TOPIC Isolation Isolation -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.

Ideal -Initiate isolation through history taking and initial assessment. Reviewing the medication and laboratory result of the patient may give insight to a potential infectious process. If previously diagnosed with PTB, RSV or chicken pox, isolation is already warranted. Although in some potentially infectious cases like diarrhea, cough, rash, fever and draining wound, isolation should already be done. Alerting the physician on the identified signs and symptoms is next step. -Tools regarding updated isolation precaution guidelines should be viewed throughout the area (pamphlets, posters, and signs). These precautionary measures heightened the awareness and adherence of the individuals isolated and the health care providers.

Reality - Triage nurses are not available in the area, therefore patients are came in and out of the emergency room making the other patients at risk in getting the disease.

RRL -Infection Control Today: TIMELY INITIATION OF ISOLATION PRECAUTIONS (2006) retrieved at http://www.infectioncontroltoday.co m/articles/2006/06/timely-initiationof-isolation-precautions.aspx

-Isolation precautions are tools that benefit a hospitalized population and healthcare workers rather than the individual isolated. This heightened awareness is an opportunity for infection prevention programs to reinforce reasons, adherence, and execution of isolation practices. It also compels infection prevention to examine their approach to isolation, assessing its impact on the totality of patient care and assuring that this tool is used judiciously

-The area is equipped with posters and signs, though some were not easily seen, unattractive and fading.

- Vinski J, et al. Impact of Isolation on Hospital Consumer Assessment of Healthcare Providers and Systems Scores: Is Isolation Isolating? Infection Control and Hospital Epidemiology. Vol. 33, No. 5, May 2012.

-Regular cleaning protocols of housekeeping staff include disinfection of patient rooms with sodium hypochlorite after discharge, daily cleaning of bathrooms and floors, and cleaning of high-touch surfaces only if visibly soiled. Rooms randomized to

-Isolation room should be -Disinfection was not maintained by disinfecting observed. the room everyday for at least 20mins with sodium

-Society for Healthcare Epidemiology of America: Daily Disinfection of Isolation Rooms Reduces Contamination of Healthcare

daily disinfection were cleaned each morning for seven days, or until discharge. The daily disinfection took about 20 minutes per room. These isolation rooms help to prevent direct and even indirect contact transmission and droplet transmission

hypochlorite after discharge together with the daily cleaning of bathrooms and surfaces that are commonly touched by the patients to prevent direct and even indirect contact transmission and droplet transmission -Doors should be closed shut with self closing device and windows for air exchanged in order to keep the room well ventilated and provide adequate fresh air. -When a patient has a high probability to spread infection, patient should be placed directly in the isolation room. Patient placements like infants, children and patients with altered mental status are the ones who are more likely to spread infection because they need assistance in limiting transfer of infection. Therefore, hand washing areas and toilet facilities should be placed to reduce transmission of microorganisms. -Doors are maintained open.

Workers' Hands (2012)

- The observation unit in the ED is also equipped with isolation rooms for the management of potentially high risk and infectious patients. The doors of these rooms are fitted with a self closing device. For isolation rooms with no negative pressure ventilation, it is important to have them well ventilated with adequate fresh air exchange.

- Journal of Emergencies, Trauma and Shock: Occupational risk due to airborne disease challenges healthcare, Fatimah Lateef (2009)

- Appropriate patient placement is a significant component of isolation precautions. A private room is important to prevent director indirect-contact transmission when the source patient has poor hygienic habits, contaminates the environment, or cannot be expected to assist in maintaining infection control precautions to limit transmission of microorganisms (ie, infants, children, and patients with altered mental status). When possible, a patient with highly transmissible or epidemiologically important microorganisms is placed in a private room with hand washing and toilet facilities, to reduce opportunities for transmission of microorganisms.

- Improper assessment were made, and in some instances, persons with contagious diseases were able to go inside the emergency department. There are no washing area or comfort room inside the isolation room.

- Journal of Emergencies, Trauma and Shock: Occupational risk due to airborne disease challenges healthcare, Fatimah Lateef (2009)

- On arrival at ED, the patient should be evaluated for infection status, especially of potentially transmissible infection of the respiratory pathways, and important immunodepression. The patient should also be questioned about cough, expectoration, rhinorrhea, sneezing, diarrhoea or fever, and disease associated with severe immunodepression should be ruled out.

-Thorough history taking -Signs of cough and and assessment on diarrhea were not usually potentially transmissible isolated. infection of the respiratory pathways such as cough, expectoration, sneezing diarrhea, fever, rhinorrhea and patients with immunosuppression should be done. -Waiting room for infectious client should be available with a distance of 1 meter apart from another patient. Instructions on the proper usage of masks should be available. Disposal bins should also be placed in the area. Pamphlets should always be available with simple images indicating the desired precautions without need for text in different languages. Alcohol solutions should also be available for hand hygiene and should be accessible and distributed in visible places. Immunosupressed patients should be attended as soon as possible and should be separated from others while they wait. -Ideally single rooms with negative air pressure -General waiting room is available. Mask were not provided, instructions were only given to those patients who approached the nurses. No pamphlets available as well as the alcohol solutions. Immunosupressed clients were not attended asap. Although, waste bins are available.

- The Hospital Infection Control Practices Advisory Committee : Guidelines for Isolation Precautions in Hospitals Hospital Infection Control Advisory Committee,Julia S. Garner (1996)

-The waiting room should have an area where patients with possible respiratory infection can be kept at least one metre apart from other patients. In addition, such patients should be provided with a standard face protection mask (surgical mask) and instructed on correct use, as well a single-use tissues, and the area should be equipped with disposal bins. A useful way to instruct patients about these precautions is to exhibit explanatory pamphlets consisting of simple images indicating the desired precautions without need for text in different languages. The waiting area should have bottled alcohol solution available for hand hygiene, distributed in easily accessible and visible places. Patients with important immunodepression should be attended as soon as possible, but should anyway be separated from others while they wait.

- Preventive isolation in the emergency department: MAR ORTEGA, JOSEP MENSA (2009) ,

- Patients should be hospitalized in single rooms with negative air pressure relative to other neighbouring areas. The room should have

-Only one isolation room is available. A window is

- Victorian Advisory Committee on Infection Control: Guidelines for the

air conditioning that allows total replenishment at least 6 times an hour. Although ideal, this type of single room is not generally available in many ED, but a room with an external window may serve to isolate the patient. In any case, the door of the room should be kept closed. Anyone entering should wear a mask that filters out at least 95% of 1 m particles. The patient should be restricted to the room except in cases of strict necessity. In these cases the patient must wear a surgical mask. The gown and gloves must be used in accordance with standard recommendations. Health-care workers who are not immune should avoid entering the room of these patients.

should be the design of the isolation room, however this is not generally available in many emergency departments, so a room built with an external window and a door with a tight sealed shut may do. Anyone who enters the isolation room should wear masks because it filters at least 95% of 1 m particles. Patients should be confined in the room as much as possible except in cases of strict necessity. If the patients goes out of the room, surgical masks should be worn with gowns and gloves depending on the hospital protocols. HCP who are not immune and exposed to the infectious disease should avoid entering the isolation room -Patients who are diagnosed with the same disease should be occupying the same rooms.

available for adequate ventilation but the door is always open. Not all HCP wore masks, and not all patients, when leaving the isolation room were given masks to use.

classification and design of isolation rooms in health care facilities (2007)

- Precautions against droplet transmission include isolation in a single room but air conditioning is not necessary. Although not recommended, patients with the same disease may occupy the same room if single rooms are not available. Since drops do not travel far, the door to the room may be left open but this is not recommended. Health-care workers should wear a surgical mask on entering the room. Gown and gloves should be worn according to standard precautions. If the patient is transferred out of the isolation room, he/she should wear a surgical mask.

-One room for all.

- Victorian Advisory Committee on Infection Control: Guidelines for the classification and design of isolation rooms in health care facilities (2007)

- The objective is to prevent transmission of micro- organisms by direct contact with an infected or colonized patient or indirect contact after touching contaminated objects or surfaces in the immediate surroundings of the patient. These measures include: a) Isolation in a single room. Although not recommended, patients infected or colonized by the same micro-organism may occupy the same room if single rooms are not available. The patient should only leave the room when really necessary. b) Staff entering the room should wear protective gloves and gown, according to standard precautions. These items should be removed before leaving the room. After removal of the gloves, hand hygiene with alcohol solution is necessary, taking care not to re-contaminate the hands before finally leaving the room. c) The stethoscope, arterial pressure kit and other objects used in medical attention should be for personal use and not used for other patients. Lastly, in the three types of anti-transmission precautionary measures, it is important that they be carefully and strictly applied if the patient requires any kind of surgery, major or minor, since a greater number of health-care workers may be involved. In addition, staff responsible for the cleaning of the cubicle or isolation room must adhere to the same precautionary measures and take particular care to ensure the cleanliness of all the surfaces potentially contaminated by the patient. -Appropriate signage should be prominently placed outside the door of isolation rooms. The bedside and other charts should also be labelled once isolation has been ordered for a patient. Educational information on necessary precautions and procedures should be readily available and accessible (for example, in the form of information pamphlets, folders or posters, located adjacent to the isolation room) for staff, patients and visitors, while ensuring there is no breach of medical confidentiality

-If a single room is not available, patients who are diagnosed with the same disease should be placed in the same room. Patients should also avoid going out of the isolation room. Staffs entering the room should wear PPEs (masks, gloves and gown) These PPEs should be removed before leaving the room. Hand hygiene should be done nest with alcohol solution so as not to re-contaminate the area before finally leaving the room. Stethoscopes and other objects should not be used with other patients

-Patient goes in and out of the isolation room. Staffs were not fully equipped with PPEs. Hand washing and rubbing the hand with alcohol solution before leaving the room is also not practiced. Stethoscopes, as observed were used to all patients.

- Victorian Advisory Committee on Infection Control: Guidelines for the classification and design of isolation rooms in health care facilities (2007)

-Signage outside the isolation rooms should be placed. Charts and beds should also be labeled once on isolation. Educational materials should also be available such as posters, and pamphlets to the staffs, visitors and patients. -Sliding doors should not be used in isolation room

-Signage is placed, outside the isolation room. Although beds and charts were not labeled. Pamphlets were not readily available but posters are.

- Victorian Advisory Committee on Infection Control: Guidelines for the classification and design of isolation rooms in health care facilities (2007)

- Sliding doors are not recommended but if space is an issue, sliding doors should only used as a last resort due to difficulties with

-Sliding door is not used.

- Victorian Advisory Committee on Infection Control: Guidelines for the

maintenance and maintaining a seal.

due to difficulties in maintaining the seal - Staff nurses and nurse managers supported the every other day and p.m. bed-linen schedule. - No proper sorting, transport and laundering textiles.

classification and design of isolation rooms in health care facilities (2007) - Ina:y l. Ht'ndley westfai-l, bs^, Rn. Cen, ccrn (2009). Are daily bed linen changes Necessary?. Retrieved from Http://www. Nursingmanagement. Com -Sabina Fijan and Sonja ostar Turk(2012) Hospital Textiles, Are they a possible vehicle for Health Care Associated Infection?. Retrieved from:http://www.ncbi.nlm.nih.gov/p mc/articles/PMC3499872/

ER Bed linens

- According to Slovenian Public Gazette the correct hygienic management of hospital textiles is achieved by minimal technical requirements regarding sorting, transport and laundering textiles. a.Nurses felt that changing linens is not only add to the cost of hospitalization but also inconvenienced patient at times. b.Textiles include bed sheets, blanket, personal clothing, gowns, drapes for surgical procedures are possible vehicles of transmission.

- It is necessary to implement infection control practices including proper handling of dirty linen by laundry workers in order to prevent possible health-acquired infections. - Increasing the water flow through washing machine will decrease B. cereus on laundered linen - It is necessary that other - Only bedrail are only seen as potential reservoirs of bed components are infection sufficiently decontaminated to minimize the risk of crossinfection. Clear guidelines should be formulated, specifying the decontamination procedure for each component of the bed. - Devices used in each patients should be well

- An investigation into two cases of post-operative Bacillus cereus meningitis revealed that hospital linen laundered by a batch continuous washing machine was heavily contaminated by B. cereus spores.

- Barrie D, Hoffman PN, Kramer JM, Wilson JA(1994). Contamination of hospital linen by Bacillus cereus.Retrieved from: http://web.b.ebscohost.com/ - Creamer E., Humphreys H. (2008). The contribution of beds to healthcare-associated infection: The importance of adequate decontamination. Retrieved from: http://web.b.ebscohost.com/

- Mattresses and pillows that are direct contact with the patient are more potential reservoirs of infection contact with patients.

Nosoco mial

-This study investigated the rate of device-associated health careassociated infection (DA-HAI), microbiological profiles, bacterial

- According in this study,

-Navoa-Ng JA, Berba R, Galapia

Infectio ns

resistance, length of stay (LOS), and mortality rate in 9 intensive care units (ICUs) of 3 hospital members of the International Nosocomial Infection Control Consortium (INICC) in the Philippines

DA-HAIs pose far greater threats to patient safety in Philippine ICUs than in US ICUs. The establishment of active infection control programs that involve infection surveillance and implement guidelines for prevention can improve patient safety and should become a priority. - In this study, nurses had higher knowledge, perceived risk, and appropriate hais' control measures than physicians.

cleansed before using it again in another patient to decrease the risk of infection.

YA, Rosenthal VD, Villanueva VD, Tolentino MC, Genuino GA, Consunji RJ, Mantaring JB, 2011.Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings.Retrieved March 9, 2014 from http://www.ncbi.nlm.nih.gov/pubmed /21616564 - Marinelli, p., angelillo, i., 2010. healthcare workers and health careassociated infections: knowledge, attitudes, and behavior in emergency departments in italy. retrieved march 2, 2014 from http://web.b.ebscohost.com/ehost/det ail?sid=79c30d61-ba36-4cde-b529e61e65e8733a%40sessionmgr110&vi d=1&hid=127&bdata=jnnpdgu9zwhv c3qtbgl2zq%3d%3d#db=a9h&an=49 250577 - El-awady, m., harak, m., abdelrahman, a., elmorsy, e., ragab, a., makhdoom, n., allam, a., 2010. hospital acquired infections in madinah-ksa: epidemiology and intervention for reduction. retrieved march 2, 2014, from http://web.b.ebscohost.com/ehost/det ail?sid=9b218f90-e34e-430f-ab5293b7ef9d0b66%40sessionmgr198&vi d=1&hid=127&bdata=jnnpdgu9zwhv c3qtbgl2zq%3d%3d#db=a9h&an=52 519791

- Healthcare workers and health care-associated infections: knowledge, attitudes, and behavior in emergency departments in italy. according to Parmeggiani, C., et al, nurses are more knowledgeable about hais control measure.

- Even though nurses had higher knowledge about infection control, doctors should also be knowledgeable, or equal knowledge with the nurses in order to have lower risk of infection in the hospital.

- The study showed that the incidence rate of HAIs. in phase I was 55% and reduced to 4% in phase III after the conduction of seminars directed to health care staff.

- Heath care workers should be aware of the protocols about infection control. In order to be aware, seminars, conferences are important for the health care workers to attend to.

- Up to 60% of hospital staff's uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. it remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.

- In the medical practice, it is important to assess or to consider the nurses and doctors uniform since it gets contact with the patients. it is important to clean the uniform, and to change the uniform every day. Uniforms can be sources of infection. - Both nurses and doctor should be aware of the hospital acquired infection, and how it spreads in order to decrease the risk of spreading the infection

-Wiener- well, y., galuty, m., rudensky, b., schlesinger, y., attias, d., yinnon, a., 2011. nursing and physician attire as possible source of nosocomial infections. retrieved march 2, 2014 from http://www.ncbi.nlm.nih.gov/pubmed /21864762

- The finding that both doctors and nurses had an appreciation of various aspects of the hospital environment that could be related to hai suggests that changes in products and procedures are going to be more effective than increased educational efforts in reducing hais.

- Rucker, m., brasch, j., haise, c., 2011. textile products and prevention of hospital acquired infections: understanding the hospital perspective. retrieved march 2, 2014 from http://web.b.ebscohost.com/ehost/det ail?sid=e111a2c9-8c1b-4608-ba32722a64e5e46d%40sessionmgr110&vi d=1&hid=127&bdata=jnnpdgu9zwhv c3qtbgl2zq%3d%3d#db=bth&an=669 66419 -In order to provide quality care to our patients, we need to be more cautious in our things that they encounter. For example, the Sphygmomanometers and stethoscopes should be clean when in contact with the patients to reduce the spread of microorganism - Christine Kim G. Castillo, Kuh T. Malicay, Angelyn P. Perez. 2010. Nurses as Patient Advocates in Preventing nosocomial Infections: A Determinative Study of Potentially Pathogenic Bacterial Vital SignsTaking Paraphernalia. Retrieved March 9, 2014 from http://ejournals.ph/index.php?journal =MF&page=article&op=viewArticle &path%5B%5D=3701

- Accordingly, the most common causes of nosocomial infections are Escherichia coli, Staphylococcus aureus, and Pseudomonas sp., all of which are found significantly in the samples taken from GTLMH. In the sphygmomanometer cuffs, a high number of Microbacillus sp. was found in the OPD, while Lactobacillus sp. was found to be higher in number in the ER and DR. in the stethoscopes, bacteria were found to be evenly distributed in the four areas. Of these areas, the OPD was found to have the most number of identified bacteria which may be attributed to the number of patients going there for consultation. ER and RR have the least number of bacteria identified possibly because they accommodate

- Sphygmomanometers and stethoscopes are important vital signs taking paraphernalia for monitoring patients condition in the hospital wherein thorough disinfecting of these paraphernalia are sometimes neglected.