Historically the terms ‘isolation’ and ‘barrier nursing’ have been used by nurses to describe the physical separation of persons suspected or known to be infected with a communicable disease from those who are not. Today most patients with infective conditions can be nursed in a general hospital with modern wards and single rooms using ‘Standard Precautions’ (Department of Health and Hospital Infection Society 2001). However, there are certain infections that require a higher level of containment, e.g. new or ‘novel’ infections, or those that are extremely resistant, e.g. multi-drug resistant tuberculosis. These patients would usually be transferred to an Infectious Disease Unit where specialised accommodation and equipment would be provided according to the category of the infection.
‘Protective isolation’
This is the term used to describe nursing precautions taken to keep a vulnerable patient, e.g. a person with compromised immunity, free from infection risks that might be encountered in the normal ward environment.
Different precautions may also be used to ‘isolate’ non-infective patients such as those who are undergoing radiotherapy treatments that render the person a radioactive hazard to fellow patients.
This section consists of three parts:
3 Radioactive hazard isolation
Learning outcomes
By the end of this section you should know how to:

prevent the spread of infection while nursing a patient with a specific communicable disease (source isolation)

protect a patient from infection when he or she may be at a greater risk than normal (protective isolation)

prevent hazard to carers and visitors when radioactive substances are used.
1. SOURCE ISOLATION
In this instance, the ‘infected’ area is the isolation area where the infected patient is being nursed, the ‘non-infected’ area being that outside the isolation area.
Indications and rationale for source isolation
This is carried out
to prevent the spread of infection from patients who have or are suspected of having a specific communicable infection, for example:

an infection caused by methicillin-resistant
Staphylococcus aureus (MRSA). This infection, especially if present in the bloodstream, poses the greatest problem for patients who are already at high risk, e.g. those with invasive devices or being ventilated. Guidelines for care of persons with MRSA vary between acute, community and domestic care settings. Precautions are based on an individual risk assessment and the type of healthcare setting (
Working Party on MRSA 1998)
[Many of these items are disposable and a supply of them should be kept in an adjacent area outside the isolation area]
5. Linen for the bed, and personal towels for the patient
6. Individual crockery and cutlery, which can be processed in a dishwasher should be routinely used. However, in some circumstances, disposable items may be required (please check with the local infection control policy or infection control team)
7. Facilities for the treatment, or disposal of, infected linen and rubbish
8. Equipment needed for appropriate personal and nursing care should remain within the isolation area for the duration of the isolation precautions to prevent the transmission of infection. All items used must be decontaminated and disinfected before reuse according to local control of infection policy
9. Thermometer, sphygmomanometer, stethoscope and watch or clock with a second hand as required for recording vital signs
10. Special containers for the collection of laboratory specimens if required
11. The patient’s documentation should remain outside the isolation area and details of recordings and care be completed by ‘uncontaminated’ personnel to maintain a safe environment.

Guidelines and rationale for this nursing practice
Disposal of infected material
Local guidelines should be followed regarding the disposal of contaminated waste. In an institutional setting, two nurses are required: one to remain in protective clothing within the isolation area, the second nurse to remain free from contamination outside it.