UNC Hospitals' Isolation Precautions
Prevention of Disease Transmission
Hospital Epidemiology UNC Hospitals TABLE OF CONTENTS
UNC Hospitals' Isolation Precautions Policy is based upon
the latest recommendations from the Centers for Disease Control and Prevention.
A simple category system is used, based upon how the infection or
disease is transmitted. All healthcare workers must be familiar with the
isolation precaution system in order to prevent the spread of infections
to patients, coworkers, visitors, and themselves.
Infection Control Manual CONTENTS
The complete Isolation Precautions Policy is located in
the Infection Control Manual. Infection Control Manuals are located at
every nurses station and in all clinical areas. The policy includes an
alphabetical listing of infections and the type and duration of precautions
needed, an indepth explanation of each precaution category, and a quick
reference for the more frequently seen infections. All healthcare workers
are encouraged to become familiar with the Isolation Precautions Policy.
If help is needed, the healthcare worker may call Infection Control at
61636 or have the operator page the Infection Control Nurse on call.
Standard Precautions CONTENTS
Standard Precautions are the primary tool for the successful
control of hospitalacquired infections. Standard Precautions are those
precautions designed for the care of all patients' regardless of their
diagnosis or presumed infection status. These Precautions replace the old
system of "Universal Precautions" and apply to the following
· all body fluids, secretions, and excretions (except sweat)
· nonintact skin
· mucous membranes
There are several important components of Standard Precautions
with the most important being good handwashing. Hands should be washed
thoroughly with an antimicrobial soap (Bactoshield or Alcare foam) before
and after patient care. When gloves are worn, they should be removed before
leaving the patient's room and hands washed. Never leave the patient's
room while still wearing gloves. Disease causing germs adhere well to glove
surfaces and can then be carried to the next patient or medical equipment
A second important component of Standard Precautions is
the wearing of protective attire to prevent direct contact with a patient's
blood or body fluids. Gloves, gown, and protective eyewear are provided
by the Hospitals and can be found in all patientcare areas in personal
protective equipment cabinets.
Remember, if it is wet and not yours, wear gloves!
Airborne Precautions CONTENTS
in addition to Standard Precautions, Airborne Precautions
are used for those patients who have or are suspected of having infections
transmitted by the airborne route. This means that the bacteria or virus
causing their disease is so small that it can be suspended in the air for
long periods of time and may be carried for long distances on air currents.
Examples of diseases that require Airborne Precautions are tuberculosis
(TB), varicella (chickenpox), zoster (shingles), and measles. The following
measures are required for Airborne Precautions.
· The patient must be placed in a special isolation room.
Isolation rooms are private rooms with a negative air pressure in relation
to the outside corridor, have 6 air exchanges per hour, and the room air
is directly exhausted to the outside. A complete listing of isolation rooms
is maintained by Bed Control. Hospital Epidemiology, and the Nursing supervisors.
· All employees must wear a respirator, such as the N95
respirator, to enter an Airborne Isolation room (a surgical mask is not
an approved respirator) for patients with known or suspected tuberculosis.
Respirators must also be worn when participating in coughinducing procedures
such as bronchoscopy or sputum induction with TB patients. Visitors of
TB patients will wear surgical masks.
· If the patient's diagnosis is varicella, zoster, or
measles, employees need not wear a respirator if they have had natural
disease or have been adequately immunized. Occupational Health Service
can assist you in determining your immune status if you are uncertain.
Employees who are not immune to the disease should not enter the room unless
absolutely necessary. If they must enter, they must wear an approved respirator
such as the N95. Visitors should be assisted by the nursing or medical
staff in determining their immune status (i.e., natural disease, immunization).
Immune visitors need not wear a mask. Nonimmune visitors should be discouraged
from entering. If visitation is essential, then the nonimmune visitor
must wear a surgical mask.
· Patients who require Airborne Precautions are allowed
to leave the isolation room for essential purposes only (e.g., a diagnostic
procedure that cannot be done in the patient's room). If the patient must
be transported to another location in the hospital, the patient must wear
a surgical mask and the receiving area notified that the patient requires
Airborne Precautions. Both of these steps are important to prevent the
transmission of disease to other patients, employees, and visitors.
Examples of diseases that require Airborne Precautions
include tuberculosis, varicella, zoster, and _______________
To enter the room of a patient on Airborne Precautions who may have tuberculosis, the employee
must wear a _______________, not a surgical
Protective Precautions CONTENTS
In addition to Standard Precautions, Protective Precautions
are designed to protect the patient with impaired resistance to infection.
These precautions will replace our former categories of Compromised Host
Precautions, Transplantation Precautions, and Bone Marrow Transplant Precautions.
Such patients require varying degrees of protection as determined by their
attending physician. Healthcare workers and visitors should pay careful
attention to the Protective Precautions card outside the patient's room
to identify the precautions required. For all patients requiring Protective
Precautions, the following measures are followed.
· The patient is placed in a private room with the air
pressure positive in relation to the outside corridor.
· Hands should be washed thoroughly with an antimicrobial
soap before entering the patient's room and before providing direct patient
· Only essential personnel and visitors should enter the
patient's room. No one should enter who is ill or feel like they may be
· The patient is allowed no live plants, fresh fruits
or uncooked vegetables. Exceptions to fruits and vegetables may be allowed
with the approval of the attending physician.
· The patient should leave their room only for essential
purposes. If the patient must leave their room, they should be instructed
to wear a surgical mask. Exceptions to this policy may be made by the attending
physician. Notify the receiving department that the patient requires Protective
Identifyinq the patient who
requires Isolation Precautions CONTENTS
As with our old system of isolation, we will continue
to place an isolation precaution card in the wall plaque outside the patient's
room door. Each card will clearly state the type of precautions to be observed
by all employees and visitors. These cards will be colored coded as were
the old cards with gold cards for Airborne and Droplet Precautions and
a blue card for Contact Precautions. The Protective Precautions card will
be white with red letters. Isolation Precautions cards are stocked in Central
Distribution and should be available for use in all patient care areas.
In order to protect the confidentiality of the patient, no disease specific
or diagnostic information should be written on the card. Healthcare workers
and visitors who are unsure of the correct precautions to follow should
check at the nurses station for clarification.
As with all infection control measures, isolation precautions are designed to prevent the spread of infection from one person to another. The responsibility for the practice of infection control lies within the hands of every healthcare worker.
DropIet Precautions CONTENTS
In addition to Standard Precautions, use Droplet Precautions
for those patients who are known or suspected of having diseases spread
by the droplet route. Droplet transmission occurs when the person coughs
or sneezes and releases large respiratory droplets into the air. Unlike
airborne particles, these droplets are heavy and fall to surfaces rapidly,
usually falling within 3 feet of the patient. These particles are too heavy
to remain in the air and to be carried on air currents. Examples of infections
that require Droplet Precautions are meningococcal meningitis, Respiratory
Syncytial Virus (RSV), and pertussis. The following measures are required
for Droplet Precautions.
· Place the patient in a private room. No special ventilation
· Employees and visitors must wear a surgical mask to
enter the room.
· If the patient must leave their room, notify the receiving
area and have the patient wear a surgical mask when possible to minimize
the dispersal of droplets.
Contact Precautions CONTENTS
In addition to Standard Precautions, use Contact Precautions
for those diseases that are spread by direct or indirect contact. This
means that the bacteria or virus can be acquired by either directly touching
the infected site or body fluid or by touching equipment that may be contaminated
with infectious material. Examples of infections that are spread by the
contact route are multiply antibioticresistant bacteria such as methicillinresistant
S. aureus (MRSA) and vancomycinresistant enterococcus (VRE), RSV
(which also requires Droplet Precautions), and Clostridium difficile
enterocolitis. The following measures are required for Contact Precautions.
· Place the patient in a private room. No special ventilation
· Gloves are to be worn when entering the room. A gown
should be worn if you anticipate that your clothing will become contaminated
with infectious materials (e.g., wound drainage or respiratory secretions).
Gown and gloves should be removed before leaving the patient's room and
hands washed thoroughly.
· When possible, dedicate the use of patientcare equipment
such as stethoscopes and walkers. This avoids sharing of items between
patients. If use of common equipment is unavoidable, then adequately clean
and disinfect the item with Vesphene 11 or alcohol before use for another
· If the patient must leave their room for diagnostic
tests or treatments, notify the receiving department that the patient requires
Checkpoint questions CONTENTS
A pediatric patient who is admitted with a diagnosis
of RSV pneumonia would require being placed on and Precautions.
For patients who require Contact Precautions, all employees
and visitors who enter the patient's room must wear
ISOLATION PRECAUTIONS POSTTEST
Read each statement carefully and circle whether the statement
is True or False.
1. Standard Precautions mean that we wear gloves only for patients who are known
to be HIV positive or Hepatitis B positive.
2. Employees and visitors who have had varicella (chickenpox) or have received
the varicella vaccine do not need to wear a respirator to enter the room of a
patient who is on Airborne Precautions for active varicella.
3. Everyone who enters a Droplet Precautions room must
wear a surgical mask.
4. Everyone who enters a Contact Precautions room must
wear clean gloves.
5. The isolation precaution card that is placed outside the patient's room door
should clearly state the patient's diagnosis.