ISOLATION/BARRIER NURSING ,

ZONING
by
Dr.SANGEETA.KAMATCHI

What is Isolation/Barrier Nursing?

Infection control and prevention methods that are used to
decrease the transfer of microorganisms
Isolation nursing is carried out by placing the
patient in a single room or side room.
Barrier nursing this occurs when a patient(s) is
kept in a bay and extra precautions are
implemented to prevent spread of the germ.
Why do we need to Isolate/barrier nurse?
To reduce the risk of spread of certain infections
or antibiotic resistant germs to other patients and
staff.
To protect patients from infection if they have a
weak immune system due to disease or taking

How long?
Can be any time from few days to the whole
length of hospital stay.
Visitor policy?
Use of barrier precautions by visitors
Visitors must check with the nurse in charge
before entering the room.
Babies or visitors who are sick- restricted
Visitors are required to clean their hands
when entering and leaving the isolation
room or bay with the alcohol gel provided.
It is important that visitors do not sit on the
bed as this can also transfer germs.

Air should flow into

the room

Isolation Area Barrier Nursing

Techniques Required
GREEN (GO) : General [reduced] staff
movement
YELLOW (CAUTION) : Limited staff
movement
RED (RESTRICTED) : Assigned staff only

ENGINEERING CONTROLS
Removal or isolation of a workplace hazard
through technology.
1) AIIRs Airborne infection isolation room (AIIR).
Formerly,
negative pressure isolation room.
Single-occupancy patient-care room
Environmental factors are controlled in AIIRs
to minimize the transmission of infectious
agents by droplet nuclei associated with
coughing or aerosolization of contaminated
fluids.

 AIIRs should provide negative

pressure in the room

2) PROTECTIVE ENVIRONMENT:
A specialized patient-care area.
Positive air flow relative to the corridor (i.e.,
air flows from the room to the outside
adjacent space).
HEPA filtration
High numbers (>12) of air changes per hour
(ACH)

&
Minimal leakage of air into the room

Other components:
Use of scrubable surfaces .
Cleaning to prevent dust accumulation
No fresh flowers or potted plants.
Sharps injury prevention devices, sharps
containers.

Application of Standard Infection Control

Principles when Isolating / Barrier Nursing a
Patient:
Hand Hygiene:
Staff should adopt the bare below the elbow
initiative. Roll back sleeves to expose wrists
and forearms
Protective Clothing
Movement of Staff
Food handling
Single room

.. Contd
- Sharps
- Laundry
- Clinical waste
- Equipment
- Bathing of patient
- Spillages blood/body fluid
- Staff allocation
-

Notification

GUIDELINES: ISOLATION NURSING(nurse)

Place appropriate
isolation chart and
nursing chart the door.
Trolley or shelf outside
the room :
Plastic apron and
gloves if
necessary.
Patients charts.
Alcohol based hand rub
Masks
Remove all nonessential furniture.

12

 Facilities for hand washing within infected

area
Place appropriate waste bins with liners
inside-sealed by knotting when 3/4th full
Place a container for sharps
Keep the patients personal property to a
minimum. Advise him/her to wear hospital
clothing
Do not wash on the ward -send to laundry
as infected
Equipment used for regularly by patient-in
infected zone

ENTRY PROTOCOL

Appropriate equipments

Wash hands & necessary barrier

protection.
If splatter a possibility, nurses gown
should also be impermeable.
Wash hands & change gloves during
care.
When care complete, PPE is removed
inside room.

EXIT PROTOCOL
1) Place soiled linen & gown into an
impermeable laundry bag
2) Remove gloves
3) Remove eyewear/goggles
4) Remove gown (pull off inside out)
5) Wash hands immediately
6) Remove mask
(Leave mask on until after you leave room if
airborne)
7)Leave the room and shut the door.
8) Use alcohol gel.

CLIENT CONCERNS RELATED TO

ISOLATION
Purpose of isolation & the
necessary precautions.
Sensory deprivation may
be evident by signs of
loneliness or boredom.
S & S of depression decreased motivation,
anger, lack of appetite, or
difficulty sleeping.

ISOLATION ROOM CHECKLIST

Class S *

Class N * Class P *

Hand wash basin in room

Yes

Yes

Yes

Ensuite Bathroom (Shower,

toilet, WHB)

Yes

Yes

Yes

HEPA filters on supply

Yes

Airlock

Yes

Optional

Sealed room, door grills for

controlled airflow

Yes

Yes

Air changes/hour

6-12

6-12

S = Standard Isolation: For patients who require contact or

droplet isolation
N= Negative Isolation: For patients who require air borne
droplet nuclei isolation e.g. Tuberculosis
P = Positive Isolation : For patients who are profoundly
immuno compromised e.g. transplant and on
immunosuppressive treatment.

TO PREVENT TRANSMISSION TO HCWs AND

OTHERS
STRICT ISOLATION AND BARRIER NURSING
MUST BE PRACTICED AT ALL TIMES

ZONING in Operation Theatre

Sequence of increasingly clean zones
Aim - absolute asepsis at operating site.
1) Protective Zone
Reception
Waiting area
Trolley bay
Changing room

2) Restricted/Clean Zone:
Pre-op room
Recovery room
Plaster room
Staff room
Store

Sterile/Aseptic Zone:

Operating theatre
Anaesthesia Induction Room
Scrub Room
Area for instrument packing and sterilization

Disposal Zone:

Dirty Utility
Area where used equipment are cleaned
Bio medical waste is disposed
Disposal corridor

RELATIONSHIP BETWEEN THE ZONES OF THE

OPERATING SUITE
There should be unidirectional access from
the clean zone to the aseptic zone
(operating theater), preferably via the
scrub-up area.
The operating theatre should be restricted
to just the personnel involved in the actual
operation
In principle the clean zone should require
exiting through the outer zone.

OT SHOWING TRAFFIC FLOWS

DISPOSALS
STERILIZING
DEPT

STERILE
PREPARATION

SCRUB
Operation Theatre

PATIENT OUT,
PATIENT IN

STAFF
CHANGE

Sterile Zone
Temp : 21 degree C +/- 3 degree C
Relative humidity : 40 % to 60 %
Fresh Air allowance : 10 per hour with Total air
changes 25 per hour. Total fresh air with no
recirculation in super speciality surgery.
Air filters : Through HEPA filters with filtration
level up to 0.3 microns and 99.97 % efficiency
with pre filters in the system(proven helpful in
super speciality OTs).
Positive pressure = 25 P

OTHER AREAS
Fresh air changes minimum 5 per hour and total
15 per hour with washable filters with filtration
level up to 5 microns.
One separate dedicated AHU designed to maintain
Positive pressure gradient so as to ensure flow of
air from sterile to clean and protective zone.
Aluminum air conditioning ducts with differential
pressure gauge / manometer across HEPA filters
so as to detect clogging or reduced flow of air.
No shelves will be provided inside OT.
Purified water will be supplied for scrub with steel
scrub and facility of dispensing of hand wash

Contd
Recommended floor surface is Epoxy resin
flooring, which has been found to be
seamless, scratch proof, hard enough for
wheeled trolleys, stain free and antistatic.
Laminar flow which is a low turbulence
downward displacement air flow towards the
operation zone through stainless steel
perforated grills is recommended
Drains, sewerage pipes and water line should
be avoided at least near and above operation
theatre sterile zones

Contd
Air curtains at the entry of sterile
zone should been planned.

ZONING
SAFE ENVIRONMENT IN OT

SAFE SURGERY

Thank
You