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1. STANDARD SAFETY MEASURES

2. INTRODUCTION Standard safety measures 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. These measures are to be used when providing care to all individuals, whether or not they appear infectious or symptomatic. • Hand Hygiene • Personal Protective Equipment (PPE) • Needle stick and Sharps Injury Prevention • Cleaning and Disinfection • Respiratory Hygiene (Cough Etiquette) • Waste Disposal • Safe Injection Practices

3. Standard Safety measures are the minimum infection prevention practices that should be used in the care of all patients all of the time. These practices are designed to both protect the healthcare worker and to prevent the healthcare worker from spreading infections among patients. Standard safety precautions are the basic infection prevention and control measures necessary to reduce the risk of transmission of infectious agent from both unrecognized and unrecognized sources of infection. DEFINITION

4. TERMINOLOGIES Standard Safety Precaution BMW PPE NSI TBP Etiquettes Healthcare workers Standard precations Occupational Health

5. ELEMENTS OF STANDARD PRECAUTION Hand hygiene Gown Mask Face protection Gloves Safe injection practices Patient care equipments/devices Environmental control Textile and laundry Worker safety Patient placement and transport Respiratory hygiene/cough etiquette Infection control practices for lumbar puncture

6. TYPES OF SAFETY MEASURES TYPES OF SAFETY: Normative safety - Normative safety is a term used to describe products or designs that meet applicable design standards. Substantive safety - Substantive or objective safety means that the real-world safety history is favorable, whether or not standards are met.

7. Perceived safety- Perceived or subjective safety refers to the level of comfort of users. For example, traffic signals are perceived as safe, yet under some circumstances, they can increase traffic crashes at an intersection

8. SAFETY MEASURES Safety measures are activities and precautions taken to improve safety, i.e. reduce risk related to human health.Common safety measures include: 1.Root cause analysis 2. Visual examination for dangerous situations 3.Visual examination for flaws such as cracks, peeling, loose connections. 4.Safety margins/Safety factors 5.Implementation of standard protocols and procedures 6.Training of employees, vendors, product users

9. 7.Instruction manuals 8.Instructional videos 9.Examination of activities by specialists 10.Government regulation 11.Industry regulation. 12.Self-imposed regulation of various types. 13.Statements of Ethics 14.Periodic evaluations of employees, departments, etc.

10. STANDARD SAFETY MEASURES IN HOSPITAL PHYSICAL ENVIRONMENT

11. BIOMEDICAL WASTE MANAGEMENT

12. STANDARD PRECAUTIONS

13. PPE(PERSONAL PROTECTIVE EQUIPMENTS) Personal protective equipment (PPE) is used to assess the risk of exposure to body substances or contaminated surfaces before any health-care activity. Select PPE based on the assessment of risk: – clean non-sterile gloves – clean, non-sterile fluid-resistant gown – mask and eye protection or a face shield.

14. BIOMEDICAL WASTE MANAGEMENT: Cat- 1 Human Anatomical Wastes Cat- 2 Animal Anatomical Wastes Cat- 3 Microbiology and Biotechnology wastes

15. Cat- 4 Waste Sharps Cat- 5 Discarded medicines and Cytotoxic drugs

16. Cat- 6 Soiled wastes include items contaminated with blood, body fluids such as cotton, dressings, linen, beddings etc. Cat- 7 Solid wastes i.e. waste generated from disposable items other than sharps such as tubing, catheters, IV sets.

17. Cat- 8 Liquid wastes ( washing, cleaning ) Cat- 9 Incineration ash Cat- 10 Chemical wastes ( disinfectants, insecticides )

18. COLOR CODING FOR SEGREGATION OF BMW: YELLOW Process of segration: Incineration and Deep burial RED Process of segration:- Auto claving / Microwaving / Chemical treatment BLUE Process of segration:-Auto claving /Microwaving / Chemical treatment & Destruction / Shredding BLACK Process of segration:-. Disposal in secured landfill PUNCTURE PROOF CAN Process of segration:- chemical disinfectants/autoclaving folowed by shredding/mutation.

19. Principles of Control of Hazards of Biomedical Waste in Health Care Establishment: Each institution should develop its own bio waste management policy Measures such as universal safety precautions, hand washing and proper segregation of waste material should be encouraged. Rationale patient management policy should be followed and admissions restricted to those for whom it is felt absolutely necessary. Proper house-keeping is essential and the hospital premises should be kept clean and well-ventilated.

20. Steps in the Management of Biomedical Waste : 1.Survey of waste generated. 2.Segregation of hospital waste 3.Collection & Categorization of waste. 4.Storage of waste.( Not beyond 48 hrs. ) 5.Transportation of waste. 6.Treatment of waste.

21. HAND HYGIENE Hand wash- 40-60 seconds Hand rub- 20-30 sec Hand scrub- 5min (first wash of the day) - 2-3min (in between operations)

22. Gowning and Apron 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. Remove soiled gown as soon as possible, and perform hand hygiene.

23. FACIAL PROTECTION (EYES, NOSE, AND MOUTH) When the health care provider is involved in an activity in which body fluids may be sprayed or splashed, appropriate barriers must be used. If a splash to the face may occur, goggles and facemask are warranted. 

24. Gloving Wear 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. Remove after use, before touching non-contaminated items and surfaces, and before going to another patient. Perform hand hygiene immediately after removal

25. Safe injection practice Disposed immediately after use in puncture resistant container. Not placed on environment surfaces. Not recapped if recapping is essential use one hand technique(scoop). Close sharp container when 3/4 full and 7days maximum. Never reuse needles,syringes or lancets. Never administer medications from the same syringe to more than one patient,even if the needle is changed or you are injecting through an intervening length of IV tubing. Do not enter a medication vial,bag or bottle with used syringe or needle. Never use medications packaged as single dose or single use for more than one patient. Always use aseptic technique when preparing and administering injections.

26. Patient care equipments Handle equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures,contamination of clothing, and transfer of pathogens to other patients or the environment. Clean, disinfect, and reprocess reusable equipment appropriately before use with another patient.

27. Environment control and cleaning Use adequate procedures for the routine cleaning and disinfection of environmental and other frequently touched surfaces.

28. Textile and laundry Key principles for handling soiled laundry: not shaking the items avoiding contact of one’s body and personal clothing. Dispose soiled items in water soluble bag. Dispose non soiled items in blue bag.

29. Patient placement and Transport Determine patient placement based on: - Route(s) of transmission of the known/suspected infectious agent,availability of single rooms and options for cohorting (patients with the same pathogen in the same room) - Patients with higher risk for pathogen transmission are prioritize to be admitted in a single room(e.g, uncontained secretions,or wound drainage) Healthcare worker transporting a patient with missible infection should contain the site of infection (e.g apply a dressing over a surgical site infection & offer a surgical mask for a coughing patient.

30. Safe work practices Prevention of needle sticks and other sharps related injuries. Precautions during aerosol-generating procedures. Prevention of mucous membrane contact

31. Respiratory hygiene/cough etiquette Persons with respiratory symptoms should apply source control measures: Cover their nose and mouth when coughing/sneezing with tissue or mask, dispose of used tissues and masks, and perform hand hygiene after contact with respiratory secretions.

32. Patient care equipment and Instruments/ devices All patient care equipments that is soiled with blood, body fluids,secretions or excretions shall be handled in a manner that will prevent skin and mucous membrane exposures. Wear PPE(e.g. gloves, gown) according to the level of anticipated contamination, when handling patient care equipment and instruments/devices that are visibly soiled or may have been in contact with blood or body fluids . Remove organic material from critical and semi- critical instrument/devices,using recommended cleaning agents before high level disinfection and sterilization to enable effective disinfection and sterilization processes. Single use,disposable items must be disposed of properly. Make sure that reusable equipment has been cleaned and reprocessed appropriately,prior to use on another patient.

33. TRANSMISSION-BASED PRECAUTIONS (TBP) Transmission-based precautions (TBPs) are used in addition to standard precautions when standard precautions alone may be insufficient to prevent transmission of infection. TBPs are used for patients known or suspected to be infected or colonized with epidemiological important or highly transmissible pathogens that can transmit or cause infection. TBPs are not required for patients with blood borne viruses, such as HIV, hepatitis B virus or hepatitis C virus.

34. cont. The type of TBPs applied is based upon the mode of transmission of the pathogen. For diseases that have multiple routes of transmission, more than one TBP category is applied. The following are the routes of transmission. - Airborne transmission, e.g., pulmonary tuberculosis, chickenpox, measles - Droplet transmission, e.g., influenza, pertussis (whooping cough), rubella - Contact transmission (direct or indirect), e.g., viral gastroenteritis, Clostridium difficile, MRSA, scabies

35. NURSES MANAGEMENT Nursing staff is responsible for implementing patient care practices. Therefore, they should be familiar with practices to prevent the occurrence and spread of infections. The senior nursing administration is responsible for: 1. Participating in the Infection Control Committee. 2. Promoting that development and improvement of nursing techniques. They should constantly review aseptic nurse policies with approval by the Infection Control Committee. 3. Developing training programs for members of the nursing staff. 4. Supervision the implementation of techniques for prevention of infections in specialized areas such as the operation theatre ICU, maternity unit and newborns. 5. Monitoring of nursing adherence to policies.

36. The nurse in-charge of ward is responsible for: 1. Maintaining the hygiene consistent with the hospital policies and good nursing practices in the ward. 2. Monitoring aseptic techniques, including hand washing, use of isolation. 3. Promptly reporting an evidence of infection to the attending physician. 4. Initiating patient isolation, and ordering culture specimens from any patient showing signs of a communicable disease when the physician is not immediately available. 5. Limiting the patient exposure to infections, visitors, hospital staff, other patients or equipment, used for diagnosis or treatment 6. Maintaining a safe and adequate supply of ward equipment, drugs and patient care supplies.

37. The nurse in-charge of infection is a member of the infection control team and is responsible for: 1. Identifying noso-comial infections. 2. Investigation of the type of infection and infecting organism. 3. Participating in training of the personnel. 4. Surveillance of hospital infections. 5. Participating in investigation of outbreak. 6. Development of infection control policy and review and approval of patient care policies relevant to infection control. 7. Ensuring compliance to local and natural regulations. 8. Providing expert advice in matters relating to transmission of infections.

38. ABSTRACT Health Care Workers and Standard Precautions: Perceptions and Determinants of Compliance in the Emergency and Trauma Triage of a Tertiary Care Hospital in South India Background. Careful adherence to standard precautions can protect both health care workers (HCWs) and patients from infections. The present study identified the perceptions and compliance with the use of standard precautions and assessed the determinants of noncompliance among the HCWs in an emergency and trauma triage centre.  Methods- A cross-sectional study using a semi structured questionnaire was carried out to collect the relevant information from the study participants. 

39. Results- A total of 162 HCWs were recruited into the study, who reported varying degrees of compliance with standard precautions. While most of them declared the use of hand rub (95%) and gloves (77%), reported use of protective eye gear and outer protective clothing was very low (22 and 28%, resp.). Despite a perceived risk of exposure to blood-borne infections, 8% of the HCWs had not completed the hepatitis B vaccination schedule. About 17% reported at least one needle stick injury in the past year but only 5.6% received medical attention.  Conclusion- Inadequate adherence to standard precautions among health care providers warrants new training and monitoring strategies. Establishment of an effective occupational health cell incorporating these elements including periodic surveillance could be the way forward.

40. What are the standard safety measures one can take and teach to people in this covid 19 ?

41. CONCLUSION Standard precautions are the work practices required to achieve a basic level of infection prevention and control and Transmission-based precautions are used when standard precautions alone are not sufficient to prevent the spread of an infectious agent.

42. BIBLIOGRAPHY Books: - Clement nisha,essential management of nursing services and education,Jaypee brothers ,medical publication,first edition 2016,page-320-325 - Clement I. Textbook of nursing foundation, Jaypee Brothers medical publishers (p) Ltd, Bangladesh; 2nd edition (2017). Page no-570-589. - K.Deepak ,A comprehensive textbook on nursing management, EMMESS Medical pubilishers,second edition 2019,page -519- 525. -Baveja C.P. Textbook of Microbiology, arya publication New Delhi; 5th edition (2015).page no: 602-610. - Barar navneet kaur,Textbook of advanced Nursing practice,Jaypee publication,New Delhi, first edition-2015,page no- 514- 528. - Baseer Sabeer ,A concise textbook of advanced nursing practice,EMMESS medical publication,New Delhi,First edition,Third reprint- 2016,Page no- 324-341.

43. JOURNAL - Arinze.Onyia SU, Ndu AC, Aguwa EN, Modebe I, Nwamoh UN. Knowledge and practice of standard precautions by health care workers in a tertiary health institution in Enugu, Nigeria. Nigerian journal of clinical practice. 2018;21(2):149-55. - LAKSHMI G, MERITON S, CHRISTINA M. A study on personal protective equipment use among health care providers, Tamil Nadu. International Journal of Community Medicine and Public Health. 2016;5. - Bekele T, Ashenaf T, Ermias A, Arega Sadore A. Compliance with standard safety precautions and associated factors among health care workers in Hawassa University comprehensive, specialized hospital, Southern Ethiopia. Plos one. 2020 Oct 15;15(10).

44. WEBSITE - Akagbo Sandra Enyonam,Pricilla nortey,Mercy M Ackumey (30th Aug,2017) Standard safety precautions, Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577785/ (Accessed: 24th march,2021). - BR Anil Kumar (4th Dec,2017) Standard safety precaution, Available at: https://www.slideshare.net/AnilKumarGowda/standard-safety-precautions (Accessed: 24th march,2021) - Infection prevention and control of epidemic‐ and pandemic‐prone acute respiratory diseases in health care ‐ WHO Interim Guidelines. World Health Organization, June 2007. Available at http://www.who.int/csr/resources/publications/WHO_2007/index.html. (Accessed on 24th march,2021)