TIMELY INITIATION OF ISOLATION PRECAUTIONS:

Safety has become a familiar buzzword in hospitals around the country. Nurses have always known how important providing a safe environment is to our patients, but did you ever think of it in the context of isolation? Rapid identification of possible infectious symptoms and timely initiation of transmission-based precautions can eliminate unnecessary exposure for employees, visitors, and other patients.

The Centers for Disease Control and Prevention (CDC) estimates 2 million patients annually acquire infections in U.S. hospitals, and 90,000 die (one every 6 minutes). Healthcare-acquired infections (HAIs) are estimated to cost at least $6.7 billion annually in 2002 dollars1. While the literature cites healthcare-acquired bloodstream infections and surgical site infections as two of the most common adverse events, prevention of transmission of an infectious process is an important aspect for providing quality care.

It is totally within a nurses scope of practice to implement measures to promote a safe environment for clients and others2 and to utilize critical thinking skills learned in nursing school. Neither facility policy nor an MD order can discharge the nurses responsibility for assuring patient safety, or for complying with all of the other rules and requirements, according to the Texas Nursing Practice Act.2

One study in a large teaching hospital found a lack of knowledge as being the most important barrier for not applying isolation precautions.3 Reasons often heard by the infection control practitioner for why isolation has not been implemented varies from, I didnt know the patient needed to be isolated, to I dont have a doctors order to isolate. Dont let that be a deterrent to get the ball rolling. Be sure to familiarize yourself with the Nurse Practice Act for the state in which you hold your licensure, in regard to your duty to provide nursing care.

Prompt initiation of isolation precautions by the nurse is the key to minimizing exposure to contagious illnesses. When potentially infectious symptoms such as diarrhea, cough, congestion, rash, draining wounds, or fever are identified during the nursing assessment, these should be a red flag for nurses to implement isolation. In some cases, the admitting diagnosis may be indicative of the type of isolation warranted, such as pulmonary tuberculosis, RSV, or chickenpox. Other key factors, such as a thorough history, detailed physical examination, and review of labs and medications, may offer some insight into a potential infectious process. There is no reason that a registered nurse cannot make the call to initiate isolation before getting a physicians order. Alerting the physician of identified signs and symptoms of infections is important, but lack of an order does not preclude initiating the process of providing a safe environment for patients, visitors, and employees. Of course, the nurse should refer to the facilitys isolation guidelines for the appropriate type of precautions.

Nurses should develop a professional relationship with the infection control practitioner (ICP) by allowing them to serve as a resource person. The ICPs expertise and knowledge in reducing risks for infection can be invaluable in providing quality patient care and optimal outcomes. Knowing when and if it is appropriate to discontinue precautions is another important function of the ICP that can significantly impact patient care in many ways.

Teaching patients, parents, or other caregivers about isolation precautions as they relate to an illness, and proper hand hygiene is also paramount to providing a safer environment, improving compliance, and preventing transmission of infections and other adverse outcomes. This process should begin at admission and continue throughout the hospitalization. Actual observation of practice is a good tool to utilize with gentle reminders when techniques start to wane.

First, do no harm. Be a thinker and a doer. Assess and initiate isolation precautions when warranted by your assessment. Your intervention may prevent an undesirable outcome for the customer. 

Kathy Ware, RN, CIC, is the infection control practitioner at Texas Childrens Hospital, with a primary focus on the Neonatal Intensive Care Unit Levels 2 and 3. She has been in the infection control field for 11 years and has been certified for six years, and is a member of the Houston chapter of the Association for Professionals in Infection Control and Epidemiology (APIC), where she was recently elected to serve as a board member.

References:

1. Graves N. Economics and preventing hospital-acquired infection. Emerging Infectious Disease 2004.

2. Texas Nursing Practice Act.

3. Sax H. et al. Knowledge of standard and isolation precautions in a large teaching hospital. Infect Cont Hosp Epidem. March 2005, Vol. 26, No.3, 298-304.