Care of Severely Compromised Patients

Extract

Patients with certain diseases (for example, leukemia, cancer, and extensive skin conditions, such as severe burns or dermatitis) and patients who are receiving certain therapeutic regimens (for example, total body irradiation, steroid or antimetabolite therapy) are highly susceptible to infection. These compromised patients are often on special “protective” patient-care regimens intended to reduce the risk of infection. One such regimen, Protective Isolation (as outlined in the previous editions of Isolation Techniques for Use in Hospitals), does not appear to reduce this risk any more than strong emphasis on appropriate handwashing during patient care.

Protective isolation, as previously outlined, may fail to reduce the risk of infection because compromised patients are often infected by their own (endogenous) microorganisms or are colonized and infected by microorganisms transmitted by the inadequately washed hands of personnel or by nonsterile items used in routine protective isolation. Such items may include patient-care equipment, food, water, and air. Some studies suggest that vigorous efforts to exclude all microorganisms by using patient-isolator units, eradicating endogenous flora, and sterilizing food, water, and fomites may prevent or delay onset of some infections; thus, these procedures have been recommended by some for use with very-high-risk patients who have a predictable temporary period of high susceptibility. However, these extraordinary and expensive precautions do not appear warranted for most compromised patients.