Name: - Caring For A Patient On Isolation Precaution

Name:________________________________________________

Caring for a Patient on Isolation Precaution

Basic Concept: Isolation Precaution is the second tier of the prevention isolation guidelines (CDC,2007),
which are based on the mode of transmission of the disease. Isolation precautions or transmission based
precautions are categorized to airborne, droplet and contact precautions. The category determines the
choice of barrier devices or protection that health worker needs. It includes the appropriate use of
personal protective equipment (PPE) such as gowns, gloves, masks, eyewear and other protective
devices or clothing.

Objectives:
1. To prevent and control infection and its spread.

2. To reduce and/or eliminate sources and transmission of infection.
3. To help protect client and health care provider from disease.
Materials/Equipment:
Soap in soap dish or liquid soap in dispenser
Paper towel
Clean gown
Disposable gloves
Eyewear or goggles / Face shield
Bonnet
Clean tissue
IV stand
Trash Bag
Puncture-proof container/hub
Preparation:
1. Assess isolation indication.

2. Review agency policies and precautions necessary for specific isolation systems and consider
measures you will perform while in the patient’s room.
3. Review nurse’s notes or speak with colleagues regarding patient’s emotional state and
adjustment to isolation.
4. Assess client’s knowledge and significant others for the need to wear a gown and gloves during
the care.
5. Perform hand hygiene and prepare all equipment needed to take into patient’s room.
6. Prepare for entrance in the isolation room.
Steps Rationale
1. Put on the bonnet applying the correct
technique, being sure to tuck hair under
the bonnet.
2. Apply either surgical mask or respirator
around mouth and nose.
If needed apply eyewear or goggles
snugly around eyes and face. If
prescription glasses are worn, side
shield may be used.
3. Apply cover gown, being sure that it
covers all outer garments.
4. Pull sleeves down to wrist.
5. Tie securely at neck and waist.
6. Apply clean gloves over gown sleeves.
7. Enter patient’s room.
Use clean tissue to open the door knob.
8. Explain purpose of isolation and
necessary precautions to patient and
family.
9. Offer opportunity to ask questions.
10. Assess for evidence of emotional
problems that occur from isolation.
11. Arrange supplies and equipment for
use. If equipment will be removed for
reuse, place clean paper towel.
12. Assess vital signs.
a. If patient is infected or colonized
with resistant organism, equipment
remains in the room whenever
possible. This includes stethoscope
and BP cuff.
b. If the stethoscope is to be reused,
clean diaphragm or bell with
alcohol. Set aside on clean surface.
c. Use individual or electronic or
disposable thermometer. If
disposable thermometer indicates a
fever, assess for other
signs/symptoms. Confirm fever
using electronic thermometer.
13. Administer medications
a. Give oral medications in wrapper or
cup.
b. Dispose of wrapper or cup in plastic
lined receptacle.
c. Administer injection.
d. Discard safely needle in sharp
containers and syringe in
appropriate receptacle.
14. Administer hygiene, encouraging
patient to discuss questions or concerns
about isolation. Provide informal
teaching at this time.
a. Avoid allowing gown to become
wet.
b. Avoid leaning over from wet
surfaces.
c. Remove linen from bed; avoid
contact with gown. Place inlinen baf
according to agency policy.
d. Remove gloves and perform hand
hygiene. Wear another gloves, if
further care is necessary.
15. Collect specimens.
a. Place specimen containers on clean
paper towel in patient’s bathroom.
Follow procedure for collecting
specimen of body fluids.
b. Transfer specimen to container
without soiling outside of the
container. Place container in plastic
bag and place label on outside of
the bag or per facility policy.
c. Label specimen per facility policy.
d. Perform hand hygiene and wear
another gloves, if additional
procedures are needed.
16. Dispose linens and trash bag as they
become full.
a. Use sturdy, moisture resistant single
bags to contain soiled particles. Use
double bag if outside bag is
contaminated.
b. Tie bags securely at top in knot.
17. Remove all reusable pieces of
equipment. Clean any contaminated
surfaces with hospital approved
disinfectant.
18. Explain to client when you plan to
return to room. Ask whether client
requires any personal items.
19. Leave isolation room. Remember order
of the removal of protectives barriers
depends on what is worn in room. This
sequence describes steps to take if all
barriers were to be worn.
a. Remove gloves. Remove one glove
grasping cuff and pulling glove
inside out over hand. Discard glove.
With ungloved hand, tuck finger
inside cuff of remaining glove and
pull it off, inside out.
b. Untie neck strings, then back strings
of gown. Allow gown to fall from
shoulders. Remove hands from
sleeves without touching outside of
gown. Hold gown inside at shoulder
reams and fold inside out; discard in
laundry bag.
c. Untie top mask string and then
bottom strings, pull mask away
from face and drop into trash
receptacle (do not touch outer
surface of mask).
d. Remove bonnet and discard.
e. Perform hand hygiene for a
minimum 10 seconds.
f. Leave room and close door if
necessary. Door should be closed if
client is in negative airflow room.
20. Do documentation of nursing care
rendered to the patient
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Name:________________________________________________

Caring for a Patient on Isolation Precaution

1. To prevent and control infection and its spread.

Soap in soap dish or liquid soap in dispenser

Eyewear or goggles / Face shield

1. Assess isolation indication.

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