Shifa Muhammed Shaffi
2nd year bsc nursing
Almas collage of nursing
Barrier nursing is a largely ancient term for a set of
strict infection control techniques used in nursing.
The aim of barrier nursing is to protect medical staff
against infection by patients and also protect
patients with highly infectious diseases from
spreading their pathogens to other non-infected
Barrier nursing was created as a means to
maximize isolation care. Since it is impossible to
isolate a patient from society and medical staff while
still providing care, there are often compromises
made when it comes to treating infectious patients.
Barrier nursing is a method to regulate and minimize
the number and severity of compromises being made
in isolation care, while also preventing the disease
Barrier nursing or isolation techniques is
intended to confined the microorganisms
within a given and recognizing area. It is a
set of infection control techniques used in
The nursing technique by which a patient
with an infectious disease is prevented from
infecting other people is called barrier
Care and treatment of patient with deadly
contagious diseases which have no treatment
option; give control the main purpose of this
Provides protection, for other patients and
medical personnel, not infected with the
The patient should be nursed in a single room which
has a washbasin and source of hot and cold water.
All surfaces in the single room should be washable.
Hand washing should be emphasized by the people
who are attending the patient.
The number of people entering the room should be
reduced to minimum and all those who enter the
room should be instructed to practice proper gown
and mask techniques. special nurses should be
assigned to look after the patient.
Protective clothing, preferably disposable gowns
should be worn by all who visit or attend the patient.
There should be some kind of working surfaces, such
as a trolley or table in the room to give facilities for
Clinical thermometer, sphygmomanometer,
syringes, etc. should be left inside the room for
the whole stay of the patient in the room.
Clients chart should be kept outside.
In case of children, toys should be washable or
disposable and paper bags which can be
incinerated should be provided for adults.
The room should contain one big foot operation
bin lined with the polythene bag so that articles
which are to be incinerated may be placed
within it. A second polythene lined bin should be
provided for solid linen.
Cleaning of the room must be carried out under
the supervision of the nursing staff.
All surfaces should be washed with antiseptic
solution is advised by the microbiology
department using a proper towel or rags which
should be incinerated.
Staff should know the methods advocated by the
microbiology department for the sterilization or
disinfection of equipment, excreta, linen or
discharges from the patient.
If vacuum cleaner is used, the dust bag should be
lined with a paper bag so that the dust can be
removed for incineration and the external part
of the vacuum cleaner must be washed well. It
should be thoroughly cleaned when once the
patient has been discharged.
Nothing from that room should be kept outside
for general use without first being sterilized.
Any instruction as regarded to the strength of
disinfection and length of time required for their
action must be followed precisely.
If possible all equipments in the room should be
disposable such as linen, flannels, syringes,
bedpans, plates etc. a washing towel should be
used exclusively for the patient and left in his
room throughout his stay there.
Recommended cleaning material antiseptics
should be available in the room and kept
exclusevely for the patient such as lotions,
a) Standard precautions
b) Transmission based precautions
Standard precautions are used in the care of
all hospitalized individuals regardless of their
diagnosis or possible infection status.
They are used in any situations involving
blood, body fluids, excretions, and secretions
except sweat, non intact
Standard precautions include:
1) Perform proper hand hygiene after contact
with blood, body fluids, secretions,
excretions and contaminated objects.
Whether or not gloves are worn.
perform proper hand hygiene immediately
after removing gloves
Use a antimicrobial agent or an antiseptic
agent for the control of specific outbreak
Use an non antimicrobial product for
routine hand hygiene
2) Wear clean gloves when touching blood,
body fluids, secretions, excretions and
contaminated item( that is, soiled
Clean gloves can be unsterile unless
their use is intended to prevent the
entrance of microorganisms into the
Remove gloves before touching
uncontaminated items and surfaces.
Perform proper hand hygiene
immediately after removing gloves.
3) Wear a mask, eye protection, or a face
shield, if splashes or sprays of blood, body
fluids, secretions or excretions can be
4) Wear a clean, non sterile, water resistant
gown if client care is likely to result in
splashes or spray of blood, body fluids,
secretions, or excretions. The gown is
intended to protect clothing.
Remove a soiled gown carefully to avoid
the transfer of microorganisms to others
(that is, client to other health care
Cleanse hand after removing gown
5) Handle client with equipment that is soiled
with blood, body fluids, secretions or
excretions carefully to prevent the transfer of
microorganisms to other and to the
Make sure reusable equipment is cleaned and
Dispose of single use equipments correctly.
6) Handle all soiled linen as little as possible. Do
not shake it. Bundle it up with the clean side
out and dirty side in and hold away from self so
that the nurse’s uniform or clothing is not
contaminated. Use appropriate laundry bags.
Hazards of on-site ward based laundring.
Treat all linen as contaminated so wear gloves.
7) Place used needles and other sharps directly into
puncture resistant containers as soon as their
use is completed. Do not attempt to recap
needles or place sharps back in their sheaths
using two hands; use the one handed scoop
technique or other safety devices. Using two
hand can result in a needle stick puncture injury
if the nurse accidently misses the cover.
8) Respiratory hygiene/ cough etiquette.
Informing personnel if they have any symptoms
of respiratory problems.
Health educate patients and visitors to cover
their mouth/ nose while coughing and sneezing.
Use surgical masks on coughing person when
Provide alcohol based hand rubbing
dispensers and supplies for hand hygiene and
educating patients and staff in their use.
Encourage hand hygiene after coughing or
Separating coughing persons at least 3 feet
away from others in a waiting room or have
Transmission based precautions are used to
protect the nurse and others from acquiring
the infectious organisms.
Transmission based precautions are used in
addition to standard precautions for client
with known or suspected infections that are
spread in one of 3 ways: by airborne or
droplet transmission or by contact.
The 3 type of Transmission based precautions
may be used alone or in combination but
always in addition to standard precautions.
Used to prevent or reduce the transmission
of microorganisms that are airborne in small
droplet nuclei or dust particles containing
the infectious agents
Place client in an airborne infection isolation
room [AIIR]. An AIIR is a private room that
has negative air pressure, 6- 12 air changes
per hour, and either discharge of air to the
outside or a filtration system for the room
If private room is not available, place client
with another client who is infected with the
Wear an N95 respirator mask when entering
the room of a client who is known to have or
suspected of having primary tuberculosis.
Susceptible people should not enter the room
of a client who has rubeola (measles) or
vericella (chickenpox). If they must enter,
they should wear a respirator mask.
Limit movement of the client outside the
room to essential purposes. Place a surgical
mask on the client during transport.
Keep patient room door closed.
Place client in a private room.
If private room is not available, place client
with another client who is infected with the
Used to reduce the risk of transmission of
microorganism transmitted by large particle
Droplets usually travels 3 feet or less within
air and thus special air handling is not
required, however never recommendations
suggest a distance of 6 feet be used for
Use of respiratory protection such as mask
when entering the room recommended and
definitely if within 3 feet of patient.
Limit movement and transport of the
Use mask on the patient if they need to be
moved and follow respiratory hygiene /
Keep at least 3 feet apart between infected
patient and visitors.
Contact precautions used for clients known to
have or suspected of having serious illness easily
transmitted by direct client contact with items
in the client’s environment.
Place client as described in standard precautions
change gloves after contact with infectious material.
Remove gloves before leaving the client’s room.
Cleanse hands immediately after removing gloves.
Use an antimicrobial agent. If the client is infected
with C. difficile, do not use an alcohol based hand rub
because it is not effective on these spores. Use soap
After hand hygiene, do not touch possibly
contaminated surfaces or items in the room.
Limit movement of the client outside the
Dedicate the use of noncritical client care
equipment to be single client or to clients
with the same infecting microorganisms.
Make sure any infected or colonized areas
are confined or covered.
Ensure that patient care items, bedside
equipment and frequently touched surfaces,
receive daily cleaning.
Compromised clients (those who highly
susceptible to infection) are often infected bt
their own microorganisms, by microorganisms on
the inadequately cleanse hands of health care
personnel and by non sterile items (food, water,
air, and client- care equipment).
Clients who are severely compromised include
Have disease, such as leukemia, or treatment such as
chemotherapy, that depress the client’s resistance to
Have extensive skin impairment, such as severe
dermatitis or major burns, which cannot be
effectively covered with dressing.
Initiation of particles to prevent the transmission
of microorganisms is generally a nursing
responsibility and is based on a comprehensive
assessment of the client.
This assessment takes into account the status of
the client’s normal defense mechanisms, the
client’s ability to implement necessary
precautions, and the source and mode of
transmission of the infectious agent.
The nurse then decides whether to wear gloves,
gowns, masks and protective eye wears. In all
client situations, nurses must cleanse their hands
before and after giving care.
Use strict aseptic technique when performing
any invasive procedure (eg. Inserting an IV
needle or catheter) and when changing surgical
Change iv tubing and solution containers
according to hospital policy ( every 48- 72
Check all sterile supplies for expiration date and
Prevent urinary infection by maintaining a closed
urinary drainage system with a downhill flow of
urine. Keep the drainage bag and spout off the
Implement measures to prevent impaired skin
integrity and to prevent accumulation of
secretions in the lung.
All health care providers must apply PPE
according to the risk of exposure to
potentially infective material.
The PPE include:
3) Face mask
4) Eye wear
Gloves help to prevent the transmission of
pathogens by direct and indirect contact.
Gloves protect the hands when the nurse
likely to handle any body substances, for
example, blood, urine, feces, sputum and
non intact skin..
Gloves reduce the likelihood of nurses
transmitting their own endogenous
microorganisms to individuals receiving care.
Nurses who have open sores or cuts on the
hand must wear gloves for protection.
Gloves reduce the chance that the nurses
hand will transmit microorganisms from one
client or an object to an other client.
Clean or disposable water resistant gowns or
plastic aprons are worn during procedures
when the nurse’s uniform is likely to become
Sterile gowns may be indicated when the
nurse changes the dressing of client with
extensive wound (eg. Burns).
Single use gown technique (use a gown only
once before it discarded or laundered) is the
usual practice in hospitals.
After the gown is worn, the nurse discards it
or place it in a laundry hamper.
Masks are worn to reduce the transmission of
organisms by the droplet contact and
airborne routes and by splitters of body
Various types of masks differ in their
filtration effectiveness and fit.
Single use disposable surgical masks are
effective for use while the nurse provides
care to most clients but should be changed if
they become wet or soiled
Disposable particulate respirators of
different types may be effective for droplet
transmission, splatters and airborne
Currently, the category ‘N’ respirator at 95%
efficiency (referred to as an N95 respirator)
meets tuberculosis, SARS, and influenza
During certain techniques requiring surgical
asepsis to prevent the droplet contact
transmission of exhaled microorganisms to
the sterile field or to a client’s open wound
and to protect the nurse from splashes of
body substances from the client.
Protective eye wear (goggles, glasses or face
shield) and masks are indicated in situations
where body substances may splatter the
If the nurse wear the prescription eye
glasses, goggles must still worn over the
glasses because the protection must extend
around the sides of the glasses.
Many pieces of equipment are supplied fir
single use only and are disposed of after use.
Sometimes, however are reusable.
Appropriate handling of soiled equipment
and reusable. Essential to prevent
inadvertent exposure of health care workers
to articles contaminated with body
substances and to prevent the contamination
of the environment.
Articles contaminated, or likely to likely to
have been contaminated, with infective
material such as pus, blood, body fluids,
feces, or respiratory secretions need to be
enclosed in a sturdy bag impervious to
microorganisms before they are removed
from the room of ant client.
A single bag, if it is sturdy and impervious to
microorganisms and if they contaminated
articles can be placed in the bag without
soiling or contaminating its outside.
Double bagging if the above condition is not
Follow agency protocol, or use the following CDC
guidelines to handle and bag soiled items.
Place garbage and soiled disposable equipment
in the plastic bag and tie the bag. If the bag is
sturdy and impermeable a single bag is
adequate. If not, place the first bag inside
another impermeable bag.
Place non disposable or reusable equipment that
is visibly soiled in a labeled bag before removing
it from the client’s room or cubicle, and send it
to a central processing area for
Glass bottles or jars and metal items placed in
separating from rubber and plastic items.
Disassemble special procedure tray into
Handle soiled linens as little as possible and
with the least agitation possible before
placing it in the laundry hamper.
This prevents gross microbial contamination
of the air and individuals handling the linen.
If placed in a leak proof container with a
secure lid with a biohazard label, no need
Use care when collecting specimens to avoid
contaminating the outside of the container.
Containers are visibly contaminated on the
outside should be placed inside a sealable
plastic bag before sending them to the
laboratory. This prevents personnel from
having handle contact with potentially
Dishes require no special precautions.
Some agencies use paper dishes for
convenience, which are disposed of in the
Blood pressure equipment need no special
precautions unless it become contaminated
with infective material. If does not become
contaminated, follow agency policy to
In some agencies, a disposable cuff is used
for clients placed on contact precautions.
Place needles, syringes, and sharps into a
puncture resistant container.
To avoid puncture wounds, use approved
safety or needleless systems and do not
detach from the syringes or recap the needle
Avoid transporting clients with infections
outside their own rooms unless absolutely
necessary. If the client must be moved, the
nurse implements appropriate precautions
and measures to prevent contamination of
In addition, the nurse notifies personnel at
the receiving area of any infection risk so
that they can maintain necessary
When a patient requires isolation to the
private room, a sense of loneliness
sometimes develops because normal social
relationships become disrupted. This
situation can be psychologically harmful,
especially for children.
Isolation disrupts normal social relationships
with visitors and care givers.
take the opportunity to listen to a patient
concern or interest. If you rush care or show
a lack of interest in a patient’s needs, he or
she feels rejected and even more isolated
Take measures to improve the patient’s
sensory stimulation during isolation.
Make sure the room environment is clean and
Providing comfort measures such as
repositioning, a back massage, or a warm
sponge bath increase physical stimulation.
Depending upon the patient condition,
encourage him or her to walk around the
room or sit up in a chair .
Recreational activities such as board games
or cards are an option to keep the patient
An object is sterile when it is free from all
It is well known that sterile techniques is
practiced in operating rooms and special
Less known perhaps is the sterile technique is
also employed for many procedures in general
In these situations, all the principles of surgical
asepsis are applied as in the operating or
delivery rooms; however, not all of the sterile
techniques that follow are always required.
A sterile field is a microorganism free area.
Nurse often establish a sterile field by using
the inner most side of a sterile wrapper or by
using a sterile drape.
When the field is established, sterile supplies
and sterile solution can be placed on it.
Sterile forceps are used in many instances to
handle and transfer sterile supplies.
Sterile liquids are preferably packaged in
amounts adequate for one use only because
once a container has been opened, there is
no assurance that it will remain sterile.
Sterile gloves may be applied by the open
method or closed method.
Open method is most frequently used outside
the operating room because the closed
method requires that the nurse wear a
Gloves are worn during many procedures to
enable the nurse to handle sterile items
freely and to prevent clients at risk from
becoming infected by microorganisms or
unsterile gloves or the nurse’s hands.
Sterile gowning and closed gloving are chiefly
carried out in operating or delivery rooms,
where surgical asepsis is necessary.
The closed method of gloving can be used
only when a sterile gown is worn because the
gloves are handled through the sleeves of the
Before these procedure, the nurse applies a
hair cover and a mask and perform a surgical
Using proper precaution with general medical
asepsis, appropriately using PPE and avoiding
carelessness in the clinical area will place the
care giver at significantly less risk of injury.
Hepatitis C, a worldwide epidemic greater then
HIV, has become a significant concern to all
health care workers because no vaccine against
the virus or post exposure prophylaxes currently
Prevention remain the primary goal.
The hepatitis B vaccine and vaccination series
available to all employees.
An infection prevention nurse also known as
infection control nurse, helps prevent and
identify the spread of infectious agents like
bacteria, viruses in a health care environment.
ICNs are meticulous and detail oriented
individuals who can effectively communicate
best practices to their colleagues to ensure the
safety of patients in an institutions care.
Their knowledge of the risks of various infectious
agents is crucial when dealing with both
contained infectious and broader outbreaks.
Gathering and analysing infection data to
make evidence based decision.
Educating medical and public health
professionals on infection prevention
protocols to facilitate emergency
Isolating and treating infected individuals to
contain the spread of infectious diseases.
Assisting with the development of action
plans in case of a community or hospital
outbreak to minimize the potentially
Collaborating with government agencies such
as the CDC to ensure that infection control
practices are implemented and enforced.
Studying pathogens to determine origin in
order to prevent future outbreaks.
Assisting scientists and physicians with
developing treatments and vaccines to
ensure the health and safety of patients and
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