Standard precautions in health care

Background

Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources. They are the basic level of infection control precautions which are to be used, as a minimum, in the care of all patients.

Hand hygiene is a major component of standard precautions and one of the most effective methods to prevent transmission of pathogens associated with health care. In addition to hand hygiene, the use of personal protective equipment should be guided by risk assess- ment and the extent of contact anticipated with blood and body fluids, or pathogens.

In addition to practices carried out by health workers when providing care, all individuals (including patients and visitors) should comply with infection control practices in health-care settings. The control of spread of pathogens from the source is key to avoid trans- mission. Among source control measures, respiratory hygiene/cough etiquette, developed during the severe acute respiratory syndrome (SARS) outbreak, is now considered as part of standard precautions.

Worldwide escalation of the use of standard precautions would reduce unnecessary risks associated with health care. Promotion of an institutional safety climate helps to improve conformity with recommended measures and thus subsequent risk reduction. Provision of adequate staff and supplies, together with leadership and educa- tion of health workers, patients, and visitors, is critical for an enhanced safety climate in health-care settings.

Important advice

·    Promotion of a safety climate is a cornerstone of prevention of transmission of pathogens in health care.

·       Standard precautions should be the minimum level of precautions used when providing care for all patients.

·        Risk assessment is critical. Assess all health-care activities to determine the personal protection that is indicated.

·  Implement source control measures for all persons with respiratory symptoms through promotion of respiratory hygiene and cough etiquette.

Checklist

Health policy

·         Promote a safety climate.

·         Develop policies which facilitate the implementation of infection control measures.

Hand hygiene

·     Perform hand hygiene by means of hand rubbing or hand washing (see detailed indications in table).

·     Perform hand washing with soap and water if hands are visibly soiled, or exposure to spore-forming organisms is proven or strongly suspected, or after using the restroom. Otherwise, if resources permit, perform hand rubbing with an alcohol-based preparation.

·         Ensure availability of hand-washing facilities with clean running water.

·       Ensure availability of hand hygiene products (clean water, soap, single use clean towels, alcohol-based hand rub). Alcohol-based hand rubs should ideally be available at the point of care.

Personal protective equipment (PPE)

·      ASSESS THE RISK of exposure to body substances or contaminated surfaces BEFORE any health-care activity. Make this a routine!

·      Select PPE based on the assessment of risk:

o   clean non-sterile gloves

o   clean, non-sterile fluid-resistant gown mask and eye protection or a face shield.

Respiratory hygiene and cough etiquette

·         Education of health workers, patients and visitors.

·         Covering mouth and nose when coughing or sneezing.

·         Hand hygiene after contact with respiratory secretions.

·         Spatial separation of persons with acute febrile respiratory symptoms.

Health-care facility recommendations for standard precautions

KEY ELEMENTS AT A GLANCE

1.  Hand hygiene

Summary technique:

·         Hand washing (40–60 sec): wet hands and apply soap; rub all surfaces; rinse hands and dry thoroughly with a single use towel; use towel to turn off faucet.                      

·         Hand rubbing (20–30 sec): apply enough product to cover all areas of the hands; rub hands until dry.                                                                                                         

Summary indications

·         Before and after any direct patient contact and between patients, whether or not gloves are worn

·              Immediately after gloves are removed.      

·               Before handling an invasive device

·         After touching blood, body fluids, secretions, excretions, non-intact skin, and contaminated items, even if gloves are worn.                                                                               

·             During patient care, when moving from a contaminated to a clean body site of the patient

·             After contact with inanimate objects in the immediate vicinity of the patient      

2. Gloves

·           Wear when touching blood, body fluids, secretions, excretions, mucous membranes, non-intact skin.

·     Change between tasks and procedures on the same patient after contact with potentially infectious material.

·         Remove after use, before touching non-contaminated items and surfaces, and before going to another patient. Perform hand hygiene immediately after removal.    

3. Facial protection (eyes, nose, and mouth)

·         Wear (1) a surgical or procedure mask and eye protection (eye visor, goggles) or (2) a face shield to protect mucous membranes of the eyes, nose, and mouth during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.

4. Gown

·         Wear to protect skin and prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.

·         Remove soiled gown as soon as possible, and perform hand hygiene.

5. Prevention of needle stick and injuries from other sharp instruments

Use care when:

·         Handling needles, scalpels, and other sharp instruments or devices.

·         Cleaning used instruments.

·         Disposing of used needles and other sharp instruments.      

6. Respiratory hygiene and cough etiquette

Persons with respiratory symptoms should apply source control measures:

·         Cover their nose and mouth when coughing/sneezing with tissue or mask, dispose of used tissues and masks, and perform hand hygiene after contact with respiratory secretions.

Health-care facilities should:

·         Place acute febrile respiratory symptomatic patients at least 1 metre (3 feet) away from others in common waiting areas, if possible.

·         Post visual alerts at the entrance to health-care facilities instructing persons with respiratory symptoms to practice respiratory hygiene/cough etiquette.

·         Consider making hand hygiene resources, tissues and masks available in common areas and areas used for the evaluation of patients with respiratory illnesses.

7. Environmental cleaning

·         Use adequate procedures for the routine cleaning and disinfection of environmental and other frequently touched surfaces.           

8. 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.

9. 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.

10.  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.