Chapter 5: Isolation

________UNIVERSAL PRECAUTIONS

________STRICT ISOLATION

         Isolation is designed to prevent transmission of microorganisms from infected or colonized patients to other patients, visitors, and health care providers.  Many current isolation concepts are shrouded in time-honored tradition and though they are generally based on sound epidemiology, few existing data from prospective, well-controlled studies support their efficacy.[i]  There are at least six different isolation categories (strict, MRO, contact, respiratory, AFB, and special) each with specific recommendations.  For practical purposes, we recognize two types of isolation status: universal precautions, which apply to all burn patients, and isolation, which is applied to patients with transmissible microbial pathogens. 

I.  Universal Precautions

A.  The minimum requirements:

1.      All patients have a private room.

2.      Handwashing is required before entering and after leaving the patient's room.

3.      Gowns, gloves, masks, and eyeware must be worn if contact with any body secretions is anticipated (e.g. wound dressing changes, tubbings, central line placements, and endotracheal tube care).

II.  Isolation

A.     Requirements

     In addition to the requirements for universal precautions, gowns, gloves, masks, and eyewear are worn in the room at all times.

        B.  Multiple Resistant Organisms (MRO)

1.      Approximately 92 percent of Staphylococcus aureus isolates are resistant to penicillin.[ii]   These isolates are considered methicillin-resistant S. aureus organisms (MRSA).

2.      Patients who are colonized or infected with MRSA require three negative nasal and rectal swabs, and swabs from any open areas including wounds and tube sites, taken at one week intervals off all antibiotics before they can be removed from MRSA isolation status.  Contact the infection control specialist for specific directions regarding sites to be cultured.  

3.      Other diseases or conditions requiring MRO isolation include:

a.     Vancomycin resistant Enterococcus (VRE)

b.     Clostridium difficile diarrhea

III.  For all other less common pathogens, follow the

        recommendations of the local infection control specialist.