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Source isolation

Evidence-based approaches

Rationale

Source isolation is used for patients who are infected with, or are colonized by, infectious agents that require additional precautions over and above the standard precautions used with every patient in order to minimize the risk of transmission of that agent to other vulnerable persons, whether patients or staff. Common reasons for source isolation include infections that cause diarrhoea and vomiting, entailing the use of enteric precautions; infections that are spread through the air, entailing the use of airborne or droplet precautions; and infection or colonization with antibiotic-resistant bacteria, requiring contact precautions. Note that the patient’s other nursing and medical needs must always be taken into account and infection control precautions may need to be modified accordingly.

Patients requiring source isolation are normally cared for in a single room, although outbreaks of infection may require affected patients to be nursed in a cohort, that is, isolated as a group. A single-occupancy room will physically separate patients who present a risk from others who may be at risk, and will act as a reminder to any staff dealing with that patient of the need for additional infection control precautions. Single-occupancy rooms used for source isolation should have en-suite toilet and bathroom facilities wherever possible, and contain all items required to meet the patient’s nursing needs during the period of isolation (e.g. instruments to assess vital signs), which should remain inside the room throughout the period of isolation. If this is not possible because insufficient equipment is available on the ward, any items taken from the room must be thoroughly cleaned and disinfected (normally with a chlorine solution) before being used with any other patient.

The air pressure in the room should be negative or neutral in relation to the air pressure in the rest of the ward (note that some airborne infections will require a negative pressure room). A lobby will provide an additional degree of security and space for donning and removing personal protective equipment and performing hand hygiene. Some facilities have lobbies that are ventilated so as to have positive pressure with respect to both the rest of the ward and the single-occupancy room; this allows the room to be used for both source and protective isolation. Where insufficient single rooms are available for source isolation, they should be allocated to those patients who pose the greatest risk to others, using a tool such as the Lewisham Isolation Prioritization System (LIPS) to prioritize patients (Breathnach et al. 2010) (Figure 3.6). As a general rule, patients with enteric symptoms, that is diarrhoea and vomiting, or serious airborne infections, such as tuberculosis, will have the highest priority for single-occupancy rooms. If this situation arises, it will mean that additional precautions will be required for some patients on the open ward, for example gloves and aprons will still be required while caring for someone colonized with MRSA even if they are not isolated.

Figure 3.6 Lewisham Isolation Prioritization System (LIPS). Used with permission of Lewisham Healthcare NHS Trust. For more information and updates contact Lewisham Healthcare NHS Trust. ACDP, Advisory Committee on Dangerous Pathogens; CJD, Creutzfeldt-Jakob disease; ESBL, extended–spectrum beta lactamase producers; Gent, gentamicin; GRE, glycopeptide–resistant enterococci; ITU, intensive care unit; MDRTB, multi-drug resistant tuberculosis; MRSA, meticillin resistant Staphylococcus aureus; NICU, neonatal intensive care unit; PVL, Panton-Valentine leukocidin; RSV, respiratory syncytial virus; SCBU, special care baby unit, TB, tuberculosis; TSE, transmissible spongiform encephalopathy; VHF, viral haemorrhagic fever; VRE, vancomycin–resistant enterococci.

Principles of care

Attending to the patient in isolation

Meals

Meals should be served on normal crockery