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Isolation

Isolation

Definition

Isolation refers to the precautions that are taken in the hospital to prevent the spread of an infectious agent from an infected or colonized patient to susceptible persons.

Purpose

Isolation practices are designed to minimize the transmission of infection in the hospital, using current understanding of the way infections can transmit. Isolation should be done in a user friendly, well-accepted, inexpensive way that interferes as little as possible with patient care, minimizes patient discomfort, and avoids unnecessary use.

Precautions

The type of precautions used should be viewed as a flexible scale that may range from the least to the most demanding methods of prevention. These methods should always take into account that differences exist in the way that diseases are spread. Recognition and understanding of these differences will avoid use of insufficient or unnecessary interventions.

Description

Isolation practices can include placement in a private room or with a select roommate, the use of protective barriers such as masks, gowns and gloves, a special emphasis on handwashing (which is always very important), and special handling of contaminated articles. Because of the differences among infectious diseases, more than one of these precautions may be necessary to prevent spread of some diseases but may not be necessary for others.

The Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practice Advisory Committee (HICPAC) have led the way in defining the guidelines for hospital-based infection precautions. The most current system recommended for use in hospitals consists of two levels of precautions. The first level is Standard Precautions which apply to all patients at all times because signs and symptoms of infection are not always obvious and therefore may unknowingly pose a risk for a susceptible person. The second level is known as Transmission-Based Precautions which are intended for individuals who have a known or suspected infection with certain organisms.

Frequently, patients are admitted to the hospital without a definite diagnosis, but with clues to suggest an infection. These patients should be isolated with the appropriate precautions until a definite diagnosis is made.

Standard Precautions

Standard Precautions define all the steps that should be taken to prevent spread of infection from person to person when there is an anticipated contact with:

  • Blood
  • Body fluids
  • Secretions, such as phlegm
  • Excretions, such as urine and feces (not including sweat) whether or not they contain visible blood
  • Nonintact skin, such as an open wound
  • Mucous membranes, such as the mouth cavity.

Standard Precautions includes the use of one or combinations of the following practices. The level of use will always depend on the anticipated contact with the patient:

  • Handwashing, the most important infection control method
  • Use of latex or other protective gloves
  • Masks, eye protection and/or face shield
  • Gowns
  • Proper handling of soiled patient care equipment
  • Proper environmental cleaning
  • Minimal handling of soiled linen
  • Proper disposal of needles and other sharp equipment such as scalpels
  • Placement in a private room for patients who cannot maintain appropriate cleanliness or contain body fluids.

Transmission Based Precautions

Transmission Based Precautions may be needed in addition to Standard Precautions for selected patients who are known or suspected to harbor certain infections. These precautions are divided into three categories that reflect the differences in the way infections are transmitted. Some diseases may require more than one isolation category.

AIRBORNE PRECAUTIONS. Airborne Precautions prevent diseases that are transmitted by minute particles called droplet nuclei or contaminated dust particles. These particles, because of their size, can remain suspended in the air for long periods of time; even after the infected person has left the room. Some examples of diseases requiring these precautions are tuberculosis, measles, and chickenpox.

A patient needing Airborne Precautions should be assigned to a private room with special ventilation requirements. The door to this room must be closed at all possible times. If a patient must move from the isolation room to another area of the hospital, the patient should be wearing a mask during the transport. Anyone entering the isolation room to provide care to the patient must wear a special mask called a respirator.

DROPLET PRECAUTIONS. Droplet Precautions prevent the spread of organisms that travel on particles much larger than the droplet nuclei. These particles do not spend much time suspended in the air, and usually do not travel beyond a several foot range from the patient. These particles are produced when a patient coughs, talks, or sneezes. Examples of disease requiring droplet precautions are meningococcal meningitis (a serious bacterial infection of the lining of the brain), influenza, mumps, and German measles (rubella ).

Patients who require Droplet Precautions should be placed in a private room or with a roommate who is infected with the same organism. The door to the room may remain open. Health care workers will need to wear masks within 3 ft of the patient. Patients moving about the hospital away from the isolation room should wear a mask.

CONTACT PRECAUTIONS. Contact Precautions prevent spread of organisms from an infected patient through direct (touching the patient) or indirect (touching surfaces or objects that that been in contact with the patient) contact. Examples of patients who might be placed in Contact Precautions are those infected with:

  • Antibiotic-resistant bacteria
  • Hepatitis A
  • Scabies
  • Impetigo
  • Lice.

This type of precaution requires the patient to be placed in a private room or with a roommate who has the same infection. Health care workers should wear gloves when entering the room. They should change their gloves if they touch material that contains large volumes of organisms such as soiled dressings. Prior to leaving the room, health care workers should remove the gloves and wash their hands with medicated soap. In addition, they may need to wear protective gowns if there is a chance of contact with potentially infective materials such as diarrhea or wound drainage that cannot be contained or if there is likely to be extensive contact with the patient or environment.

Patient care items, such as a stethoscope, that are used for a patient in Contact Precautions should not be shared with other patients unless they are properly cleaned and disinfected before reuse. Patients should leave the isolation room infrequently.

Resources

BOOKS

Edmond, M. "Isolation." In A Practical Handbook for Hospital Epidemiologists, edited by L. A. Herwaldt and M. D. Decker. Thorofare, NJ: Slack Inc., 1998.

KEY TERMS

Colonized This occurs when a microorganism is found on or in a person without causing a disease.

Disinfected Decreased the number of microorganisms on or in an object.

Latex A rubber material which gloves and condoms are made from.

Phlegm Another word for sputum; material coughed up from a person's airways.

Stethoscope A medical instrument for listening to a patient's heart and lungs.

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Isolation

ISOLATION

"Isolation" is the defense mechanism characteristic of obsessional neurosis. The links of a thought, idea, impression, or feeling with other thoughts or behaviors are broken by means of pauses, rituals, magical formulas, or other such devices.

In "The Neuro-Psychoses of Defense," Freud conceived of defense, in hysteria as well as in phobias and obsessions, as a form of isolation: "defense against the incompatible idea [is] effected by separating it from its affect; the idea itself [remains] in consciousness, even though weakened and isolated" (1894a, p. 58).

In the case of the "Rat Man," Freud wrote suggestively of "isolation" though still without naming it as a specific neurotic defense mechanism. He wrote that, in contradistinction to hysteria, in which amnesia attests to a successful repression, obsessional neurosis reveals that "[t]he infantile preconditions of the neurosis may be overtaken by amnesia, though this is often an incomplete one. . . . The trauma, instead of being forgotten, is deprived of its affective cathexis; so that what remains in consciousness is nothing but its ideational content, which is perfectly colourless and is judged to be unimportant" (Freud 1909d, pp. 105-106). Thus, in obsessional neurosis, "patients will endeavour to 'isolate ' all such protective acts from other things" (p. 243).

In Inhibitions, Symptoms and Anxiety (1926d), Freud returned to the analysis of isolation as a defense mechanism in obsessional neurosisa view that Anna Freud would further develop in 1936and he emphasized how isolation involves the "the taboo on touching" to the extent that it involves "removing the possibility of contact; it is a method of withdrawing a thing from being touched in any way. And when a neurotic isolates an impression or an activity by interpolating an interval, he is letting it be understood symbolically that he will not allow his thoughts about that impression or activity to come into associative contact with other thoughts" (pp. 121-122).

Elsa Schmid-Kitsikis

See also: Defense mechanisms; Ego and the Mechanisms of Defence, The ; Inhibitions, Symptoms and Anxiety ; Neurotic defenses; Obsessional neurosis.

Bibliography

Freud, Anna. (1966). The ego and the mechanisms of defence. New York: International Universities Press.

Freud. Sigmund. (1894a). The neuro-psychoses of defence. SE 3: 41-61.

. (1909d). Notes upon a case of obsessional neurosis. SE 10: 151-318.

. (1926d). Inhibitions, symptoms and anxiety. SE 20: 75-172.

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Isolation

ISOLATION

In epidemiology isolation refers to a procedure used in communicable disease control. It consists of a separation of cases (persons or animals) for a disease's period of communicability. The cases are isolated in a specific location and under conditions that minimize the risk of direct or indirect transmission of the infectious agents to those who may be susceptible. The American Public Health Association's Control of Communicable Diseases Manual, 17th edition, recommends "universal precautions" to prevent the transmission of blood-borne agents and strict hygienic measures such as thorough hand washing after attending to infectious cases and disinfection of articles that have been in contact with infectious cases.

The Centers for Disease Control's Guidelines for Isolation Precautions in Hospitals identifies several categories of isolation that are appropriate according to the mode of transmission of the infectious agent. Strict isolation is used for highly contagious or virulent infections in which the agent may be spread by direct contact or droplet. Procedures include segregation in a private room; use of gowns, masks, and gloves; and sometimes special ventilation. Contact isolation is used for less dangerous conditions spread by direct contact. Measures similar to strict isolation are employed, but more than one person may share a room and sometimes barrier nursing suffices. Respiratory isolation is used to prevent airborne transmission of infectious agentsit resembles contact isolation in that infectious patients may share a room. Tuberculosis isolation is used for patients known or suspected to be excreting tubercle bacilli in sputum. A private room with the door closed is required, as well as the same procedures used for contact and respiratory isolation and the use of respirator-type masks by all who enter the room. Gowns are used but gloves are unnecessary. Enteric precautions are used when the infectious agent is transmitted in feces. These precautions resemble contact isolation and include particular care in sanitary disposal of feces. Drainage/secretion precautions are used when patients are discharging purulent material, such as that from an abscess or other infected body site. A private room is not necessary, and gowns and gloves are indicated if attendants have to touch contaminated material.

John M. Last

(see also: Barrier Nursing; Communicable Disease Control; Nosocomial Infections; Quarantine; Universal Precautions )

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Isolation

389. Isolation (See also Imprisonment, Remoteness.)

  1. Alcatraz Island The Rock; former federal prison in San Francisco Bay. [Am. Hist.: Flexner, 218]
  2. Alisons House reclusive woman guards secrets and poems of her dead sister. [Am. Drama: Glaspel Alisons House in Sobel, 18]
  3. Aschenbach, Gustave von spiritual and emotional solitude combine in writers deterioration. [Ger. Lit.: Death in Venice ]
  4. Count of Monte Cristo Edmond Dantès imprisoned in the dungeons of Château DIf for 14 years. [Fr. Lit.: The Count of Monte Cristo, Magill I, 158160]
  5. Crusoe, Robinson man marooned on a desert island for 24 years. [Brit. Lit.: Robinson Crusoe, Magill I, 839841]
  6. Dickinson, Emily (18301886) secluded within the walls of her fathers house. [Am. Lit.: Hart, 224]
  7. Hermit Kingdom Korea, when it alienated itself from all but China (c. 1637c. 1876). [Korean Hist.: NCE, 1233]
  8. Iron Curtain political and ideological barrier of secrecy concealing Eastern bloc. [Eur. Hist.: Brewer Dictionary, 490]
  9. Magic Mountain, The suspended in time, which exists in flat world below. [Ger. Lit.: The Magic Mountain, Magill I, 545547]
  10. Man Without a Country, The story of man exiled from homeland. [Am. Lit.: The Man Without a Country, Magill I, 553557]
  11. Olivia abjured the company and sight of men. [Br. Lit.: Twelfth Night ]
  12. prisoner of Chillon cast into a lightless dungeon and chained there for countless years. [Br. Lit.: Byron The Prisoner of Chillon in Benét, 817]
  13. Selkirk, Alexander (16761721) marooned on Pacific island; thought to be prototype of Robinson Crusoe. [Scot. Hist.: EB, IX: 45]
  14. Sleepy Hollow out-of-the-way, old-world village on Hudson. [Am. Lit.: Legend of Sleepy Hollow in Benét, 575]
  15. Stylites medieval ascetics; resided atop pillars. [Christian Hist.: Brewer Dictionary, 1045]
  16. Stylites, St. Simeon lived 36 years on platform atop pillar. [Christian Hagiog.: Attwater, 309]

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isolation

i·so·la·tion / ˌīsəˈlāshən/ • n. the process or fact of isolating or being isolated: the isolation of older people. ∎  an instance of isolating something, esp. a compound or microorganism. ∎  [as adj.] denoting a hospital or ward for patients with contagious or infectious diseases. PHRASES: in isolation without relation to other people or things; separately: environmental problems must not be seen in isolation from social ones.

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isolation

isolation (I-sŏ-lay-shŏn) n.
1. the separation of a person with an infectious disease from noninfected people. See also quarantine.

2. (in surgery) the separation of a structure from surrounding structures by the use of instruments.

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isolation

isolation Any technique aimed at separation of the parts of a system or its database in order to enhance computer security.

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