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

5 If the patient has an infection requiring droplet or airborne
precautions that may present a risk to people encountered
in the other department or in transit, they will need to wear
a mask or respirator of the appropriate standard. Provide
the patient with the mask and explain why it is required and
how and when it is to be worn (i.e. while outside their singleoccupancy
room) and assist them to don it if necessary.
Protective isolation
Evidence-based approaches
Rationale
Protective isolation is used to minimize the exposure to
infectious agents of patients who are particularly at risk of
infection. Although the evidence that protective isolation
successfully reduces the incidence of infection is limited
( Wigglesworth 2003 ), probably because many infections
are endogenous (i.e. caused by the patient’s own bacterial
fl ora), it is used to reduce the risk of exogenous infection
(cross-infection from other people or the environment) in
groups who have greatly impaired immune systems ( Fraise
and Bradley 2009 ), such as autologous and allogenic bone
marrow transplant patients. Patients who have compromised
immune systems often have greatly reduced numbers
of a type of white blood cell called a neutrophil; this condition
is known as neutropenia and those people suffering
from it are described as neutropenic. Neutropenia is graded
from mild to severe according to how few neutrophils are
in the circulation and hence how much the risk of infection
is raised.
Single-occupancy rooms used for protective isolation
should have neutral or positive air pressure with respect to
the surrounding area. High-effi ciency particulate air (HEPA)
fi ltration of the air in the room may reduce exposure to
airborne pathogens, particularly fungal spores. A room
with positive pressure ventilation must not be used for any
patient infected or colonized with an organism that may be
spread through an airborne route; in this circumstance if an
immunocompromised patient has such an organism, they
should be nursed in a room with neutral air pressure or with
a positive pressure lobby.
Principles of care
Diet for the immunocompromised patient
■ Educate the patient in the importance of good food hygiene
in reducing their exposure to potential pathogens;
they should choose only cooked food from the hospital
menu and avoid raw fruit, salads and uncooked vegeta-
Protective isolation
To prevent airborne cross-infection. E
Providing the patient with relevant information will reduce
anxiety.
bles. Stress the importance of good hand hygiene before
eating or drinking. Uncooked foods are often heavily colonized
by micro-organisms, particularly Gram-negative
bacteria ( Moody et al . 2006 ); potential pathogens on the
hands may be inadvertently consumed while eating or
drinking.
■ Educate the patient’s family in the importance of
good food hygiene, particularly good hand hygiene,
and advise that any food brought in for the patient
should be in undamaged, sealed tins and packets obtained
from well-known, reliable firms and within the
expiry date. Correctly processed and packaged foods
are more likely to be of an acceptable food hygiene
standard.
■ Provide the patient with fi ltered water or sealed cartons
of fruit juice (not fresh) to drink ( Vonberg et al. 2005 ).
Do not supply bottled water. Tap water may occasionally
be contaminated with potential pathogens; long-life fruit
juice has been pasteurized to remove micro-organisms;
bottled water very often contains more micro-organisms
than tap water.
Discharging the neutropenic patient
■ Crowded areas, for example shops, cinemas, pubs
and discos, should be avoided. Although the patient’s
white cell count is usually high enough for discharge,
the patient remains immunocompromised for some time
( Calandra 2000 , E ).
■ Pets should not be allowed to lick the patient, and new
pets should not be obtained. Pets are known carriers of
infection ( Lefebvre et al . 2006 ).
■ Certain foods, for example take-away meals, soft cheese
and pâté, should continue to be avoided. These foodstuffs
are more likely to be contaminated with potential
pathogens ( Gillespie et al . 2005 ).
■ Salads and fruit should be washed carefully, dried and,
if possible, peeled, to remove as many pathogens as possible
( Moody et al . 2006 ).
■ Any signs or symptoms of infection should be reported
immediately to the patient’s general practitioner or to
the discharging hospital. Any infection may have serious
consequences if left untreated.
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