barrier nursing – definition, nursing care and universal precautions

BARRIER NURSING

UPDATED 2024

The term “barrier nursing” is given to a method of nursing care that has been used for over one hundred years when caring for a patient known or thought to be suffering from a contagious disease such as open pulmonary tuberculosis.

Barrier nursing is an approach to patient care that involves implementing strict infection control measures and physical barriers to prevent the transmission of infections. The goal of barrier nursing is to protect both healthcare providers and patients from the spread of infectious agents.

• Isolation nursing is carried out by
  placing the patient in a single room or side room
• Barrier nursing: this occurs when a
  patient’s is kept in a bay and extra precautions are implemented to prevent
  spread of the germ

It is sometimes
called “bedside isolation”. As the name implies, the aim is to erect a barrier
to the passage of infectious pathogenic organisms between the contagious
patient and other patients and staff in the hospital, and hence to the outside
world. Preferably, all contagious patients are isolated in separate rooms, but
when such patients must be nursed in a ward with others, screens are placed
around the bed or beds they occupy

The nurses wear gowns, masks, and sometimes rubber gloves, and they observe strict rules that minimize the risk of passing on infectious agents. All equipment and utensils used to care for the patient are immediately placed in a bowl of sterilizing solution, and attending nurses observe surgical standards of cleanliness in hand washing after they have been attending the patient. Bedding is carefully moved in order to minimize the transmission of airborne particles, such as dust or droplets that could carry contagious material, and is cleansed in special facilities that include the use of steam heat for sterilization

Barrier Nursing Care

• No visitors, only essential key staff
  should be allowed in the isolation area
• One nurse should look after the
  isolation cases and ideally should not be involved in any other patient care
• Write the name of the Barrier Nurse
  on the front of the kennel
• Use paper disposable towels for hand
  drying and the cleaning of kennels as this will help reduce the risk of
  spreading infection
• Color Code all re-usable equipment
  RED to identify as for isolation use ONLY so it doesn’t go walk-about
• Have a separate waste bin for these
  cases
• Consider using a specific color vet
  bed for these patients only
• Consider using pulp disposable bowls
  and trays for highly infectious patients so these can be discarded once used
• Ensure a batch of disposable Personal
  Protective Equipment such as gloves, aprons, masks, and overshoes are readily
  available in the immediate vicinity
• Autoclave or dispose of all reusable
  equipment before using an another patient

UNIVERSAL PRECAUTIONS

Standard precautions
are meant to reduce the risk of transmission of blood borne and other pathogens
from both recognized and unrecognized sources. They are the basic level of
infection control precautions which are to be used, as a minimum, in the care
of all patients.

Hand hygiene
is a major component of standard precautions and one of the most effective
methods to prevent transmission of pathogens associated with health care. In
addition to hand hygiene, the use of personal protective equipment should be
guided by risk assessment and the extent of contact anticipated with blood and
body fluids, or pathogens

Universal Precautions include

• Using disposable gloves and other
  protective barriers while examining all patients and while handling needles,
  scalpels, and other sharp instruments
• Washing hands and other skin surfaces
  that are contaminated with blood or body fluids immediately after a procedure
  or examination
• Changing gloves between patients and
  never reusing gloves

Universal Precautions Apply to the Following Body Fluids

• Blood
• Semen and vaginal secretions
• Cerebrospinal fluid (CSF)
• Synovial fluid
• Pleural fluid
• Pericardial fluid
• Amniotic fluid

The Center for Disease Control (CDC) recommends the procedure called Standard Precautions which includes the following:

• All healthcare workers should
  routinely use appropriate barrier protection to prevent skin and mucous
  membrane exposure when contact with blood or body fluids is anticipated. Gloves
  must be worn during phlebotomy and changed after contact with each patient.
  Masks, protective eyewear, face shields, and/or gowns should be worn as
  indicated when there is a potential for splashing or splattering of blood
  and/or body fluids
• Wash hands immediately if
  contaminated with blood or body fluids and after removing gloves
• Take the necessary precautions to
  prevent injuries caused by needles, scalpels and other sharp instruments. Sharp
  items must be placed in a puncture-resistant container
• Mouth pieces, resuscitation bags, or
  other ventilation devices should be available for use in areas in which the
  need for resuscitation is predictable
• Healthcare workers with exudative
  lesions or weeping dermatitis should cover those areas with an occlusive
  bandage
• Pregnant healthcare workers are not
  known to be at any greater risk of contracting HIV infection than those who are
  not pregnant. Because the infection can be transmitted perinatally
• Pregnant healthcare workers should be
  especially familiar with and strictly adhere to precautions to minimize the
  risk of acquiring HIV or Hepatitis B

Immunization of employees is required for infectious agents (measles, mumps, rubella) transmitted by air.

Key Features of Barrier Nursing:

1. Personal Protective Equipment (PPE):
   • Barrier nursing involves the use of various types of PPE, including gloves, gowns, masks, and eye protection. These protective measures create a physical barrier between healthcare workers and potentially infectious materials.
2. Isolation Precautions:
   • Patients who are placed under barrier nursing often require isolation precautions. These precautions can include contact isolation, droplet isolation, or airborne isolation, depending on the mode of transmission of the infectious agent.
3. Restricted Movement:
   • Limiting the movement of patients to essential activities helps prevent the spread of infectious agents within the healthcare facility. Movement restrictions may include limitations on visitation, patient transport, and participation in group activities.
4. Environmental Controls:
   • Strict cleaning and disinfection of the patient’s environment, including surfaces and equipment, are essential components of barrier nursing. This helps reduce the risk of environmental contamination and transmission of pathogens.
5. Visitor Restrictions:
   • Barrier nursing often involves restricting or controlling visitor access to prevent the potential spread of infections. Visitors may be required to wear PPE and follow specific infection control measures.
6. Education and Training:
   • Healthcare providers involved in barrier nursing receive specialized education and training on proper infection control practices, the correct use of PPE, and the implementation of isolation precautions.
7. Respiratory Hygiene/Cough Etiquette:
   • Encouraging patients and healthcare workers to practice proper respiratory hygiene, including covering the mouth and nose when coughing or sneezing, helps prevent the spread of respiratory infections.
8. Waste Management:
   • Proper disposal of contaminated materials and waste is crucial in minimizing the risk of transmission of infectious agents.
9. Hand Hygiene:
   • Stringent hand hygiene practices are a fundamental aspect of barrier nursing. Healthcare workers must perform handwashing or use hand sanitizers before and after patient contact and after removing PPE.

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