Protective isolation or contact isolation ?

Question

Hello,
Currently studying second year of nursing school, I have completed an internship in pediatrics where patients with cystic fibrosis were present due to exacerbation. I noticed that they were isolated and I can not find on any official website (HAS for example) what the kind of isolation is: is it a protective isolation or a contact isolation? It was a contact isolation when the patient had antibiotic-resistant bacteria. If the patient does not have MRSA, is it a contact isolation anyway? Why?

Answer

Hello
Thank you for your interest in cystic fibrosis patients.
I have no information on the identified bacteria in the sputum of patients hospitalized in the ward.
Generally there are two types of hygienic precautions: "standard" hygienic precautions for any hospitalized patient: hand hygiene, wearing gloves during contact with body fluids ... and specific hygienic precautions like contact isolation, droplet isolation, protective isolation...
Here is a classification of germs in the sputum of cystic fibrosis patients:
Class 1: Saprophytic bacteria and sensitive to most antibiotics such as Haemophilus influenzae, sensitive Staphylococcus aureus, Streptococcus pneumoniae
Class 2: Pseudomonas aeruginosa sensitive to most antibiotics
Class 3: multi-resistant bacteria such as Staphylococcus aureus resistant to methicillin, 3rd generation cephalosporin-resistant Pseudomonas aeruginosa or resistant to imipeneme, Stenotrophomonas maltophilia and Alcaligenes ...
Class 4: Burkholderia cepacia, Ralstonia Picketti ...
You will find different types of isolations adapted to the identified germs in the sputum of patients, but also to their "situations" (patient not colonized, transplanted patient).
For classe 1, hygiene standard precautions, and sometimes protective isolation, are recommended to avoid cross-contamination with patients having more resistant germs
For class 2, contact isolation is recommended. This aims to prevent the transmission of an infectious agent known or suspected from a patient infected to uninfected individuals and non-carriers but susceptible (patients and professionals). These precautions are diffusion barriers for the infectious agent from the patient or his immediate environment.
For classes 3 and 4 (sometimes also class 2), droplet isolation is recommended. (A droplet isolation is a contact isolation with travel restrictions, mask worn by the patient when leaving the room and mask for caregivers in proximity care).
This isolation is recommended for a patient with a (or more) multi-resistant germ.
For transplanted patients, and patients not colonized, a protective isolation is recommended. A protective isolation is intended to prevent the transmission of any potentially infectious agent to these immunocompromised patients. They form a barrier to the entry of infectious agents in the immediate environment of the patient.
You can find more information (in French) on these websites
www.sante.gouv.fr/maitrise-de-la-diffusion-des-bacteries-multiresistantes-aux-antibiotiques.html

www.sf2h.net/publications-SF2H/SF2H_prevention-transmission-croisee-2009.pdf

www.sf2h.net/publications-SF2H/SF2H_surveiller-et-prevenir-les-IAS-2010.pdf

Cordialy
Marythé Kerbrat

13.11.2012