149. CCA Study Notes: Isolation Precautions, PPE & Safe Care

The Big Picture

Isolation precautions are guidelines that help prevent infection from spreading. There are two main types. Standard Practices are used with every client. Transmission-Based Practices add extra precautions when a client has or may have certain contagious diseases.

You also need to understand protective equipment, safe handling of contaminated items, sharps safety, client transport, and respectful care. The goal is to control infection while still protecting the client’s dignity, choices, and emotional needs.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

What Are Isolation Precautions?

Isolation precautions are guidelines for preventing the spread of pathogens.

The precautions described here were developed in the United States in 1996 by the Centers for Disease Control and Prevention. Health Canada accepted them, and they are used in many Canadian health care facilities and community care agencies.

There are two main types:

1. Standard Practices, also called Routine Practices or Standard Precautions.
2. Transmission-Based Practices.

The main difference is when they are used.

• Standard Practices are used at all times.
• Transmission-Based Practices are used for clients with certain communicable diseases.
• Transmission-Based Practices are followed in addition to Standard Practices.

A communicable disease is caused by disease-causing microbes and spreads easily. It is also called a contagious disease.

Contamination is the process of being exposed to microorganisms, including pathogens.

Standard Practices: Used With Every Client

Standard Practices help prevent infection from contact with:

• blood
• body fluids, secretions, and excretions, except sweat, whether blood is visible or not
• non-intact skin, such as open sores, wounds, cuts, scrapes, or other breaks
• mucous membranes, including those in the nose, eyes, mouth, vagina, and rectum

You cannot tell by looking at someone whether they carry pathogens. For this reason, Standard Practices should be used with all clients in all settings.

Hand Hygiene Under Standard Practices

Practise hand hygiene:

• after touching blood, body fluids, secretions, excretions, non-intact skin, mucous membranes, or contaminated items
• even when you wore gloves
• immediately before putting on gloves
• immediately after removing gloves
• between client contacts
• when needed to prevent microbes from moving to another person or area
• between different tasks or procedures on the same client to prevent cross-contamination between body sites

Use plain soap for routine handwashing. Your supervisor will tell you when another soap or agent is needed.

Gloves Under Standard Practices

Wear clean, disposable, nonsterile gloves when touching:

• blood
• body fluids, secretions, or excretions
• non-intact skin
• mucous membranes
• contaminated items

Change gloves:

• between tasks and procedures on the same client
• after contact with material that may contain high levels of contamination

Remove gloves promptly after use.

Remove them:

• before touching clean items or surfaces
• before going to another client

Practise hand hygiene immediately after removing them.

Masks and Eye Protection

Wear a mask and eye protection when a task is likely to produce splashes or sprays of blood, body fluids, secretions, or excretions.

Eye protection includes:

• goggles
• face shields

These protect the eyes, nose, and mouth from splashes and sprays.

Gowns

Wear a gown for procedures or tasks likely to cause splashes or sprays of blood, body fluids, secretions, or excretions.

A clean, nonsterile gown is adequate for this purpose.

Remove a used gown as soon as possible. Practise hand hygiene after removing it.

Equipment and Environmental Surfaces

Handle used care equipment carefully. Do not allow contaminated equipment to touch your:

• skin
• mucous membranes
• clothing

Do not use one client’s reusable item for another client until the item has been cleaned and disinfected or sterilized.

Discard single-use items correctly.

Follow employer procedures for routine cleaning and disinfection of:

• environmental surfaces
• bed rails
• bedside equipment
• other frequently touched surfaces

Soiled Linen

Follow employer policy for linen contaminated with blood, body fluids, secretions, or excretions.

Do not:

• allow soiled linen to touch your skin, mucous membranes, or clothing
• shake soiled linen

Shaking linen can transfer microbes to other clients or the surrounding area.

Sharps Safety Under Standard Practices

Sharps are items that may pierce the skin. Examples include needles, scalpels, razor blades, lancets, and broken glass.

Use extreme care when:

• handling sharps
• handling sharp instruments after procedures
• cleaning used instruments
• disposing of used needles

Never recap used needles. Do not handle them with both hands. Never point a used needle toward any body part. Use a one-handed scoop technique or a mechanical device that holds the needle sheath.

Never:

• remove a used needle from a disposable syringe by hand
• bend a used needle by hand
• break a used needle by hand
• otherwise handle a used needle unnecessarily by hand

Place disposable syringes, needles, scalpel blades, and other sharps in puncture-resistant containers.

Place reusable syringes and needles in a puncture-resistant container for transport to the reprocessing area.

Use barrier devices for rescue breathing during emergencies.

Client Placement Under Standard Practices

A private room is used when a client:

• contaminates the surrounding area
• does not or cannot help maintain hygiene or environmental control

Follow your supervisor’s instructions when a private room is unavailable.

Transmission-Based Practices

Transmission-Based Practices are extra precautions used to contain pathogens within a certain area, usually the client’s room.

They apply only to clients infected or colonized with certain pathogens. They are used in addition to Standard Practices.

You will be told when these precautions have been ordered.

There are three types:

1. Airborne precautions
2. Droplet precautions
3. Contact precautions

The type used depends on how the pathogen spreads.

Rooms and Signs

In facilities, clients under Transmission-Based Practices usually stay in private or semi-private rooms.

The room must have:

• handwashing facilities
• toilet facilities
• wastebaskets
• laundry containers lined with plastic bags
• garbage containers lined with plastic bags

An isolation sign is usually placed outside the room to show that precautions are in use.

Transmission-Based Practices are sometimes used in home care. An isolation sign is not needed in the client’s home.

Follow employer policies for isolation precautions.

Airborne Precautions

Airborne precautions are used for known or suspected infections caused by microbes transmitted through airborne droplets.

Examples include:

• measles
• chicken pox
• tuberculosis, or TB
• febrile respiratory illness, or FRI
• severe acute respiratory syndrome, or SARS
• COVID-19

Airborne Precaution Rules

• Follow Standard Practices.
• Place the client in a private room.
• Keep the room door closed.
• Keep the client in the room.
• Wear respiratory protection, such as an N-95 respirator, when entering the room of a client with known or suspected TB, SARS, or COVID-19.
• A disposable surgical mask does not provide enough protection for these situations.
• Follow employer policy when caring for a client with TB.
• Do not enter the room of a client with known or suspected measles or chicken pox when you are susceptible ⓘ to that disease.
• If you are susceptible but must enter, wear respiratory protection.
• Respiratory protection is not needed for measles or chicken pox when you are immune.
• Limit movement or transport outside the room.
• The client must wear a mask when leaving the room for any reason.

For home care, these precautions may need to be revised. For example, wear respiratory protection in the client’s home if you are not immune. Check with your supervisor and the care plan before entering the home.

Droplet Precautions

Droplet precautions are used for known or suspected infections spread through droplets produced by:

• coughing
• sneezing
• talking

Examples include:

• meningitis
• pneumonia
• influenza
• mumps
• COVID-19

Droplet Precaution Rules

• Follow Standard Practices.
• Use a private room if possible.
• Keep the room door closed unless the client’s bed is more than 1 m (3 ft.) from the door.
• Wear a disposable surgical mask when working within 1 m (3 ft.) of the client.
• Wear a mask when entering the room when employer policy requires it.
• Limit movement and transport outside the room.
• The client should wear a mask when leaving the room.

In home care, household members should avoid sharing common articles or eating utensils.

Check with your supervisor and the care plan before entering the home.

Contact Precautions

Contact precautions are used for known or suspected infections spread through:

1. Direct contact, such as skin-to-skin contact during care.
2. Indirect contact, such as contact with surfaces or care items in the client’s room.

Examples include:

• multidrug-resistant organisms, or MROs
• gastrointestinal infections
• respiratory infections
• skin infections
• wound infections

Contact Precaution Rules

• Follow Standard Practices.
• Use a private room if possible.
• Leave the room door open according to the client’s preference.
• Wear gloves when entering the room.
• Make sure the gloves cover your wrists and the cuff of your sleeve or gown.
• Change gloves after touching material likely to have high concentrations of microbes, such as fecal material or wound drainage.
• Remove gloves before leaving the room and turn them inside out during removal.
• Discard gloves in the contaminated-waste container according to employer policy.
• Practise hand hygiene immediately after removing gloves.

Your supervisor will tell you which agent to use. This is usually an antimicrobial agent or a waterless, alcohol-based hand sanitizer.

• Do not touch potentially contaminated surfaces or items after glove removal and hand hygiene.
• Use a paper towel to touch the doorknob when opening the door.
• Discard that paper towel in the garbage inside the room as you leave.
• Remove the gown before leaving the room.
• Keep your clothing away from potentially contaminated surfaces.
• Limit movement or transport outside the room.
• Maintain precautions when transport is necessary.

Wear a gown when entering the room if the client:

• is incontinent
• has diarrhea
• has an ileostomy
• has a colostomy
• has wound drainage that is not contained by a dressing

For home care, check with your supervisor and the care plan before entering the home.

General Rules for Transmission-Based Practices

Before and During Care

• Wear required PPE.
• Collect needed equipment before entering the room to limit trips in and out.
• Protect equipment and supplies from contamination.
• Consider an item contaminated if it falls on the floor. Do not use it.
• Prevent drafts because pathogens can be carried in the air by drafts.
• Do not touch your hair, nose, mouth, eyes, or other body parts while providing care.
• Do not touch a clean area or object with contaminated hands.
• Place clean items brought into the room on paper towels.
• Use paper towels when turning faucets on and off.

Floors, Equipment, Linen, and Waste

• Clean floors with mops wetted with disinfectant solution.
• Use paper towels to handle contaminated items.
• Remove items from the room in sturdy, leak-proof plastic bags.
• Double-bag items when the outside of the first bag is or may become contaminated.
• Follow employer policy when removing and transporting disposable and reusable items.
• Return reusable dishes, eating utensils, and trays to the kitchen or food service department.
• Discard disposable dishes, utensils, and trays in the waste container in the client’s room.
• Do not shake linen.

Tell Your Supervisor If You Have

• fever
• cuts or open skin areas
• vomiting
• diarrhea
• a sore throat
• a cough

Personal Protective Equipment

Personal protective equipment (PPE) is clothing and equipment that forms a barrier between microbes and a person’s hands, eyes, nose, mouth, and clothing.

PPE includes:

• gloves
• gowns
• masks
• eye protection

Your supervisor and employer policy guide you about when PPE is required.

Other protective clothing may include plastic aprons, shoe covers, boots, and leg coverings. These protect clothing, wrists, and arms from blood, body fluids, secretions, excretions, splashes, and sprays.

Putting On and Taking Off a Full Set of PPE

The order matters.

Before Entering the Client’s Room

Practise hand hygiene first.

Then put PPE on in this order:

1. Gown
2. Mask
3. Goggles or face shield
4. Gloves

You may then enter the client’s room.

Taking PPE Off

While still in the client’s room:

1. Remove gloves.
2. Practise hand hygiene.
3. Remove the gown.
4. Practise hand hygiene.

After leaving the room:

5. Remove goggles or the face shield.
6. Remove the mask.
7. Practise hand hygiene.

Masks and Respiratory Protection

Disposable surgical masks:

• help prevent pathogens from entering the mouth and nose
• protect against splashes and sprays of blood, body fluids, secretions, and excretions
• help prevent microbes from spreading from the wearer’s respiratory tract

Breathing makes a mask moist over time.

A wet or moist mask is contaminated. Replace it with a new mask when it becomes damp.

Different situations require different masks.

When respiratory protection is required, use a special mask that filters the air. An N-95 respirator is one example used for airborne precautions.

You are responsible for being fitted for the correct mask and wearing it properly according to employer policy.

The precautions described here require masks for staff, clients, and visitors when airborne or droplet precautions are in place.

N-95 Respirators and Fit Testing

An N-95 respirator provides respiratory protection against certain airborne infections, including TB and SARS.

The N-95 is the most common size because it fits most people. It is not intended for people with beards.

If an N-95 does not fit, another size must be fit-tested.

During fit testing, a trained fit-tester may spray a sweet or bitter solution toward the person wearing the mask.

If the person tastes the solution, the mask does not have a proper seal around the nose and mouth. Without a good seal, the mask does not prevent the airborne pathogen from entering as intended.

Wearing a Mask: Correct Order

Keep the steps in order.

1. Practise hand hygiene.
2. Pick up the mask by its upper ties. Do not touch the section that will cover your face.
3. Place the mask over your nose and mouth.
4. Place the upper strings over your ears and tie them toward the top of your head.
5. Tie the lower strings at the back of your neck. Keep the lower section under your chin.
6. Pinch the metal band around your nose so the top fits snugly. If you wear glasses or eye protection, keep the mask snug under the bottom edge of the eyewear.
7. Practise hand hygiene.
8. Put on gloves when needed.
9. Provide care. Avoid coughing, sneezing, and unnecessary talking.
10. Replace the mask if it becomes moist or contaminated.
11. When the task is finished, remove and discard the gloves. Wash your hands.
12. Remove the mask by untying the lower strings first, then the upper strings. Hold the upper strings, remove the mask, and bring the strings together so the inside folds inward. Do not touch the inside of the mask.
13. Discard the mask according to employer policy.
14. Practise hand hygiene.

The mask ties are the least contaminated parts. The face section is the most contaminated, especially when damp.

Gowns

A gown must completely cover your clothing.

A proper gown has:

• long sleeves
• tight cuffs
• an opening at the back
• ties at the neck and waist

The inside and neck of the gown are considered clean. The outside and waist strings are considered contaminated.

Gloves should cover the cuffs of the gown.

Gowns are used once before laundering or disposal.

• Replace a wet gown with a dry gown because a wet gown is contaminated.
• Discard disposable paper gowns after one use.
• Launder reusable cloth gowns before using them again.

Putting On and Removing a Gown

Putting the Gown On

1. Remove your watch and jewellery.
2. Roll up your uniform sleeves.
3. Practise hand hygiene.
4. Pick up a clean gown and let it unfold without shaking it.
5. Put your hands and arms through the sleeves.
6. Make sure the gown covers the front of your uniform and fits snugly at the neck.
7. Tie the strings at the back of the neck.
8. Overlap the back of the gown. Make sure it covers the uniform and fits snugly.
9. Tie the waist strings at the back.
10. Put on gloves and make sure they cover the gown cuffs.
11. Provide care to the client.

Removing the Gown

12. Remove and discard the gloves. Practise hand hygiene.
13. Remove the gown:
    1. Untie the waist strings.
    2. Practise hand hygiene.
    3. Untie the neck strings without touching the outside of the gown.
    4. Peel the gown away from the neck and shoulders.
    5. Turn the outside of the gown toward the inside.
    6. Hold the gown at the inside shoulder seams and bring your hands together.
14. Roll the gown away from you while keeping it inside out.
15. Discard the gown according to employer policy.
16. Practise hand hygiene.

Keeping the contaminated surface inside helps prevent it from touching your uniform or skin.

Goggles and Face Shields

Goggles and face shields protect the eyes, nose, and mouth from splashes or sprays of:

• blood
• body fluids
• secretions
• excretions

Protection may be needed when:

• providing client care
• cleaning instruments
• disposing of contaminated fluids

Discard disposable eye protection after use.

Clean reusable eye protection with soap and water, then disinfect it before reuse.

Safe Handling of Sharps

Support workers do not administer injections, but they may find needles or other sharps that someone disposed of incorrectly.

Be alert for stray sharps, especially when a client frequently uses needles.

Used needles must not be bent or broken.

Place used needles and other sharps into a container that is:

• tightly capped
• puncture-resistant
• leak-proof
• labelled

The container may be made from steel or heavy plastic.

Other containers are acceptable when they meet the required safety criteria.

What to Do After a Sharps Injury

A needle stick or other sharps injury must never be ignored.

If a sharp pierces your skin:

1. Report the incident at once.
2. Immediately encourage bleeding from the injury site.
3. Flush the area with plenty of water for about 5 minutes.
4. Seek prompt medical attention according to employer policy.

A sharps injury creates a risk of infection, including HIV, hepatitis B, and hepatitis C.

Treat all clients as potential carriers of these viruses.

The client may be asked for consent ⓘ to testing to help manage the exposure. Protect confidentiality ⓘ throughout the process.

Home Care Sharps Containers

Home care agencies may use different sharps containers from those used in facilities.

Examples of safe containers include:

• empty bleach bottles
• coffee cans with plastic lids taped closed
• plastic milk bottles

Do not use:

• glass containers
• clear plastic containers

The home care agency collects the containers and disposes of them according to agency policy and local laws.

Biohazardous Waste

Biohazardous waste contains items contaminated with blood, body fluids, secretions, or excretions that may harm others.

Examples include:

• used gloves
• dressings
• incontinence products
• soiled linen

Place these items in specially marked containers according to employer policy.

The containers use sturdy, leak-proof plastic bags that may be colour-coded. They are marked with the universal BIOHAZARD symbol.

When Double-Bagging Is Needed

One bag is usually enough.

Double-bagging is needed when:

• contaminated waste touches the outside of the first bag
• the bag contains linen that is wet or soiled

Two workers are needed to double-bag items in an isolation room.

Use this order:

1. The worker inside the room places contaminated items into a bag and seals it.
2. The worker outside the room holds open a clean second bag and makes a wide cuff to protect their hands.
3. At the doorway, place the contaminated bag inside the clean bag.

Handling Soiled Linen

Handle soiled linen as little as possible.

Bag it immediately in the room where it was used. Use a linen bag marked with the BIOHAZARD symbol.

Do not:

• sort soiled linen in client care areas
• rinse it in client care areas
• overfill the bag

The bag must still close securely.

Double-bag linen that is very wet or soiled to prevent leakage.

Place the linen bag in a laundry hamper lined with a biohazard plastic bag.

Transporting a Client Under Transmission-Based Practices

Clients under Transmission-Based Practices usually remain in their rooms. They sometimes need to leave for treatment or testing.

Transport procedures differ between facilities. Some facilities use beds to prevent contamination of wheelchairs and stretchers. Other facilities use wheelchairs or stretchers.

Follow employer policy.

For safe transport:

• Make sure the client wears a clean gown or pyjamas and an isolation gown.
• Put a mask on a client under airborne or droplet precautions.
• Cover draining wounds.
• Give the client tissues and a leak-proof bag for used tissues.
• Wear a gown, mask, and gloves when required by the isolation precaution.
• Place an extra layer of sheets and absorbent pads on the stretcher or wheelchair when protection from draining fluids is needed.
• Do not allow anyone else into the elevator.
• Tell staff in the receiving area about the isolation precautions so they use the needed protective equipment.
• Disinfect the stretcher or wheelchair after use.

Safe Care Includes Emotional and Social Needs

Transmission-Based Practices can affect more than infection control.

Clients may receive fewer visits because staff or visitors hesitate to put on PPE or fear infection. A client may feel:

• lonely
• unloved
• rejected
• ashamed
• guilty

Self-esteem may suffer, and depression is a risk.

Precautions allow you to interact safely with the client. Do not treat the client as though the person is the problem.

Supporting Dignity and Belonging

Helpful actions include:

• Treat the client with respect, kindness, and dignity.
• Remember that the pathogen is undesirable, not the client.
• Support the client in making choices and decisions whenever possible.
• Offer newspapers, magazines, or other reading materials when appropriate.
• Offer hobby materials when possible.
• Place a clock or radio in the room.
• Encourage telephone contact with family and friends.
• Provide a current television schedule.
• Organize your work so you have time to visit.
• Say hello from the doorway when the door is allowed to remain open.

Helping Children and Clients With Dementia

Young children and clients living with dementia may not understand why isolation precautions are needed.

PPE may frighten a child. It may increase confusion, fear, or agitation in an adult living with dementia.

Helpful approaches include:

• Let the client see your face before putting on a mask or eye protection.
• Tell the client who you are and what you plan to do.
• Speak in a calm, soothing voice.
• Do not hurry the client.
• Follow the care plan and your supervisor’s instructions for individual approaches.
• Report increased confusion or changes in behaviour to your supervisor.

Common Mix-Ups

Wrong Idea	Better Idea
Transmission-Based Practices replace Standard Practices.	They are added to Standard Practices.
A surgical mask gives the required respiratory protection for TB, SARS, or COVID-19 under airborne precautions.	Respiratory protection such as an N-95 is required.
Every bag of biohazardous waste needs double-bagging.	One bag is usually enough. Double-bag only under the stated conditions.
Used reusable equipment can go directly from one client to another.	Clean and disinfect or sterilize it before another client uses it.
Wearing gloves removes the need for hand hygiene.	Hand hygiene is still required before and after glove use.