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Protective isolation

Definition

Protective isolation is the practice of isolating a patient who does not have a competent immune system in order to protect them from potentially harmful organisms. It was formerly known as ‘reverse barrier nursing’.

Related theory

Protective isolation is used to minimize the exposure to infectious agents of patients who are particularly at risk of infection. The evidence that protective isolation successfully reduces the incidence of infection is limited (Abad et al. [1]), probably because many infections are endogenous (i.e. caused by the patient's own bacterial flora). Protective isolation is used to reduce the risk of exogenous infection in groups that have greatly impaired immune systems, such as bone marrow transplant patients. Patients who have compromised immune systems often have greatly reduced numbers of a type of white blood cell called a neutrophil; this condition is known as neutropenia and those affected are described as neutropenic. Neutropenia is graded from mild to severe according to how few neutrophils are in the circulation and hence how severe the risk is (Godwin et al. [46]).
Single‐occupancy rooms used for protective isolation should have neutral or positive air pressure with respect to the surrounding area.

Evidence‐based approaches

Principles of care

The patient should be given information about the importance of good food hygiene in reducing their exposure to potential pathogens. Neutropenic patients should avoid unpasteurized dairy products, raw or runny eggs, pâté and sushi; other potentially hazardous foods such as raw fruit, salads and uncooked vegetables may be eaten as long as good food hygiene is followed. This includes washing raw ingredients, peeling fruit or vegetables, storing foods at correct temperatures and avoiding reheating food.
It is important that the patient and their family understand the importance of good hand hygiene before eating or drinking (as potential pathogens on the hands may be inadvertently consumed) and the need for good food hygiene. Any food brought in for the patient should be in undamaged, sealed tins and packets obtained from well‐known, reliable firms and must be within the expiry date, as correctly processed and packaged foods are more likely to be of an acceptable food hygiene standard. Previously served food should not be reheated.

Post‐procedural considerations

Discharging a neutropenic patient

Patients who have recently been neutropenic should be advised to avoid crowded areas, for example shops, cinemas, pubs and other entertainment venues (Calandra [11]). They should be advised that pets should not be allowed to lick them, and new or other people's pets should be avoided. Pets are known carriers of potential pathogens (Lefebvre et al. [72]).
Certain foods, for example take‐away meals, soft cheese and pâté, should continue to be avoided as these foodstuffs are more likely than others to be contaminated with potential pathogens (Gillespie et al. [44]). Salads and fruit should be washed carefully, dried and, if possible, peeled to remove as many pathogens as possible (Moody et al. [79]).
It is vital that the patient and their family know that any signs or symptoms of infection, such as a temperature, should be reported immediately to the patient's GP or to the discharging hospital. Any infection may have serious consequences if not treated promptly.
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