Key messages

• Patients may require source isolation or protective isolation.

• Engineering considerations include source isolation, protective isolation, mechanics of intensive care unit isolation, and room utilities.

• Nursing considerations include dress, gloves, and masks.

• When the room is vacated, all surfaces must be thoroughly cleaned with warm water containing detergent and then dried. Introduction

Two categories of patients admitted to the intensive care unit (ICU) need care delivered in isolation from other patients: immunocompromised patients who are susceptible to all kinds of infecting agents, and patients infected with communicable diseases or colonized or infected with an organism that may have important consequences for other susceptible patients in the ICU. In both cases the objective is to insert a barrier between these patients and all other patients in the ICU, hence the old term 'barrier nursing'. However, this term does not convey the important difference between the two groups. The susceptible patient is at risk from the environment and the people he or she comes into contact with and 'protective isolation' is the goal, whereas the infected patient may be a risk to people he or she is in contact with and other patients and 'source isolation' is the goal. Although the principles of protective and source isolation are very different, the two groups may overlap. For example, the susceptible burned patient may become colonized or infected with a multiple antibiotic-resistant organism.

When designing and planning an ICU, provision for isolation needs to be assured to avoid closure due to a problem of susceptibility or infection. Provision for both protective isolation and source isolation will be necessary in an ICU serving a diverse patient population.

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