Should a Patient with Stevens-Johnson Syndrome Be Isolated?
Yes, patients with Stevens-Johnson syndrome must be barrier-nursed in isolation in a side room to reduce nosocomial infections, which are a leading cause of death in SJS/TEN. 1
Rationale for Isolation
The requirement for barrier nursing and isolation is based on the critical vulnerability of SJS patients to life-threatening infections:
Extensive epidermal loss creates a massive portal for infection. The denuded dermis becomes coated with necrotic debris and acts as a substrate for microbial colonization, initially by Staphylococcus aureus and later by Gram-negative organisms, particularly Pseudomonas aeruginosa. 1
Sepsis is the most common cause of death in SJS/TEN. Cutaneous infection impairs re-epithelialization and can progress to systemic sepsis, making infection prevention paramount to reducing mortality. 1
Barrier nursing significantly reduces nosocomial infection risk. This is a core component of the skin management regimen applicable to all SJS patients in all settings. 1
Specific Isolation Requirements
The isolation environment must be carefully controlled:
Side room with controlled humidity on a pressure-relieving mattress 1
Ambient temperature raised to 25-28°C to minimize insensible fluid losses and maintain thermoregulation 1
Strict barrier nursing protocols to prevent introduction of pathogens 1
Infection Surveillance Protocol
While isolated, patients require intensive monitoring:
Regular bacterial and fungal surveillance cultures from three areas of lesional skin (particularly sloughy or crusted areas) on alternate days throughout the acute phase 1
Clinical monitoring for infection signs including confusion, hypotension, reduced urine output, decreased oxygen saturation, increased skin pain, rising C-reactive protein, and neutrophilia 1
Targeted antimicrobial therapy only when clinically indicated - prophylactic antibiotics should NOT be used as they increase colonization with resistant organisms, particularly Candida albicans 1, 2, 3
Common Pitfalls to Avoid
Do not use prophylactic antibiotics indiscriminately. This increases skin colonization with resistant organisms and Candida, worsening outcomes. 1, 2, 3
Do not manage SJS patients in general wards. They require specialized burn unit or ICU care with barrier nursing capabilities, particularly when body surface area involvement exceeds 10%. 1, 2
Do not delay transfer to specialized centers. Early transfer to facilities experienced in managing extensive skin loss reduces mortality. 2
The isolation requirement is not because SJS is contagious (it is not), but rather to protect the profoundly immunocompromised patient with massive skin barrier disruption from acquiring potentially fatal nosocomial infections. 1