Isolation

ISOLATION (from Latin isolatio - separation, isolation), seclusion, separation, a sanitary measure consisting in the separation of a contagious patient or a person suspected of contagious disease with the aim of preventing the spread of the disease. Patients are isolated for the period during which they remain contagious; those suspected of contagious disease are isolated for the duration of the incubation period. According to the International Sanitary Convention of 1926, in international communications, isolation is mandatory for patients with plague, cholera, yellow fever, typhus, and smallpox; persons who have been in contact with patients or those suspected of disease may only be subjected to observation (temporary isolation): in plague - up to 6 days, in cholera - up to 5 days, in yellow fever - up to 6 days. In typhus and smallpox, observation is not applied to the aforementioned persons; persons who may be considered lice carriers or persons who have been in danger of contracting typhus are subject to disinsection; those suspected of smallpox infection may be vaccinated; both groups may be placed under medical observation. Isolation (observation) of persons who have been in contact with contagious patients, according to the convention, is applied to passengers arriving at ports or at sea borders on an infected vessel. At land borders, isolation is mandatory only for persons in whom symptoms of disease are detected; among persons surrounding these patients - only those who have been in contact with patients with pulmonary plague. Passengers who have been in contact with other contagious patients are not subject to observation at land borders. Legislation of the USSR (Provisional Regulations on the Sanitary Protection of the Borders of the Union of SSR, 1926) also provides for isolation (in addition to those listed above) of patients with relapsing fever. Within the USSR, as in a number of other countries, sanitary physicians are granted the right to isolate other contagious and those suspected of contagious diseases if their presence together with healthy persons is associated with obvious danger to others and threatens the spread of infection among the population. The list of infections for which isolation is mandatory is established by local mandatory regulations. Due to the great practical importance that the duration of isolation of patients has, the People's Commissariats of Health of the USSR have established isolation periods for a number of infections. Below is a table of these periods, approved by the Medical Scientific Council of the RSFSR in 1929. (During the period of isolation, insured patients are paid by the insurance fund.) Similar periods have been established in other union republics. Contagious patients may be isolated either in special medical institutions (contagious disease hospitals) or at home. With respect to certain infections, special rules of isolation are also applied (e.g., when isolating patients with yellow fever, it is necessary to eliminate the possibility of mosquitoes becoming infected - screening of windows and doors). When isolating a patient at home, it is advisable to require 1) isolation of the patient in a separate room, 2) assignment of a special person to care for the patient. This person must take all necessary measures not to spread infection among others (changing clothes, washing, etc.). For isolating persons during the disinfection of the premises where a contagious patient was located, as well as for the sanitary treatment of these persons, isolation houses are used (see). For temporary isolation of persons suspected of contagious disease within general hospitals, special small-sized wards or isolation wards are allocated (see Hospital, Isolation Ward), where patients are kept until diagnosis is established. Similar wards or rooms, isolated from other premises, are also allocated for isolating suspicious patients in dormitories, especially children's (in children's institutions).

I. Dobrotser. Isolation of the mentally ill represents a measure applied in a psychiatric hospital and consisting in placing the mentally ill patient in a separate room. ISOLATION PERIODS FOR CONTAGIOUS PATIENTS AND PERSONS WHO HAVE BEEN IN CONTACT WITH CONTAGIOUS PATIENTS. Name of disease Yellow-fever group 1. Typhoid fever 2. Paratyphoid 3. Cholera 4. Bacillary dysentery II. Parasitic typhuses 5. Typhus 6. Relapsing fever III. Acute exanthemas 7. Smallpox natural 8. Smallpox chickenpox Duration of the period after which a former contagious patient is considered safe 9. Measles 10. Rubella measles After two negative results of examination of feces and urine for typhoid bacillus. The first examination is performed one week after the disappearance of clinical symptoms, in particular a drop in temperature. Repeated examinations are performed with a 5-day interval (after administration of laxatives). If it is impossible to perform bacteriological examination - no earlier than 2 weeks after the disappearance of clinical symptoms, in particular a drop in temperature. If the patient after two examinations turns out to be a bacillus carrier, he is placed under medical observation and is not admitted to work for the entire period of bacillus carriage, if he serves at a central water supply, in a bakery, canteen, in a confectionery or dairy enterprise. Note. In chronic bacillus carriage, workers at the central water supply and in the enterprises listed above are transferred to other work. The same as in typhoid fever. Bacillus carriers are not admitted to production for the manufacture of sausage products. After two negative results of examination of feces for cholera vibrios. The first examination is performed no earlier than 5 days after clinical recovery from cholera. If examination is impossible - separation is terminated no earlier than 7 days after the disappearance of clinical symptoms of the disease. Note. Bacillus carriers of cholera vibrios are subject to mandatory separation. In bacteriologically established forms - after two negative examinations for the corresponding microbe (with an interval of 5 days). In case of impossibility to perform bacteriological examination - no earlier than 10 days after the disappearance of clinical symptoms of dysentery. Note. Chronic bacillus carriers are subject to separation only during the period of exacerbation. After 10 days after a drop in temperature provided thorough personal disinsection. At normal temperature - after 18 days from the last attack, provided thorough personal disinsection. After complete falling off of smallpox crusts, no earlier than 40 days from the onset of the disease. After falling off of crusts, but no earlier than 14 days from the onset of the rash. Note. In an already developed epidemic in a children's institution, patients who have had the disease are admitted after the disappearance of acute manifestations of the disease. After 7 days from the onset of the rash. Duration of the separation period for persons who have been in contact with contagious patients Separation applies only to persons serving the enterprises listed in section I, who are admitted to these enterprises after a single negative examination of feces for typhoid bacillus, but remain under medical observation for 1 month. The same as in typhoid fever. Separation is terminated after a single negative result of examination of feces for cholera vibrios, but no earlier than 5 days from the day of contact with the patient. Separation is not applied. After 7 days from the onset of the rash. Note. In an already developed epidemic in a children's institution, those who have had the disease

are permitted after the acute manifestations of the disease have disappeared. * Chronic bacillary carriage is defined as lasting more than 3 months. Separation is terminated after disinfection of the body and clothing, after which medical supervision is established for 12 days. Separation is terminated after disinfection of the body and clothing, after which medical supervision is established for 8 days. Separation is terminated after vaccination against smallpox, after which medical supervision is established for 14 days. Note. Vaccination against smallpox is carried out immediately for those in contact upon establishment of the diagnosis. For adults, as well as children who have had the disease, separation is not applied. For children who have not had the disease, separation is applied for 21 days. Note. In case of an epidemic developing in a children's institution, separation is not applied even to those who have not had the disease. For adults, as well as children who have had the disease, separation is not applied. For children who have not had the disease, separation is applied for 21 days. Note. In case of an epidemic developing in a children's institution, separation is not applied. The same as for measles. Duration of isolation for contagious patients and persons who have been in contact with contagious patients. (Continuation.) Disease name 11. Scarlet fever and scarlatiniform rash IV. Other infections 12. Whooping cough 13. Mumps 14. Diphtheria 15. Glanders 16. Plague 17. Anthrax 18. Epidemic cerebrospinal meningitis 19. Epidemic encephalitis 20. Epidemic poliomyelitis (Heine-Medina disease) 21. Erysipelas Duration of the period after which a former contagious patient is considered safe Duration of separation for persons who have been in contact with contagious patients After 40 days from the onset of the disease and in the absence of acute purulent complications. For children, as well as adults serving in children's institutions, after 40 days from the onset of the disease (cough). For children, as well as adults serving in children's institutions - 14 days after disappearance of clinical manifestations of the disease. For adults not serving in children's institutions - after disappearance of clinical manifestations. Note. In case of an epidemic developing in a children's institution, those who have not had the disease are admitted to the institution after disappearance of clinical manifestations of the disease. After two negative examinations of throat and nose secretions with a two-day interval. The first examination is performed after disappearance of acute clinical manifestations, but not earlier than 14 days from the onset of the disease. The total period of separation should not exceed 8 weeks from the day of recovery. If it is impossible to perform bacteriological examination - after 14 days from complete disappearance of acute clinical manifestations, but not earlier than 21 days from the onset of the disease. In acute form - separation for the entire period of the disease, in chronic form - for the entire time the patient has open foci. After recovery, the patient remains under long-term (for several years) medical supervision. In bubonic plague - after disappearance of clinical symptoms (regression, resolution of buboes) and after healing of skin ulcers formed at the site of opened buboes, carbuncles, and pustules. In pneumonia - after obtaining negative results from multiple examinations of sputum for plague bacilli. After disappearance of the bacilli, but not earlier than disappearance of clinical manifestations. After two negative examinations of the mucous membrane of the throat and nose for meningococci. The first control examination is made after disappearance of acute clinical manifestations from the meninges and not earlier than 21 days from the onset of the disease. If bacteriological examination is impossible - not earlier than 30 days from the onset of the disease in the absence of acute manifestations from the meninges. After cessation of acute manifestations of the disease. After cessation of acute manifestations, but not earlier than 21 days from the onset of the disease. After cessation of clinical manifestations. For children who have not had the disease - separation for 12 days after isolation of the patient. For children who have had the disease, as well as adults in the absence of acute inflammatory manifestations from the throat and nasopharynx - separation is terminated the day after isolation of the patient. For children who have not had the disease - separation for 14 days after isolation of the patient. For adults who have not had the disease, serving in children's institutions, separation is not applied, but medical supervision is established. Note. Children who have not had the disease may be admitted to a children's institution on condition of their isolation within the institution itself. For children who have not had the disease - for 21 days after isolation of the patient. For children who have had the disease, and adults, separation is not applied. For children, as well as adults serving in children's institutions - separation is terminated in the absence of acute inflammatory manifestations in the throat and nose and after a single negative bacteriological examination of the secretions from the mucous membrane of the throat and nose. If examination is impossible, separation is terminated after 7 days from isolation of the patient and in the absence of acute inflammatory manifestations from the throat and nose. Note. Virulent bacillary carriers - children, as well as adults serving in children's institutions - are subject to separation until obtaining three negative results of bacteriological examination, performed at intervals of 4 days. However, the total period of separation should not exceed 8 weeks from the time of establishment of bacillary carriage. Separation is not applied. After 6 days with normal temperature (mandatory thermometry 2 times a day, in the morning and evening). Separation is not applied. For children, as well as adults serving in children's institutions - after a single negative examination of the nasal and throat mucous membranes. If it is impossible to perform bacteriological examination - after 4 days from separation from the patient. Separation is not applied. For children, separation is terminated after 10 days from isolation of the patient. Adults are not subject to separation. Persons of the medical and care personnel who are in contact with erysipelas patients are not admitted to surgical and maternity departments. S. Zh. E. t. XI. ^sa*e a lockable room. I. belongs to the category of harsh restrictive measures, around which there was recently a struggle that has not ended even in our time. The usual indication for I. is strong motor excitement of the patient, requiring restraint by the hands of the care personnel, especially when the patient has aggressive tendencies; I. is also applied to weak patients if they irritate other patients with their screaming, unpleasant actions, or importunity; in this case, I. is used to prevent attacks on them by stronger patients. The positive side of I. lies in the prevention of injuries, almost inevitable when restraining an excited patient with the hands of personnel and in collisions between patients; the personnel is less distracted from their other duties, their physical strength and mental equilibrium are preserved. Despite this, there are many more negative aspects. Supervision of the isolated patient inevitably weakens, as direct observation is greatly hindered. Many patients during I. become unmanageable: they tear their clothes, undress, become untidy, smear themselves and the walls of the isolation ward, etc. This extremely complicates physical care for them. In conscious patients, hostile attitude toward the personnel often intensifies: they use moments of food delivery or going to the toilet, bathroom to attack; returning them to the isolation ward sometimes requires mobilizing all available personnel of the department and presents not only an ugly scene but also a very difficult task. With prolonged I., patients become wild and mentally degenerate. For the personnel, I. is also not indifferent, especially if it is practiced frequently: care for patients is mechanically simplified and becomes rougher, and the personnel (including doctors) noticeably degenerate. In case of a patient's tendency to suicide or self-harm, isolation is absolutely contraindicated. In general, it should be viewed as one of the restrictive measures that should be avoided in all cases when this is practically possible. In well-equipped psychiatric hospitals with sufficient and well-trained personnel, I. is not used at all. With a shortage of personnel, its poor quality, inability to properly and fractionally group patients, especially when the psychiatric hospital is overcrowded, it is sometimes impossible to completely avoid I. In each individual case, if therapeutic means are not applicable, one has to choose between various restrictive measures: narcotics ('chemical straitjacket'), wet or dry wrappings (the latter are equivalent to tying the patient) and I. In such circumstances, I. is the least objectionable if applied to weak but annoying patients, whom it saves from severe injuries. Under any circumstances, I. must be viewed as a potent remedy requiring strict dosage. It should be prescribed exclusively by a physician, its duration should be minimal, its beginning and termination, as well as indications for it, must be accurately recorded in the department journal each time. Description of the room used for isolation, the so-called 'strong department' - see Hospital, psychiatric, v. Grombach.