Patient isolation procedures

Isolation Procedures Once a victim of chemical or biological agents or weapons gets to the hospital or another healthcare facility, that person may have to abide by patient isolation procedures. These include Standard Precautions, Airborne Precautions, Droplet Precautions, and Contact Precautions. These precautions are spelled out in the third edition of Medical Management Of Biological Casualties Handbook published by the U.S. Army Medical Research Institute of Infectious Disease located at Fort Detrick in Frederick, Maryland. 

Isolation is usually not necessary, but hospital policy may require isolation procedures. Stool precautions are usually necessary. The nurse washes the hands thoroughly after all patient care and die handling of stool specimens. 

B. Isolation Procedures (Barrier Nursing). In the context of biological agent casualties, adherence to principles of patient isolation is essential to preventing cross-infection with transmissible agents. 

The unique facilities available at USAMRIID also include a 16-bed clinical research ward capable of BL-3 containment, and a 2-bed patient care isolation suite where ICU-level care can be provided under BL-4 containment. Here, healthcare personnel wear the same positive-pressure suits as are worn in BL-4 research laboratories. The level of patient isolation required depends on the infecting organism and the risk to healthcare providers. Patient care can be provided at BL-4. There is no patient-care category analogous to BL-3 humans who are ill as a result of exposure to BL-3 agents are cared for in an ordinary hospital room with barrier nursing procedures. 

ISOLATION PROCEDURES FOR PATIENT CARE AT USAMRIID, BY DISEASE AGENT OR TYPE OF EXPOSURE... 

Hospital personnel who are observing recommended isolation procedures do not require prophylactic therapy, nor do contacts of patients with bubonic plague. However, people who were in the same environment and who were potentially exposed to the same source of infection as the contact case should be given prophylactic antibiotics. In addition, previously vaccinated individuals should receive prophylactic antibiotics if they have been exposed to a plague aerosol. 

TNF was originally identified because of its cytotoxic activity against some tumor cell lines and its ability to induce hemorrhagic necrosis of solid tumors in various animal models. However, the clinical use of TNF as an anticancer drug has been so far limited by its severe cardiovascular side effects. Therefore, TNF treatment is limited to regional and local administration of high doses of TNF, often in combination with chemotherapy, as accomplished in isolated limb and isolated hepatic perfusion (ILP and IHP, respectively) [5]. In the case of ILP, typically metastases are treated, patients benefit from this procedure by salvage of limbs from a loss by amputation. 

If an outbreak occurs, the first step would be to properly isolate those with the disease. Health officials should be diligent regarding use of adequate isolation facilities and precautions. If they are at all uncertain about correct procedures for isolating patients, they should contact the state or local health department or CDC. All the contacts of the patients should be vaccinated as soon as possible. In the event that there are many cases in a city vaccinations may be given to the entire population of that city. 

Acridinium ester—labeled chemiluminescent probes have been utilized to detect the specific protein-coding transcripts and to distinguish between transcripts that code for the 190-kDa protein and the two closely related 210-kDa proteins. The assay is called the hybridization protection assay (D3). In this assay, RNA isolated from the patient s white blood cells is first amplified by PCR. The amplified product is incubated with the chemiluminescent probe. The unhybridized probe is removed by selective hydrolysis in sodium tetraborate buffer, containing surfactant Triton X-100 at pH 8.5, in an incubation step at 60°C for 6 min. After the sample is cooled to room temperature, the chemiluminescence of the hybridized probe is measured in a luminometer. The procedure is reported to detect one leukemic cell in a population of a million or more normal cells. It is also rapid, requiring less than 30 min. Its reliability has been attested to by correlation with results obtained on karyotypic and Southern blot analysis (D3). 

In another experimental setting in vitro data on the cell surface antigen expression were obtained for PBMCs isolated from chronic lymphocytic leukemia (CLL) patient blood samples and cultured in the presence of DIMS (according to standard procedures). Cultured cells were collected and stained with the corresponding antibodies for detection of the expression of cell surface antigens. Subsequendy they were analyzed by flow cytometry. 

Nevertheless, immunotoxins may be useful for purging cancer cells in bone marrow aspirate isolated from patients undergoing autologous bone marrow transplantation [29,30]. When no suitable bone marrow donor is available, the patients own marrow cells are collected for repopulation of immune cells after radiation and chemotherapy. The small fraction of leukemic cells in autologous bone marrow cells can be removed with immunotoxins before they are reintroduced to the patient for restoring their immune system. Because this procedure... 

The investigators evaluated the safety of their nonviral somatic-cell gene therapy system, which they call transkaryotic implantation, in six patients with severe hemophilia. The procedure involved isolation of dermal fibroblasts from the patients upper arms. The fibroblasts were then transfected with a factor VIII genebearing plasmid. Cells that expressed factor VIII were cloned, propagated, and implanted into the patients abdomens. This technique can be considered as a less invasive form of ex vivo gene therapy. 

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