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

Prevention and management of inoculation injury
Procedure guideline 3.15 Protective isolation: entering the isolation room
Essential equipment
■ Hand hygiene facilities
■ Disposable plastic apron
■ Additional equipment, including PPE, for any procedure to be undertaken
Preprocedure
Action Rationale
1 Collect all equipment needed. To avoid entering and leaving the room unnecessarily.
Procedure
2 Ensure you are ‘bare below the elbow’ (see Procedure
guideline 3.1 ).
To facilitate hand hygiene and to avoid transferring any contamination
to the patient from long sleeves or cuffs. E
3 Put on a disposable plastic apron. To provide a barrier between the front of the uniform or
clothing, which is the most likely area to come in contact
with the patient. E
4 Clean hands with soap and water or alcohol handrub. To remove any contamination from the hands which could
be transferred to the patient ( WHO 2009 , C ).
5 Close the room door after entering. To reduce the risk of airborne transmission of infection from
other areas of the ward and ensure that air conditioning and
fi ltration work as effi ciently as possible. E
Visitors
1 Ask the patient to nominate close relatives and friends
who may then, after instruction (see steps 1–5, above),
visit freely. The patient or their representative should ask
other acquaintances and non-essential visitors to avoid
visiting during the period of vulnerability.
2 Exclude any visitor who has had symptoms of infection
or been in contact with a communicable disease in the
previous 48 hours.
3 Educate all visitors to decontaminate their hands before
entering the isolation room.
4 Visiting by children, other than very close relatives, should
be discouraged.
Prevention and management
of inoculation injury
Related theory
Healthcare workers are at risk of acquiring bloodborne
infections such as human immunodefi ciency virus (HIV),
the virus that causes acquired immune defi ciency syndrome
The incidence of infection increases in proportion to the
number of people visiting but unlimited visiting by close
relatives and friends diminishes the sense of isolation that
the patient may experience; large numbers of visitors are
diffi cult to screen and educate. E
Individuals may be infectious both before and after developing
symptoms of infection ( Chadwick et al. 2000, C ).
Hands carry large numbers of potentially pathogenic microorganisms
that can be easily removed ( WHO 2009, C ).
Children are more likely to have been in contact with infectious
diseases but are less likely to be aware of this, and
are more likely to develop infections because they have less
acquired immunity. E
(AIDS), hepatitis B and hepatitis C. While the risk is small,
fi ve episodes of occupationally acquired HIV infection
had nonetheless been documented in the UK up to 2002
( Health Protection Agency 2005 ). In 2006–7, 914 incidents
of occupational exposure to bloodborne viruses were
reported, of which between one-fi fth and one-third could
have been prevented through proper adherence to universal
precautions and the safe disposal of hazardous waste
( Health Protection Agency 2008 ). An understanding of the
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