Patient care

Standard precautions are used to care for all patients to prevent nosocomial infections and apply to contact with blood, body fluids, secretions and excretions (except sweat), nonintact skin, and mucous membranes. Transmission-based precautions (second-tier precautions) are used for patients known to be or suspected of being infected with a highly transmissible infection. The rules to be followed for achieving isolation are based on the mode of transmission of the particular organism: airborne, droplet, and contact. Thus, if the organism is spread by droplet (such as tuberculosis), then all items that come in contact with the patient's upper respiratory tract are isolated and destroyed or disinfected. Those in contact with the patient are also protected from droplet transmission by wearing protective barriers such as special masks (and, if necessary, gowns, caps, boots, and gloves), by careful and thorough hand hygiene, and by keeping the hands away from the nose and mouth to prevent transmission of infections. Most agencies use disposable equipment as much as possible in the care of an isolated patient. Contaminated disposables are double-bagged for safe disposal, usually by incineration. Contaminated linens and other nondisposable equipment are also double-bagged and marked “isolation, ” so that they will be properly decontaminated or disinfected on receipt by the laundry or supply service. Laboratory specimens also are double-bagged and marked with the particular type of isolation, so that personnel handle them appropriately. CDC recommendations and institutional procedure are followed for the specific type of isolation that is in effect. The purpose of the isolation precautions is explained to the patient and family to decrease their fears and to increase their cooperation, and the family and other visitors are taught how to use and discard the required barriers and esp. how to thoroughly cleanse their hands. When an at-risk patient (such as an immunosuppressed patient) requires protection from others (reverse isolation), equipment brought to the patient's room is disposable or sterilized, and human contacts wear barriers that must be clean or sterile depending on the circumstances and protocol. After use, these items are handled in the agency's usual manner, with no special care necessary beyond those specified for the care of every patient.