like to locate a copy of the following article and complete the optional activity: RAO, G. and JEANES, A., (1999). A Pragmatic approach to the use of isolation facilities. (Full reference in resource section). 19
Optional Activity For this activity you will be required to undertake some reading. Locate the article by Rao, G and Jeanes, A (1999) A pragmatic approach to the use of isolation facilities. Write down some notes on the following: Why is the demand on the decreasing Isolation facilities greater than ever before? How can we ensure that the limited facilities are prioritised? List the factors that are taken into account in the scoring system developed by Dr. G Rao. What are the benefits of using such scoring system? 20
SUHT Risk Assessment: Isolation Priority Scoring System. Using a priority system, individuals should be risk assessed and assigned a score. The level of priority, high, medium or low, can then be determined depending on their total score and therefore the appropriate isolation facility assigned, as demonstrated below: Score Priority Appropriate Isolation Facility > 45 HIGH IDU (Infectious Diseases Unit)- negative pressure room. 25-40 MEDIUM Sideroom on main ward +/- bathroom facilities. <20 LOW As available/cohort nursed. The scoring system is based on factors likely to influence transmission of a pathogen such as current knowledge of pathogenic potential and mechanism of transmission. An explanation of how the scores are reached can be found in the SUHT Isolation Policy (2002). It also takes into account factors such as susceptibility of other patients. E.g. a patient with chickenpox on an oncology ward poses a greater risk to the other patients than he would on a general medical ward, as this group of patients are more susceptible. This patient would therefore be assigned a higher score as a result of the susceptibility of the other patients. As a result of this risk assessment system the patients that pose a higher risk have a higher priority and therefore the system ensures the appropriate patients to be assigned to the appropriate isolation facility. It also assists when evidence based decisions are required to determine the priority of the limited side rooms. An example of the use of the Priority System. Patient who is faecally incontinent, on an elderly care ward, with Clostridium difficile. Condition or Infection Clostridium difficile ACDP Category Route of Transmission Evidence for Hospital Spread 2 Faeco -oral Moderate Little Antibiotic Resistance Variable factors e.g. patient susceptibility, dispersal risk Faecal Incontinence Continent & cooperative Score 35 30 Length of Isolation Until diarrhoea resolved for 48hrs Risk Category MEDIUM MEDIUM 21
Activity What does the above example tell you about where this patient should be nursed and why?. If you identified that this patient should be nursed in a side room on the main ward you were correct. This reason being that the score for this patient with this infection was 35. When should we undertake a risk assessment? A risk assessment should be undertaken for all patients who potentially require isolation using the Isolation priority scoring system. As with any risk assessment, it is important that decisions are documented. The regular review is also important in ensuring that optimal use is made of these isolation facilities and also to ensure that patients are not in isolation for longer than is necessary. The impact of isolation on the patient will be explored in section 5. Activity You may at this point wish to revisit the SUHT Isolation Policy and familiarise yourself with the flow chart on p.9 and the scoring table (Table 2 common conditions and pathogens) on p.10. How would you determine the score for a condition not listed in table 2?.. If a condition is not listed in table 2 it is unlikely that you will have the necessary information to work the score out for yourself. In this case, it is important that you contact the or Medical Microbiologist for advice. Assessment Activity The assessment activity for this unit requires you to determine the risk assessment score and appropriate isolation facility for the scenarios listed on the next page. 22
Assessment Activity 4: Isolation Scoring Quiz For the following assessment you will need to refer to SUHT Isolation Policy 2002. Using the SUHT Isolation policy determine the isolation risk assessment score for the following patients and determine where they should be isolated: NB: SCORING FOR MRSA: Medicine/Elderly Care: Medical Wards refer to Guidelines for Management of MRSA in the Medical Unit. Elderly Care wards refer to SUHT MRSA Policy. 1. Patient with possible infective diarrhoea. Patient is faecally continent. 2. Patient with MRSA 17 in sputum. 3. Patient on a surgical ward with Group A streptococcus. Patient has responded well to antibiotic therapy for the last 36 hours. 4. Patient with headlice. 5. Patient with clostridium difficile. Patient is faecally incontinent. 6. Patient with chickenpox on medical/surgical ward. 7. Patient with salmonella. Patient is faecally continent and has no loose stools. 8. Patient with MRSA 15 in leg wound, not covered by waterproof dressing 9. Patient with VRE (vancomycin resistant enterococcus) on an oncology ward. 10. Patient with suspected meningitis. Patient has a cough.. 11. Patient with scabies. 12. Patient with hepatitis B. Name Date. 23
5. The Patient Experience Isolation affects individual patients in different ways, and as social beings, humans do not like being isolated from others (Wilson, 2003). In the previous sections of this pack we have identified the need for source isolation, explored principles of isolation care and isolation precautions, and looked at the use of risk assessment. But what impact does source isolation have on the patient involved? Activity Imagine you are stranded alone on a desert island. Write down a few words to express how you think you may feel in this situation. What would you miss?.. Did you have thoughts of happiness that you were away from the hustle and bustle of everyday life on a lovely exotic sunny island? Or did being deserted on your own generate feelings of loneliness, isolation and distress. You may miss communicating with others or might enjoy the peace and quite. Activity Are these feelings similar to that experienced by your patients being nursed in isolation? Jot down a few notes about how you think your patient feels in isolation Was this easy? Do you know how you patients in isolation are feeling? Now we will test your perceptions in practice 24
Activity Identify a patient and go and speak to them about their feelings and experiences of being in Isolation. Jot down their experiences and your comments and thoughts. What were their feelings and experiences? Were they similar to your perceptions? Were they positive or negative? It is well documented that isolation can have psychological effects on the patient and a number of studies have been undertaken regarding patients experiences in isolation. Activity (Optional) Locate & read the article Knowles, H., (1993) The experience of Infectious patients in isolation (full reference can be found in the resource section at the back of the pack). Are there comparisons between the work you undertook in the previous activities in this section and that cited in the article? Do you agree with the findings in the article?.. The study by Knowles (1993) found that some patients valued the privacy that isolation provided, whilst for others it had a negative impact and expressions of neglect, stigmatisation, loneliness and confusion were common. The study also found that on the whole nurses were able to describe the experiences of their patients in isolation. However, often the needs of these patients were not met due to factors such as time constraints and the fear of infection. As nurses we are in a prime position to improve the experience for our patients in isolation and must ensure that appropriate actions are taken in order to facilitate this. Assessment Activity (Optional) You can now move on to the assessment activity for this section, which returns to the article, Knowles (1993), The experience of Infectious patients in Isolation, and requires you to explore your role in improving the isolation experience for the patient. 25
Assessment Activity 5 (Optional): The Patient Experience Read the article Knowles (1993) The Experience of Infectious patients in isolation. Now complete the following: 1. List 5 negative experiences of being in isolation. 2. List 3 positive experiences of being in isolation. 3. List some examples of how being in isolation provides a barrier to making contact. 4. What factors prevent nurses from meeting the needs of their patients in isolation? 5. What can you do to improve the experience for patients in isolation? (Continue overleaf if necessary) Name.. Date.. 26
Summary Well done. You have reached the end of this learning resource pack. Hopefully having worked through the pack, by reading, completing the in text and assessment activities and reflecting on your own practice, you have enhanced and increased your knowledge, awareness and practice in relation to Source Isolation. We encourage you to utilise and promote this to your colleagues in order to facilitate safe, effective, evidence based isolation care, and also to ensure that the needs of your patients in isolation are recognised and addressed. 27
References CENTRES FOR DISEASE CONTROL AND PREVENTION., (1996). Guideline for isolation precautions in hospital. American Journal of Infection Control. 24, pp.24 52. GOULD, D. and BROOKER, C., (2000). Applied Microbiology for Nurses. Basingstoke: Palgrave Macmillan. KNOWLES, H., (1993). The Experience of Infectious Patients in Isolation. Nursing Times. 89 (30), pp. 53-56. RAO, G. and JEANES, A., (1999). A Pragmatic approach to the use of isolation facilities. Bugs and drugs. 5 (1), pp 4 6. SOUTHAMPTON UNIVERSITY HOSPITALS TRUST., (2002). Isolation Policy and Posters. Southampton: SUHT WILSON, J., (2003). Infection Control in Clinical Practice. London: Balliere Tindall. 28
Bibliography AYLIFFE, G., BABB, R. & TAYLOR, L., (2001). Hospital-acquired infection Principles and prevention. 3 rd Ed. London: Arnold. GAMMON, J., (1999). Isolated instance, the effects of Source Isolation on the Patient. Nursing Times. 95 (2), pp.57-60. HORTON, R. and PARKER, L., (2002). Informed Infection Control Practice. Edinburgh: Churchill Livingstone MADEO, M. & Owen, E., (2002). Isolation a patient satisfaction survey. British Journal of Infection Control. 3 (3), pp. 18-20. 29
Appendix 1: Components of Standard Precautions... Standard Precautions are the basic principles of Infection Control Practice. They should be used for all patients at all times. Hand Hygiene Covering cuts and graze Protective Clothing Cleaning and Decontamination Safe handling of body fluid spillages Disposal of Sharps Disposal of Waste and excreta Care of Linen 30
Resources required for Completion of Pack 1. SUHT Isolation policy (2002) 2. Medical Wards also require: Guidelines for Management of MRSA within the Medical Unit (2003). 3. Elderly Care Wards also require: SUHT Policy for the Management & Prevention of MRSA Outbreaks. Optional resources: 1. Rao, G. and Jeanes, A., (1999). A Pragmatic approach to the use of isolation facilities. Bugs and drugs. 5 (1), pp 4 6. 2. Knowles, H., (1993). The Experience of Infectious Patients in Isolation. Nursing Times. 89 (30), pp. 53-56. 31
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