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Slide 1 This Is the Second Lecture Under “Isolation/Precautions” Entitled the “Evolution of Isolation Precautions in Healt Slide 1 This is the second lecture under “Isolation/Precautions” entitled “Evolution of Isolation/Precautions the “Evolution of Isolation Precautions in Healthcare Facilities”. in Healthcare Facilities” In this section, we will take an historical look at how the system http://www.victorianpicturelibrary.com/nurse-and-patient-in-hospital of isolation/precautions has evolved, ending right before the most currently updated CDC (Centers for Disease Control & prevention) Guidelines from 2007. It is recommended that you review Table 1 of the Required Reading entitled “History of http://www.corbisimages.com/images/Corbis- Guidelines for Isolation Precautions in Hospitals” prior to viewing BE041340.jpg?size=67&uid=2ef0f72b-81db-40c6-9140-72ad1b38184f djh©2015 this part of the lecture. This is a 2-page table summarizing the different systems of isolation/precautions used up until the CDC’s most current recommendations. Those most current recommendations will be presented in the third lecture. Slide 2 Plague Hospital, 1500’s This is a plague hospital from the 1500s depicted in historical art, and this would be called an infection control nightmare. You see you have two plague patients in a bed. They had pneumonic plague, which is highly transmissible from person to person and very likely to occur during the 1500s when bubonic plague seeded into the lymph nodes and became secondary pneumonic plague. You have post-mortem care going on and http://3.bp.blogspot.com/-k963sxXjGsw/ULlKXcnapwI/AAAAAAAACa0/ft63q the plague bodies are highly infectious. You have no personal 4gD9zQ/s1600/Hotel_Dieu_in_Paris_about_1500.gif djh©2015 protective equipment in use, which they did not know about then. This lack of any type of isolation/precautions certainly contributed to the transmission of this disease over three centuries. Slide 3 15th Century An interesting phenomenon occurred in this time period. There Plague Doctors were two groups of medical practitioners: the plague physician http://www.delpiano.com/carnival/html/medico_peste.html and the plague surgeon. The plague physician wore the costume depicted in these pictures, which consisted of a leather hat, a mask with herbs, garlic, and/or arsenic in the beak, heavy leather gloves, and a big long gown often made with very heavy material. The stick was to ward off the evil spirits that persons at http://render.fineartamerica.com/images/images-stretched-canvas- that time believe caused plague. The other doctor was the search/15.00/15.00/black/break/images-medium/plague-doctor-france- 18th-century-sheila-terry.jpg djh©2015 plague surgeon. The plague surgeon’s job was to cut open the buboes of bubonic plague, and they wore no personal protective equipment. The infection rate in the surgeon was 5 to 7 times higher than that of a physician. In a way, plague physicians used the first crude personal protective equipment before they really knew about it. Slide 4 Thus, we started out with no isolation when caring for persons No Isolation with infectious diseases. This was the practice for centuries, before it was discovered that germs cause disease. http://www.postaprint.co.uk/ilnimages/i821900.jpg djh©2015 Slide 5 As early as 1877, the first published recommendations on Historical Overview hospital isolation precautions surfaced. They were in the form of • 1877: first published a hospital handbook for nurses that recommended placing recommendations for patients with infectious diseases in separate facilities. These Isolation/Precautions (I/P) became known as infectious disease hospitals. Not a plague • Hospital handbook for nurses- hospital, meningitis hospital, and a tuberculosis hospital, rather place patients with infectious diseases in separate facilities, AKA a hospital where all infectious patients would be housed infectious disease hospitals together. djh©2015 Slide 6 This is an original picture of one of several cottages built at a Infectious Disease Cottage hospital in 1919 to serve as infectious disease wards. icu-web.org/icuweb/images/687/160x128.jpg djh©2015 Slide 7 This concept didn’t work, because there was no physical This Didn’t Work separation between the types of diseases. For example, a tuberculosis patient would be placed in a ward with other types Why? of infected patients. This resulted in nosocomial transmission of • Infected patients not separated infectious diseases. from each other according to their disease • Few, if any, aseptic procedures followed djh©2015 Slide 8 Setting aside a floor or Personnel in infectious disease hospitals began to focus efforts ward for patients with towards reducing nosocomial transmission. One way to do this similar diseases was to set aside a floor or award for patients with similar diseases. In other words, patients with like infectious conditions were placed together; not just patients with any infectious disease. http://whyfiles.org/195bird_flu/images/army.jpg djh©2015 Slide 9 1890-1900: Aseptic The practice of aseptic technique was staring to be techniques recommended recommended in nursing textbooks from 1890-1900 until the in nursing textbooks present, where it continues to be an essential principle of Early Johnson & Johnson sterile surgery products infection control. One definition of “aseptic technique” is “the effort taken to keep patients as free from hospital micro- organisms as possible” (Crow 1989). http://chestofbooks.com/food/household/Woman-Encyclopaedia- 4/images/Making-an-ice-poultice-The-block-of-ice-on-a-plate-a-basin.jpg http://www.kilmerhouse.com/ djh©2015 Slide 10 In 1910, a cubicle system of isolation started. Here they placed 1910: Cubicle System of Isolation a patient in multi-bed wards and hospital personnel used Cubicles in which babies were changed, separate gowns, washed their hands and disinfected patient Each supplied with individual air-conditioning, to prevent air-borne infections objects after use. This was known as “barrier nursing” and • Multi-bed wards • Wearing gowns, provided, for general hospitals, an alternative to placing patients handwashing, disinfection in infectious disease hospitals. This term is still used today. If • “Barrier Nursing” you look at the outbreaks reported of Ebola virus in Kikwit and • Alternative to infectious http://pages.uoregon.edu/adoption/ archive/LenroottoERltr.htm other places in Africa, they use the term “barrier nursing”. disease hospitals djh©2015 Reports will mention that when barrier nursing was used, cases of Ebola transmission between HCW’s and patients remarkably decreased. Slide 11 Isolation Ward on This is an example of an isolation ward on the Queen Mary. Queen Mary http://www.sterling.rmplc.co.uk/vis ions/iso1.jpg djh©2015 Slide 12 About this time we started seeing a rise in the development of TB hospitals opened in U.S. & England TB hospitals, also known as sanatoriums. These were hospitals just for TB patients in the US and in other countries, such as England. I have several different pictures of these in the upcoming slides. On this slide is a photograph of a TB observation ward at the Army Base Hospital No. 20 in 1919. www.archives.upenn.edu/img/alum/ww1tb.jpg djh©2015 Slide 13 Ninette Tuberculosis Here is a picture taken at the Ninette Tuberculosis Sanatorium Sanatorium in Manitoba in Manitoba. One of the treatment protocols was to be out in the http://www.gefor.4t.com/micobacterias/fotos/ninette.jpg sun and in the fresh air. Here are some patients sitting out in the fresh air. Patients taking the air at the Ninette Tuberculosis Sanatorium, Manitoba djh©2015 Slide 14 Here is an interesting picture, because this is an actual Open Air Treatment Hospital illustration of a hospital showing the concept of open air treatment. This is not a cross-section of the hospital-this is actually how it looked. One side of the hospital was completely opened to the outside. The main treatment was quiet, rest, and good food. The average stay in this facility was 86 days. http://sau53.org/dcs/classes/8grade/cemetery/hill/tbguys.jpg djh©2015 Slide 15 Here is a schedule for the day at this TB facility. Get up and Oakwood Hall Sanatorium take your temperature, have breakfast, have milk, exercise, rest, take temperature again, have dinner, more exercise, have tea, recreation, rest, take temperature again, supper, more recreation, milk, and then finally, lights out. During rest periods, patients had to remain completely still and silent. www.micklebring.com/ oakwood/ch08.htm djh©2015 Slide 16 X-ray Machines Here is one of the older chest x-ray machines. http://cmsimg.nurse.com/apps/pbcsi.dll/bilde?Site=CM&Date=20090504&Category= NE02&ArtNo=105040019&Ref=H2&MaxW=195&border=0 djh©2015 Slide 17 TB Treatments in the One of the treatments for TB in the early 1900s was to actually early 1900s do this procedure. A chest tube used to cause a pneumothorax (collapse) in the lung. The theory was that the unaffected lung would recover if TB was only in one lung. That was actually done, but not very effective. http://tb.lung.ca/tb/tbhistory/timeline/pneumo.html djh©2015 Slide 18 Then we come to the 1950s and we have hospitals for infectious 1950’s disease beginning to close and instead patients were seen in outpatient and general hospitals, with the exception of TB http://esparto-spartans.com/gallery/The-Fifthys/America-in- http://www.scripophily.com/webcart/vi the-1950s-old-time-radio-otr-cassettes gs/mickeymouseclubvig.jpg hospitals. TB hospitals stayed around a little longer until the mid • Infectious disease hospitals began to close 60s. –outpatient & general hospital preferred • Exception: those designed for TB djh©2015 Slide 19 By the late 60s, patients with infectious diseases were housed in 1960’s wards in the general hospital, either in a specifically designed http://www.dressthatman.com/pics/pant single patient isolation room or in regular single or multiple collegefashion.net /pant425b.jpg • In mid-1960’s, TB hospitals began to patient rooms.
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