Wednesday, 19 May 2010

NEUTROPENIC PRECAUTIONS

Unlike other types of precaution procedures, neutropenic precautions (also known as protective precautions and reverse isolation) guard the patient who is at increased risk for infection against contact with potential pathogens. These precautions are used primarily for patients with extensive noninfected burns, those who have leukopenia or a depressed immune system, and those receiving immunosuppressive treatments. (See Conditions and treatments requiring neutropenic precautions, page 130.)
Neutropenic precautions require a single room equipped with positive air pressure, if possible, to force suspended particles down and out of the room. The degree of precautions may range from using a single room, thorough hand-hygiene technique, and limitation of traffic into the room to more extensive precautions requiring the use of gowns, gloves, and masks by facility staff and visitors. The extent of neutropenic precautions may vary from facility to facility, depending on the reason for and the degree of the patient's immunosuppression.
To care for patients who have temporarily increased susceptibility, such as those who have undergone bone marrow transplantation, neutropenic precautions may also require a patient isolator unit and the use of sterile linens, gowns, gloves, and head and shoe coverings. In such cases, all other items taken into the room should be sterilized or disinfected. The patient's diet also may be modified to eliminate raw fruits and vegetables and to allow only cooked foods and possibly only sterile beverages.
Equipment
Gloves • gowns • masks• neutropenic precautions door card.
Gather any additional supplies, such as a thermometer, stethoscope, and blood pressure cuff, so you don't have to leave the isolation room unnecessarily.
Preparation of equipment
Keep supplies in a clean enclosed cart or in an anteroom outside the room.
Implementation
  • After placing the patient in a single room, explain isolation precautions to the patient and his family to ease patient anxiety and promote cooperation.
  • Place a neutropenic precautions card on the door to caution those entering the room.
  • Wash your hands with an antiseptic agent before putting on gloves, after removing gloves, and as indicated during patient care.
  • Wear gloves and gown according to standard precautions, unless the patient's condition warrants a sterile gown, gloves, and a mask.
  • Avoid transporting the patient out of the room; if he must be moved, make sure he wears a gown and mask. Notify the receiving department or area so that the precautions will be maintained and the patient will be returned to the room promptly.
  • Don't allow visits by anyone known to be ill or infected.
Special considerations
  • Don't perform invasive procedures, such as urethral catheterization, unless absolutely necessary because these procedures risk serious infection in the patient with impaired resistance.
  • Instruct the housekeeping staff to put on gowns, gloves, and masks before entering the room; no ill or infected person should enter. They should follow the same requirements as the staff, depending on the patient's condition and facility policy.
    P.130

  • Make sure the room is cleaned with freshly prepared cleaning solutions. Because the patient doesn't have a contagious disease, materials leaving the room need no special precautions beyond standard precautions.

Documentation
Document the need for neutropenic precautions on the nursing care plan and as otherwise indicated by your facility.