universal precautions

universal precautions

1. UNIVERSAL PRECAUTIONS

2. Background … .. In 1985, largely because of the emergence of HIV/AIDS, guidelines for protecting healthcare workers from becoming infected with HIV and other Blood borne infections (e.g., HCV) were quickly developed and became known as Universal Precautions (UP ). Universal precautions protect staff and patients from hospital acquired infection.

3. Definition : “ Universal Precautions is the term applied to treating all blood , tissues and some body fluids as potentially infectious .The appropriate level of Precautions necessary is determined according to the extent of possible exposure to blood & body fluid and not because of the speculation of the infectious status of the patient”

4. Body fluids to be treated with Universal Precautions 1. Cerebrospinal fluid Peritoneal fluid Pleural fluid Pericardial fluid Synovial fluid Amniotic fluid Urine Semen Vaginal secretions 2. Any other fluid containing visible blood including saliva 3. Tissues & organs

5. Universal precautions includes Care of the skin Hand washing Protective Apparel Procedure for safe handling of sharps Procedure for safe disposal of sharps Management of blood and body fluid spillages Waste disposal

6. Care of the skin…. Bacteria and viruses cannot penetrate intact skin. It is therefore vital to keep the skin in good condition and prevent cracking , chapping and drying of the skin. regularly check skin for cuts and cover with a waterproof dressing to allow adequate hand washing. Following removal of gloves wash hands Ensure thorough drying of skin following hand wash.

7. Hand washing….. Hand washing is considered the simplest and most important action to prevent infection transmission Microbes on human skin can be classified into two groups: 1. R esident flora 2. Transient/contaminated flora Resident flora : Not easy to eliminate by scrubbing since they are adapted to living on human hands. Transient /contaminated flora :Easy to eliminate by scrubbing with soap or detergent. This kind of microbe can be frequently found on the skin of health care workers.

8. Hand washing Indications BEFORE: Starting Work Examining a Patient Administering an Injection Handling Disinfected Instruments Putting on Gloves Going Home AFTER: Examining a Patient Handling Instruments or Potentially Contaminated Items or Body Secretions/Excretions Removing gloves Using the toilet or latrine Sneezing or Coughing

9. USING PROTECTIVE BARRIERS…… # The wearing of protective appreal provides the healthcare worker with a barrier between themselves and potential blood and bodyfluid . # Common barriers are gloves, aprons, masks, eye protectors, caps, and sturdy footwear.

10. Rationale for Barrier Use BARRIER PROTECTS PATIENTS PROTECTS HEALTH CARE WORKERS PRECAUTIONS Gloves Preven t microorganism s on th e servic e provider’ s hands fro m comin g i n contac t with th e client Preven t th e servic e provider’s hand s fro m comin g i n contact wit h th e client’ s bloo d o r other bod y fluids , mucous membranes , an d non - intact skin , a s wel l a s instruments, othe r items , o r surface s that hav e bee n contaminate d with bloo d o r othe r bod y fluids Mask Preven t droplet s fro m the servic e provider’ s (an d other person s i n th e clinic ) nose an d mout h whic h contain microorganism s tha t are expelled during talking, coughin g an d breathing fro m contac t wit h th e client Preven t th e muco u s membranes o f th e servic e provider’ s nose an d mout h fro m bein g exposed t o splashe s o f bloo d an d other bod y fluids ; als o protect s from droplet s containing microorganisms. Mas k shoul d cove r nose, mouth , an d cheek s and exten d belo w th e chin.

11. BARRIER PROTECTS PATIENTS PROTECTS HEALTH CARE WORKERS PRECAUTIONS Eye protecto r s N o protectio n documented Preven t th e mucou s membranes o f th e servic e provider’ s eyes fro m bein g expose d t o splashes o f bloo d o r othe r bod y fluid Cap Preven t microorganism s in servic e provider’ s hai r o r on ski n she d fro m th e service provider’ s hea d fr om falling o n th e steril e field N o protectio n documented

12. BARRIER PROTECT PATIENTS PROTECT HEALTH CARE WORKERS PRECAUTIONS Jacket , gow n & plastic apron Preven t microorganism s on th e servic e provider’ s arms, tors o & clothin g from comin g i n contac t wit h the client Prevent s th e servic e provider’s ski n fro m bein g expose d t o splashe s o f bloo d o r othe r body fluids A waterproo f apro n shoul d be wor n unde r th e jacke t or gow n durin g al l procedure s in whic h larg e amount s o f blood & othe r bod y fluid s ar e likely (e.g. , cesarea n delivery) Shoes Clea n footwea r minimises th e numbe r of microorganism s brought fro m othe r area s o f the facilit y o r th e outsid e into th e surgical/procedur e area Fro m steppin g on contaminate d sharp s o r from falling equipment S turd y shoe s shoul d b e worn i n surgery . Healt h care worker s shoul d neve r walk barefoo t i n th e operating room. Clean plastic or leathe r boot s tha t cove r the whol e foo t are recommended . Sandal s & ope n shoe s ar e not recommended.

13. Selection of Protective Barriers Typ e o f Exposure Protective Barrier Example Lo w Risk : Contac t wit h i ntact skin ; n o exposur e to blood Glove s not essential Injection Mino r woun d dressing Mediu m risk: Probabl e contac t with blood , bu t splashing unlikely Gloves Gow n or apro n ma y be necessary Pelvi c exa m Handling of laboratory Specimens IU D insertio n IU D remova l Large , ope n wound dressing Intravenou s Drawin g of blood cathete r inse rtio n o r removal Hig h risk: Contac t wit h blood likely ; splashing probable ; uncontrolled bleeding Gloves Apron Eyewear Mask Majo r surgica l procedures Ora l surgery Vagin a l delivery

14. Procedure for safe handling of sharps Needles must never be re-sheathed or recapped Staff must obtain assistance when taking blood or giving injections to uncooperative or confused patients Never carry sharps by the hand , if transporting always place in an appropriate container Needles must never be broken or bent prior to disposal Needles must never be passed from hand to hand When performing phlebotomy , cannulation or giving injections , all staff must wear appropriate disposable gloves Never reuse a sharp

15. Procedure for safe disposal of sharps Do not dispose of sharps with other clinical waste . Sharps bins to be kept in location that precludes injury to patients , visitors and staff ensuring that sharps bins are situated at a suitable height i.e. not placed on the floor or above shoulder height. Always dispose of needles as a complete unit into a sharps container never disassemble prior to disposal Sharps containers should be ¾ full prior to sealing and disposal Never force a sharp into a sharps container

16. Management of spillage Spillage Disinfectant Procedure Blood Body fluid containing blood 1% hypocholrite solution NaDCC (Sodium dichloroisocyanurate ) granules Wear protective clothing . Soak up excess fluid using disposable paper towels. Cover area with towels soaked in 1% hypocholrite and NaDCC . Leave for at least 2 minutes. Dispose of as infectious waste - yellow bag. Clean area with hot water and detergent Dry area using disposable paper towels Dispose of protective clothing as above Wash hands.   Urine and vomitus 1% hypocholrite solution NaDCC (Sodium dichloroisocyanurate ) granules The excess urine/vomit must be mopped up with paper towels first. This is because if urine or vomit comes into direct contact with the chlorine product toxic fumes will be released. The room should be well ventilated (i.e. window open) before this procedure is carried out .  

17. Spillage of body fluids not containing blood / For blood on carpets or soft furnishings 1% hypocholrite solution NaDCC (Sodium dichloroisocyanurate ) granules Wear protective clothing PPE. Soak up fluid with paper towels. Wash area with hot water and detergent. Rinse with hot water. Dispose of paper towels and protective clothing in clinical waste (infectious waste- yellow bag).Wash hands Spillage from a Sharps Container 1% hypocholrite solution NaDCC (Sodium dichloroisocyanurate ) granules Wear protective clothing Gather up spilled sharps using the equipment in the ‘Community Sharps handling kit’ stored in every health centre. Follow procedure as for blood spillage on floor area where sharps were spilled.

18. WASTE DISPOSAL

19. Precautions for Laboratories To supplement the "universal precautions" listed above the following precautions are recommended: 1. All specimens of blood and body fluids should be put in a well-constructed container with a secure lid to prevent leaking during transport. 2. All persons processing blood and body-fluid specimens, e.g., removing tops from vacuum tubes, should wear gloves. Masks and protective eyewear should be worn if mucous membrane contact with blood or body fluids is anticipated. Gloves should be changed and hands washed after completion of specimen processing.

20. 3. For routine procedures, such as histologic and pathologic studies or microbiologic culturing, a biological safety cabinet is not necessary. However, biological safety cabinets should be used whenever procedures are conducted that have a high potential for generating droplets. 4. Mechanical pipetting devices should be used for manipulating all liquids in the laboratory. Mouth pipetting must not be done. 5. Use of needles and syringes should be limited to situations in which there is no alternative, and the recommendations for preventing injuries with needles outlined under universal precautions should be followed. 6. Laboratory work surfaces should be decontaminated with an appropriate chemical germicide after a spill of blood or other body fluids and when work activities are completed .

21. 7. Contaminated materials used in the laboratory should be decontaminated before reprocessing or be placed in bags or other containers and disposed of according to the Universal procedures. 8. Equipment that has been contaminated with blood or other body fluids should be decontaminated and cleaned before being repaired in the laboratory or transported to the manufacturer. 9. All persons should wash their hands after completing laboratory activities and should remove protective clothing before leaving the laboratory.

22. Almost from the moment universal precautions were issued and hospitals and clinics began implementing them, it was recognized that this new strategy, while protecting hospital personnel (patient-to-personnel transmission), sacrificed some measures of preventing patient-to-patient and personnel-to-patient transmission.

23. Also, because many people with bloodborne infections such as HIV/AIDS do not have symptoms, nor can they be visibly recognized as being infected, Universal Precautions had to be modified to include all persons—patients and clients— attending healthcare facilities regardless of whether or not they are infected .

24. Standard Precautions are designed for the care of all persons— patients, clients and staff—regardless of whether or not they are infected.

25. Standard Precautions are evidence based clinical work practices published by the Centre of Disease Control (CDC) in 1996 and updated in 2007 that prevent transmission of infectious agents in healthcare settings.

26. Chain of Infection Standard Precautions breaks the chain of infection thus minimizing transmission of infection within the Healthcare environment.

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

28. Standard precaution B reaking the chain of transmission sharps Linen

29. Standard precaution Breaking the chain of transmission Disposal of biowaste Environmental cleaning Routinely care, clean and disinfect equipment and furnishings in patient care areas  

30. Standard precaution Breaking the chain of transmission Patient care equipment 1.Handle soiled equipment in a manner to prevent contact with skin or mucous membranes and to prevent contamination of clothing or the environment 2. Clean reusable equipment prior to reuse  

31. Standard precaution Breaking the chain of transmission Patient resuscitation Use mouthpieces, resuscitation bags or other ventilation devices to avoid mouth-to- mouth resuscitation Patient placement Place patients who contaminate the environment or cannot maintain appropriate hygiene in private rooms

32. Conclusion !!!!!..............