Public Health Agency

Isolation of patients


Isolation precautions should be used for patients who are either known or suspected to have an infectious disease, are colonised or infected with a multi-resistant organism or who are particularly susceptible to infection.   

1.   Source Isolation aims to confine the infectious agent and prevent its spread from one patient to another. (Source isolation was previously known as ‘barrier nursing’).

2.  Protective Isolation aims to protect an immunocompromised patient who is at high risk of acquiring micro-organisms from either the environment or from other patients, staff or visitors.

It is important that standard IPC precautions are implemented at all times and all patients must be assessed on admission to ensure that they are placed in appropriate isolation if necessary. Patients with certain conditions must be isolated immediately for example:

  • Diarrhoea and/or vomiting
  • Undiagnosed rashes and fevers
  • Known Carbapenem Producing Enterobacteriaceae  (CPE) patients/carriers
  • Suspected or confirmed Group A streptococcal infection (i.e. necrotizing fasciitis)
  • Patients shedding Meticillin-resistant staphylococcus aureus (MRSA), Glycopeptide-resistant enterococci (GRE)
  • Patients admitted from a hospital outside NI who may be infected/colonised with resistant micro-organisms
  • Bacterial meningitis

Source Isolation

Source isolation can be achieved by nursing the patient in a single room or a negative pressure isolation room/unit with an ensuite toilet. Inclusion of a ventilation system distinguishes an isolation room from a single room. Isolation is usually carried out in a single (preferably en-suite) room with hand washing facilities and with the door kept closed. Occasionally cohort nursing (placing the patient in a room/bay area with other patients who are infected or colonised with the same microorganism), may be considered. Cohorting should only be done as a last resort and on the advice of the local IPC team/PHA. If co-horting patients, a dedicated team of staff should care for these patients; however this can only be implemented if sufficient staff are available. The type of IPC precautions required for a patient in source isolation will depend on the mode of transmission of the organism causing the illness i.e. airborne, droplet, contact, or standard.

Protective Isolation

Many infections acquired by immunocompromised patients are endogenous infections (An infection caused by an infectious agent that is already present in the body, but has previously been inapparent or dormant), however transmission of infection from other patients, staff or the environment can be a risk and therefore extra precautions are required. Patient’s requiring protective isolation should be nursed in a single room. Where possible this room should have an ante-room, positive pressure ventilation and Hepa filtered air. The room should have an en-suite and hand washing facilities and the doors(s) should be kept closed at all times. For maximum effect, only one of the doors in the ante-room should be open at any time when entering or leaving the cubicle. It is important to note, that in some cases, if an immunocompromised patient has a concurrent communicable disease, source isolation may be required and positive pressure ventilation may be inappropriate – these patients should be discussed with the IPC Team/Microbiologist/Clinician.

Patients should remain in isolation whilst they remain symptomatic; a risk assessment should be undertaken to ascertain if and when isolation precautions can be relaxed.

It is the responsibility of ALL members of staff to comply with isolation and Infection Control procedures. Healthcare Associated Infections (HCAI’s) are generally transmitted by healthcare workers and one person’s failure to comply with simple procedures may negate the diligence of the rest of the team.


  1. Damani D (2012) Manual of Infection Control Procedures. 3rd Edition. Greenwich Medical Media: London
  2. Ayliffe GAJ, Fraise AP, Geddes AM, Mitchell K.  Control of hospital infection.  A Practical Handbook. 5th Edition 2009 Edward Arnold (Publishers) Ltd
  3. Department of Health (2013) Health Building Note 04-01 (Supplement 1) Isolation facilities for infectious patients in acute settings. London: Department of Health
  4. DHSSPS circular HSS(MD)41/2004 on Isolation Rooms (including Mechanically Ventilated rooms). Best Practice Standards for Capital Planning. December 2004