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[[File:Aeromedical Biological Containment System (ABCS).jpg|thumb|265px|The [[Aeromedical Biological Containment System]] (ABCS) is an air-transportable ''high isolation'' module for movement of highly contagious patients.<ref>{{cite news|last1=Blake|first1=Matthew|title=The private jet NOBODY wants to fly on: Inside the air ambulance used to transport Ebola victims around America|url=http://www.dailymail.co.uk/news/article-2796852/the-private-jet-wants-fly-inside-aircraft-used-transport-ebola-victims-america.html|accessdate=26 October 2014|work=Daily Mail (UK)|date=17 October 2014}}</ref>]]
[[File:Aeromedical Biological Containment System (ABCS).jpg|thumb|265px|The [[Aeromedical Biological Containment System]] (ABCS) is an air-transportable ''high isolation'' module for movement of highly contagious patients.<ref>{{cite news|last1=Blake|first1=Matthew|title=The private jet NOBODY wants to fly on: Inside the air ambulance used to transport Ebola victims around America|url=http://www.dailymail.co.uk/news/article-2796852/the-private-jet-wants-fly-inside-aircraft-used-transport-ebola-victims-america.html|accessdate=26 October 2014|work=Daily Mail (UK)|date=17 October 2014}}</ref>]]
'''High isolation''' is used to prevent the spread of unusually highly contagious, or high consequence, infectious diseases (e.g., smallpox, Ebola virus). It stipulates mandatory use of: (1) gloves (or double gloves if appropriate), (2) protective eyewear (goggles or face shield), (3) a waterproof gown (or total body Tyvek suit, if appropriate), and (4) a [[respirator]] (at least FFP2 or N95 NIOSH equivalent), ''not'' simply a surgical mask.<ref>Puro, Vincenzo (2008), [http://www.newmicrobiologica.org/PUB/allegati_pdf/2008/2/165.pdf “Risk management of febrile respiratory illness in Emergency Departments”]; ''[[New Microbiologica]]'', 31, 165-173.</ref> Sometimes [[negative pressure room]]s or [[Respirator#Powered air-purifying respirators (PAPRs)|powered air-purifying respirator]]s (PAPRs) are also used.
'''High isolation''' is used to prevent the spread of unusually highly contagious, or high consequence, infectious diseases (e.g., smallpox, Ebola virus). It stipulates mandatory use of: (1) gloves (or double gloves if appropriate), (2) protective eyewear (goggles or face shield), (3) a waterproof gown (or total body Tyvek suit, if appropriate), and (4) a [[respirator]] (at least FFP2 or N95 NIOSH equivalent), ''not'' simply a surgical mask.<ref>Puro, Vincenzo (2008), [http://www.newmicrobiologica.org/PUB/allegati_pdf/2008/2/165.pdf “Risk management of febrile respiratory illness in Emergency Departments”]; ''[[New Microbiologica]]'', 31, 165-173.</ref> Sometimes [[negative pressure room]]s or [[Respirator#Powered air-purifying respirators (PAPRs)|powered air-purifying respirator]]s (PAPRs) are also used.

⚫
==Effects of isolation==
Isolation can have the following negative effects on patients and staff:
*Patient may not be able to receive visitors, and in turn, become lonely
*Patients may experience depression, anxiety, and anger
*Small children may feel their isolation is a punishment<ref name="AtkinsonMurray1985">{{cite book|author1=Atkinson LD|author2=Murray ME|title=Fundamentals of nursing: a nursing process approach|year=1985|publisher=Macmillan Pub. Co.|page=374|isbn=978-0-02-304590-5}}</ref>
*Staff may need to spend more time with patients
*Patients may not be able to receive certain types of care due to the risk that other patients may become contaminated. This includes forms of care that involve use of equipment common to all patients at the facility, or that involve transporting the patient to an area of the facility common to all patients.


==Isolation of health care workers==
==Isolation of health care workers==
Line 66: Line 58:


Health care workers who become infected with certain contagious agents may not be permitted to work with patients for a period of time. The [[Occupational Safety and Health Administration|Occupational Safety and Health Administration (OSHA)]] has implemented several standards and directives applicable to protecting health care workers from spread of infectious agents. These include blood borne pathogens, personal protective equipment, and respiratory protections. The CDC has also released resource for health care facilities to assist in assessing and reducing risk for occupational exposure to infectious diseases. The purpose of these standards and guidelines are to prevent the spread of disease to others in a health care facility.<ref>{{Cite web|url=https://www.osha.gov/SLTC/healthcarefacilities/infectious_diseases.html|title=Safety and Health Topics {{!}} Healthcare - Infectious Diseases {{!}} Occupational Safety and Health Administration|website=www.osha.gov|access-date=2019-05-01}}</ref>
Health care workers who become infected with certain contagious agents may not be permitted to work with patients for a period of time. The [[Occupational Safety and Health Administration|Occupational Safety and Health Administration (OSHA)]] has implemented several standards and directives applicable to protecting health care workers from spread of infectious agents. These include blood borne pathogens, personal protective equipment, and respiratory protections. The CDC has also released resource for health care facilities to assist in assessing and reducing risk for occupational exposure to infectious diseases. The purpose of these standards and guidelines are to prevent the spread of disease to others in a health care facility.<ref>{{Cite web|url=https://www.osha.gov/SLTC/healthcarefacilities/infectious_diseases.html|title=Safety and Health Topics {{!}} Healthcare - Infectious Diseases {{!}} Occupational Safety and Health Administration|website=www.osha.gov|access-date=2019-05-01}}</ref>

⚫
== Consequences of isolation ==
Disease isolation is rarely disputed for its importance in protecting others from disease. However, it is important to consider the consequences disease isolation may have on an individual. For instance, patients may not be able to receive visitors, and in turn, become lonely. Patients may experience depression, anxiety, and anger.<ref>{{Cite journal|last=Furuno|first=Jon P.|last2=Krein|first2=Sarah|last3=Lansing|first3=Bonnie|last4=Mody|first4=Lona|date=2012|title=Health care worker opinions on use of isolation precautions in long-term care facilities|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526888/|journal=American journal of infection control|volume=40|issue=3|pages=263–266|doi=10.1016/j.ajic.2011.03.019|issn=0196-6553|pmc=PMC3526888|pmid=21784557|via=}}</ref> Small children may feel their isolation is a punishment.<ref>{{Cite journal|last=Gostin|first=Lawrence O.|date=2015-03-17|title=Law, Ethics, and Public Health in the Vaccination Debates: Politics of the Measles Outbreak|url=https://jamanetwork.com/journals/jama/fullarticle/2119391|journal=JAMA|language=en|volume=313|issue=11|pages=1099–1100|doi=10.1001/jama.2015.1518|issn=0098-7484}}</ref> Staff may need to spend more time with patients. Patients may not be able to receive certain types of care due to the risk that other patients may become contaminated. This includes forms of care that involve use of equipment common to all patients at the facility, or that involve transporting the patient to an area of the facility common to all patients. Given the impact of isolation on patients, social and emotional support may be needed.<ref>{{Cite journal|last=Gammon|first=John|last2=Hunt|first2=Julian|date=2018-01-25|title=Source isolation and patient wellbeing in healthcare settings|url=https://www.ncbi.nlm.nih.gov/pubmed/29368561|journal=British Journal of Nursing (Mark Allen Publishing)|volume=27|issue=2|pages=88–91|doi=10.12968/bjon.2018.27.2.88|issn=0966-0461|pmid=29368561}}</ref>

Although a majority of health care professionals advocate for disease isolation as an effective means of reducing disease transmission. However, some health care professionals are concerned with implementing such control protocols given the possible negative consequences on patients. Patients isolated with [[Methicillin-resistant Staphylococcus aureus|Methicillin Resistant Staphylococcus Aureus]] (MRSA) can also be negatively impacted by having less documented care/bedside visits from attending and residents.<ref>{{Cite journal|last=Masse|first=Vincent|last2=Valiquette|first2=Louis|last3=Boukhoudmi|first3=Soraya|last4=Bonenfant|first4=Francis|last5=Talab|first5=Yasmine|last6=Carvalho|first6=Jean-Christophe|last7=Alarie|first7=Isabelle|last8=Carrier|first8=Nathalie|last9=Farand|first9=Paul|date=2013|title=Impact of methicillin resistant Staphylococcus aureus contact isolation units on medical care|url=https://www.ncbi.nlm.nih.gov/pubmed/23451144|journal=PloS One|volume=8|issue=2|pages=e57057|doi=10.1371/journal.pone.0057057|issn=1932-6203|pmc=PMC3581535|pmid=23451144|via=}}</ref>


== Ethics of Disease Isolation ==
== Ethics of Disease Isolation ==

Revision as of 01:41, 1 May 2019

Not to be confused with biocontainment or quarantine.
For other uses, see Isolation (disambiguation).
This illustration of a TB ward from OSHA demonstrates several aspects of hospital infection control and isolation: engineering controls (dedicated air ductwork), PPE (N95 respirators), warning signs and labels (controlled entry), dedicated disposal container, and enhanced housekeeping practices.

Disease isolation is a form of infection prevention and control used to prevent the spread of a communicable disease to others.Various forms of isolation exist, including strict isolation, contact isolation, respiratory isolation, and high isolation. The Centers for Disease Control and Prevention created these precaution measures to protect the general community. These precautions are reviewed and implemented at the local level among public health and health care facilities. Disease isolation could include patients with a communicable disease and contacts to a communicable disease who are at risk of spreading it to others. Contacts are anyone who have been in contact with a communicable and are at risk of developing the disease. This can include family members, friends, and health care workers. Isolation can occur within a health care setting, a person’s home, and other environments, such as schools, prisons, etc. However, these precautions may have negative consequences on an isolated individual. Therefore, this topic is discussed and reviewed regarding the ethics of disease isolation when comparing the right of the individual versus the right of the community.

Importance of Disease Isolation

Contagious diseases can spread to others through various forms. Four types of infectious disease transmission can occur: (1) contact transmission, which can be through direct physical contact, indirect contact through fomites, or droplet contact in which airborne infections spread short distances, (2) vehicular transmission, which involves contaminated objects, (3) airborne transmission, which involves spread of infectious particles through air, and (4) vector transmission, which is spread through insects or animals.[1] Depending on the contagious disease, transmission can occur within a person's home, school, worksite, health care facility, and other shared spaces within the community. Even if a person takes all necessary precautions to protect oneself from disease, such as being up-to-date with vaccines and practicing good hygiene, he or she can still get sick. Some people may not be able to protect themselves from diseases and may develop serious complications if they contract the disease. Therefore, disease isolation is an important infection prevention and control practice used to protect others from disease.[2] Disease isolation can prevent healthcare-acquired infections of hospital-acquired infections (HCAIs), reduce threats of antibiotic resistance infections, and respond to new and emerging infectious disease threats globally.[3]

Types of precautions

The U.S. Centers for Disease Control and Prevention (CDC) created various levels of disease isolation (also described "precaution"). These precautions are also reviewed and revised by the CDC.

Universal/standard precautions

Main article: Universal precautions

Universal precautions refer to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The practice was widely introduced in 1985–88.[4][5] In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions. Use of personal protective equipment is now recommended in all health settings.

Transmission-based precautions

Main article: Transmission-based precautions

Transmission-based precautions are additional infection control precautions — over and above universal/standard precautions — and the latest routine infection prevention and control practices applied for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens. The latter require additional control measures to effectively prevent transmission.[6][7]

There are three types of transmission-based 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.
  • Droplet precautions are intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions.
  • Airborne precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], M. tuberculosis, and possibly SARS-CoV).

Isolation

According to the CDC, isolation is used to protect the general public from possible exposure of a contagious disease. Isolation is the act of separating a sick individual with a contagious disease from health individuals without that contagious disease.[8]

Special equipment is used in the management of patients in the various forms of isolation. These most commonly include items of personal protective equipment (gowns, masks, and gloves) and engineering controls (positive pressure rooms, negative pressure rooms, laminar air flow equipment, and various mechanical and structural barriers). Dedicated isolation wards may be pre-built into hospitals, or isolation units may be temporarily designated in facilities in the midst of an epidemic emergency.[9]

Isolation should not be mistaken as the same as quarantine or biocontainment. Quarantine is the compulsory separation and confinement, with restriction of movement, of healthy individuals or groups who have potentially been exposed to an agent to prevent further infections should infection occur. Biocontainment refers to laboratory biosafety in microbiology laboratories in which the physical containment (BSL-3, BSL-4) of highly pathogenic organisms is accomplished through built-in engineering controls.[10]

Many forms of isolation exist.

Strict isolation

Strict isolation is used for diseases spread through the air and in some cases by contact.[11] Patients must be placed in isolation to prevent the spread of infectious diseases.[12] Those who are kept in strict isolation are often kept in a special room at the facility designed for that purpose. Such rooms are equipped with a special lavatory and caregiving equipment, and a sink and waste disposal are provided for workers upon leaving the area.[13]

Contact isolation

Contact isolation is used to prevent the spread of diseases that can be spread through contact with open wounds. Health care workers making contact with a patient on contact isolation are required to wear gloves, and in some cases, a gown.

Respiratory isolation

Respiratory isolation is used for diseases that are spread through particles that are exhaled.[11] Those having contact with or exposure to such a patient are required to wear a mask.

Reverse isolation

Reverse isolation is a way to prevent a patient in a compromised health situation from being contaminated by other people or objects. It often involves the use of laminar air flow and mechanical barriers (to avoid physical contact with others) to isolate the patient from any harmful pathogens present in the external environment.[14]

High isolation

The Aeromedical Biological Containment System (ABCS) is an air-transportable high isolation module for movement of highly contagious patients.[15]

High isolation is used to prevent the spread of unusually highly contagious, or high consequence, infectious diseases (e.g., smallpox, Ebola virus). It stipulates mandatory use of: (1) gloves (or double gloves if appropriate), (2) protective eyewear (goggles or face shield), (3) a waterproof gown (or total body Tyvek suit, if appropriate), and (4) a respirator (at least FFP2 or N95 NIOSH equivalent), not simply a surgical mask.[16] Sometimes negative pressure rooms or powered air-purifying respirators (PAPRs) are also used.

Isolation of health care workers

Isolation wards may need to be hastily improvised during epidemics such as in this image of WHO workers in Lagos, Nigeria managing Ebola patients in 2014.

Disease isolation is relevant to the work and safety of health care workers. Health care workers may be regularly exposed to various types of illnesses and are at risk of being getting sick. Disease spread can occur between a patient and a health care worker, even if the health care workers takes all necessary precautions to minimize transmission, including proper hygiene and being up-to-date with vaccines. If a health care gets sick with a communicable disease, possible spread may occur to other health care workers or susceptible patients within the health care facility. This can include patients with a weakened immune system and may be at risk for serious complications.[17]

Health care workers who become infected with certain contagious agents may not be permitted to work with patients for a period of time. The Occupational Safety and Health Administration (OSHA) has implemented several standards and directives applicable to protecting health care workers from spread of infectious agents. These include blood borne pathogens, personal protective equipment, and respiratory protections. The CDC has also released resource for health care facilities to assist in assessing and reducing risk for occupational exposure to infectious diseases. The purpose of these standards and guidelines are to prevent the spread of disease to others in a health care facility.[18]

Consequences of isolation

Disease isolation is rarely disputed for its importance in protecting others from disease. However, it is important to consider the consequences disease isolation may have on an individual. For instance, patients may not be able to receive visitors, and in turn, become lonely. Patients may experience depression, anxiety, and anger.[19] Small children may feel their isolation is a punishment.[20] Staff may need to spend more time with patients. Patients may not be able to receive certain types of care due to the risk that other patients may become contaminated. This includes forms of care that involve use of equipment common to all patients at the facility, or that involve transporting the patient to an area of the facility common to all patients. Given the impact of isolation on patients, social and emotional support may be needed.[21]

Although a majority of health care professionals advocate for disease isolation as an effective means of reducing disease transmission. However, some health care professionals are concerned with implementing such control protocols given the possible negative consequences on patients. Patients isolated with Methicillin Resistant Staphylococcus Aureus (MRSA) can also be negatively impacted by having less documented care/bedside visits from attending and residents.[22]

Ethics of Disease Isolation

Public health interventions such as surveillance, isolation, and quarantine serve as an important method to protect the general community from disease transmission. However, such interventions pertaining g to disease isolation pose an ethical question on rights of the individual versus rights of the general community.

Infectious Disease as a topic for Bioethics

Infectious disease and interventions related to the containment of infectious diseases may not be considered a primary topic of importance among bioethics, such as topics related to euthanasia, assisted reproduction, genetics, etc. This may be due to the following reasons: the bias for topics toward high-tech, wealthy-world topics such as euthanasia and assisted reproduction, the blinding optimism that infectious diseases are no longer a threat or in need of further discussion due to the success of antibiotics and vaccines, and the labeling of “other” among certain infectious diseases such as AIDS, tuberculosis, Ebola, etc. However, it is important to recognize infectious disease as a primary topic of bioethics because such interventions do have certain implications on the individual and may infringe on basic human rights and liberties.[23]

Disease Isolation as an Ethical Public Health Action

Most people believe that disease isolation as a public health intervention is a moral and just action. Numerous case studies have shown that disease isolation served an effective intervention implemented during a hospital or community-wide outbreak.  

Greatest Good for Greatest Number[24]

As in the case of a disease outbreak such as measles or Ebola, public health interventions such as disease isolation and quarantine are ethical and necessary for protecting the community from further disease transmission. Using felicity calculus to predict the outcomes (consequences) of moral action between the individual rights versus the rights of the general public during disease isolation, it is justified that disease isolation is most likely to result in the greatest amount of positive outcomes for the largest number of people.

Use of Reciprocity[25]

The use of reciprocity justifies the use of implementation of restrictive measures such as disease isolation because it is morally justified and therefore morally legitimate.Moral legitimacy is met for disease isolation as an ethical practice in public health based on the reciprocal relationship between the individual and the state:

The individual is obligated to:

  • Protect others by preventing further spread of disease
  • Respect the instructions from public health authorities and sequester themselves in their homes and not attend public gatherings
  • Act as a first responder (if a healthcare professional) by providing services to protect and restore public health

The state is obligated to:

  • Provide support to individuals burdened as a result of restrictive measures (e.g. compensation for missed work, providing access to food and other necessities for those quarantined and isolated, assistance for first responders to balance personal/professional obligations)
  • Ensure several legal protections are in place for those subjected to restrictive measures
  • Communicate all relevant information regarding the necessity of restriction

Use of Disease Isolation in Hospital Settings[26]

Isolation practices and procedures are important interventions for the following reasons:

  1. Prevents healthcare-acquired infections of hospital-acquired infections (HCAIs)
  2. Reduces threats of antibiotic resistance infections
  3. Responds to new and emerging infectious disease threats globally   

Ethical Concerns of Disease Isolation as a Public Health Intervention

People have also advocated for more refined public health protocols surrounding disease isolation given its consequences on the individual. A study found that although a majority of health care professionals will advocate for disease isolation as an effective means of reducing disease transmission, many are concerned with implementing such control measures given the possible effects on the patients, including confusion, depression, and lowered self-esteem.[27] Another study showed an association between negative patient experiences and isolation, possibly due to the current guidelines for isolating patients with infectious diseases being outdated and argues that given the impact isolation has on one's health, welfare, and liberty, more research and discussions should be done on disease isolation and patients should be provided with strengthened forms of support (e.g. social and emotional support).[28] Patients isolated with Methicillin Resistant Staphylococcus Aureus (MRSA) can also be negatively impacted by having less documented care/bedside visits from attendings and residents.[29]

See also

References

  1. ^ McCue, Jack D. (1990), Walker, H. Kenneth; Hall, W. Dallas; Hurst, J. Willis (eds.), "The Contagious Patient", Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.), Butterworths, ISBN 9780409900774, PMID 21250179, retrieved 2019-05-01
  2. ^ Swanson, John; Jeanes, Annette (2011). "Infection control in the community: a pragmatic approach". British Journal of Community Nursing. 16 (6): 282–288. doi:10.12968/bjcn.2011.16.6.282. ISSN 1462-4753. PMID 21642912.
  3. ^ Gammon, John; Hunt, Julian (2018-02-08). "A review of isolation practices and procedures in healthcare settings". British Journal of Nursing (Mark Allen Publishing). 27 (3): 137–140. doi:10.12968/bjon.2018.27.3.137. ISSN 0966-0461. PMID 29412028.
  4. ^ CDC. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR Morb Mortal Wkly Rep 1988;37(24):377-82, 87–8.
  5. ^ CDC. Recommendations for preventing transmission of infection with human T- lymphotropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR Morb Mortal Wkly Rep 1985;34(45):681-6, 91–5.
  6. ^ Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
  7. ^ Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care, WHO Interim Guidelines.2007 p. 53
  8. ^ "Quarantine and Isolation | Quarantine | CDC". www.cdc.gov. 2018-10-03. Retrieved 2019-05-01.
  9. ^ "Fundamental Nursing - Textbook (Paperback): Leana Uys: 9780636042087 | Books | Buy online in South Africa from Loot.co.za". www.loot.co.za. Retrieved 2019-05-01.
  10. ^ "Quarantine and Isolation | Quarantine | CDC". www.cdc.gov. 2018-10-03. Retrieved 2019-05-01.
  11. ^ a b Uys LR (1999). Fundamental nursing. Pearson South Africa. p. 249. ISBN 978-0-636-04208-7.
  12. ^ White L (2004). Foundations of nursing. Cengage Learning. p. 757. ISBN 978-1-4018-2692-5.
  13. ^ Lawrence J; Dee May (2003). Infection control in the community. Elsevier Health Sciences. p. 136. ISBN 978-0-443-06406-7.
  14. ^ Tamaroff MH, Nir Y, Straker N (1986). "Children reared in a reverse isolation environment: effects on cognitive and emotional development". J. Autism Dev. Disord. 16 (4): 415–424. doi:10.1007/bf01531708.
  15. ^ Blake, Matthew (17 October 2014). "The private jet NOBODY wants to fly on: Inside the air ambulance used to transport Ebola victims around America". Daily Mail (UK). Retrieved 26 October 2014.
  16. ^ Puro, Vincenzo (2008), “Risk management of febrile respiratory illness in Emergency Departments”; New Microbiologica, 31, 165-173.
  17. ^ "WHO | Infection prevention and control". WHO. Retrieved 2019-05-01.
  18. ^ "Safety and Health Topics | Healthcare - Infectious Diseases | Occupational Safety and Health Administration". www.osha.gov. Retrieved 2019-05-01.
  19. ^ Furuno, Jon P.; Krein, Sarah; Lansing, Bonnie; Mody, Lona (2012). "Health care worker opinions on use of isolation precautions in long-term care facilities". American journal of infection control. 40 (3): 263–266. doi:10.1016/j.ajic.2011.03.019. ISSN 0196-6553. PMC 3526888. PMID 21784557.{{cite journal}}: CS1 maint: PMC format (link)
  20. ^ Gostin, Lawrence O. (2015-03-17). "Law, Ethics, and Public Health in the Vaccination Debates: Politics of the Measles Outbreak". JAMA. 313 (11): 1099–1100. doi:10.1001/jama.2015.1518. ISSN 0098-7484.
  21. ^ Gammon, John; Hunt, Julian (2018-01-25). "Source isolation and patient wellbeing in healthcare settings". British Journal of Nursing (Mark Allen Publishing). 27 (2): 88–91. doi:10.12968/bjon.2018.27.2.88. ISSN 0966-0461. PMID 29368561.
  22. ^ Masse, Vincent; Valiquette, Louis; Boukhoudmi, Soraya; Bonenfant, Francis; Talab, Yasmine; Carvalho, Jean-Christophe; Alarie, Isabelle; Carrier, Nathalie; Farand, Paul (2013). "Impact of methicillin resistant Staphylococcus aureus contact isolation units on medical care". PloS One. 8 (2): e57057. doi:10.1371/journal.pone.0057057. ISSN 1932-6203. PMC 3581535. PMID 23451144.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  23. ^ login.proxylib.csueastbay.edu. doi:10.1111/j.1467-8519.2005.00441.x https://login.proxylib.csueastbay.edu/login?qurl=https://onlinelibrary.wiley.com%2fdoi%2ffull%2f10.1111%2fj.1467-8519.2005.00441.x. Retrieved 2019-03-29. {{cite web}}: Missing or empty |title= (help)
  24. ^ csueb-primo.hosted.exlibrisgroup.com https://csueb-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_crossref10.18785/ojhe.1102.02&context=PC&vid=01CALS_UHL&search_scope=01CALS_UHL&tab=books_local&lang=en_US. Retrieved 2019-04-03. {{cite web}}: Missing or empty |title= (help)
  25. ^ Viens, A. M.; Bensimon, Cécile M.; Upshur, Ross E. G. (2009-05-15). "Your Liberty or Your Life: Reciprocity in the Use of Restrictive Measures in Contexts of Contagion". Journal of Bioethical Inquiry. 6 (2): 207–217. doi:10.1007/s11673-009-9149-2. ISSN 1176-7529.
  26. ^ csueb-primo.hosted.exlibrisgroup.com https://csueb-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_proquest1999190789&context=PC&vid=01CALS_UHL&search_scope=01CALS_UHL&tab=books_local&lang=en_US. Retrieved 2019-04-04. {{cite web}}: Missing or empty |title= (help)
  27. ^ csueb-primo.hosted.exlibrisgroup.com https://csueb-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_sciversesciencedirect_elsevierS0196-6553(11)00266-5&context=PC&vid=01CALS_UHL&search_scope=ARTICLES&tab=all_articles&lang=en_US. Retrieved 2019-04-04. {{cite web}}: Missing or empty |title= (help)
  28. ^ csueb-primo.hosted.exlibrisgroup.com https://csueb-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_proquest2055107028&context=PC&vid=01CALS_UHL&search_scope=01CALS_UHL&tab=books_local&lang=en_US. Retrieved 2019-04-04. {{cite web}}: Missing or empty |title= (help)
  29. ^ "Methicillin-resistant Staphylococcus aureus (MRSA)". AccessScience. Retrieved 2019-04-04.

External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=Isolation_(health_care)&oldid=894952965"