Barrier nursing

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Barrier nursing is a set of stringent infection control techniques used in nursing. The aim of barrier nursing is to protect medical staff against infection by patients and also protect patients with highly infectious diseases from spreading their pathogens to other non-infected people.

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Barrier nursing was created as a means to maximize isolation care. Since it is impossible to isolate a patient from society and medical staff while still providing care, there are often compromises made when it comes to treating infectious patients. Barrier nursing is a method to regulate and minimize the number and severity of compromises being made in isolation care, while also preventing the disease from spreading. [1]

History and usage

The term "barrier nursing" was first used by the Centre for Disease Control (CDC) to describe early infection control methods in the late 1800s. [2] From the mid-1900s to early 2000s, 15 new terms had emerged and were also being used to describe infection control. The variety of terms that described infection care led to a misunderstanding of practice recommendations and eventual low adherence to isolation precautions; this eventually forced the CDC to combine all 15 terms into one term called isolation. [3] Nowadays barrier nursing is becoming a less commonly used term and is not even recognized by most reputable databases or online scientific journals. Yet when it is seldom used, it relates mostly to circumstantial protocols for situations regarding isolation health care. [4] [5]

Simple vs strict barrier nursing

Simple barrier nursing

Simple barrier nursing is used when an infectious agent is suspected within a patient and standard precautions aren't working. Simple barrier nursing consists of utilizing sterile: gloves, masks, gowns, head-covers and eye protection. [3] [6] Nurses also wear personal protective equipment (PPE) to protect their bodies from infectious agents. Simple barrier nursing is often used for marrow transplants, human Lassa virus transmission, viral hemorrhagic fever and other virulent diseases. [6] [5]

Strict barrier nursing

Strict, or rigid, barrier nursing is used for the rarer and more specific deadly viruses and infections: Ebola and rabies. Strict barrier nursing is a lot more demanding in terms of safety measure requirements because of the catastrophic effects that can occur if the disease or virus is allowed through the barrier. If patients cannot be isolated from one another completely, they have to at least be isolated from the rest of the patients within the hospital. In strict barrier nursing the patients and staff are usually isolated from the common population, and every attempt is made to establish a barrier between the inside and outside of the ward. The staff going on duty have to remove all outer clothing, pass through an airlock and put on a new set of PPE. When a staff member is going off duty, they are required to take a thorough shower and leave everything that was taken into the room to be disinfected or destroyed. While strict barrier nursing methods cannot always be enforced, especially in lower income areas and countries, any modifications made must be based on sound principles. Since infection can be spread through fomites, clothes or oxygen, all efforts must be made to limit the spread of these vessels. The doctor's or nurse's hands must be thoroughly washed after touching anything in the cubicle. Taps and door-handles should be elbow- or foot-operated. Hands should be washed in the cubicle and dried outside to eliminate contamination from paper or cloth towels. In addition, antiseptic hand-cream, dispensed from a foot-operated wall container would also serve as an additional precaution. [1] [7] [8]

Psychiatric effects of barrier nursing

Positive effects

Negative effects

Although participants understood the importance for Personalized Protective equipment, they still found that its use increased their fear and sense of stigma. [9]

Many researchers have indicated that healthcare professionals may regard a patient in source isolation differently from others. In studies regarding barrier nursing of patients with methicillin-resistant Staphylococcus aureus, medical staff admitted to spending less time with patients in source isolation. [9]

Solutions to negative effects of barrier nursing/isolation

Related Research Articles

Body substance isolation is a practice of isolating all body substances of individuals undergoing medical treatment, particularly emergency medical treatment of those who might be infected with illnesses such as HIV, or hepatitis so as to reduce as much as possible the chances of transmitting these illnesses. BSI is similar in nature to universal precautions, but goes further in isolating workers from pathogens, including substances now known to carry HIV.

<span class="mw-page-title-main">Universal precautions</span> Medical standard for contact avoidance

Universal precautions refers to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The infection control techniques were essentially good hygiene habits, such as hand washing and the use of gloves and other barriers, the correct handling of hypodermic needles, scalpels, and aseptic techniques.

Methicillin-resistant <i>Staphylococcus aureus</i> Bacterium responsible for difficult-to-treat infections in humans

Methicillin-resistant Staphylococcus aureus (MRSA) is a group of gram-positive bacteria that are genetically distinct from other strains of Staphylococcus aureus. MRSA is responsible for several difficult-to-treat infections in humans. It caused more than 100,000 deaths worldwide attributable to antimicrobial resistance in 2019.

<span class="mw-page-title-main">SARS</span> Disease caused by severe acute respiratory syndrome coronavirus

Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the virus SARS-CoV-1, the first identified strain of the SARS-related coronavirus. The first known cases occurred in November 2002, and the syndrome caused the 2002–2004 SARS outbreak. In the 2010s, Chinese scientists traced the virus through the intermediary of Asian palm civets to cave-dwelling horseshoe bats in Xiyang Yi Ethnic Township, Yunnan.

<span class="mw-page-title-main">Hospital-acquired infection</span> Infection that is acquired in a hospital or other health care facility

A hospital-acquired infection, also known as a nosocomial infection, is an infection that is acquired in a hospital or other healthcare facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a healthcare-associated infection. Such an infection can be acquired in a hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other clinical settings. A number of dynamic processes can bring contamination into operating rooms and other areas within nosocomial settings. Infection is spread to the susceptible patient in the clinical setting by various means. Healthcare staff also spread infection, in addition to contaminated equipment, bed linens, or air droplets. The infection can originate from the outside environment, another infected patient, staff that may be infected, or in some cases, the source of the infection cannot be determined. In some cases the microorganism originates from the patient's own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the protective skin barrier. Though the patient may have contracted the infection from their own skin, the infection is still considered nosocomial since it develops in the health care setting. The term nosocomial infection is used when there is a lack of evidence that the infection was present when the patient entered the healthcare setting, thus meaning it was acquired or became problematic post-admission.

<span class="mw-page-title-main">Asepsis</span> Absence of disease-causing microorganisms

Asepsis is the state of being free from disease-causing micro-organisms. There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is derived from the older antiseptic techniques, a shift initiated by different individuals in the 19th century who introduced practices such as the sterilizing of surgical tools and the wearing of surgical gloves during operations. The goal of asepsis is to eliminate infection, not to achieve sterility. Ideally, a surgical field is sterile, meaning it is free of all biological contaminants, not just those that can cause disease, putrefaction, or fermentation. Even in an aseptic state, a condition of sterile inflammation may develop. The term often refers to those practices used to promote or induce asepsis in an operative field of surgery or medicine to prevent infection.

Infection prevention and control is the discipline concerned with preventing healthcare-associated infections; a practical rather than academic sub-discipline of epidemiology. In Northern Europe, infection prevention and control is expanded from healthcare into a component in public health, known as "infection protection". It is an essential part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.

<span class="mw-page-title-main">Isolation (health care)</span> Measure taken to prevent contagious diseases from being spread

In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient. Various forms of isolation exist, in some of which contact procedures are modified, and others in which the patient is kept away from all other people. In a system devised, and periodically revised, by the U.S. Centers for Disease Control and Prevention (CDC), various levels of patient isolation comprise application of one or more formally described "precaution".

<span class="mw-page-title-main">Isolation ward</span> Medical ward designed to prevent the spread of infection

In hospitals and other medical facilities, an isolation ward is a separate ward used to isolate patients with infectious diseases. Several wards for individual patients are usually placed together in an isolation unit.

Transmission-based precautions are infection-control precautions in health care, in addition to the so-called "standard precautions". They are the latest routine infection prevention and control practices applied for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens, which require additional control measures to effectively prevent transmission. Universal precautions are also important to address as far as transmission-based precautions. Universal precautions is the practice of treating all bodily fluids as if it is infected with HIV, HBV, or other blood borne pathogens.

An admission, discharge, and transfer (ADT) system is a backbone system for the structure of other types of business systems. An ADT system is one of four types of core business systems: ADT, financial, scheduling, and acuity. Core business systems are systems used in a health care facility for financial payment, quality improvement, and encouraging best practices that research has proven beneficial.

<span class="mw-page-title-main">Prevention of viral hemorrhagic fever</span>

Prevention of viral hemorrhagic fever is similar for the different viruses. There are a number of different viral hemorrhagic fevers including Ebola virus disease, Lassa fever, Rift valley fever, Marburg virus disease, Crimean-Congo haemorrhagic fever (CCHF) and yellow fever. Lassa, Ebola, Marburg and CCHF can be spread by direct contact with the body fluids of those infected. Thus the content here covers the prevention of Ebola.

<span class="mw-page-title-main">N95 respirator</span> Particulate respirator meeting the N95 standard

An N95 respirator is a disposable filtering facepiece respirator or reusable elastomeric respirator filter that meets the U.S. National Institute for Occupational Safety and Health (NIOSH) N95 standard of air filtration, filtering at least 95% of airborne particles that have a mass median aerodynamic diameter of 0.3 micrometers under 42 CFR 84, effective July 10, 1995. A surgical N95 is also rated against fluids, and is regulated by the US Food and Drug Administration under 21 CFR 878.4040, in addition to NIOSH 42 CFR 84. 42 CFR 84, the federal standard which the N95 is part of, was created to address shortcomings in the prior United States Bureau of Mines respirator testing standards, as well as tuberculosis outbreaks, caused by the HIV/AIDS epidemic in the United States. Since then, N95 respirator has continued to be solidified as a source control measure in various pandemics that have been experienced in the United States and Canada, including the 2009 swine flu and the COVID-19 pandemic.

<span class="mw-page-title-main">Dale Fisher</span> Australian physician (born 1960)

Dale Andrew Fisher FRACP is an infectious diseases physician who specialises in Infectious Diseases and a Senior Consultant in the Division of Infectious Diseases at the National University Hospital, Singapore. He is also a professor of medicine at the Yong Loo Lin School of Medicine, National University of Singapore, and the chair of the National Infection Prevention and Control Committee through the Ministry of Health, Singapore. In 2020, he became group chief of Medicine for National University Health Systems.

<span class="mw-page-title-main">Workplace hazard controls for COVID-19</span> Prevention measures for COVID-19

Hazard controls for COVID-19 in workplaces are the application of occupational safety and health methodologies for hazard controls to the prevention of COVID-19. Multiple layers of controls are recommended, including measures such as remote work and flextime, personal protective equipment (PPE) and face coverings, social distancing, and enhanced cleaning programs. Recently, engineering controls have been emphasized, particularly stressing the importance of HVAC systems meeting a minimum of 5 air changes per hour with ventilation or MERV-13 filters, as well as the installation of UVGI systems in public areas.

In epidemiology, a non-pharmaceutical intervention (NPI) is any method used to reduce the spread of an epidemic disease without requiring pharmaceutical drug treatments. Examples of non-pharmaceutical interventions that reduce the spread of infectious diseases include wearing a face mask and staying away from sick people.

<span class="mw-page-title-main">Impact of the COVID-19 pandemic on healthcare workers</span>

The COVID-19 pandemic has impacted healthcare workers physically and psychologically. Healthcare workers are more vulnerable to COVID-19 infection than the general population due to frequent contact with infected individuals. Healthcare workers have been required to work under stressful conditions without proper protective equipment, and make difficult decisions involving ethical implications. Health and social systems across the globe are struggling to cope. The situation is especially challenging in humanitarian, fragile and low-income country contexts, where health and social systems are already weak. Services to provide sexual and reproductive health care risk being sidelined, which will lead to higher maternal mortality and morbidity.

<span class="mw-page-title-main">Source control (respiratory disease)</span> Strategy for reducing disease transmission

Source control is a strategy for reducing disease transmission by blocking respiratory secretions produced through breathing, speaking, coughing, sneezing or singing. Multiple source control techniques can be used in hospitals, but for the general public wearing personal protective equipment during epidemics or pandemics, respirators provide the greatest source control, followed by surgical masks, with cloth face masks recommended for use by the public only when there are shortages of both respirators and surgical masks.

<span class="mw-page-title-main">Medical textiles</span> Textiles for medical and healthcare use

Medical textiles are numerous fiber-based materials intended for medical purposes. Medical textile is a sector of technical textiles that emphasizes fiber-based products used in health care applications such as prevention, care, and hygiene.

An occupational infectious disease is an infectious disease that is contracted at the workplace. Biological hazards (biohazards) include infectious microorganisms such as viruses, bacteria and toxins produced by those organisms such as anthrax.

References

  1. 1 2 "Barrier Nursing". BMJ. 1 (5492): 876. 1966. doi:10.1136/bmj.1.5492.876. ISSN   0959-8138. PMC   1844403 . PMID   20722197.
  2. ↑ Gammon J (March 26 – April 8, 1998). "A review of the development of isolation precautions". British Journal of Nursing. 7 (6): 307–310. doi:10.12968/bjon.1998.7.6.5727. ISSN   0966-0461. PMID   9661353.
  3. 1 2 Landers T, McWalters J, Behta M, Bufe G, Ross B, Vawdrey DK, Larson E (October 2010). "Terms used for isolation practices by nurses at an academic medical center". Journal of Advanced Nursing. 66 (10): 2309–2319. doi:10.1111/j.1365-2648.2010.05398.x. ISSN   0309-2402. PMC   2974777 . PMID   20722801.
  4. ↑ Riley U (2009). Treleaven J, Barrett AJ (eds.). Hematopoietic Stem Cell Transplantation in Clinical Practice. Edinburgh: Churchill Livingstone. pp. 355–361. ISBN   9780443101472.
  5. 1 2 Enría DA, Mills JN, Bausch D, Shieh WJ, Peters CJ (2011). Guerrant RL, Walker DH, Weller PF (eds.). Tropical Infectious Diseases: Principles, Pathogens and Practice (Third ed.). Edinburgh: W.B. Saunders. pp. 449–461. doi:10.1016/B978-0-7020-3935-5.00068-9. ISBN   9780702039355.
  6. 1 2 Mahmoud HK, Schaefer UW, Schüning F, Schmidt CG, Bamberg M, Haralambie E, Linzenmeier G, Hantschke D, Grosse-Wilde H (1984-11-01). "Laminar air flow versus barrier nursing in marrow transplant recipients". Blut. 49 (5): 375–381. doi:10.1007/BF00319885. ISSN   0006-5242. PMID   6388667. S2CID   21403239.
  7. ↑ Formenty P (2014). "Ebola Virus Disease". Emerging Infectious Diseases. Amsterdam: Academic Press. pp. 121–134. doi:10.1016/B978-0-12-416975-3.00009-1. ISBN   9780124169753.
  8. ↑ Warrell MJ (2014). Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ (eds.). Manson's Tropical Infectious Diseases (Twenty-Third ed.). London: W.B. Saunders. pp. 195–206.e2. doi:10.1016/B978-0-7020-5101-2.00018-2. ISBN   9780702051012.
  9. 1 2 3 4 5 6 7 8 9 Barratt R, Shaban R, Moyle W (2010). "Behind barriers: patients' perceptions of source isolation for Methicillin‑resistant Staphylococcus aureus (MRSA)". Australian Journal of Advanced Nursing. 28 (2). hdl: 10072/35631 .
  10. ↑ "PRIME PubMed | 'Patient perspective'--psychological effects of barrier nursing isolatio". www.unboundmedicine.com. Retrieved 2017-12-14.
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