02.08 Isolation Precaution Types (PPE)

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Overview

  1. Isolation precautions types
    1. Standard precautions
    2. Contact precautions
    3. Droplet precautions
    4. Airborne precautions

Nursing Points

General

  1. Standard precautions
    1. Hand hygiene
    2. Gloves
    3. Examples:
      1. Body fluid contact
  2. Contact precautions
    1. Transmission
      1. Direct physical contact
        1. Person to person
        2. Fecal-oral
    2. Standard precautions
    3. Gown
    4. Examples:
      1. MRSA(Methicillin resistant Staphylococcus aureus)
      2. MDRO (Multidrug resistant organism)
      3. C. diff (Clostridium difficile)
  3. Droplet precautions
    1. Transmission
      1. Sneezing
      2. Coughing
      3. Talking
    2. Standard precautions
    3. Mask
    4. Examples:
      1. Flu
      2. Mumps
      3. Meningitis
      4. Anything transmitted greater than 5 microns in size
  4. Airborne precautions
    1. Transmission
      1. Sneezing
      2. Coughing
    2. N95 Mask & hood
      1. Need to be sized and fitted
      2. Nurses with facial hair
    3. Negative pressure room
      1. Use ante room
      2. Make sure everyone else uses ante room
    4. Examples:
      1. Measles
      2. Tuberculosis
      3. Anything smaller than 5 microns
  5. Things to consider
    1. Build rapport
    2. Ask questions
    3. Engage the patient and family

Nursing Concepts

  1. Safety
  2. Infection control

Patient Education

  1. Educate patients on need for isolation control while encouraging positive rapport building and reducing feelings of isolation.

Reference Links

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Video Transcript

In this lesson, we’re going to take a look at isolation precautions, and how to manage them.

Precautions are just a fancy word for things you should do to protect yourself or the patient. Standard precautions are what you should be doing with every patient. You should always wash your hands before and after each patient (that also includes using the hand sanitizer foam). A good rule of thumb is to always wear gloves around your patient, especially when you don’t know what’s going on with them. A good example of this would be if you just happened to help them out of bed without gloves on and later find out that they’re MRSA positive – definitely should have worn gloves on that one!

The other thing you need to consider with standard precautions is a splash guard or goggles. If you THINK you might get splashed in the face (think emptying the foley bag), then you might want to wear a splash guard. You don’t want to get splashed in the face with body fluids (been there, done that).

The best thing you can do is to use your nursing judgment. If you think you’ll be exposed to anything you don’t wouldn’t want to be exposed to, then err on the side of caution and wear what you think is appropriate! If you think your patient that has diarrhea is possibly C. diff positive, wear a gown and maybe some goggles, plus double gloves.

Another thing about standard precautions is that you’ll pretty much always use them in any other precaution, plus some extra PPE. So let’s look at contact precautions.

Now, contact precautions are pretty easy to remember. If you touch the patient by direct physical contact, you run the risk of getting an infection or picking up whatever bug the patient has on them and potentially carrying it to another patient. So this is person to person contact or something like fecal oral route (we’ll talk about this in a sec).

What you’ll want to do for these patients is to use standard precautions PLUS a gown. Examples of infections that you’ll use for this are things like MRSA (methicillin resistant staph aureus), MDRO (multi drug resistant organisms) or C. diff. This is where that whole fecal oral route thing comes up. It’s literally what you think it is. Not washing your hands after a C.diff patient and then going on break to eat your sandwich can ruin your day. So wash your hands after your C. diff patients.

Now, there’s always a ton of confusion between droplet precautions and airborne (trust me, I get mixed up too). Let’s look at droplet first.

Droplet precautions require a mask, that’s easy. The reason you’ll need a mask on this one is because these infections are transmitted by sneezing, coughing and even talking. Examples of this one are things like flu, meningitis, and mumps. In this case, also use those good ole’ standard precautions too.

Now that we’ve got a handle on droplet, let’s look at airborne.

Like droplet precautions, airborne precautions deal with using a mask to protect yourself. But there are some caveats to this one.

First off, you’ve gotta use the mask because it’s transmitted by coughing or sneezing and even BREATHING. They’re tiny particles! HOWEVER, the infection particle is so small it’ll actually go through the surgical masks, so you have to use a special mask called an N95 mask. You usually have to be fitted with these by your facility.

Now, for guys like me who like to have a beard, your N95 mask won’t work because it won’t create a seal properly, so if that’s the case, you’ll wear a specialized hood that filters the air. Again, you’ll probably have to be fitted for it.

A big part of a airborne precautions is the use of a negative pressure room. It basically sucks all of the air out of the room into a closed system and kicks it out in the ventilation system to prevent contamination. So make sure if you’re assigned a patient with a suspected or confirmed airborne illness to make sure they’re in the right room.

The other important part of negative pressure room is the use of something called an ante room. An ante room is a special room where you basically prep to go inside. You’ll go in, close the door, get all gloved up with your mask on, and then go into your patient’s room. Make sure everyone goes through the ante room and that the main room to the patient is never opened. Educate the family on using it too!

Now, I do want to hit a couple of nursing things that don’t quite fit anywhere else in this lesson, and that’s what you should be doing for your patients.

Being in the hospital is already a tough thing to deal with. Now throw on the idea that you’re going to have to close the door to the patient’s room or wear masks and gloves and gowns while you care for the patient. It’s tough for the patient to not only be there, but isolation rooms can also make the patient feel isolated from everyone else.

Focus on building rapport with your patient. You’re gonna be there all day, so make sure that you still build that relationship. Ask your patient questions and engage them in conversation. Sometimes they’re made to feel gross. For instance, there’s a large number of patients who are transient carriers of MRSA (I’m one of them), so if I was admitted and they did the swab on me, I’d be on automatic contact precautions. I’m not gross, but the going through the process will make me feel that way. So be sure you give a damn about your patients, in spite of them being in isolation.

The last thing we want to do is make their illness worse because we’ve made them feel isolated and alone because of an infection.

When we look at nursing concepts for isolation precautions, we want to focus on safety and infection control for both you, the nurse, and the patients.
So let’s recap.

When you use standard precautions, wash your hands and use good judgment.

Contact precautions are direct contact with the patient, so use a gown.

When you’re dealing with droplet precautions, be sure to use a mask!

For your airborne precautions, make sure your patient is in the negative pressure room with an ante room and make sure you have the right mask on.

When in doubt, combine your precautions to protect yourself, the patient, and other patients!

That’s all for this lesson with isolation precautions. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 5

A 60-year-old client has been admitted to the hospital with Creutzfeldt-Jakob disease. Which type of isolation precautions must the nurse use while caring for this client?

  • Question 2 of 5

A 50-year-old client with measles has been admitted to the hospital and is in isolation. The client’s daughter asks the nurse, “How can I keep from catching this myself if I have been vaccinated?” Which answer from the nurse is most appropriate?

  • Question 3 of 5

A 31-year-old client has developed meningococcal meningitis after recently traveling out of the United States. Which type of precautions would the nurse most likely implement in this situation?

  • Question 4 of 5

The nurse is caring for a client with watery diarrhea following a course of clindamycin. The nurse suspects clostridium dificile. Which of the following isolation precautions are necessary for this client? Select all that apply.

  • Question 5 of 5

A nurse is caring for a client with varicella zoster. The nurse is instructing the client and the family about how to prevent transmission of the disease while in the hospital. Which directions should the nurse provide as part of this teaching? Select all that apply.

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