![1. Airborne precautions
• For patients known or suspected to be infected with
pathogens that can be transmitted by the airborne
route
– eg. TB
– Respiratory tract infections,
Airborne transmission occurs
1. Airborne droplet nuclei
– small-particles [<5μm] of evaporated droplets that may
remain suspended in the air for long periods of time
2. Dust particles containing the infectious agent.](https://image.slidesharecdn.com/standardprecaution-221208064455-4d044332/85/Standard-Precaution-ppt-37-320.jpg)
Standard Precaution.ppt
- 1. Standard Precaution • What are standard precautions? –They are a set of guidelines • help reduce the transmission of HAI in hospitals. • reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals.
- 2. Standard Precaution • When should Standard Precautions be used? • They should be used by ALL health care workers at ALL times when attending to ALL patients, • regardless of their diagnosis or presumed infectious status.
- 3. Guidelines in Standard Precautions • Handwashing • Gloves • Personal protective equipment (PPE) • Patient care equipment – Cleaning of instruments • Environmental control – Management of spills
- 4. HANDWASHING
- 5. HANDWASHING • Hands of health care workers (HCW) are often colonized with pathogens from patients and from environmental surfaces. • Bacteria that cause hospital-associated infections (HAI) are most frequently spread from one patient to another on the hands of HCW. • Essential to wash hands before contact with any patient and after
- 6. Some reasons why HCW do not wash their hands as often as they should: • heavy workloads (too busy) • Sinks are not available or are poorly located • skin irritation caused by frequent exposure to soap and water • hands don’t look dirty • handwashing takes too long
- 7. Culture plate showing growth of bacteria 24 hours after a nurse placed her hand on the plate
- 8. S. aureus carriage • % of patients with methicillin-resistant S. aureus (MRSA) who carry the organism on the skin under their arms, on their hands or wrists, or in the groin area. 13-25% 40% 30-39%
- 9. INDICATIONS FOR HANDWASHING • Before doing any invasive procedures and before handling any invasive devices. • After contact with blood, body fluids, secretions or excretions and contaminated item – irrespective of whether gloves were worn. • After gloves are removed. • Between patient contacts. • Contact with ‘dirty’ and ‘clean’ sites on the same patient
- 10. Handwashing must take place before • Contact with a patient • Wearing gloves • Administration of parenteral medicine • Handling of invasive devices and catheters • Moving from a contaminated body site to a clean body site of the same patient • Meal break
- 11. Handwashing must take place after • Removal of gloves • Contact with blood, body fluids or other clinical material; • Patient contact • Contact with wounds • Handling of invasive devices, catheters, drains and nebulizers • Using the toilet
- 12. HANDWASHING TECNIQUE • Nails must be clean and short. • All jewelry should be removed prior to handwashing, • Wet hands under running water • Apply soap covering all surfaces of the hands. • Vigorously rub all surfaces of lathered hands for 10- 15 seconds. • Rub hands systematically covering all surfaces – especially the tips of the fingers, the thumbs and the finger webs.
- 15. HANDWASHING TECNIQUE • Rinse hands under running water. • Hands should be dried with a clean or sterile single use towel. – An automatic dryer is an alternative method for drying of hands. • Leave adequate single use hand towels beside the sinks • Keep a foot-operated bin to discard towels – Used towels are collected and sent to the laundry for washing and reuse.
- 16. HANDWASHING AGENTS • Soap – Liquid soap is better than bar soap. – If only bar soap is available, use small pieces which should be just adequate for the day, • placed on a rack so that no water is retained (as in a dish). • 2% - 4% chlorhexidine gluconate • 7.5% povidone iodine.
- 17. ALCOHOL HAND RUBS • Used as an alternative to handwashing with soap and water or disinfectants. • Do not use for visibly soiled hands. • Has a good immediate activity. • Does not require drying with a towel • Does not require a designated area for hand washing. • Less time consuming and does not cause drying of skin. • Can be prepared in-house – (97 ml of 70% alcohol + 3 ml of glycerol).
- 18. SURGICAL HAND SCRUB • Remove all jewelry before scrubbing • Nail brush should be used only for the first hand wash of the day to remove debris from underneath nails. • Apply 3-5 ml of antiseptic detergent (eg. 4% chlorhexidine or 7.5% povidone iodine) to moistened hand and forearms • Vigorously rub all surfaces of hands and forearms for approximately 3-5 minutes.
- 19. SURGICAL HAND SCRUB • The disinfection process must be thorough and systematic, covering all areas of the hands and forearms. • Do not use brushes. • Hands should be held high while washing with water • Initial scrub should last for 3-5 minutes. In between cases, scrubbing should last for 2 to 3 minutes.
- 20. PERSONAL PROTECTIVE EQUIPMENT (PPE) • PPE provides a protective physical barrier that reduces contamination –clothes, skin and the mucous membranes of the eyes, nose and mouth. • PPE includes – gloves, mask, gown, apron, goggles, boots and caps. – The mask should be a standard surgical splash proof mask and not a gauze mask.
- 21. PERSONAL PROTECTIVE EQUIPMENT (PPE) • HCW should asses the risk of exposure to blood, body fluids, excretions or secretions and should choose their items of PPE according to the risk. • Discard used PPE appropriately and wash hands after attending to patients.
- 22. PATIENT CARE EQUIPMENT • Handling of used patient care equipment soiled with blood, body fluids, secretions and excretions to prevent – skin and mucous membrane exposures, – contamination of clothing and – transfer of microorganisms to other patients and environment.
- 23. PATIENT CARE EQUIPMENT • Single-use items –are discarded properly and never re-used. –However, if such items have to be reused cleaning and high level disinfection is recommended • Reusable equipment –Should be cleaned and disinfected or sterilized appropriately.
- 24. PATIENT CARE EQUIPMENT Cleaning of instruments • Carried out before disinfection and sterilization. • Thorough cleaning with detergent and water will remove most microorganisms. • Wear personal protective equipment (plastic apron, heavy duty gloves) • The sink should be deep enough to completely immerse the equipment. • Remove any gross soiling on the instrument by rinsing in tap water.
- 25. PATIENT CARE EQUIPMENT Cleaning of instruments • Immerse all parts in water with detergent. – Follow the manufacturer’s instructions. • Instrument should remain below the surface of the water while brushing and cleaning. – Take precautions to prevent splash and injury. – Ensure all visible soiling is removed from the instrument. • Rinse in hot water (45oC) unless contraindicated. • Dry the instrument. • Inspect to ensure the instrument is clean. • Keep cleaning equipment (brushes and cloths) clean and dry between uses.
- 26. ENVIRONMENTAL CONTROL • The hospital environment should be visibly clean, free from dust and dirt • Routine cleaning and disinfection of environmental surfaces, beds, bedrails, bedside equipment. • Wet cleaning and damp dusting only – prevent pathogens from being airborne from the surfaces that are being cleaned. • Use a general purpose detergent for environmental cleaning.
- 27. ENVIRONMENTAL CONTROL • Keep the environment dry, clean, well ventilated and exposed to sunlight. • Do not use disinfectants unless indicated eg. spills, isolation rooms • Keep mops and buckets clean, dry and inverted. • Use different cleaning equipment for clinical areas, toilets. • Routine culturing of environment and air is not useful.
- 28. Management of spills Blood and body fluid spills • Wear heavy duty gloves. • Soak up fluid using absorbent material (paper towels, gauze, wadding). • Pour 1% hypochlorite solution till it is well soaked. Leave for at least 10 minutes. • Remove the absorbent material and discard as clinical waste. • Clean area with detergent and water and dry. • Discard gloves as clinical waste. • Wash hands.
- 29. LINEN • Handle, transport and process soiled linen so as to prevent skin and mucous membrane exposures and contamination of clothing. • Ideally blood and body fluid stained linen and linen from patients in contact isolation should be washed in – Washing machine with a hot cycle using bleach. – Or should be soaked in 0.5-1% hypochlorite solution for 30 minutes in the wards/operation theatre before sending to the laundry.
- 30. OCCUPATIONAL HEALTH AND BLOOD BORNE PATHOGENS • Health care workers may be at risk of acquiring infections during their work. • Work practices should be adopted to minimize the risk of getting infected. • Staff should be immunized against Hepatitis B.
- 31. Handling of sharps • Sharps such as scalpels, lancets, needles and syringes should be single use only. • Take care to prevent injuries when using, handling after procedures, cleaning and disposing of sharps. • Avoid recapping used needles. – If this is necessary use a one-handed “scoop” technique. • Do not remove used needles from disposable syringes by hand.
- 32. Handling of sharps • Do not bend, break or otherwise manipulate used needles by hand. • Discard sharps directly into a ‘sharps bin’ – which is located as close as practical to the area in which the items were used. • Discard used sharps immediately and never leave them lying around. • If the sharp bin is at a distance, the used sharp should be carefully carried to it on a tray
- 33. Handling of sharps • Dispose of the sharp container when it is ¾ full. Never let the sharp bin fill up more than ¾ full. • Sharps must not be passed directly from hand to hand. • Place reusable syringes and needles in a puncture resistant container for transport to the reprocessing area. • Use clean gloves during phlebotomy to reduce blood contamination of hands.
- 34. ‘sharps’ bin • This should be made of leak proof and puncture proof material. – Improvised ‘sharp’ bin made of thick cardboard could be used. • The bin should have an opening on top, sufficient only to dispose the used syringes and needles conveniently
- 36. Additional Precautions For patients known or suspected to be infected with pathogens, to interrupt transmission of those pathogens – in addition to Standard Precautions, – Additional precautions are needed • There are three types of Additional Precautions: 1. Airborne precautions 2. Droplet precautions 3. Contact precautions.
- 37. 1. Airborne precautions • For patients known or suspected to be infected with pathogens that can be transmitted by the airborne route – eg. TB – Respiratory tract infections, Airborne transmission occurs 1. Airborne droplet nuclei – small-particles [<5μm] of evaporated droplets that may remain suspended in the air for long periods of time 2. Dust particles containing the infectious agent.
- 38. 1. Airborne precautions………. • Patient should be in a single room or cohorting – door closed at all times – Separate toilet and bathroom • Standard precautions should be used – Gowns, gloves & hand washing – Masks • N95 or equivalent • Check for fit before entering • Remove after leaving the room
- 39. 1. Airborne precautions………. • Visitors – must also wear mask – hand washing on leaving • Patient Medical Records – must not be taken into the room. • Signage of room.
- 40. 1. Airborne precautions………. • Cleaning of the room – May require additional cleaning with a disinfectant agent depending on organism. – Consult with microbiologist
- 41. 2. Droplet precautions • Respiratory droplets are generated – when a patient coughs, sneezes, talks – during procedures such as suctioning and chest physiotherapy. – Respiratory infections –eg ………………………… • Transmission via large-particle droplets (> 5μm size) • requires close contact between source and recipient persons – droplets travel usually one meter or less, through the air.
- 42. 2. Droplet precautions……. • Single room for the patient, if available – Cohort a patient in a room with a patients who have active infection with the same pathogen – Or maintain a space of at least one meter between the infected patient and other patients
- 43. 2. Droplet precautions……. • Hand hygiene • Gloves, Gown/apron • Mask – Standard surgical splash proof masks (not a gauze mask) for health care workers • N95 mask not necessary – Remove mask after leaving patients room. • Protective eyewear – If needed to prevent conjunctival contamination
- 44. 2. Droplet precautions……. • Visitors to patient room – Surgical mask, gowns and protective eyewear – hand washing • Patient Medical Records must not be taken into the room. • Signage of room • Room cleaning – Standard cleaning protocol. – May require additional cleaning with a disinfectant agent depending on organism. – Consult with microbiologist.
- 45. 3. Contact precautions • Transmission of micro-organisms by the contact route is the most common mode for healthcare associated infections. – MRSA • Transmission may occur via 1. direct contact or 2. indirect contact
- 46. 3. Contact precautions 1. Direct contact transmission • Directly from one person to another person, – healthcare workers handling patients • Direct contact transmission can also occur between two patients – Also visitors and bystanders
- 47. 3. Contact precautions 2. Indirect contact transmission • contaminated intermediate object or person. – via the environment and fomites (eg stethoscopes, BP apparatus). – Patient care devices, instruments and equipment that are inadequately cleaned/sterilized between patients
- 48. 3. Contact precautions • Single room for the patient if available. – If not available, patients should be cohorted. • Wear gloves on entering the room. • Gown. • Hand washing – before and after contact with the patient and on leaving the room • Restrict patient movement outside the room • Appropriate environmental and equipment cleaning, disinfection and sterilization.
- 49. Contact precautions • Visitors to patient room – Surgical mask, gowns and protective eyewear – hand washing • Patient Medical Records must not be taken into the room. • Signage of room. • Room cleaning – Standard cleaning protocol. – May require additional cleaning with a disinfectant agent depending on organism. – Consult with microbiologist