STANDARD PRECAUTION

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STANDARD PRECAUTION

• Prof. Dr. Ida Parwati, PhD.
• Department of Clinical Pathology
• Division of Infectious and Tropical Diseases
• Dr. Hasan Sadikin General Hospital
• Faculty of Medicine - Unpad

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DEFINITION

• Standard Precautions
• Previously known by various names including
  universal precautions
• Standard precautions are designed to reduce the
  risk of transmission of bloodborne and other
  pathogens from both recognized and unrecognized
  sources to a susceptible host.
• They are the basic level of infection control
  precaution
• Hospital Infection is the result of a combination
  of factors Microbial source Transmission
  Susceptible host Infection

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History of Infection Control Precautions
Year Infection Control Precautions
1877,1910 Separates facilities, Antisepsis and disinfections ... etc
1985 UNIVERSAL PRECAUTIONS (guidelines for protecting healthcare worker because the emergence of HIV other bloodborne pathogens)
1987 BODY SUBSTANCE ISOLATION ( focused on protecting patients and health personnel from all moist body fluids not just blood semen, vaginal secretions, wound drainage, sputum, saliva etc
1996 STANDARD PRECAUTIONSTwo level approach Standar Precautions which apply to all clients and patients attending healthcare facilities Transmission-based Precautions which apply only to hospitalized patients
2007 ISOLATION PRECAUTIONS (new pathogens SARS, Avian Influenzae H5N1, H1N1)
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Isolation precaution
Transmission-based precautions
Standard precautions

• Universal precautions

• Airborne precautions

• Body substance isolation

• Droplet precautions

• Contact precaution

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Key Elements of Standard Precautions

• Hand hygiene
• Gloves
• Mask, gogles, face masks
• Gown
• Prevention of needle stick injuries from sharp
  instruments
• Respiratory hygiene cough etiquette
• Environmental cleaning
• Linens
• Waste disposal
• Patient care equipment

PPE
WHO, 2007
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Definitions of Hand hygiene

• Hand-washing
• Washing hands with plain soap and water
• Antiseptic hand-wash
• Washing hands with water and soap or other
  detergents containing an antiseptic agent
• Alcohol-based hand-rub
• Rubbing hands with an alcohol-containing
  preparation
• Surgical hand hygiene/antisepsis
• Hand-washing or using an alcohol-based hand-rub
  before operations by surgical personnel

Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
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My five moments for hand hygiene
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This I do believe ! The single most important
thing that you can do to stop the spread of any
germs is to wash your hands
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PPE
PPE Working Condition
gloves should be used when touching blood, body fluids, secretions, excretions, or contaminated items and for touching mucous membranes and nonintact skin.
gowns should be used during procedures and patient care activities when contact of clothing and/or exposed skin with blood, body fluids, secretions, or excretions is anticipated. Aprons are sometimes used as PPE over scrubs, such as in hemodialysis centers when inserting a needle into a fistula.
Mask and goggles or a face shield should be used during patient care activities that are likely to generate splashes and sprays of blood, body fluids, secretions, or excretions.
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Precaution for suspected Avian Influenza Full
Barrier Precaution
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Activities at risk of sharp injury

• Needle re-capping
• Body fluids aliquoting
• Open the tubes
• Throw the sharps not to sharp container

• HBV 27 37 ( 30)
• HCV 3 10 (3,0 )
• HIV 0,2 0,4 (0,3)

Discard if 2/3 full
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Transmission-Based Precautions

• Used in addition to Standard Precautions for
  Specified Patients
• Designed for the Care of Specified Patients known
  or suspected to be infected by epidemiologically
  important pathogens spread by airborne,
  droplet, or contact transmission.

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Droplet Transmission

• For infectious agents with droplet nuclei gt 5
  microns
• Examples
• Pertussis
• Meningococcal meningitis
• Precaution Examples
• Private room
• Mask if within 3 of patient

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Droplet Precautions

• Prevent infection by large droplets from
• Sneezing
• Coughing
• Talking
• Examples
• Neisseria meningitidis
• Pertussis
• Influenza

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Airborne Transmission

• For infectious agents with droplet nuclei lt 5
  microns
• Examples
• Tuberculosis
• Measles
• Precaution Examples
• Isolation rooms under negative pressure
• N95 or HEPA respirator use

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Airborne Precautions for Avian Influenza

• Respiratory Protection
• N95 respirator
• Patient in isolation/cohorting
• Patient Transport
• Limit patient movement
• and transport,
• place a surgical mask
• on the patient
• Airborne isolation room, if available
• Air exhaust to outside or
• re-circulated with HEPA filtration

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Linens

• Handle, transport, and process used linen in a
  manner which
• Prevents skin and mucous membrane exposures and
  contamination of clothing.
• Avoids transfer of pathogens to other patients
  and or the environment.

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Waste disposal

• Ensure safe waste management.
• Treat waste contaminated with blood, body fluids,
  secretions and excretions as clinical waste, in
  accordance with local regulations.
• Human tissues and laboratory waste that is
  directly associated with specimen processing
  should also be treated as clinical waste.
• Discard single use items properly.

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Patient care equipment

• 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.

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Contact Precautions

• For protection against skin-to-skin contact and
  physical transfer of microorganisms to a host
  from a source
• Precaution Examples
• Private room
• Handwashing
• Glove changes
• Examples
• Scabies
• VRE

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