Isolation (health care)

Isolation is a public health process that uses procedures and equipment to separate people who are sick with a contagious disease from others who do not have the illness. A person whose immune system is not working properly may also be placed in isolation to protect them from infections carried by others—this scenario is called protective isolation since the goal is to protect the patient from the environment. Isolation is not the same as the quarantine process, which separates people who might have been exposed to a contagion from others until it is determined if they have been infected.

Background

Isolation is used to control the spread of contagious diseases. A contagious disease is one that can be spread from a person who has the disease to someone who does not. Contagious diseases are infectious diseases. These diseases are caused by pathogens such as viruses, bacteria, fungi, or parasites. Contagious diseases can be spread in a variety of ways. Indirect contact, where a person touches something that is contaminated with the contagion and then touches their mouth, nose, or eyes, is one way. Contagions can also be spread through the air and by droplets of mucus propelled by coughs and sneezes. Another route of spread is through direct contact with the person who has the disease by the immediate physical transfer of pathogens to a susceptible host, commonly through skin-to-skin contact, sexual intercourse, or contact with bodily fluids.

Contagious diseases range in intensity from common colds to severe, potentially life-threatening infections such as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), smallpox, measles, tuberculosis, and COVID-19. Medical professionals use preventive measures to avoid spreading diseases between patients, such as wearing gloves and masks and thorough handwashing. Additional precautions, including isolation, are used for diseases that present a greater risk of death and for patients who are immunocompromised. Immunocompromised people have a problem with their immune system that makes it harder for them to fight off infections.

The word isolation comes from the Latin word insula, meaning “island.” Before people developed ways to treat serious illnesses, the most effective way to limit the spread of disease was to keep sick people separate from healthy people. Following the devastation of the bubonic plague outbreak known as the Black Death (1346-1353), the first hospital specifically established to treat the victims was established in the fifteenth century on the island of Santa Maria di Nazareth near Venice. Patients sent there for treatment were said to be “islanded”; this gradually became the word isolated and referred to patients with a contagious infection who were separated to limit the spread of the infection.

Overview

Isolation can be a very effective means of controlling disease because it limits who comes in contact with the pathogen causing the disease. Those who do go near the infected person take precautions to limit their exposure to the pathogen and to prevent it from leaving the isolation area. Many times, the patient is placed in a private room. Different isolation procedures are used for various types of contagions. The exact procedures can vary between countries and in different medical facilities. The procedures are also dependent on the way the contagion, which causes the disease, is spread.

In most cases, the patient will be kept in a separate room or in a room with other patients with the same condition. A notification that the patient or patients are in isolation will be posted on the doorway. However, isolation does not mean that the patient or patients remain alone in the room. Medical personnel and some visitors will be allowed to enter. In most cases, everyone who enters the room will wear personal protective equipment, or PPE. This might include masks that cover the mouth and nose, gowns that cover street clothes, gloves made of latex or a similar non-latex material, shoe covers, and possibly goggles or a face shield. PPE will be removed when exiting the room and either disposed of or stored for cleaning. Staff and visitors generally wash their hands before entering and after leaving the room. In addition, other precautions may be followed based on the type of contagion.

Contact Contagion. Some diseases are spread by contact with the patient or with objects they have used or touched. Gloves and gowns are worn by visitors to the isolation area, and handwashing is emphasized. Hospital staff also use special containers and procedures for cleaning the room, washing and sanitizing the patient’s laundry, and disposing of anything that comes in contact with blood or other bodily fluids.

Droplet Contagion. Patients with respiratory infections can spread disease through mucus droplets propelled by sneezes, coughs, or even forceful speaking. These droplets can often spread three to six feet or farther. Precautions to avoid droplet contagion include the use of masks, goggles or plastic face shields, and gowns.

In 2024, the Centers for Disease Control and Prevention (CDC) updated respiratory illness guidance, replacing fixed isolation periods with symptom-based recommendations.

Airborne Contagion. Some contagions are small enough to become airborne. This means they can float in the air around and near the patient. These contagions require strict precautions to prevent them from moving outside of the patient’s room. Rooms to contain airborne contagions are often equipped with a negative air pressure system. Negative air systems use gentle air pressure to draw contagions from the room into a filtered system. These rooms are equipped with doors that also help contain the air; there will often be a whooshing sensation when these doors are opened because of the pressurized system.

Other precautions will be taken as well. These include the use of special masks, such as the N95, that help filter the air, goggles or face shields, gowns, and shoe covers. Visitors will often be more restricted for patients with these contagions.

Issues with Isolation. While isolation is an important method for controlling the spread of contagious diseases, it does present some problems. The most serious are the emotional and mental health issues it may cause patients and families. Although most isolated patients are allowed some visitors, the reduced contact with others and the restrictions on who can visit can be upsetting to both the patient and their loved ones. This sometimes has consequences, such as depression.

The patient might react to the emotional stress of isolation by becoming uncooperative with treatment and staff. The additional work required to comply with isolation procedures may make staff members less likely to spend as much time with these patients. This can increase the risk of negative outcomes for patients in isolation. However, these problems can sometimes be overcome with increased communication. Another potential issue with isolation is that it increases the cost of care. This is because the additional PPE supplies and special equipment are costly. The need for private rooms can also affect the hospital’s capacity to treat other patients.

The World Health Organization’s 2020 report on mental health and COVID-19 states that emotional support and regular communication with family can help reduce depression and improve well-being during periods of isolation.

Bibliography

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