Isolation practices: a historical perspective.

Isolation practices assume a major role in the activities of many hospital infection prevention and control programs, yet few of the practices have been studied for efficacy. The origins for some of these practices can be traced to the nursing literature published in the American Journal of Nursing in the early part of the century. Others originated with public health measures for quarantine of communicable diseases in the community or attempts to simulate operating room practices for compromised patients. This historical review presents information about isolation practices from the perspective of the American Journal of Nursing with additional information from some Centers for Disease Control and American Hospital Association publications. The American Journal of Nursing was selected because it is a major source for content of nursing textbooks from which most nurses first learn isolation practices. Nurses are also the persons primarily responsible for the implementation of isolation practices in hospitals. Two themes emerged from this historical review: (1) a continuing debate about the importance of the inanimate environment and the importance of the airborne route versus the importance of contact with moist body substances as major modes of transmission of infectious agents and (2) a continuing debate between those who believe in special isolation techniques only for persons with diagnosed infections and those who believe all persons may harbor potentially infectious agents and who therefore focus attention on assessment of care requirements where contact with body substances is anticipated. This review is intended to encourage critical evaluation of isolation practices in use in hospitals today.