CONDITIONS OF ISOLATION (a) Isolation should be continued for the period of the in dividual's infectivity. Its termination should be determined by bacteriological means where possible or practicable, otherwise the clinical condition of the individual is the only criterion, in which event it should be continued until complete convalescence.
In many instances, either by reason of the economic condition of the patient or his family, or because the case occurs in the person of a transient, it is impossible to isolate the patient at his dwelling. In this event it is necessary to effect a removal of the patient to some place where satisfactory isolation may be successfully accomplished. If the patient is to remain at home, he must be removed to a room or suite of rooms not frequented by other members of the family, and attended by an individual who gives his sole attention to the patient's care. Preferably, and in some cases necessarily, the attendant must be a trained nurse, because it is impossible for a layman to suddenly acquire a subconscious familarity with the routine of isolation pro cedures. Under no circumstances must the attendant be one who prepares food or food stuffs to be consumed by other persons than the patient. The attendants should if possible be individuals who are either naturally or artificially immunized to the disease in question.
From the standpoint of the patient's cheer, as well as promot ing natural disinfection, the isolation rooms should be sunny. well ventilated, and screened. All surplus furnishings should be removed. Within the room should be placed a tub of disin fectant solution and a basin of a suitable disinfectant should be kept on a stand just outside the door.
All of the members of the family and visitors should be excluded. The only visitors permitted should be the attending physician or the representative of the health authorities. When entering the room to minister to the patient, the attendant should don a gown that protects the outer clothing, and before leaving the room thoroughly wash his hands in the disinfectant. Contaminated objects should be immersed in the tub of disin fectant before their removal. The general precautions to be observed by the attendant will be discussed later.
Where satisfactory conditions of isolation cannot be provided at the patient's home, that individual should be removed else where. Large cities provide special isolation hospitals for this
purpose. Small communities rarely have such facilities and in the event of an epidemic frequently isolate patients in hos pital tents.
Isolation hospitals, as at present constructed are of two types, namely the so-called pavilion plan and the cubicle plan.
The pavilion plan is of English origin. It involves the classi fication of the patients upon admission according to their ill ness and their direction to separate wards or pavilions where are segregated all patients suffering from the same disease. Each ward or pavilion has a separate staff of attendants. In a large city such a hospital may give satisfactory results if carefully operated, but several disadvantages exist. First, a large initial investment to build the separate wards or pavilions is necessary, and the administration is not flexible. Second, patients ad mitted may already be incubating a second disease, or a mis take in a diagnosis may have been made, so that the patients in a given ward are exposed to a second infection, and the newly admitted patient is also exposed, so that re-infections or" cross " infections are not unusual. The disease is the unit considered.
The cubicle plan is of French origin, having been developed in the hospital of the Pasteur Institute by Grancher. As applied the character of the institution where the patients are housed is of secondary importance, the feature of prime im portance being the nursing technique employed. This is termed medical asepsis as contrasted with the surgical asepsis of the operating room. Its effort is to prevent the transfer of infective agents from one patient to another. The patient is the unit considered. From the standpoint of hospital operation the aseptic technique aims to confine each different infection to a physically separate unit. The patients may be confined in separate rooms or be in wards. In the latter event the beds are placed at least six feet apart and separated by screens to prevent droplet transference. (Fig. 5). Where the nursing staff is thoroughly drilled in the following instructions, cross infections are exceedingly rare, mistaken diagnoses do not endanger the other patients and the elasticity of operation makes the expenses much lower. The success however, de pends entirely on the proficiency of the nursing staff in the aseptic technique.