Barrier and Reverse Barrier Nursing

Introduction

Infectious diseases are contagious and can be a threat in the care of patients. The nurse, being the first point of contact with the patient, should ensure the control of the spread by following preventive strategies.

Definitions

Barrier Nursing

Barrier nursing is a set of nursing-related interventions performed for patients with infectious diseases to prevent the spread to others.

Reverse Barrier Nursing

Reverse barrier nursing is nursing care measures rendered in preventing the transmission of infection from healthcare personnel to the patient receiving hospital services.

Purposes

• To prevent spread of infection to patients and hospital staff.
• To prevent nosocomial infection.

Types of Isolation

• Source isolation/barrier nursing.
• Protective isolation/reverse barrier nursing.

Components of Barrier Nursing

• Contact precaution.
• Airborne precaution.
• Droplet precaution.
• Respiratory hygiene.
• Safe injection practices.

Contact Precaution

Contact precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient’s environment.

Measures to be Taken

• Use gloves for routine care.
• Discard gloves after touching infective instruments or materials.
• Maintain proper hand hygiene by hand washing and using sanitizer.
• Principles of hand hygiene.
• Before touching a patient.
• Before a procedure.
• After body fluid exposure.
• After touching the patient.
• After touching objects in the patient’s surroundings.
• Use proper PPE in case of direct contact with the infected patients.
• Limit visitors.
• Ensure periodic cleaning and disinfection.

Droplet Precaution

Droplet precautions are intended to prevent transmission of pathogens through close respiratory or mucous membrane contact with respiratory secretions.

Measures to be Taken

• Use mask (N95 respirator mask).
• Limit visitors.
• Place the patient in a cross-ventilated private room; doors can be kept opened.

Airborne Precaution

Airborne precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air.

Measures to be Taken

• Place the patient in a well-ventilated private room that has negative air pressure.
• Use PPE.
• Disinfect periodically.
• Ensure following standard safety protocols for handling biomedical waste.

Respiratory Hygiene

Respiratory hygiene/cough etiquette refers to measures that are followed by persons with copious respiratory secretions due to a respiratory infection to prevent the transmission of the infection to other persons.

Measures for Respiratory Hygiene

• Cover the mouth and nose with a tissue when coughing or sneezing.
• In the absence of a handkerchief or tissues, cover the nose and mouth with the arm during coughing or sneezing.
• Dispose of the tissue after use in the nearest waste container.
• Perform hand hygiene after contact with respiratory secretions and contaminated objects or materials.
• Posters in local language elaborating cough etiquette and hand hygiene must be displayed in the hospital.

Safe Injection Practice

Giving injection is a routine work of a nurse. The World Health Organization (WHO) has set a few guidelines for safe injection practices to prevent medication errors and injuries. A common campaign for safe injection practice is One Needle, One Syringe and One Time Only.

Specific Guidelines for Safe Injection Practices

• Follow proper infection control practices such as hand hygiene.
• Maintain aseptic technique during the preparation and administration of injected medications.
• Never administer medication from the same syringe to more than one patient.
• Never enter a vial with a used syringe or needle.
• Do not use medications packaged as single-dose or single-use for more than one patient.
• Do not use bags of intravenous solution as a common source of supply for more than one patient.
• Limit the use of multidose vials and dedicate them to a single patient whenever possible.
• Do not keep multidose vials in the immediate patient treatment area.
• Medications should be prepared in an area that is free from contamination on a clean work surface.
• Always use face masks when injecting a material or inserting a catheter into the epidural or subdural space.
• Follow all the 10 rights for medication administration.
• Ensure the correct location of the site for medication administration.
• Assess the injection site for skin breakdown, damage, abscess, and discoloration.
• For patients receiving continuous injection, ensure rotation of the site.
• Avoid recapping, and dispose of the needles in a puncture-proof container.

Follow hospital protocol for preventing needlestick injuries.

Special Considerations

Barrier Nursing (Protecting others from the patient)

• Purpose: Prevent transmission of infectious agents from the patient to others.
• Patient Type: Those with contagious diseases (e.g., TB, MRSA, COVID-19).
• Environment: Isolation room with clear signage and restricted access.
• PPE Requirements: Gloves, gowns, masks, eye protection—strictly enforced.
• Equipment Use: Dedicated or disposable; disinfect reusable items thoroughly.
• Waste Disposal: Treat as biohazardous; follow infection control protocols.
• Visitor Policy: Limited or prohibited; visitors must follow full PPE protocols.
• Staff Training: Emphasize hand hygiene, donning/doffing PPE, and contamination prevention.

Reverse Barrier Nursing (Protecting the patient from others)

• Visitor Policy: Limited and strictly controlled; visitors must be symptom-free.
• Purpose: Shield immunocompromised patients from external pathogens.
• Patient Type: Neutropenic, post-transplant, chemotherapy, or severely immunosuppressed.
• Environment: Sterile or positive-pressure rooms with HEPA filtration.
• PPE Requirements: Clean gowns, gloves, masks for all entering the room.
• Hygiene Protocols: Rigorous hand hygiene; sanitize all items brought in.
• Food & Flowers: No raw foods, fresh flowers, or unwashed produce allowed.
• Monitoring: Frequent assessment for early signs of infection.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884

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