Standard precautions

universal precautions, standard work precautions, healthcare worker precautions

1. STANDARD PRECAUTIONS Dr. Ruqaiyah Nadeem (MBBS, M.D) Department of Microbiology

2. “ Prevention Is Better Than Cure” This phrase fits aptly to hospital/health care associated infection.

3. The fundamental ethic of health care is that sick persons must receive care. This premise carries an unstated consequence: an occupational risk to healthcare workers who respond to the needs of contagious patients.

4. RESULT: Total 100 mobile phones of healthcare professional were swabbed to check microbial flora harboured on mobile phones. |out of 100 mobile phones 79% were found to be contaminated with microbial flora.

5. Microbes: Living organisms that cannot be seen with the naked eye Pathogen: A microbe that can cause disease Infection: An illness caused by pathogens or germs Communicable infections: Infections that can spread from one person to another Infection

6. Ways Infections Are Transmitted Focus on: The airborne route of transmission (Tuberculosis (TB), measles, and chickenpox) The direct route of transmission (Herpes and conjunctivitis) The bloodborne route of transmission (HIV, Hepatitis B, Hepatitis C)

7. Chain of Infection (cont.) For a person to get a communicable infection, six key conditions must be met. Eliminating any one of the six key elements breaks the chain and prevents the spread of infection.

8. Chain of Infection (cont.)

9. Breaking the Chain of Infection

10. The concept of Universal Health Precautions emphasizes that all our patients should be treated as though they have potential blood born infections, and can infect the caring health care workers. ( CDC ) Why Standard Precautions

11. What is Standard Precautions Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes) and mucous membranes. They are indicated while handling all patients, specimens and sharps.

12. Measures to be followed All individuals, whether or not they appear infectious/ symptomatic or not All specimens (blood or body fluids) whether they appear infectious or not All needles and sharps whether they appear infectious or not

13. Components of Standard Precaution Hand hygiene Personal protective equipments Sharp handling Spillage cleaning Disinfection Waste handling

14. HAND HYGIENE

15. Hand washing is the single most important method of disease prevention Bacteria and Viruses can be spread via dirty hands and the y are too small to be see n with the human eye. You must wash you hands properly in order to remove them.

16. PERSONAL PROTECTIVE EQUIPMENT

17. Personal protective Equipment Specialized clothing or equipment worn by an employee for protection against infectious materials. (Occupational safety & health Administration, OSHA)

18. Types of PPE Used in Healthcare Settings Gloves – protect hands Gowns/aprons – protect skin and/or clothing Masks and respirators– protect mouth/nose Goggles – protect eyes Face shields – protect face, mouth, nose, and eyes Head cover – to prevent falling of hair Surgical shoes/cover- to protect HCWs & environment.

19. GLOVES: use when touching blood, body fluids, secretions, excretions, contaminated items, for touching mucus membranes & non-intact skin GOWNS: use during procedures and patient care activities when contact of clothing/ exposed skin with blood/ body fliuds , secretions, or excretion is anticipated.

20. STEPS TO PUT ON PPE Remove all personal items (jewelry, watch, phone etc) Put on scrub suit & rubber boots Move to clean area

21. Donning of PPE Perform Hand hygiene Examination gloves Disposable gown Sterile gloves (long cuff) Water proof disposable apron Head cap/ hood Face shield/ Goggles Face mask

22. Doffing of PPE Hand hygiene Remove gown Hand hygiene Remove head cover/ head neck covering Hand hygiene Remove outer pair of gloves Hand hygiene Remove Apron Hand Hygiene on gloved hands

23. Perform hand washing Remove inner pair of gloves Hand hygiene Remove rubber boots Hand hygiene Remove mask Hand hygiene Remove goggles

24. Standard precaution Breaking the chain of transmission Hand washing Use of personal protective equipment

25. What Type of PPE Would You Wear? Suctioning oral secretions? Transporting a patient in a wheel chair? Responding to an emergency where blood is spurting? Drawing blood from a vein? Cleaning an incontinent patient with diarrhea? Irrigating a wound? Taking vital signs?

26. Suctioning oral secretions? Gloves and mask/goggles or a face shield – sometimes gown Transporting a patient in a wheel chair? Generally none required Responding to an emergency where blood is spurting? Gloves, fluid-resistant gown, mask/goggles or a face shield Drawing blood from a vein? Gloves Cleaning an incontinent patient with diarrhea? Gloves w/ wo gown Irrigating a wound? Gloves, gown, mask/goggles or a face shield Taking vital signs? Generally none

27. PROBLEM SOLVING EXERCISE A nurse in an ICU records pulse of a patient, records it in case sheet and then goes back to nursing station. While transporting the specimen, a drop of blood fell on her palm. Then she enters the operation theater to assist for a surgery. Q. How many times she has to perform hand hygiene? Q. What are the hand hygiene methods she has to perform and for how much duration? Q. What are the hand hygiene products to be used?

28. Answer Hand rub: 5 times (70-80% alcohol for 20-40secs) Before recording pulse After recording pulse Before drawing blood After drawing blood After recording in case sheet Hand wash: Once after blood drop fell on palm (2-4% chlorhexidine for 40-60secs) Hand Scrub: Once before assisting surgery (4% chlorhexidine for 3-5mins)

29. NEEDLE STICK INJURY

30. Definition WHO defines needle stick injuries (NSI’s) as a penetrating stab wound from a needle (or other sharp object) that may result in exposure to blood or other body fluids. Main concern is exposure to blood or other body fluids of person carrying infectious disease.

31. Risk of Infections Following a needlestick injury the healthcare workers are at a great risk of transmission of : Hepatitis B virus Hepatitis C virus HIV

32. Estimated risk of infection following needlestick injury

33. PREVENT NEEDLESTICK INJURY NEVER RECAP NEEDLES DISPOSE IN WHITE PUNCTURE-PROOF CONTAINER AVOID OVERFILLING DISPOSAL CONTAINERS HEPATITIS B VACCINATION If unavoidable use single hand-scoop technique

34. First aid management DO’s Irrigate the site vigorously with water for atleast 5mins. Report to Medical Superintendent (MS) DON’T’s Do not panic Do not place the pricked finger into mouth Do not squeeze blood from wound Do not use antiseptics and detergents

35. RESPIRATORY HYGIENE

36. Respiratory hygeine & cough etiquette Cover the nose/mouth with single-use tissue paper when coughing, sneezing, wiping & blowing noses If no tissues are available, cough or sneeze into the inner elbow or hand Follow hand hygiene after contact with respiratory secretions Keep contaminated hands away from mucous membranes of eyes nose

37. In high risk areas of airborne transmission such as pulmonary medicine OPD Give mask to patients with cough Sputum collection should be done in an open well ventilated room.

38. SPILL MANAGEMENT

39. Evacuate the contaminated area Wear a pair of heavy duty gloves Mark the contaminated area with chalk Use a pair of forceps / tongs/ pan and brush to sweep broken glass (never pick up pieces with your hands even if gloved) Discard broken glass in sharps container Use disposable paper towels/ absorbent material (gauze piece, cotton, blotting paper etc) to absorb

40. Saturate the area with 1 % hypochlorite ( freshly prepared) Wait for 15-20mins Discard absorbent material Wipe area with disinfectant Clean & disinfect forceps/tongs/brush & pan Remove gloves & discard Wash hands

41. SPECIFIC PRECAUTIONS

42. Transmission based precautions (Specific Precautions) CONTACT PRECAUTIONS DROPLET PRECAUTIONS AIRBORNE PRECAUTIONS SPECIFIC PRECAUTIONS

43. Patients with enteric infections & diarrhea Highly contagious skin lesions Clostridium difficile infection Multi drug resistant organisms(MDROs) isolated in a hospital setting eg . MRSA ( Methicillin resistant S.aureus ) CONTACT PRECAUTIONS

44. CONTACT PRECAUTIONS ISOLATION PATIENT MOVEMENT PPE HAND WASHING ENVIRONMENTAL CLEANING

45. It is required when disease with droplet transmission is suspected, eg Respiratory Syncitial virus, Mycoplasma , Parainfluenza , Pertussis, Plague, Meningococcus , C.diphtheriae DROPLET PRECAUTIONS

46. DROPLET PRECAUTIONS ISOLATION PATIENT MOVEMENT PPE

47. AIRBORNE PRECAUTIONS PATIENT MOVEMENT ISOLATION PPE PULMONARY TB CHICKENPOX MEASLES SARS

48. Sterilisation : Sterilisation is a process by which all living microorganisms, including viable pores, are destroyed or removed from an article, body surface or medium. Disinfection: A process that destroys or removes most if not all pathogenic organisms but not bacterial spores. Asepsis: A process where the chemical agents ( called antiseptics) are applied on to the body surfaces (skin), which kill or inhibit the microorganisms present on the skin.

49. Disinfectants Uses Ethyl Alcohol (70%) Handrubs Isopropyl Alcohol Thermometers & small instruments Formaldehyde Fumigation of OT, preservation of specimens Glutaraldehyde (2%) Endoscopes, cystoscopes Phenols ( phenol, lysol , cresol) Surface disinfectant Povidone iodine Antiseptic for wounds, preoperative, before venipuncture Chlorine Disinfection of portable water Common disinfectants

50. Sodium hypochlorite Household bleach. Lab disinfectant(1%), for blood spills (10%),disinfection of other items before final disposal Bacillocid ( Quaternary ammonium compund + glutaraldehyde ) OT fumigation Ethylene oxide Used in Central Sterile Services Department (CSSD) For sterilisation of various equipments Hydrogen peroxide Ventilator disinfection, plasma sterilisation