Health protection

1. UNIVERSAL HEALTH
PRECAUTIONS
an Update
Dr.MANISH POKRA

2. What are UniversalPrecautions
Universal precaution are
control guidelinesdesignedto
protect workers
from exposureto Diseases
spreadby Bloodandother Body
fluids.

4. UniversalPrecautions
– Applied universally in caring for allpatients
• Hand washing
• Decontamination of equipment anddevices
• Use and disposal of needles and sharpssafely
(no recapping)
• Wearing protective items
• Prompt cleaning up of blood and body fluid spills
• Systemsfor safe collection of waste anddisposal

5. WhyUniversal Precautions

6. DEFINITION
StandardPrecautions
Previously known by various names including “universal
precautions”
Sstandard precautions are designed to reduce the riskof
transmissionof bloodborne andother pathogens from
both recognized and unrecognized sources to a
susceptible host.
Theyare the basic level of infection control precaution
Hospital Infection is the result of a combination of factors:
Microbial source+Transmission+Susceptiblehost =
Infection
•
•
•
•

7. Historyof Infection Control Precautions
Year Infection Control Precautions
1877,1910 Separatesfacilities, Antisepsis and disinfections ... etc
1985 UNIVERSALPRECAUTIONS(guidelines for protecting healthcare
worker becausethe emergence of HIV& other bloodborne
pathogens)
1987 BODYSUBST
ANCEISOLATION( focused on protecting patients and
health personnel from all moist body fluids not just blood:semen,
vaginal secretions, wound drainage, sputum, salivaetc
1996 STANDARDPRECAUTIONS:Twolevelapproach:
•Standar Precautions which apply to all clients andpatients
attending healthcarefacilities
•Transmission-basedPrecautionswhich apply only to hospitalized
patients
2007 ISOLATIONPRECAUTIONS(new pathogens; SARS,Avian Influenzae
H5N1,H1N1)

8. EveryProcedureincreasesthe
Riskof Infection to HCW

9. Objectives:
Participants will:
• Understand and become familiar with
universal precautions.
• Learn the importance of good hygiene
and hand washing.
• Learn proper hand washing techniques.
• Learn the proper technique for applying
and removing gloves.

10. WhyUniversalhealth
Precautions.
Theconceptof UniversalHealth
Precautionsemphasizesthat all our
patients shouldbe treated as
thoughthey havepotential blood
borninfections, and can infect the
caringhealth care workers. ( CDC)

11. We Do Not Know who is Infected

12. Humanmaterials/Tissuesconsidered
HighlyInfectious
• 1 Blood
• 2 Semen
• 3 Vaginal secretions
• 4 CSF
• 5 Synovial fluids
• 6Amniotic fluid
• 7All other bodyfluids

13. Not Infectious unless contaminated with
Blood or Bodyfluids.
•
•
•
•
•
•
•
Feces,
Nasalsecretions,
Sputum,
S
weat,
Tears,
Urine / Vomitus,
Salivaunless blood
stained.

14. Hand washing is the most
important method of disease
prevention
Bacteria and bacteria can
be spread via dirty hands
and the are too small to
see with the human eye.
You must wash you hands
properly in order to
remove them.

15. HANDWASHING
• There is no Health precaution likeHand
washing.
• Washing with simple toilet soap- reducesthe
rate of transmission of common infections
including the HIV.

17. Howto Washour hands

18. Indications for Hand Washing
•
•
In prolonged contact with patient.
Before taking care of Immune supressed,New born
infants, patients in ICU/ ICCU,Dialysis Units, Burn’s
Units.
Before and after touchingwounds.
When Microbial contamination of Hands,likely to
occur when in contact with mucous membranes,
body fluids, and other secretions contaminatedwith
Blood, and serous fluids.
•
•

19. What to beusedfor handwashing
• In most circumstances Non medicated soapsand
detergents are effective in removing mosttransient
contaminants.
In demanding circumstances, in handlingpotentially
harmful infections, useEthyl or Isopropylalcohol.
Detergent formulations containingChlorhexidine
Povidone,or Hexachlorophene are effective in
prevention of spread ofinfections.
•
•

20. Wordsof WisdomonHand
Washing
Soap,water and
Common senseare still be
BestAntiseptics
William Osler

21. 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

22. Useof Gloves
Useof a pair of
disposableplastic
glovescanprotect
if chancesof
contactwith
Bloodor Body
fluid is
anticipated/inevitable.

23. Useof Mask, Cap,Eye Wear
• Will certainlyprotect
usfrom splashesof
Blood or Bodyfluids.
• Don't underestimate
the importance of
Useof Capand
Mask.
• It equallyprotects
our patients.

24. UP recommends the use of
Personal Protective
Equipment
• Gloves
• Aprons
• Gowns
• Protective
eyewear
• Face shields
• Masks

25. Usesof Capand Mask
Stringent useof
Mask andCap
cansave
severalLivesin
the Hospital

26. Useof Foot wear
•Wearing foot wear covering entire
sole protects the entry of Microbes
from the contaminated floors with
Blood and Body fluids.
•Remember many of us have cracks on
our feet.

27. Useof Impervious Gown
Asimplethin Plastic
apronunderneaththe
linen isof great help in
preventing the
soakingour inner
clothesandexposure
to harmfulmicrobes.

28. Universal Precautions also
include:
• Proper handling and
disposal of needles.
• Taking precautions to
prevent injury from
scalpels, needles, and
other sharp
instruments.

29. Disposalof Needlesand Sharps
• All used needles and sharps should be
deposited in thick walled punctureresistant
containers.
• Bending, Reshaping,should be prohibited.
• Donot recap the needles toavoid needle stick
injures,
• All used Disposable syringes and needles
should be discarded into Bleach solutionat
the work station before finaldisposal.

30. Dealingwith UsedNeedle
Shredding
continuesto be
Important
Method
Of dealingwith
used Needle

31. ManagingOccupationalExposureto HIV
Infection
Post-Exposure Prophylaxis (PEP:
• PEP– Following occupational HIVexposure, short-
course of ARVdrugs canbe used to reduce the
likelihood of infection
• Register occupational exposures
• Ensurethat HIVcounselling, testing,andARV
drugs are available
• Educatehealthcare workers

32. Post-Exposure Prophylaxis (PEP)
• Immediate stepspost- exposure
• Washexposed wound or skin with soap andwater
• For needle or sharp injury, allow to bleed for afew
seconds before washing
• Inform supervisor of type of exposure and the actions
taken
• Assureconfidentiality to theHCW
• Ensuresupport and referral for treatment

33. Guidelinesfor PEP
• Ideally, initiate PEPtreatment within 2
hoursof exposure
• If sourcepatient isHIV negative,
discontinuePEPandretest at 6 weeks,
3 months,and6 months
• If sourcepatient isHIV positive,
counsel,support, andrefer the HCW
for continued treatment

34. Guidelines for PEP (continued)
–Follow approved PEPregimen( suggested)
–Examples
• ZDV200 mg 3 times daily for 4weeks
• Combivir tablet (300 mg ZDVand 150 mg
lamivudine) twice daily+
• Indinavir 800 mg 3 times daily for 4weeks

35. Dealingwith Needle stick
Injuries
• Consider all Needle stick injuries asaserious
health hazard in the era ofAIDS
• All events of Needle stick injuries tobe
reported to the supervisorystaff.
• Washthe injured areas with soap andwater.
• Encourage bleeding if any.
• Prophylaxis for prevention of HIV/HBVistop
priority.
• Anti retroviral prophylaxis, ifnecessary should
started within 2 hours, ( if injury is from HIV
positive or high riskgroup).

36. AvoidNeedle Stick Injuries

37. Hazardsof Needlestick
Injuries
HIV HBV and HCVviral
infections canspreadbyNeedle
stickInjuries
Nursingstaff are at greater risk
SeveralInjuries are preventable

38. Decontamination of Hospital
Linen
• All the linen contaminated with
Blood or Body fluids should be
soaked in 1: 100 bleachsolution
for 30minutes.
• AdvisedAutoclaving, asthe most
ideal procedure for
decontaminating Linen

39. Spillageof Blood/Body fluids
• Acommon health hazard in the working
environment.
• Never wipe the spillage with workingwet
mop.
Always cover the spills with paperand
pour 1 %Hypochlorite or Bleaching
powder to decontaminate the spillswith
HIV/HBV virus.

40. Careof Endoscopes
• Endoscopesare delicate/precious
instruments.
• Follow the instruction ofManufacturers.
• It is commonly cleaned with2 %
Glutaraldehyde solution.
• Specified time schedules to be followedto
decontaminate for HIV.
• Mycobacterium needs even >2 hours for
decontmination.

41. Decontaminationof Metal Instruments
• Hold all contaminated instrumentswith
Gloved hands.
• Subject all metal instruments towashing
with soapandwater.
• Treat all contaminated instrumentswith
2%Glutaraldehyde. For at least 30
minutes.
• Many consider sterilizing in Hot airoven
if not sharpinstruments.

42. AnestheticTubing'sandother
Equipment's
• Sincethey are in intimate contact with
Human secretion need utmost attention
in decontamination.
• Treat all Non disposable ashighly
hazardous, if used without safepractices
can infect the next patient undergoing
procedures.
• Soakingin 2 % Glutaraldehyde is
common practice in Developingworld.

43. Pregnant Health CareWorkers
• Not at more risk than other, Health care
workers.
• Should adopt Universal Health
Precautions with morededication,
• Ifneglected the Unborn is at grave risk of
attaining congenital infections.
• TheLaboratory supervisors should
monitor/ guide the HCW’sforadherence
to scientificpractices.

44. OperatingonHIV/High risk groups
• It is aconcern all should be caredequally.
• HIVinfected carries the risk of beingneglected
at the time ofcrisis.
• Lawmany not changefor equality but
motivated health workers should bringin
changeof attitude.
• Adherence of Universal Healthprecaution
bring in safety to allHCW.
• Follow the precautions even in Non HIV
patients assome of our patients are in
window period and more dangerousthan
truly positive with Serotesting.

45. Caution on OperatingHIV
SeroNegative Patients
•Universal precaution apply to all our
patients irrespective of Blood testswe
undertake.
•We handle somany patients in
emergency situation with out anydetails.
•Education on Universalprecautions
participation of you and educatingyour
subordinates/Juniors will make alot of
Difference in the workEnvironment.

46. Precaution for Invasive
Procedures
• All HCW’swho participate in invasive
procedures must routinely useappropriate
barrier precautions.
• All Health care workers who perform/assist
vaginal, and cesareandeliveries should wear
gloves and gowns when handling, the
placenta, and the newborn, till blood and
amniotic fluid hasbeen removed frominfants.
• Amniotic fluid is rich in HIV/HBV virus,in
infected mothers.

47. HandlingDentistry Patients
Blood, Saliva, Gingival fluid from all
Dental patients should be
considered infective, Dental, workers
should wear surgical mask, gloves
and eye wear

48. CaringBleeding Patients
• Primary health care workers who handle thepatients
in Emergencies, andAccidents to be trained in basic
principles of Universal Health careprecautions.
Mouth to Mouth resuscitation is life saving in the
Critically injured accident victims. May beneglected
becauseof fear of HIVinfection.
If the situation warrants, Bleeding from mouth can
be wiped out with clean cloth, or Handkerchief, and
still one can doresuscitation.
•
•

49. Importance of Vaccinationin
Hepatitis BInfection.
• We have >400 Million carriers with Hepatitis
Binfections.
• EveryHCWis at risk of Contactinginfection.
• Vaccination is safe -Genetically Engineered
vaccination remains the great hope for
prevention, apart from Major componentof
Universal precautions.

50. Vaccination for HBVinfection
• All HCW’smust take at least three dosesof
Vaccine,
At 0 – 1 – 6 months. without discontinuation of
the schedule.
• All Health care workers many not attain equal
response.
• High risk HCW’s should undergo estimation of
anti HBs ( antibodies ) to know whether they
were well protected.

51. Problem of HBVvaccines in the
Developing world
• Who paysfor theVaccine.
• Many who work in unorganized sector, donot
get Institutional support ofVaccine.
• Life, at risk if Infected with HBV
• More Awareness to be brought in by
Managers of the Hospitals, topromote to
vaccinate their Employees.

52. 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.

53. Droplet Transmission
• For infectious agents with droplet nuclei >
5 microns
• Examples:
– Pertussis
– Meningococcal meningitis
• Precaution Examples:
– Private room
– Mask if within 3’ of patient

54. Droplet Precautions
• Prevent infection
by large droplets
from
– Sneezing
– Coughing
– Talking
• Examples
– Neisseria meningitidis
– Pertussis
– Influenza

55. 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

56. 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.

57. Contact Precautions
• For protection against skin-to-skin contact and physical
transfer of microorganisms to a host from a source
Precaution Examples:
– Private room
– Hand washing
– Glove changes
Examples
– Scabies
– VRE
•
•

59. Never forget to take HepatitisB
Vaccineif Youare a HCW

60. Majority of OSHA CDC,andNIOSH
guidelinesare incorporated.

61. • TheProgrammecreated byDr.T.V.Rao MD
for the Medical andHealth CarePersonal in
the DevelopingWorld
• Email
• doctortvrao@gmail.com