Isolation (medicine)
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In an isolation of a is in nursing homes and hospitals by spatial separation of transmission of pathogens prevented. Either immune-weakened patients are protected from pathogens or other people and the environment from a patient with a contagious disease. The patients are usually housed in isolation rooms; some hospitals have complete isolation wards . In addition, there are special isolation wards in special treatment centers for highly infectious patients .
Inpatient facilities have in-house hygiene plans in which special regulations for isolation are laid down, which are based on the requirements of the Infection Protection Act.
Isolation of infectious patients
The standard isolation is mainly used on surgical wards to keep patients with infected (“septic”) wounds away from patients without wound infection (“aseptic”). You will be accommodated in separate rooms.
With so-called source isolation, patients are isolated in the hospital if the hygiene plan provides for it. As a rule, these are patients who have a reportable infection or who are suspected of having such a disease and who are at risk of transmission to other patients, for example if they are colonized with MRSA or other antibiotic-resistant bacteria on the skin, in excretions or secretions or in the airways.
Depending on the infectiousness or contagiousness , the isolation of infected people is limited to individual measures of spatial separation (e.g. own toilet) through strict or strict isolation to quarantine . Several patients suffering from the same infection can be housed together in one room within a so-called cohort isolation. Quarantined patients are treated in special isolation wards. The largest German special isolation ward for highly contagious diseases is located at the Charité Medical Clinic, which specializes in infectious diseases and pneumology, in Berlin .
On the other hand, people who live in a care facility may not be strictly isolated, as such a measure would inappropriately restrict the resident's right to self-determination and freedom of movement. On the other hand, the facility is required to largely ensure the protection of roommates. The Commission for Hospital Hygiene and Infection Prevention therefore recommends setting out detailed procedures in the hygiene plan, which must be weighed up on a case-by-case basis depending on the situation. Only those measures should be used that "have been shown to reduce the risk of transmission from a hygienic point of view or have a high probability."
transport
Infectious patients should only leave their room if they have to be moved for medical reasons or transported for examination purposes. Within the hospital, the department concerned (e.g. X-ray, magnetic resonance tomography) must be informed beforehand about the type of infection and the necessary protective measures. This also applies to relocation to other facilities. If there is an infection that is transmitted by droplets or aerosols, the patient should wear mouth and nose protection for transport if possible. Areas with increased patient or visitor traffic should be avoided as far as possible during transport.
Actions to be taken after isolation has ended
If the patient's contagiousness has demonstrably decreased to such an extent that staff and fellow patients are no longer at risk, the isolation measures can be ended. So that the patient environment does not pose an increased risk of infection for others, a so-called final disinfection must be carried out, which includes all surfaces and objects that may be contaminated with the pathogens, including the patient's bed and the wet room. The selection of the suitable disinfectant depends on its effectiveness against the pathogen present. The personnel carrying out the reprocessing must comply with appropriate protective measures.
Isolation of immunocompromised patients
In patients who have a weak immune system for various reasons , protective or reverse isolation may be necessary. The aim is to protect a patient with a significantly weakened immune system from environmental and germs. Such immunosuppression occurs, for example, in large-scale burns, after an organ transplant or chemotherapy that was carried out because of cancer . This is especially true in the case of leukemia , when a stem cell transplant has to be performed. In this case, the need for isolation is made dependent on the number of leukocytes in the blood ; In the case of AIDS , the number of CD4 lymphocytes can indicate a risk .
Action
The procedure is laid down in the hygiene plan. It is primarily based on the type of infection or the immune status of the patient at risk. The basic or standard hygiene, which must be applied to every patient, is usually supplemented with barrier care measures (so-called “coat care”): before patient contact, employees put on personal protective equipment (PPE) or additional protective clothing.
Isolation room
An isolation room is a single room with its own wet room; a shared room is only equipped accordingly in the case of cohort isolation . For reverse isolation or to accommodate patients with z. B. Chickenpox infection, isolation rooms with an anteroom (so-called sluice) are recommended in order to ensure a sufficient spatial distance between potentially infectious and infected persons and materials. Protective clothing is put on in the anteroom and potentially contaminated material (including used protective clothing) is disposed of or disinfected before it is brought outside or into the room. Infectious laundry is collected in labeled, liquid-tight bags or containers. Certain reusable aids, care utensils and devices (e.g. blood pressure monitor, stethoscope) remain in the room.
In the hospital, isolation rooms are marked with signs. Employees and visitors only enter the room after hand disinfection and appropriate equipment, for example with mouth and nose protection , protective gloves and a fresh smock put on, which are disposed of in the laundry bin or waste bin provided after leaving the room. Hand disinfection is then carried out again. When entering the isolation room again, a new smock is used.
Isolation ward
In an isolation ward, all rooms are equipped with an anteroom; the ward itself - like an intensive care unit - can only be entered through a lock room . Some hospitals do not have a special isolation ward, but rather have several single rooms with anteroom on the bed wards, which function as a lock if necessary. If there is an increased number of infectious patients (e.g. a flu outbreak), individual wards are rededicated as isolation wards.
Web links
Individual evidence
- ↑ a b A. Heuwinkel-Otter, A. Nümann-Dulke, N. Matscheko (eds.): People care - the practical companion for care professionals. Springer-Verlag, Heidelberg 2009, ISBN 978-3-540-79320-5 , p. 288.
- ^ A b Nicole Menche (Ed.): Care Today. Elsevier, Urban & Fischer, Munich 2011, ISBN 978-3-437-28141-9 , p. 292.
- ↑ Prevention of infections in homes. Recommendation of the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI). In: Federal Health Gazette. 48, 2005, pp. 1061-1080, pp. 1073. doi: 10.1007 / s00103-005-1126-2 ; accessed on March 6, 2019.
- ↑ a b KRINKO recommendation: infection prevention as part of the care and treatment of patients with communicable diseases. Federal Health Gazette 2015, 58: 1151–1170 DOI 10.1007 / s00103-015-2234-2, pp. 1161f. Retrieved March 18, 2019
- ↑ Recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute, Definitions - Glossary, Federal Health Gazette 2014, 57: 696–732, p. 697 DOI 10.1007 / s00103-014-1980-x ; accessed on March 7, 2019
- ↑ Overview of infectious diseases and required measures as a basis for stipulations in the hygiene plan. KRINKO 2016 ; accessed on March 7, 2019.
- ↑ Isolation ward or single room for influenza? Doctors newspaper online from January 12, 2019 ; accessed on March 7, 2019.