4 Barrier Precautions and Isolation .ppt

Infection Prevention in hospitalized patients

1. MTI, Khyber Teaching Hospital, Peshawar
BARRIER PRECAUTIONS AND
ISOLATION
By
RehmatUllah
Nursing Director, MTI KTH, Peshawar

2. MTI, Khyber Teaching Hospital, Peshawar
Objectives of the Session
The participants will be able to;
Describe Standard precautions
Discuss Safe Injection Practices
Demonstrate Careful handling of sharps
Discuss Contact transmission & Isolation,
Droplet transmission & Isolation, Airborne
transmission & Isolation
Describe types of PPE & Criteria for Selection

3. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
Adaptation of uniform precautions for all patients regardless of
their diagnosis is called Standard (Universal) Precautions
Designed to reduce the risk of transmission of micro-organisms
from both recognized and unrecognized sources of infection in
the hospital.
Applies to all patients regardless of their diagnosis.
Shall be implemented when contact with any of the following are
anticipated:
Blood
All body fluids, secretions and excretions, with the exception of sweat
regardless of whether or not they contain visible blood.
Non-intact skin (this includes rashes)
Mucous membranes

4. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
1.Correct Hand hygiene practices
2.Use of personal protective equipment (e.g., gloves, gowns,
masks)
3.Safe handling of potentially contaminated equipment/surfaces/
sharp disposal in the patient environment.
4.Safe injection practices
5.Respiratory hygiene/cough etiquette
6.Reprocessing of equipment
7.Use of aseptic technique
8.Environmental cleaning
9.Safe handling and disposal of stock, linen and waste; and
10.Safe handling and transport of patient specimens.

5. MTI, Khyber Teaching Hospital, Peshawar
1. HAND HYGIENE:
Hand hygiene should be maintained before and after each physical contact as
per MTI-KTH hand hygiene guideline.
Effective hand hygiene relies on three mechanisms
of action
1.The rubbing action, or friction, that enables the
mechanical removal of microorganisms;
2.The antimicrobial properties of the hand cleansing
product (e.g. ABHR, soap) killing remaining
microorganisms; and
3.The drying of hands after hand cleaning to reduce
further spread of microorganisms.
ABHR=Alcohol-based hand rub
STANDARD PRECAUTIONS

6. MTI, Khyber Teaching Hospital, Peshawar
Hand Hygiene Technique

7. MTI, Khyber Teaching Hospital, Peshawar
Hand hygiene to minimize spread of
infection
WHO 's “My 5 Moments for
Hand Hygiene”:
1.Before Touching a Patient
2.Before Clean/Aseptic
Procedure
3.After Body Fluid Exposure
Risk
4.After Touching a Patient
5.After Touching Patient
Surroundings

8. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
2. USE OF PERSONAL PROTECTIVE EQUIPMENT
(PPE)
a. GLOVES:
Gloves should be worn whenever there is a risk of exposure with the
following:
1. Blood or Blood products
2. Body fluids;
a) Urine. b) Feces. c) Saliva.
d) Mucous membranes. e) Wound drainage. f) Drainage
tubes.
g) Broken skin. h) Performing Venipunctureor other invasive procedures
i) Amniotic fluid, Cerebro–Spinal fluid, Pericardial/ Pleural fluid, Peritoneal fluid,
Synovial fluid.

9. MTI, Khyber Teaching Hospital, Peshawar
2. USE OF PERSONAL PROTECTIVE
EQUIPMENT (PPE) (Cont……)
b. MASKS:
Should be worn during procedures that are likely to generate droplets
/splashing of blood / body fluids and removed after procedure.
c. GOWN /APRON:
Should be worn when there is potential for soiling clothing with blood / body
fluids.
d. EYE SHIELD /GOGGLE:
Wear eye shield /goggle over the eyes during procedures that are likely to
generate splash of blood / body fluids.
e. SHOE COVERS:
Shoe cover should be used while cleaning spillage, entering into restricted
areas without changing personal shoes etc.
f. RESUSCITATION EQUIPMENT :
Mouth pieces or other ventilation devices should be available as alternatives for
mouth to mouth resuscitation.

10. MTI, Khyber Teaching Hospital, Peshawar
Personal Protective Equipment

11. MTI, Khyber Teaching Hospital, Peshawar
Selection of PPE
Appropriate PPE should be selected;
To prevent contamination of skin and/or clothing
To be guided by the anticipated type and
amount of exposure to blood and body
substances
According to the likely transmission route of
microorganisms

12. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
3. SAFE HANDLING OF POTENTIALLY CONTAMINATED
EQUIPMENT/SURFACES/ SHARP DISPOSAL IN THE
PATIENT ENVIRONMENT :
Keep handling to a minimum
Do not recap, bend or break needles after use
Discard each needle into a sharps' container at the point
of use
Do not overload a bin if it is full
Do not leave a sharps' bin in the reach of children

13. MTI, Khyber Teaching Hospital, Peshawar
4. Safe injection practices
Breaches in handling practices has resulted in
transmission of HIV and viral hepatitis and in some
cases caused outbreaks of disease
Standard precautions, particularly aseptic technique,
form the basis of safe injection practices;
1.Applying aseptic technique
2.Sharp injecting devices
3.Intravenous solutions
4.Flushing
5.Medication vials and ampoules
6.Multi-dose vials

14. MTI, Khyber Teaching Hospital, Peshawar
Perform hand hygiene
Ensure that reusable equipment used for aseptic technique
procedures are cleaned and disinfected between use
Use aseptic technique in all aspects of parenteralmedication
administration, medication vial use and injections.
Store and prepare medications and supplies in a clean area on
a clean surface.
Never store needles and syringes unwrapped as sterility cannot
be assured
Discard all opened vials (including multi-dose vials), IV solutions
and prepared or opened syringes that were involved in an
emergency situation
Safe injection practices
Applying aseptic technique

15. MTI, Khyber Teaching Hospital, Peshawar
Open the sterile needle, cannula, syringe or Epi-pen from
package immediately prior to use.
Needles, cannulae and syringes are sterile, single-use
items; do not reuse these for another patient or to access a
medication or solution that might be used for a subsequent
patient.
Use safety engineered sharps devices whenever possible.
Discard syringes, needles and cannulae at the point of
care in an approved sharps container.
Safe injection practices
Sharp injecting devices

16. MTI, Khyber Teaching Hospital, Peshawar
Protective packaging should not be removed until immediately
prior to use.
Never use intravenous solution containers (e.g. bags or bottles)
to obtain flush solutions for more than one patient
Additions to intravenous fluids should be made under controlled
conditions
Begin/initiate administration of spiked IV solutions (IV bag
entered by the tubing spike) within one hour of preparation
Check the expiry date on IV solution; do not use if it is expired
Disinfect IV ports using friction and 70% (v/v) alcohol, and allow
to air dry prior to accessing.
Replace the entire IV tubing if disconnected, except the transient
controlled disconnections
Safe injection practices
Intravenous solutions

17. MTI, Khyber Teaching Hospital, Peshawar
Single dose syringes should be used for flush solutions.
Disinfect IV ports using friction and 70% (v/v) alcohol, and
allow to air dry before accessing.
Safe injection practices
Flushing

18. MTI, Khyber Teaching Hospital, Peshawar
Follow the manufacturer’s instructions for storage and use.
Use single-use ampoules or single-dose vials
Never enter a vial with a syringe or needle/cannulathat has
been used on a patient
Cleanse the rubber stopper/bung of the vial
Discard single dose vials after use
Unwanted portions of ampoules must be discarded at the time
the dose is prepared
Never store medication vials in clothing or pockets
Inspect vials and discard if sterility has been compromised
Examine the vial for any particulate matter, discoloration or
turbidity. If present, do not use and discard immediately
Safe injection practices
Medication vials and ampoules

19. MTI, Khyber Teaching Hospital, Peshawar
Should be used for a single patient whenever possible and
discarded immediately after use
Must only be used between multiple patients where there is
no other alternative product available
Keep multi-dose vials away from the immediate patient
environment
Dispose of opened multi-dose medication vials 28 days
after opening, or unless specified otherwise by the
manufacturer
Reflect date opened and/or date of expiration
Safe injection practices
Multi-Dose Vial

20. MTI, Khyber Teaching Hospital, Peshawar
Safe injection practices
5. USE OF ASEPTIC TECHNIQUE
set of practices aimed at minimising contamination
and is particularly used to protect the patient from
infection during procedures
1.Sequencing
2.Environmental control
3.Hand hygiene
4.Maintenance of aseptic fields
5.PPE

21. MTI, Khyber Teaching Hospital, Peshawar
The five essential principles of aseptic technique are:
1.Sequencing:
Performing a risk assessment
Pre-procedure preparation
Performing the procedure
Post procedure practices, handover and documentation
2. Environmental control:
Ensure there are no avoidable nearby environmental risk factors, such
as bed making or patients using commodes
3. Hand hygiene:
Perform hand hygiene before a procedure and after a procedure or
body fluid exposure
Safe injection practices
USE OF ASEPTIC TECHNIQUE

22. MTI, Khyber Teaching Hospital, Peshawar
The five essential principles of aseptic technique are:
4. Maintenance of aseptic fields:
Cleaning and/or disinfection of key site(s) and key part(s) prior to
procedure(s)
Establishing an aseptic field
Use of sterile equipment
Maintenance of the aseptic field, including protecting the key sites
and key parts
Use of a non-touch technique
5. PPE:
Correct selection and use of sterile and non-sterile PPE
Safe injection practices
USE OF ASEPTIC TECHNIQUE

23. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
6. Safe handling and disposal of stock, linen and
waste; and Safe handling and transport of
patient specimens
B .LAB SPECIMENS:
Use leakproof container
should be labeled with biohazard symbol for shipping
If outside contamination of the primary container occurs,
it should be placed within a second container

24. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
C. BLOOD SPILLS
Shall be cleansed by following Spillage Guideline
Decontaminate the area using the approved solution
Gloves should be worn during cleaning and decontamination
D. LINEN
Gloves should be worn while handling solid/dirty linen
The soiled/wet linen should not be shaken and should be rolled
outward to inward and place in an alginate bag then in white bag label
it and finally disposed in The Linen Hamper & sent to the laundry.
Linen contaminated with cytotoxicmaterial, or if indicated by infection
control should be double bagged in red bags, labeled and sent for
incineration
E. CLINICAL/INFECTIOUS WASTE :
Clinical waste should be disposed in designated container by the user.

25. MTI, Khyber Teaching Hospital, Peshawar
DEALING WITH SPILLAGE
What is Major Spill
Quantity
More than 30 ml of liquids
More than 30 grams of solid
Concentration
High concentrated Acid or Alkali
Characteristics of Spill
Flammable / Ignitable –can lead to fire
Toxicity-can lead to inhalational or skin injury
Corrosive –damage to skin and eyes
Substances like mercury spill

26. MTI, Khyber Teaching Hospital, Peshawar
a. LIQUID SPILL MANAGEMENT
Protocols for cleaning Spillage of Blood
Wear Gloves
Pour, without splashing, a disinfectant appropriate for the
size and surface contaminated, e.g. Isopropyl alcohol,
Dakin’s or house hold bleach 1: 100 dilor 1: 10 dilution.
Place absorbent paper (e.g. news / tissue paper over the
spill. Allow a contact time of 20 minutes.
Wipe up the spill. Put absorbent paper in the yellow bag.
Wash hands (with gloves on).
Remove gloves.
Wash hands.

27. MTI, Khyber Teaching Hospital, Peshawar
b. MERCURY SPILL MANAGEMENT
Protocols for Mercury Spillage
1.Remove everyone from the area that has been contaminated with
mercury.
2.Keep the heat below 200 C and ventilate the area.
3.Put on face mask in order to prevent breathing of mercury vapor.
4.Remove all jewelry from hands and wrists.
5.Use Personal Protective Equipment while handling mercury.
6.Cardboard sheets should be used to locate and push the spilled
beads of mercury together.
7.Mercury should be placed carefully in a container with some water.
8.Never us a broom or vacuum cleaner.
9.It should be disposed off at hazardous waste facility or given to a
mercury-based equipment manufacture.

28. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
7. RESPIRATORY HYGIENE/COUGH ETIQUETTE :
Alerts to clients
Cover the mouth and nose when coughing and sneezing
Perform hand hygiene after contact with respiratory
secretions & contaminated objects.
Maintain an appropriate distance from & between
symptomatic patients, at least 1 meter (3 feet).
Identify persons with symptoms suggestive of acute
respiratory illness & teach them to use a surgical mask &
practice cough etiquette.
screen patients for symptoms of respiratory infections &
provide a separate space in the waiting area distant from
other patients (at least 1 meter/3 feet).

29. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
8. Reprocessing of equipment
Single patient use-for use only on the same patient.
Reusable invasive equipment-used once then decontaminated e.g. surgical
equipment.
Reusable non-invasive equipment-reused on more than one patient
following decontamination between each use e.g. commode, patient trolley.
All sterilized packaged items must be checked for visible contamination, expiry
dates and that the package is intact.
Decontamination of reusable non-invasive care equipment must be
undertaken:
between each use;
after blood or body fluid contamination;
at regular predefined intervals as part of an equipment cleaning protocol;
before disinfection; and
before inspection, servicing or repair.
All reusable non-invasive equipment must be rinsed and dried following
decontamination then stored clean and dry.

30. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
9. Environmental cleaning
Prompt disposal of single use items, such as adhesive tapes
and gloves, after use
Large surfaces and surfaces frequently touched by patients,
such as bed rails, chair rails, tables and door handles, are
routinely cleaned
Devices frequently touched by patients and HCWs, including
sphygmomanometer, Glucometer, IV pumps and monitors are
routinely cleaned
All blood and body substance spills are cleaned and disinfected
Minimize clutter in shared administrative areas, such as clinical
nurses workstations, and
Ensure that keyboards, computers, tablets, telephones
(including personal mobiles) and other frequently touched
surfaces are routinely cleaned

31. MTI, Khyber Teaching Hospital, Peshawar
MODES AND ROUTES OF
TRANSMISSION

32. MTI, Khyber Teaching Hospital, Peshawar
The Disease Transmission Cycle

33. MTI, Khyber Teaching Hospital, Peshawar
MODES AND ROUTES OF
TRANSMISSION
A mode of transmission describes how a
microorganism moves between individuals.
Transmission can either occur;
Vertically, from mother to child, or
Horizontally, between individuals who are not necessarily
related.
horizontal transmission will use either a direct or indirect
mode of transmission to leave the current host and
colonisethe next host
Routes of transmission may involve;
Direct contact & indirect contact
Droplet, Airborne and/or vector-borne

34. MTI, Khyber Teaching Hospital, Peshawar
CONTACT TRANSMISSION ROUTES
Refer to the movement of microorganisms from a
colonisedor contaminated source to a susceptible
host, via either direct or indirect physical contact
Direct contact transmission involves skin-to-skin contact
and the physical transfer of microorganisms directly from one
person to another person
From colonized HCW & Patient to Other
Indirect contact transmission involves the initial transfer of
microorganisms from a host individual to an intermediary
object and then subsequent transfer to another individual.
Contact with fomitesand the environment.

35. MTI, Khyber Teaching Hospital, Peshawar
DROPLET TRANSMISSION ROUTE
Involves large droplets carrying microorganisms
from a colonised or infected individual, often
produced by coughing, talking and breathing
Due to their size, large droplets can only travel
very short distances (≤ 1 metre) before either
settling and contaminating surfaces, mucosa,
Therefore, requires close contact between the
colonised or infected host and other susceptible
individuals

36. MTI, Khyber Teaching Hospital, Peshawar
AIRBORNE TRANSMISSION ROUTE
A form of indirect transmission that occurs by the
dissemination of small expelled aerosols that can
carry microorganisms.
Aerosols are much smaller than droplets and are
often produced by coughing, talking and breathing
as well as during clinical aerosol generating
procedures (AGP) such as suctioning, intubation
and chest physiotherapy.
Such aerosols can travel long distances and can
remain suspended in the air for prolonged periods
of time

37. MTI, Khyber Teaching Hospital, Peshawar
COMMON SOURCE ROUTE
The spread of microorganisms from a single
source.
Often facilitated by the contamination of food or
water and is best illustrated by institutional
foodborne outbreaks.

38. MTI, Khyber Teaching Hospital, Peshawar
Simultaneous transmission routes
Simultaneously employ multiple transmission
routes.
For example,
NOROVIRUS can be spread by direct contact, indirect
contact, droplet transmission and common-source
transmission through contaminated food.

39. MTI, Khyber Teaching Hospital, Peshawar
TRANSMISSION-BASED PRECAUTIONS
Transmission-based precautions are to be
applied in addition to standard precautions.
There are three types of transmission-based
precautions, tailored to the different forms of
transmission:
Contact precautions
Droplet precautions; and
Airborne precautions.

40. MTI, Khyber Teaching Hospital, Peshawar
TRANSMISSION-BASED
Precautions/ ISOLATION POLICIES

41. MTI, Khyber Teaching Hospital, Peshawar
INTRODUCTION
Isolation precautions are needed to prevent the
transmission of pathogenic microorganisms within
the healthcare setting.
The patients of following disease categories
should be treated under isolation.
Severe influenza cases, Sub-acute respiratory
Syndrome (SARS), Open case of tuberculosis,
Anthrax, diphtheria, Pertussis, Pneumonic plague,
Chicken pox, and patients infected with multidrug
resistant bacterial pathogens

42. MTI, Khyber Teaching Hospital, Peshawar
ISOLATION POLICIES
Patient placement-Appropriate patient placement is
a significant component of isolation precautions.
Determine patient placement based on the following
principles:
Route(s) of transmission of the infectious agent
Risk factors for transmission in the infected patient
Risk factors for adverse outcomes resulting from health
care associated infection in other patients in the area.
Availability of single-patient rooms
Patient options for room-sharing

43. MTI, Khyber Teaching Hospital, Peshawar
CONTACT PRECAUTIONS
PURPOSE
It is the intent of this facility to use contact precautions for patients
known or suspected to have serious illness easily transmitted by
direct patient contact or by contact with items in the patient’s
environment. Examples include;
1. Multiresistantorganisms e.g.,
a. Methicillinresistant staphylococcus aureus(MRSA)
b. Pan resistant Acinetobacter
c. Vancomycinresistant enterococci(VRE)
d. Carbapenemase-producing Enterobacteriaceae(CRE)
e. Any other resistant organisms
2. Scabies
3. Clostridium difficilediarrhoea
4. Open draining wounds

44. MTI, Khyber Teaching Hospital, Peshawar

45. MTI, Khyber Teaching Hospital, Peshawar
DROPLET PRECAUTIONS
PURPOSE:
It is intent of this facility to use droplet precautions to decrease the risk of droplet transmission
of infectious agents.
Droplets may be generated by patient’s coughing, sneezing, talking, or during the performance
of procedure, e.g., suctioning. Droplet precautions may be considered for:
 Disease Duration
 Pertussis 9 days after start of treatment
 Rubella 7 days after onset or rash
 Mumps 9 days after onset of swelling
 Meningococcal infections 1 day after start of treatment
 Meningitis (Haemophilusinfluenza, type b) 1 day after start of treatment
 Influenza 5 days after onset of illness
 Mycoplasmapneumonia Until resolution of symptoms
 Plague (pneumonic) 2 days after treatment
 Diphtheria (pharyngeal) Until two cultures negative

46. MTI, Khyber Teaching Hospital, Peshawar

47. MTI, Khyber Teaching Hospital, Peshawar
AIRBORNE PRECAUTIONS
PURPOSE: It is intent of this facility to use precautions to decrease risk of air borne
transmission of infectious diseases. These precautions will be used for patients known or
suspected to be infected with a disease spread by small droplet nuclei (5mm or small).
These include:
Disease Duration
Pulmonary tuberculosis 14 days after start of effective therapy
Chickenpox or Herpes Zoster until crusting of lesions
Measles 4 days after onset of rash
SARS 10 days after resolution of symptoms
Small pox until all scabs have crusted
Viral Hemorrhagic fever Duration of Illness plus contact measures
(Due to Lassa, Marburg, Crimean-Congo fever viruses)
Develop systems (e.g., triage, signage) to identify patients with known or suspected
infections that requires Airborne Precautions upon entry into the health facility.

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49. MTI, Khyber Teaching Hospital, Peshawar
ISOLATION PROCEDURE
DROPLET PRECAUTIONS :
1. All steps as in STANDARD PRECAUTIONS PLUS
2. MASK -a mask should be worn within 3 feet of the patient.
CONTACT PRECAUTIONS
1. All steps as in STANDARD PRECAUTIONS PLUS
2. GLOVES-Gloves should be worn when entering the
room.
3. GOWNS-A gown should be worn for contact with the
patient and with patient items.
AIRBORNE PRECAUTIONS
1. All steps as in STANDARD PRECAUTIONS PLUS
2. MASK-An N-95 respirator (mask)

50. MTI, Khyber Teaching Hospital, Peshawar
ISOLATION PROCEDURE
Place patient in a single-patient room
Use of personal protective equipment
Patient transport
Limit transportation,
If needed, infected or colonized areas of the patient’s body are contained and
covered
Don clean PPE
Handle patient-care equipment and instruments/devices according to
Standard Precautions
Ensure room environment is clean before and after visit/transportation

51. MTI, Khyber Teaching Hospital, Peshawar
THANKS