Universal precautions.


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Universal precautions.

  1. 1. Universal Precautions Gopisankar.M.G.
  2. 2. Dr Ignaz Semmelweis (1818 – 1865)
  3. 3. Dr. Joseph Lister (1827 – 1912)
  4. 4. 1983  “Standard Precautions combine the major features of Universal Precautions (UP) and Body Substance Isolation (BSI)* and are based on the principle that all blood, body fluids, secretions, excretions except sweat, non intact skin, and mucous membranes may contain transmissible infectious agents. Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered.”
  5. 5. Concept “Blood ,Blood products and body fluids of all persons are potential sources of infection ,independent of diagnosis or perceived risk” Taking precautions to protect your patients and yourself….
  6. 6. Hand hygiene : “just DO it “  Hand cleansing should be done prior to and after each patient interaction, prior to and after each procedure  Hand washing with plain soap & water  The choice for visibly dirty hands  Little to no antimicrobial activity  Hand washing with antimicrobial soap (soap with antiseptic agent) & water  Using an antiseptic hand rub  Waterless, typically alcohol-based solutions
  7. 7. Do it in the right way  Wet your hands with clean running water and apply soap. Use warm water if it is available.  Rub hands together to make a lather and scrub all surfaces.  Continue rubbing hands for 15-20 seconds. Need a timer? Imagine singing "Happy Birthday" twice through to a friend.  Rinse hands well under running water.  Dry your hands using a paper towel or air dryer.  Always use soap and water if your hands are visibly dirty.
  8. 8. When using an alcohol-based hand sanitizer:  Apply product to the palm of one hand.  Rub hands together.  Rub the product over all surfaces of hands and fingers until hands are dry. Alcohol-based hand sanitizers are NOT effective when hands are visibly dirty or contaminated with blood or fecal matter as examples. (In these instances, washing with an antimicrobial soap & water might be indicated.)
  9. 9. PPE Includes  Wearing of protective gloves ideally with double layers  Eye wear and mask  Apron and gown  Safe sharp instrument handling technique
  10. 10. Gloves  Procedures involving direct contact with the blood and body substances of any patient.  Where contact with blood and body substances might be expected to occur.  Direct or potential contact with the mucous membranes of any patient.  Contact with the non-intact skin of any patient. (skin that is cut, chapped, abraded, cracked, afflicted with weeping or exudative lesions. Touching or handling any instruments, equipment, or surfaces that have been, or may have been, in contact with blood or body substances)  health care worker has cuts, scratches, or other breaks in the skin
  11. 11.  Sterile gloves should be used for all sterile procedures and for activities that involve contact with areas of the body that are normally sterile.  There should be an adequate supply of clean disposable gloves on the standard precautions stations or in other locations that are convenient to each patient's room.  Gloves used in patient's care should be worn only for contact with the patient. Once used, gloves must be discarded before leaving the patient's room.
  12. 12. Procedure for donning gloves  Remove all jewelry, including rings , wrist watch  Wash hands using an antimicrobial cleansing agent.  Dry hands thoroughly with a paper towel.  Remove the packet of gloves from the outer wrapper. Place this packet on a clean, dry, flat surface.  Unfold the packet as if opening a book. Position the packet so that the cuffed ends of the gloves are nearest to you.
  13. 13.  Grasp the center flaps and open. Both gloves must have folded cuffs. Position the packaging so that it lies flat.  Use one hand to glove the other. Grasp the edge of the right glove cuff with the fingers of the left hand, and slip the right hand into this glove. Pull it on by holding onto the cuff, but do not touch the outside of the glove.  Adjust both gloves so they fit properly. Make sure there are no gaps between the fingertips and the ends of the gloves.  Inspect the gloves for nicks and tears before and during the procedure. Obtain a new pair of sterile gloves if there is a break in aseptic technique or if a nick or tear occurs.
  14. 14.  Undertaking Hepatitis B vaccine for staff  Covering open wounds that are clean  Staff with infected wounds or active dermatitis should stay off work
  15. 15. Respirators  Masks that are designed to filter small particles spread by air born route  Ideal ones are 1. N 95 respirators 2. HEPA respirators
  16. 16. Sharp instruments  Do not pass it directly between surgeons and their assistants  Use a bowl or tray  Only one sharp instrument should be placed in the dish at a time
  17. 17.  When two surgeons are operating simultaneously , each must have their own sharps dish  Do not wrap sharp objects and needles in linen obscuring the vision as far as possible  Used needles and sharps should be disposed into approved sharps container as soon as practicable
  18. 18.  Mostly occurs in patient rooms and emergency rooms  Occurs mostly at the time of recapping and also during disposal and handling dirty linens  20% occurs before use , 10% after disposal and 70% after use and before disposal  Around 2% chance that blood is contaminated by HIV  Chance of getting it is 0.3% (with contaminated )  Hepatitis B  ranges from 1to 40%  Hepatitis C  2%
  19. 19. If bitten  Wash the area with plenty of water and soap  Squeezing or milking the site is of little benefit  Blood of patient to be sent for serology 1. HBsAg 2. HIV
  20. 20.  if patient is found to be hepatitis Positive  HBIG is used ,given as soon as possible after an accidental inoculation for the victim  Ideally within 6 hours and preferably not later than 48 hours  At the same time his blood is drawn for HBsAg if found to be negative , vaccination should be started and a full course is given  If positive no further action  Two doses 30 days apart ,short term protection for 3 months  HBsAg test can be repeated after 3 months
  21. 21. HIV  First aid care , counselling and risk assessment’  A short term provision of ART is given (28 days)  Started as soon as possible ,ie within first few hours and not later than 72 hours  Do not give it if already positive so test HIV before giving drug  But try not to delay drug admission due to testing procedures  If negative repeat after 3 and 6 months
  22. 22. Post exposure prophylaxis  HIV  Hepatitis A  Hepatitis B  Hepatitis C  Neisseria meningitidis  Mycobacterium Tuberculosis  Varicella zoster  Hepatitis E  Diphtheria  Pertussis  Rabies