The document discusses principles of hospital isolation and infection control. It covers the history of infection control committees in hospitals, the changing demands on infection control programs, staff training in infection control, and the chain of infection. It also details standard precautions, transmission-based precautions including contact, droplet and airborne, and discusses isolation rooms, protective environments, and managing environmental surfaces from an infection control perspective.

1. Dr . Ashraf Selim
Consultant in Oral Surgery
Infection Preventionist
Member in IFIC , ESIC , EDA
Principles of
Hospital Isolation

2. 
Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
 In 1969, the Joint
Commission on
Accreditation of
Healthcare
Organizations
(JCAHO)--first
required hospitals to
have organized
infection control
committees and
isolation facilities
Dr.T.V.Rao MD 2

3. 
Changing Demands on Infection
Control programme
 Today's ICP needs
knowledge of
epidemiology
statistics, patient care
practices,
occupational health,
sterilization,
disinfection, and
sanitation, infectious
diseases,
microbiology,
education and
management
3

4. 
Staff Training in ICP
 Education programs for employees
are one method to ensure competent
infection control practices.
 It is a unique challenge since
employees represent a wide range of
expertise and educational
background.
 The ICP must become knowledgeable
in adult education principles and use
educational tools and techniques that
will motivate and sustain behavioral
change.
4

5. 
CHAIN OF INFECTION
 Pathogen
 Portal of entry
 Susceptible host

6. Modes of Transmission
Direct Transmission
 Direct Contact
 Droplet
Indirect Transmission
 Vehicle-borne
 Vector-borne
 Airborne
Vertical transmission (mother to infant)
Horizontal Transmission

7. INFECTIOUS DISEASE DETERMINANTS
1. Virulence (pathogenic properties)
2. Dose (number of microbes)
3. Resistance (body’s defense mechanism)
4. I C Procedures Affect ……?

8. October 18, 2000:
250-million-year-old
bacteria revived

9. STANDARD PRECAUTIONS
 Consideration of all patients as being infected
with pathogens and therefore applying IC
procedures to the care of all patients
 Treat every patient as though infected with
incurable disease
 The Same IC Procedures Are Used For ALL
Patients

10. Standard Precautions in Health Care Settings
1. Appropriate hand hygiene
2. Barrier protective equipment:
– if splash, splatter, or sprays can be reasonably
anticipated
– choose appropriate PPE as needed: gloves, gown,
mask, eye protection (face shield, goggles)
3. Proper use and handling of patient care equipment

11. 4. Proper environmental cleaning and disinfection.
5. Proper Handling of Linen
6. Adherence to Blood-borne Pathogens Standards
7. Proper patient placement
8. Respiratory Hygiene/Cough Etiquette
9. Safe injection practices

12. Transmission of Infections
• Droplets: land directly on mucosal lining of nose,
mouth, eyes of nearby persons or can be inhaled.
• Highest exposures within 3-6 feet.
• Airborne: aerosols become smaller by evaporation;
small aerosols (≤ 5 microns) remain suspended for
longer periods, if inhaled travel deep into the lungs.
• Contact: Aerosols/ secretions contaminate nearby
surface. Touch surfaces can infect self or others.
Relative contribution of three routes varies with agent.

13. Expanded Isolation Precautions:
Transmission-based Standards
 When standard precautions are not enough
 Additional measures based on mode of
transmission
 Contact Precautions
 Droplet Precautions
 Airborne Precautions

14. Modes of Transmission via
Infectious Respiratory Secretions
• Airborne: tuberculosis, measles, varicella,
smallpox, SARS, avian influenza
• Droplet: meningococcal meningitis, rubella,
pertussis, common cold, SARS, influenza*
• Indirect contact: (fomite) RSV, SARS
• Influenza traditionally droplet, increasing
evidence for airborne component

15. Hierarchy of Infection Prevention and Control Measures
PPE
Engineering Controls
Protects
only the
wearer
Elimination of Potential
Exposures
Administrative
Controls
Protects
most
people

16. Elimination of Potential Exposures
• Example: patients with mild influenza
like illness stay home

17. Engineering Controls
• Physically separates the employee from the
hazard
• Does not require employee compliance to be
effective
• Examples:
–Physical barriers at Triage
–Airborne infection isolation room for patients
with known or suspect airborne infectious
diseases

18. Administrative Controls/ Workplace
Practices
• Policies, procedures, and programs that minimize
intensity or duration of exposure
– Examples:
• signs on door of an airborne isolation room
• triage, mask symptomatic patient
• provide tissues/ masks/hand sanitizer to
public
• Standard procedures/ behaviors in caring for
patients e.g. hand hygiene, HCW vaccination
• Only as good as enforcement

19. Personal Protective Equipment
• Lowest level of hierarchy - requires employee
compliance for efficacy
• Means higher elements of hierarchy fail to
adequately protect employee
• May involve use of gowns, gloves, eye/splash
protection or respirators
• Last line of defense

20. Face Masks vs. N95 Respirators
• Loose fitting, not designed to
filter out small aerosols
• Place on coughing patient
(source control)
• HCW should wear mask to
– protect patient during
certain procedures (e.g.,
surgery)
– protect HCW
• droplet precautions
• Mask + goggles for
anticipated spray/splash
• Tight fitting respirator,
designed to filter the air
• Protects the wearer
• HCW should wear when
concerned about
transmission by airborne
route

21. Contact Precautions
 Personal Protective Equipment
 Gown & Gloves for all patient interactions
 Don PPE on entry, discard before exiting
room. (in addition to Standard
Precautions)
 Examples: MRSA, C difficile, Norovirus, other
GI pathogens, RSV, antibiotic-resistant
pathogens

22. Droplet Precautions
 Single room preferred, no special ventilation
 Patient: Mask if transport necessary. Instruct on
respiratory hygiene/cough etiquette
 HCWs wear surgical or procedure mask within 6
feet of patient. Eye protection if splash, spray
anticipated
(in addition to Standard Precautions)

23. Airborne Precautions
 Airborne Infection Isolation Room (AIIR) if available
 Patient: Mask if transport necessary (as tolerated).
 Health care workers (HCWs):
 N95 respirator prior to entry into room, discarded
after exit.
 Hand hygiene before & after don/doff.
 Alert others if need to transfer
(in addition to Standard Precautions)

25. Isolation
Separation of a person or group of persons
infected or believed to be infected with a
contagious disease to prevent the spread
of infection (usually associated with
hospital setting) ( Source Isolation .
Protective Environment is a special type of
isolation to protect immunocompromised
patient.

26. Goal of Isolation (Protection of / from)
HCWs
Other
Patients
Environment
Visitors
(Community)
AIIR
Airborne
infectious
Isolation
Room
PATIENT
PE
Protective
Environment

27. Management of Environmental Surfaces
1. Cleaning and disinfecting non-critical surfaces in
patient-care areas are part of Standard
Precautions.
2. In general, these procedures do not need to be
changed for patients on Transmission-Based
Precautions.
3. The cleaning and disinfection of all patient-care
areas is important for frequently touched surfaces,
especially those closest to the patient.

28. 4. Also, increased frequency of cleaning may be
needed in a Protective Environment to minimize
dust accumulation.
5. In general, use of the existing facility
detergent/disinfectant is sufficient to remove
pathogens from surfaces of rooms where
colonized or infected individuals were housed this
includes those pathogens that are resistant to
multiple classes of antimicrobial agents (e.g. MRSA
, VRE.
6. Certain pathogens (e.g., rotavirus, noroviruses,
C. difficile) may be resistant to some routinely
used hospital disinfectants so higher
concentrations may be needed.

29. Airborne Infectious Isolation Room
AIIR
1. Negative Pressure room (suit ) with or without
Anteroom and inside bathroom .
2. Minimum Differential Difference ≥ 2.5 Pascal
(CDC 2007).
3. 12 ACH .
4. Minimum leakage maximum 1 inch under room
door.
5. Air is exhaust to outside (No Recirculation ) OR
must pass through HEPA filter in case of
recirculation .
6. Pressure sensor with alarm is a must .

30. Isolation Area
The optimum number of isolation rooms per
facility ranges from 1 per 30 / 100 bed in
general hospital .
In Acute care 1 per 5 bed ( ICU , NICU )

31. - +
- -
- -

37. ++
- -

39. Verifying Negative Pressure
1- Smoke Tube Test
2- Tissue Test
A thin strip of tissue should
be held parallel to the gap
between the floor and
bottom of the door. The
direction of the tissue‘s
movement
will indicate the direction of
air movement.
3-Manometer

40. Protective Environment
Positive IR
It is the engineering and design intervention that
deceases the risk of exposure to environmental fungi
for severely Immunocompromised Allogenic
Hematiopoietic stem cell Transplant (HSCT) during
their highest risk phase usually the first 100 day and
solid organ transplant.

41. 1. Positive pressure room in relation to
corridor with inside bathroom with
minimum 8 Pascal .
2. > 12 ACH is required .
3. Well sealed room.
4. Supply air must pass through HEPA filter.
5. Directed room airflow with air supply on
one side of the room that moves air
across the patient bed and out through
an exhaust on the opposite side of the
room.