Infection prevention and control - Royal Marsden Manual of Clinical ...

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116 Infection prevention and control Procedure guideline 3.10 Source isolation: preparing an isolation room Essential equipment ■ Single-occupancy room ■ Patient equipment ■ Personal protective equipment ■ Hand hygiene facilities ■ Patient information material Preprocedure Action Rationale 1 Identify the most suitable room available for source isolation, taking into account the risk to other patients and staff and the patient’s other nursing needs. Procedure 2 Remove all non-essential furniture and equipment from the room. The remaining furniture should be easy to clean. Ensure that the room is stocked with any equipment required for patient care and suffi cient but not excessive numbers of any disposable items that will be required. 3 Ensure that a bin for clinical waste with an orange bag is present in the room. This will be used for all waste generated in the room. The bag must be sealed before it is removed from the room. To ensure the best balance between minimizing the risk of cross-infection and maintaining the safety and comfort of the isolated patient. E To ensure the availability of everything required for patient care while minimizing the number of items that will require cleaning or disposal at the end of the isolation period and the amount of traffi c of people and equipment into and out of the room. E For containing contaminated rubbish within the room and minimizing further spread of infection. E 4 Place a container for sharps in the room. To contain contaminated sharps within the infected area ( DH 2006a , C ). 5 Keep the patient’s personal property to a minimum. All belongings taken into the room should be washable, cleanable or disposable. Contact the infection prevention and control team for advice as to how best to clean or wash specifi c items. 6 Ensure that all PPE required is available outside the room. Wall-mounted dispensers offer the best use of space and ease of use but if necessary, set up a trolley outside the door for PPE and alcohol handrub. Ensure that this does not cause an obstruction or other hazard. 7 Explain the reason for isolation and the precise precautions required to the patient, their family and other visitors, providing relevant patient information material where available. Allow the patient to ask questions and ask for a member of the infection prevention and control team to visit the patient if ward staff cannot answer all questions to the patient’s satisfaction. 8 Fix a suitable notice outside the room where it will be seen by anyone attempting to enter the room. This should indicate the special precautions required while preserving the patient’s confi dentiality. 9 Move the patient into the single-occupancy room. 10 Arrange for terminal cleaning of the bed space that the patient has been occupying. The patient’s belongings may become contaminated and cannot be taken home unless they are washable or cleanable. E To have PPE readily available when required. E Compliance is more likely if patients and their visitors understand the reasons for isolation; the patient’s anxiety will be reduced if they have as much information as possible about their condition. E To ensure all staff and visitors are aware of the need for additional infection control precautions. E To remove any infectious agents that may pose a risk to the next patient to occupy that bed ( NPSA 2009 , C ).
Postprocedure 11 Assess the patient daily to determine if source isolation is still required; for example, if enteric precautions have been required, has the patient been without symptoms for 48 hours? Procedure guideline 3.11 Source isolation: entering the isolation room Essential equipment ■ Personal protective equipment as dictated by the precautions required. Gloves and apron are the usual minimum; a respirator will be required for droplet precautions; eye protection if an aerosol-generating procedure is planned ■ Any equipment required for any procedure you intend to carry out in the room Preprocedure Source isolation Action Rationale 1 Collect all equipment needed. To avoid entering and leaving the infected area unnecessarily. E Procedure 2 Ensure you are ‘bare below the elbow’ (see Procedure guideline 3.1 ). To facilitate hand hygiene and avoid any contamination of long sleeves or cuffs that could be transferred to other patients. E 3 Put on a disposable plastic apron. To protect the front of the uniform or clothing, which is the most likely area to come in contact with the patient. E 4 Put on a disposable well-fi tting mask or respirator of the appropriate standard if droplet or airborne precautions are required, for example: (a) Meningococcal meningitis before completion of 24 hours of treatment (b) Pandemic infl uenza (c) Tuberculosis, if carrying out aerosol-generating procedure or the TB may be multiresistant. 5 Don eye protection if instructed by infection prevention and control team (e.g. for pandemic infl uenza) or if conducting an aerosol-generating procedure (e.g. bronchoscopy or intubation) in a patient requiring airborne/droplet precautions. To reduce the risk of inhaling organisms ( DH 2010b , NICE 2006, C ). To prevent infection via the conjunctiva ( DH 2010b, C ). 6 Clean hands with soap and water or alcohol handrub. Hands must be cleaned before patient contact ( WHO 2009, C ). 7 Don disposable gloves if you are intending to deal with blood, excreta or contaminated material, or if providing close personal care where contact precautions are required. There is often limited availability of isolation rooms ( Wigglesworth and Wilcox 2006 , R) so they must be used as effectively as possible. E To reduce the risk of hand contamination ( Pratt et al. 2007, C ). 8 Enter the room, shutting the door behind you. To reduce the risk of airborne organisms leaving the room ( Kao and Yang 2006 , R1a) and to preserve the patient’s privacy and dignity. 117
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