Barrier Nursing

Barrier Nursing
“Barrier nursing is the use of infection control practices aimed at controlling the spread of , and
eradicating , pathogenic organisms.
What is your policy on admitting patients with communicable diseases?

Patients presenting with suspected Exanthemathous fevers, open pulmonary tuberculosis, tetanus and
other communicable diseases as specifically stated by ICC will not be admitted. However they will be
referred to
Epidemic management: how will you manage a patient with suspected Avian Influenza/ any
communicable disease?
We will follow the protocol developed by the Infection Control Committee.
Do you isolate patients?
Yes, as per the policy of the Infection Control Committee, the patient will be isolated in the room
provided with negative pressure.
Who decides for isolation of any patient?
The consultant/ doctor/ ER/ Care Manager decides and isolates the patients if patient needs isolation
and the nurse informs infection control nurse and needful is done.
How will you manage MRSA/ Drug Resistant infected patients?
Washing hands after every contact and contact precautions.
STANDARD PRECAUTIONS
Standard Precaution mandates that blood and body fluids of the patient should be handled with utmost
care i.e. after wearing Personal Protective Equipment (PPE), intended to prevent transmission of
infectious diseases from one person to another .
Type Diseases Precautions

Contact ESBL, MRSA, Wear gloves, mask and apron, use
MDR, VRE, separate instruments, Placement
HIV, HBV, the patient toward the side of the
HCV, unit.
Scabies,
Escherichia
coli , and
Typhoid
Air For chicken Place patient in a isolation room,
borne pox, measles, Wear N-95 mask, keep separate
mumps & equipment, Respiratory
active T.B secretions to be disinfected with
1%hypochlorite before disposing
Droplet For Place in separate room/placement
undiagnosed towards the side of the unit, Wear
cough, mask, apron within 3 feet distance
Tuberculosis from the patient.
Reverse For immune wear mask, apron, and gloves
barrier compromised
patients.
Universal precautions
Universal precautions are defined as work practices that help prevent contact with blood and a number
of other body fluids visibly contaminated with blood.
What are the universal and standard precautions?
• Hand hygiene-
• Handle the shaps carefully-
• While discarding,
• While recapping follow scooping method
• Do not recap or manipulate needle in any way.
• PPE-glove, gown mask, goggles
• Eyewear and mask if splatter with blood or body fluids is expected.
• Mask TB and other respiratory infections
• Gown when splash with blood or body fluid is anticipated.
• Handle the blood and fluids
Handle with care with soiled linen, laboratory specimens as potentially infectious.
Barrier nursing
“Barrier nursing is the use of infection control practices aimed at controlling the spread of , and
eradicating , pathogenic organisms.
What are the categories of isolation?
a. Strict Isolation
b. Respiratory Isolation
c. Protective Isolation
d. Enteric Isolation
e. Wound & Skin Precautions
f. Discharge Precautions
g. Blood Precautions
What are the Types Of Isolation ?
 Positive Pressure Isolation
 Negative Pressure Isolation
What is Negative Pressure Isolation?
 Negative Pressure Isolation Rooms maintain a flow of air into the room, thus keeping contaminants
and pathogens from reaching surrounding areas.
 Greater exhaust than supply air volume
 Pressure differential of 2.5 Pa
 Windows to be closed.
 Tuberculosis
 Chickenpox
 Herpes zoster
 Measles
What is Positive Pressure Isolation?
Positive Pressure Isolation Rooms maintain a flow of air out of the room, thus protecting the patient
from possible contaminants and pathogens which might otherwise enter.
 Greater supply than exhaust air
 Pressure differential of 2.5 – 8 Pa, preferably 8 Pa
 Positive air flow relative to the corridor (i.e. air flows from the room to the outside adjacent
space)
 HEPA filtration, if air returned
 Bone Marrow Transplant
 AIDS
What is Reverse isolation/ Reverse Barrier?
“Reverse isolation, Isolation procedures is designed to protect a patient from infectious organisms that
might be carried by the staff, other patients, or visitors or on droplets in the air or on equipment or
materials.”
How do you Transfer out of Patients from the Barrier Nursing Area?
Inform the concerned Department about the diagnosis.
Arrange for the patient the last appointment of the day.
The concerned Department must be provided with necessary gloves and aprons.
Any porters involved must be instructed and given necessary gloves.
The nurse should accompany the patient.
What are the precautions to be followed, when you are leaving the isolation Room?
 The gloves to be removed and discarded in the appropriate bag and hand washing to be done.
 The gown worn must be removed and then hand washing must be done.
 The door must be closed once we leave the room and wash the hands with alcohol rub.
What are the precautions to be taken if patient is Discharging from the isolation room?
 The microbiologist to be informed when a patient is due for discharge.
 All the textiles are changed, packed in the yellow bag which signifies infected and is treated as per
the protocol.
 Bed, cot and other equipment are cleaned using Bacillocid 2%.
 The room will be fogged using Bacillocid 2%.
What are cases do you keep in Isolation Category?
 Herpes Simplex virus
 Herpes Zoster
 Chicken Pox
 Diphtheria
 Measles
 Swine Flu
 MRSA Pulmonary
 Air Borne diseases such as Acute Pulmonary Tuberculosis, SARS ,
Care Bundle
1. Define care bundle?
A care bundle is a collection of interventions (usually 3-7) that are evidenced based and are a means to
ensure that the application of all the interventions is consistent for all patients at all times thereby
improving outcomes
2. What are the types of care bundle?
 Insertion care bundle
 Maintenance care bundle
3. What are the quality indicators of infection?

1-VAP (ventilator associated pneumonia)
2-CRBSI (Central Line Related Blood Stream Infection)
3-CAUTI (Catheter Associated Urinary Tract Infection)
4 -SSI (Surgical Site Infection)
4. What is VAP bundle?

1-Hand hygiene
2-Head end of the patient to be raised (30-45)’
3-PUD &DVT prophylaxis
4-Sedation vacation/early extubation
5-Mouth care with chlorhexidine 2%
6-Aseptic suction before position change
7-Mobility & chest physiotherapy
6. What is CRBSI bundle?

1-Hand hygiene
2-Maximal barrier precaution upon insertion
3-2% Chlorhexidine skin sponging antiseptic
4-Daily review of line/dressing of insertion site with 2% chlorhexidine.
5-Access for removal of unnecessary lines
6-Hubs/caps disinfected with 2% chlorhexidine before use
7-IV sets/3ways stopcock change every 72hrs
8. Dressing Of Central Line-

If transparent every 7th day
If gauze dressing every 3rd day.
If oozing is there inform to doctor do dressing whenever it is wet.
while dressing do not cover with dressing around 1 cm of the central line site.
9. Use sterile gloves for every touch of the lines
8. Describe CAUTI bundle?

1-Hand hygiene
2-Routine hygiene of meatal area/perineum done
3-Secure the catheter on the thigh without kinking
4-Urine bag should be below the bladder level/
5-Follow the CBD system
6-Urine should be collected by separate container
7-Necessity of indwelling catheter reviewed
9. Describe SSI bundle
1-Proper bath with betadine or chlorhexidine solution one night before operation.
2-Thorough washing and cleaning at and around the incision site with 2% chlorhexidine solution
3-If hair removal is required remove immediately before 6 hours of operation by clipper.
4-Prophylactic antibiotic should be given prior to 60mts (1hr) of surgical incision.
5-Make sure no chance of hypoglycemia during peri-operative period.
6-Body temperature should be normal during peri-operative period (pre & post operative period)
7- Dressing should be changed after 48hrs of post surgery by aseptic techniques.

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Barrier Nursing

What is your policy on admitting patients with communicable diseases?

Type Diseases Precautions

3. What are the quality indicators of infection?

4. What is VAP bundle?

6. What is CRBSI bundle?

8. Dressing Of Central Line-

8. Describe CAUTI bundle?

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