This NCLEX review will help you learn about standard precautions and isolation precautions. Standard and isolation precautions are steps we follow to prevent the transmission of infection diseases. On the NCLEX exam and for nursing lecture exams, you need to be familiar with each precaution, what diseases are included in transmission-based precautions (which is the same as isolation precautions), and PPE worn.
In addition, I will give you three mnemonics on how to remember isolation precautions. I created these mnemonics to help you not only remember the diseases included with each precaution BUT if they are for airborne, droplet, or contact AND the special PPE you must wear!
Don’t forget to take the free isolation precautions review quiz.
Lecture on Standard and Transmission-Based Precautions
These are precautions we take with EVERY patient at ALL times because we don’t know if they have an infectious disease. By implementing these practices, we help prevent transmission of infectious diseases from one to another (ex: patient to nurse, nurse to patient, or patient to patient).
When we suspect or know a patient has an infection disease we add on TRANSMISSION-BASED PRECAUTIONS, such as CONTACT, DROPLET, and AIRBORNE.
Standard Precautions Include:
- Hand hygiene
- Wearing appropriate PPE as needed
- How to handle patient equipment
- Injection safety practices
- Environmental cleaning
- Respiratory hygiene/coughing etiquette
- Handling of laundry
- Patient room placement
Highlights to Remember:
Hand hygiene: performed before and after patient contact, after wearing gloves, touching surfaces in a patient’s room
Perform hand hygiene by using soap and water or hand sanitizer.
Always use soap and water rather than hand sanitizer for the following:
- Hands are visibly soiled
- Before eating or touching food
- After using the bathroom
- Diarrhea illnesses: C.diff, Norovirus, Rotavirus
PPE (Personal Protective Equipment): use this equipment AS NEEDED to protect skin, clothing, mucous membranes while providing care to patients. Remember we treat all the patient the same, regardless of what they do or don’t have.
Example: You are going to be suctioning a patient’s tracheostomy. The patient is not diagnosed with any infectious disease. However, you know to always follow standard precautions, regardless. So, it is important to select the appropriate PPE. During this procedure there is a risk of splash of mucous (which can contain germs) or blood in the mucous membranes (eyes, nose, mouth) and onto the clothes. So, you will want to wear the following PPE during this procedure: gloves, gown, mask, goggles or face shield.
NOTE: Now with certain transmission-based precautions you will be REQUIRED to wear specific PPE at ALL TIMES during patient contact. Therefore, when answering NCLEX questions always ask yourself “Is this person in isolation precautions? If, so what PPE must I wear at all times?'” AND “What type of PPE do I need based on the care I will be providing?”
For example, with AIRBORNE precautions you will wear an N95 mask during patient contact, BUT if you are going to be inserting an NG tube or doing a procedure that will have the potential for splashes of body fluids, you will need a gown, googles or face shield, gloves. So, select PPE wisely!
Types of PPE:
- Gloves: needed if coming into contact with fluids (vomit, stool, urine, mucous etc.) and blood.
- Gown: needed if there will be a potential contact with fluids or blood on clothing.
- Goggles/Face Mask or Respirator/Shield: needed if there will be a potential contact with fluids or blood on the mucous membranes (example: patient coughing, vomiting while providing suctioning/mouth care etc.).
Diseases included with droplet precautions:
- Pharyngeal Diphtheria
- Epiglottitis, (caused by Haemophilus influenza type b)
- Flu (contact and droplet)
- Meningococcal Disease: Sepsis, Pneumonia, meningitis
- Mumps (infectious parotitis)
- Mycoplasma Pneumonia
- Parvovirus B19 (erythema infectiosum or 5th disease)
- Pneumonic Plague
- Adenovirus (contact and droplet)
- Streptococcal pharyngitis
- Whooping Cough (pertussis)
- Scarlet fever
- Rubella (German Measles)
Who’s Adjustable Droplet Mask Stops Scary Pneumatic Fluid Parasites Plaguing Distinguished German Men? My Epic Mum’s, Rhonda.
Who’s: Whooping Cough
Adjustable: Adenovirus (remember ADD contact precautions as well)
Droplet: type of precaution
Mask: PPE you must wear at all times
Stops: Streptococcal pharyngitis
Scary: Scarlet fever
Fluid: Flu (influenza)
Parasites: Parvovirus B19
Plaguing: Pneumonic Plague
German: German Measles (Rubella)
Men: Meningococcal Disease: Meningitis, sEpsis, pNemonia
My: Mycoplasma Pneumonia
- Transmitted via droplets expelled by the person during sneezing, coughing, talking etc.…the droplets are large (when compared to airborne diseases which are smaller), travel less distance (3 feet and then fall), and can enter through the mucus membranes (eyes, nose, and mouth).
- In order to infect someone the GERMS MUST COME INTO CONTACT WITH THE MUCOUS MEMBRANES TO INFECT!!
- Wear a surgical mask during patient contact at all times and follow standard precautions. Select other types of PPE based on the type of care you will be providing. For example: mouth care on a patient in droplet precautions (risk for fluids entering eyes, skin, and clothing) also wear gloves, gown, face shield along with the surgical mask.
- Keep a distance of 3 feet or more from other patients and visitors.
- Patient must wear a surgical mask if being transported.
- Patient’s door can stay open.
- No special ventilation is required.
Diseases included with airborne precautions:
- Chicken Pox (varicella) (Airborne and Contact)
- Herpes Zoster (Varicella Zoster(disseminated) Shingles (Airborne and Contact)
- Measles (Rubeola)
- M. Tuberculosis
Airborne Chicken Number 95 Dissected Her Tubby Mealworm
Airborne: type of isolation precaution
Chicken: Chicken Pox (Varicella)
Number 95: N95 mask…special PPE you must wear at all times
Dissected Her: Disseminated Herpes Zoster (Shingles)
- Transmitted when the infected person coughs, sneezes etc. which produces respiratory droplets (which contains the germ). Normally, when people expel droplets, like in droplet diseases, the droplets dry out which kills the germ. However, with airborne diseases these germs SURVIVE the drying out process and turn into droplet nuclei.
- These droplet nuclei are residue particles (SUPER small…can’t see them) that can be inhaled and hang out in the air. These particles INFECT a person when the person INHALES THE INFECTIOUS DISEASE into their lungs (different than droplet where it enters into the mucous membranes).
- Must wear an N95 mask (blocks very small particles) while in the room at all times PLUS follow standard precautions like hand hygiene and use other types of PPE as needed depending on the type of care you will be providing.
- Single room that is an AIIR room (airborne infection isolation room which is also called negative pressure room). This special room will keep the pressure lower in the patient’s room than the outside areas.
- The room will have 6-12 air changes an hour to decrease infectious particles in the room.
- Keep room door closed at ALL TIMES!
- Limit transport unless necessary (have procedures performed at the bedside as much as possible). If patient has to leave the room, the patient must wear a surgical mask.
Diseases included with contact precautions:
- Medication-Resistant Organisms: MRSA, VRE, extended spectrum beta lactamase producers (ESBLs), Klebsiella pnemoniae carbapenemase (KPC)
- Diarrhea infections or of unknown origin: C.diff, noravirus, rotavirus…..USE SOAP AND WATER FOR HAND WASHING NOT hand-sanitizer.
- NOTE: Hepatitis A. (if patient is diapered or incontinent pt)..remember it is spread through stool
- Skin infection: impetigo, lice, scabies, herpes simplex, chickenpox (airborne and contact), skin diphtheria, shingles (airborne and contact)
- Wound infections with excessive drainage or staphylococci
- Pulmonary infections: RSV, parainfluenza
- Eye infection: conjunctivitis
Don Medical Gloves/Gown With Every Contact Precaution Session
Don: Diarrhea Infections
Medical: Mediation Resistant Organisms
Gloves/Gown: PPE you must always wear at all times
With: Wound Infections
Every: Eye infections
Contact: type of isolation precaution
Precaution: Pulmonary infections
Session: Skin infections
- Transmitted from direct or indirect contact (touching)….from the patient or something the patient has touched…their environment.
- Must at always wear a gown and gloves PLUS follow standard precautions like hand hygiene and use other types of PPE as needed depending on the type of care you will be providing.
- Single room the best or group patients together with same infection
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