7 Standard Precaution

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STANDARD PRECAUTION

Prof. Dr. Ida Parwati, PhD.Department of Clinical PathologyDivision 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 ofinfection 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 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 andhealth 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 facilitiesTransmission-based Precautions which apply only to hospitalized

patients

2007 ISOLATION PRECAUTIONS (new pathogens; SARS, Avian Influenzae

H5N1, H1N1)


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Standard precautions Transmission-based precautions

Universal precautions

Body substance isolationAirborne precautions

Droplet precautions

Contact precaution


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Key Elements of Standard Precautions

1. Hand hygiene

2. Gloves

3. Mask, gogles, face masks

4. Gown5. Prevention of needle stick & injuries from sharp instruments

6. Respiratory hygiene & cough etiquette

7. Environmental cleaning

8. Linens

9. Waste disposal

10. Patient care equipment

WHO, 2007

PPE


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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 detergentscontaining 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 beforeoperations 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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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 careactivities 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 AvianInfluenza :

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

Discard if 2/3 full

HBV : 27 37% ( 30%)

HCV : 3 10 % (3,0 %)

HIV : 0,2

0,4% (0,3%)


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Transmission-Based Precautions

Used in addition to Standard Precautions for

Specified Patients

Designed for the Care of Specified Patientsknown 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 >

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 < 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 ofclothing, and transfer of pathogens to

other patients or the environment.

Clean, disinfect, and reprocess reusableequipment 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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7 Standard Precaution

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