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

DEFINITIONStandard 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

History of Infection Control PrecautionsYear 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 PRECAUTIONS:Two 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)

Standard precautions Transmission-based precautions

• Universal precautions

• Body substance isolation

•Airborne precautions

•Droplet precautions

•Contact precaution

Key Elements of Standard Precautions

1. Hand hygiene2. Gloves3. Mask, gogles, face masks4. Gown5. Prevention of needle stick & injuries from sharp instruments6. Respiratory hygiene & cough etiquette7. Environmental cleaning 8. Linens9. Waste disposal10. Patient care equipment

WHO, 2007

PPE

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.

“My five moments for hand hygiene”

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

PPEPPE 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.

Precaution for suspected Avian Influenza :

Full Barrier Precaution

Activities at risk of sharp injury

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

Discard if 2/3 full

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

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.

Droplet Transmission

• For infectious agents with droplet nuclei > 5 microns

• Examples:– Pertussis– Meningococcal meningitis

• Precaution Examples:– Private room– Mask if within 3’ of patient

Droplet Precautions

• Prevent infection by large droplets from– Sneezing– Coughing– Talking

• Examples– Neisseria meningitidis– Pertussis– Influenza

Airborne Transmission

• For infectious agents with droplet nuclei < 5 microns

• Examples:– Tuberculosis– Measles

• Precaution Examples– Isolation rooms under negative pressure– N95 or HEPA respirator use

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

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.

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.

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.

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