STANDARD PRECAUTIONS MRS C B BELLO Introduction Standard

STANDARD PRECAUTIONS MRS C. B. BELLO

Introduction • Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. • These practices are designed to protect Health Care Practitioner(HCP) and prevent HCP from spreading infections among patients

Definition • Standard precautions are a set of basic infection prevention practices intended to prevent transmission of infectious diseases from one person to another. • They are meant to reduce the risk of transmission of blood-borne and other pathogens from both recognized and unrecognized sources.

Definition Contd. • Because we do not always know if a person has an infectious disease, standard precautions are applied to every person, every time to assure that transmission of disease does not occur • These precautions were formerly known as “universal precautions

Standard Precaution • Standard precaution is applied when dealing with blood, blood products, all body fluids, secretions except sweat • It is based on the principle that all blood, body fluids, secretions, excretions (except sweat), non-intact skin and mucous membrane may contain transmissible infectious agents

Components of Standard Precaution 1. Hand Hygiene 2. Use of personal protective equipment (e. g. , gloves, gowns, masks) 3. Safe injection practices 4. Environmental Cleaning/disinfection 5. Medical equipment care 6. Handling of textiles/laundry 7. Patient placement 8. Respiratory hygiene/cough etiquette

Hand Hygiene • Hand hygiene is a major component of standard precautions and one of the most effective methods to prevent transmission of pathogens associated with health care. • Hands must be washed with soap and water or an alcohol-based hand rub to prevent transmission of germs to others. • Good hand hygiene, including use of alcohol-based hand rubs and hand washing with soap and water.

Hand Hygiene contd • Soap and water should be used instead of an alcohol-based hand rub in the following instances: • When hands are visibly dirty, contaminated or soiled • After using the restroom • When preparing for a sterile procedure • Before eating or serving of client’s meal

Hand Washing Indication • Before and after any direct patient contact and between patients, whether or not gloves are worn • Hands must be washed before gloving and after gloves are removed • Before and after all patient care activities • If hands are contaminated with body fluids or blood • After touching blood/body fluids, secretions, excretions, mucous membrane, non-intact skin, lesions or contaminated equipment. • Inserting an I. V catheter

Technique of Hand washing • Assemble your equipment, place all at every sink in at all times. - Soap - Paper towels - Running water - Waste paper basket Ø Remove jewelry and secure in a safe place. Ø Turn on water and adjust force. Ø Wet the hands and wrist area. Keep hands lower than elbows to allow water to flow toward finger tips

Technique contd • Lather hands with soap thoroughly. Cover all the areas of the hands with the soap product • With firm rubbing and circular motions, wash the palms and back of the hands, each finger, the areas between fingers and the knuckles, wrists and forearms. • Wash at least 1 inch above area of contamination. If hands are not visibly soiled, wash to 1 inch above the wrists. • Continue this friction motion for at least 15 seconds

Technique contd • Use finger nails of the opposite hand to clean under fingernails. • Rinse thoroughly with water flowing toward fingertips • Pat hands dry, beginning with the fingers and moving upward toward forearms, with a paper towel and discard immediately • Use another clean towel to turn off the faucet. Discard towel immediately without touching other clean hand.

Personal Protective Equipment(PPE) • Personal Protective Equipment (PPE) refers to wearable equipment that is intended to protect HCP from exposure to or contact with infectious agents. • Examples include Gloves, Gowns, Face masks, Respirators, Goggles and Face shields, Boots.

PPE CONTD • Select PPE based on the assessment of risk. • The selection of PPE is based on the nature of the patient interaction and potential for exposure to blood, body fluids or infectious agents. • Note: It is important to assess the RISK of exposure to body substances or contaminated surfaces BEFORE any health-care activity. Ø Make this a routine.

PPE Contd. • Gloves: Indications: The nurse should wear gloves in the following situation • When touching blood, body fluids, secretions, excretions, mucous membranes, nonintact skin. • Change between tasks and procedures on the same patient after contact with potentially infectious material. In summary, gloves are worn if contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated items in the patient/resident’s environment occur.

PPE Contd • Gown: Indication • Wear to protect skin and prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. • Should be removed immediately after use.

PPE Contd • Face mask/face shield/eye protection (goggles) Indications • Wear a surgical or procedure mask and eye pro tection (eye visor, goggles) or a face shield to protect: • Mucous membranes of the eyes, nose, and mouth during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.

Safe Injection Practices • Injection safety is a set of measures taken to perform injections in an optimally safe manner for patients, health care personnel and others. • It includes practices intended to prevent transmission of infectious diseases between one patient and another, or between a patient and healthcare provider during preparation and administration of parenteral medications.

Safe injection contd • As defined by the World Health Organization, a safe injection does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous for the community. • Simply put; safe injection practices are part of Standard Precautions and are aimed at maintaining basic levels of patient safety and provider protections

Safe Injection Practices Contd • To follow safe injection practices, care providers should implement these recommendations: • Use aseptic technique to avoid contamination of sterile injection equipment. • Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulas, and syringes are sterile, single-use items; they should not be reused for another patient.

Safe injection contd • Use fluid infusion and administration sets (i. e. , intravenous bags, tubing, and connectors) for one patient only and dispose appropriately after use. • Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or administration set. • Use single-dose vials for parenteral medications whenever possible. • Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use

Safe injection contd • If multi-dose vials must be used, both the needle or cannula and syringe used to access the multi-dose vial must be sterile. • Do not keep multi-dose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations; discard if sterility is compromised or questionable. • Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients.

Safe injection contd Others include: • Do not recap, bend, break, or handmanipulate used needles. • Use safety features when available. • Place used sharps in a puncture-resistant container.

Medical Equipment/Patient Care equipment • Medical equipment is labeled by the manufacturer as either reusable or single-use. • Reusable medical equipment should be accompanied by instructions for cleaning and disinfection or sterilization as appropriate. • Single-use devices (SUDs) are labeled by the manufacturer for only a single use and do not have reprocessing instructions

Medical Equipment Contd. • All reusable medical equipment must be cleaned and maintained according to the manufacturer’s instructions to prevent patient-to-patient transmission of infectious agents. • The “Spaulding Classification’ is a traditional approach that has been used to determine the level of disinfection or sterilization required for reusable medical devices, based upon the degree of risk for transmitting infections if the device is contaminated at the time of use.

Medical equipment contd • Critical items (e. g. , surgical instruments) are objects that enter sterile tissue or the vascular system and must be sterile prior to use. • Semi-critical items (e. g. , endoscopes used for upper endoscopy and colonoscopy) contact mucous membranes or non-intact skin and require, at a minimum, high-level disinfection prior to reuse.

Medical equipment contd • Noncritical items (e. g. , blood pressure cuffs) are those that may come in contact with intact skin but not mucous membranes, should undergo low- or intermediate-level disinfection depending on the nature and degree of contamination. • Environmental surfaces (e. g. , floors, walls) are those that generally do not contact the patient during delivery of care. Cleaning may be all that is needed for the management of these surfaces but if disinfection is indicated, low-level disinfection is appropriate.

Medical equipment contd • Cleaning to remove organic material must always precede disinfection or sterilization because residual debris reduces the effectiveness of the disinfection and sterilization processes. • Facilities should establish policies and procedures for containing, transporting, and handling equipment that may be contaminated with blood or body fluids.

Environmental Cleaning • Cleaning refers to the removal of visible soil and organic contamination from a device or environmental surface using the physical action of scrubbing with a surfactant or detergent and water. • This process removes large numbers of microorganisms from surfaces and must always precede disinfection. • Disinfection is generally a less lethal process of microbial inactivation (compared to sterilization) that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms (e. g. , bacterial spores).

Environmental cleaning • Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated with pathogens, including those in close proximity to the patient (e. g. , bedrails) and frequently-touched surfaces in the patient-care environment (e. g. , doorknobs). • The nurse should use adequate procedures for the routine cleaning and disinfection of environmental and other frequently touched sources.

Respiratory Hygiene/Cough Etiquette contd • It highlights the need for prompt implementation of infection prevention measures at the first point of encounter with the facility. • This is targeted primarily at patients and accompanying family members or friends with undiagnosed transmissible respiratory infections • It also applies to any person with signs of illness including cough, congestion, rhinorrhea, or increased production of respiratory secretions when entering the facility and continuing throughout the duration of the visit.

Respiratory Hygiene/ Cough etiquette contd • The nurse should Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the duration of the visit. Such include: – Post signs at entrances with instructions to patients with symptoms of respiratory infection to: • Cover their mouths/noses when coughing or sneezing • Use and dispose of tissues • Perform hand hygiene after hands have been in contact with respiratory secretions

Respiratory Hygiene/ Cough etiquette contd – Provide tissues and no-touch receptacles for disposal of tissues – Provide resources for performing hand hygiene in or near waiting areas – Offer masks to coughing patients and other symptomatic persons upon entry to the facility and when out of room. – Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible.

Respiratory Hygiene/ Cough etiquette contd • If available, facilities may wish to place these patients in a separate area while waiting for care. • Use of private rooms • Negative pressure airflow of at least 6 to 12 exchanges per hour through high efficiency particulate air (HEPA) filtration.

Summary of Recommended Practices for standard precaution • Follow hand hygiene techniques • Wear clean non-sterile gloves when touching blood, body fluids, excretions or secretion, contaminated items, mucous membranes, and non-intact skin. Change gloves between tasks on the same patient as necessary and remove gloves promptly after use. • Wear PPE such as mask, eye protection e. t. c during procedures and care activities that are likely to generate splashes or spray of blood

Summary of Recommended Practices for standard precaution • Avoid recapping used needles. Place needles, sharps and scapels in appropriate punctured resistant containers after use • Handle used patient care equipment that is soiled with blood, secretions and excretions carefully to prevent transfer of microorganisms. Clean and reprocess items appropriately if used for another patient • Use adequate environmental controls to ensure that routine care, cleaning and disinfection procedures are followed.

Summary of Recommended Practices for standard precaution • Review room assignments carefully. Place patients who may contaminate the environment in private rooms (such as an incontinent patient).

TIPS • Allow patient to use personal set of care items either in home, hospital or extended care, items such as bedpans, feeding utensils, urinals, bath basins, towels thermometers must not be shared to reduce the risk of cross infection • Be careful always when handling urine, faeces, emesis and blood. • Empty contaminated fluid with care (at water level) to reduce the danger of splashing. • Handle all laboratory specimen from all patients as if infected, always place in biohazard bags during transportation or disposal

Conclusion • Standard Precaution must be applied at all times in health care facilities in order to reduce the risk of transmission of infections from patient to patient or patient to the health care provider and vice-versa • Standard precautions are used in the care of all hospitalized persons regardless of their diagnosis or possible infection status.

REFERENCES • Potter, P. A. , Perry, A. G. , Stockert, P. A. , Hall, A. M. (8 th edition) Fundamentals of Nursing. Elsevier Mosby, Missouri • Berman, A. Synder, S. J. , Kozier, B. , Erb, G. (8 th edition) Kozier & Erb’s Fundamentals of Nursing Concepts, Process, and Practice. Pearson Prentice Hall, New Jersey

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