standard precautions.pptx

Introduction
■ There are approximately 59 million healthcare workers worldwide
■ Healthcare industry is one of the most hazardous environments to
work in.
■ Employees in this industry are constantly exposed to a complex
variety of health and safety hazards in the course of their work.
■ The need of the hour is to prioritize occupational health of health
workers and ensure that the workforce is adequately trained and
healthy

Objectives
■ Discuss about standard precautions

Infection Control
Practices
Standard
Precautions
Transmission-
based Precautions

Standard Precautions
■ Previously called Universal Precautions
■ Standard Precautions are the minimum infection prevention practices that
apply to all patient care, regardless of suspected or confirmed infection
status of the patient, in any setting where health care is delivered.
■ These practices are designed to both protect health care provider (HCP)and
prevent HCP from spreading infections among patients
■ Assumes blood and body fluid of ANY patient could be infectious
https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-
practices/standard-precautions.html

• Infection prevention actions that
apply to all patient/client care
and or interactions, regardless of
suspected or confirmed infection
status of the patient/client
• Are evidence-based practices
designed to protect and prevent
spread of infection
• If followed correctly, minimise the
risk of contact with blood and other
body substances.
■ Standard Precautions are:
• Performing hand hygiene
• Appropriate and correct use of personal protective
equipment (PPE)
• Use of aseptic technique
• Safe use and disposal of sharps
• Performing routine environmental cleaning
• Cleaning and reprocessing of shared patient
equipment
• Respiratory hygiene and cough etiquette
• Safe handling and disposal of waste and used linen
Clinical Excellence Commission
6
Infection Prevention and Control Practice Handbook
Standard Precautions
■ (all day, everyday, every patient)

Key Components Of Standard Precautions
Hand hygiene
Personal protective equipment
Respiratory hygiene and cough etiquette
Prevention of injuries from sharps
Safe handling of patient-care equipment
Principles of asepsis
Environmental infection control
https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-
precautions.html

Hand Hygiene
Hand hygiene means cleaning your
hands by using either handwashing
(washing hands with soap and water),
antiseptic hand wash, antiseptic hand
rub (i.e., alcohol-based hand sanitizer
including foam or gel), or surgical hand
antisepsis.
https://www.cdc.gov/handhygiene/providers/index.html

Germs Can Spread From Surfaces
(https://www.cdc.gov/handhygiene/index.html)

Do We Really Have To Talk About Hand
Hygiene ?Again ?
YES
Hand hygiene is the single most important measure for prevention of
infection
Evidence suggests that the hands of the HCWs are the most common
vehicle for the transmission of healthcare-associated pathogens from
patient to patient and within the healthcare environment
WHO Hand hygiene technical reference manual

Types Of Hand Hygiene
■ Hand washing or hygienic hand scrub
■ Surgical hand asepsis
WHO Guidelines on Hand Hygiene in Health Care

Indications For Hand Hygiene
■ Hand wash with soap and water ( antiseptic or non-antiseptic soap)
When hands are visibly dirty or soiled with body fluids or spore forming
organisms like clostridium difficile spread is suspected
■ Alcohol-based hand rub
If hands are not visibly soiled: use an alcohol-based hand rub for
routinely decontaminating hands.
Do not use soap and alcohol based solution concomitantly
https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20HCF%20-
%20final%281%29.pdf

My Five Moments Of Hand Hygiene

Antiseptic Agents For Hand Hygiene
■ Plain water and soap:
■ Antiseptic detergents: The following antiseptic detergents can be used:
• 4% chlorhexidine gluconate-detergent (CHG)
■ Alcoholic hand rub products: Agents with 60-70% alcohol are most
efficient.
Alcohols used are either ethanol or propanol or isopropanol or
combinations of these.
Adding chlorhexidine (0.5-1%) to alcoholic hand rub increase their
persistence activity against microbes.
Some examples are:
• 0.5% chlorhexidine or povidone iodine in 70% isopropanol or ethanol.
Source : WHO Guidelines on Hand Hygiene in Health Care

Personal Protective Equipment
■ Definition
“Specialized clothing or equipment, worn by an employee
for protection against infectious materials.”
– Occupational Safety and Health
Administration, or OSHA
– Personal protective equipment (PPE) refers to
physical barriers, which are used alone or in
combination, to protect mucous membranes, airways,
skin and clothing from contact with infectious agents.
https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20HC

Types Of PPE In Health Care
■ Gloves
■ Gowns and Aprons
■ Face masks
■ Respirators
■ Goggles
■ Face shields
■ Protective footwear
https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20HCF%20-
%20final%281%29.pdf

Factors Influencing PPE Selection
■ Type of exposure anticipated
– touch, splashes or sprays, or large volumes of blood or body
fluids that might penetrate the clothing
■ Durability and appropriateness of PPE for the task
( whether a gown or apron is selected, if a gown is selected,
whether it needs to be fluid resistant/ proof, or neither).
■ Fit
(must fit the individual user)

Principles For PPE Use
■ Don before contact with the patient
– Generally before entering the room
■ Remove and discard PPE carefully
■ After doffing, immediately perform hand hygiene

PPE For Standard Precautions
■ Gloves – Use when touching blood, body fluids, secretions, excretions,
contaminated items; for touching mucus membranes and non intact skin
■ Gowns – Use during procedures and patient care activities when contact
of clothing/ exposed skin with blood/body fluids, secretions, or excretions
is anticipated
■ Mask and goggles or a face shield – Use during patient care activities
likely to generate splashes or sprays of blood, body fluids, secretions, or
excretions

Gloving
■ Gloves should be worn as an additional measure, not as a
substitute for handwashing
■ Wear gloves when contact with blood or other potentially
infectious materials is possible
■ Remove gloves after caring for a patient
■ Do not wash gloves
■ Work from “clean to dirty”
■ Limit opportunities for “touch contamination” - protect
yourself, others, and the environment
■ Perform hand hygiene immediately after removing gloves
Source :National Guidelines for Infection Prevention and Control in Healthcare
Facilities

Gloves
■ Purpose – Patient care, environmental services,
other
■ Glove material – vinyl, latex, nitrile, other
(latex products may cause allergy. Vinyl gloves may be
used if there is limited patient contact)
■ Gloves should fit the user’s hands comfortably – not
be too loose or too tight.
■ They also should not tear or damage easily.

Continued..
■ Sterile or non sterile: Sterile surgical gloves are
worn by healthcare personnel who perform invasive
patient procedures.
■ One or two pair: During some surgical procedures,
two pair of gloves may be worn.

Do’s and Don’ts of Glove Use
■ Once contaminated, gloves can become a means for
spreading infections.
■ Work from “clean to dirty”: touching clean body sites or
surfaces before you touch dirty or heavily contaminated
areas.
■ Limit opportunities for “touch contamination” -
■ – Don’t adjust your glasses, rub nose or touch face with
gloves that have been in contact with a patient
■ – light switches, door and cabinet knobs can become
contaminated if touched by soiled gloves.

Continued..
■ Change gloves as needed:
 During use if torn and when heavily soiled (even during
use on the same patient)
 Always change gloves after use on each patient
 Discard in appropriate receptacle
■ Patient care gloves should never be washed and used
again.

Gowns Or Aprons
International guidelines recommend that protective clothing (apron or
gown) should be worn by all HCWs when:
■ there is close contact with the patient, materials or equipment that
may lead to contamination of skin, uniforms or other clothing with
infectious agents; and
■ there is a risk of contamination with blood, body substances,
secretions or excretions (except sweat)
Source :National Guidelines for Infection Prevention and
Control in Healthcare Facilities

GOWNS or APRONS
■ Purpose of use:
 Isolation gowns are generally preferred PPE but aprons
are used If limited contamination is anticipated.
 If contamination of the arms is anticipated, a gown should
be selected.
 Gowns should fully cover the torso and have long sleeves
that fit snuggly at the wrist.

Material
– Natural or man-made: cotton / synthetic material
that dictate whether they can be laundered and reused
or must be disposed
– Reusable or disposable
– Resistance to fluid penetration
■ If fluid penetration is likely, a fluid resistant gown
should be used.

Face Protection
■ Usual facial protection includes a medical/
surgical mask (triple-layer surgical mask)
and eye protection (face shield or goggles)
■ Respirators: These protect from inhalation of
infectious aerosols (e.g. M.tuberculosis).
Source :National Guidelines for Infection Prevention and
Control in Healthcare Facilities

Face Protection
■ Masks – protect nose and mouth
 Should fully cover nose and mouth and prevent fluid
penetration
 Should fit snuggly over the nose and mouth.
 Masks that have a flexible nose piece and can be
secured to the head with string ties or elastic are
preferable.

Goggles
Protect eyes
– Should fit snuggly over and around eyes
– Personal glasses not a substitute for goggles
– Anti fog feature improves clarity of vision.

Face Protection
Face shields
■ Protect face, nose, mouth, eyes
■ Should cover forehead, extend below chin and
wrap around side of face
■ When irrigating a wound or suctioning copious
secretions, a face shield can be used as a
substitute to wearing a mask or goggles.

Respiratory Protection
■ Purpose: protect from inhalation of infectious aerosols
(e.g., Mycobacterium tuberculosis)
■ Filter the air before it is inhaled.
■ The device has a sub-micron filter capable of excluding
particles that are less than 5 microns in diameter.
■ EXAMPLES : N95, N99, or N100 particulate respirators.

N100
sub-micron filter
capable of
excluding particles
that are less than 5
microns in diameter

FOOTWEAR
■ A closed footwear, which can be easily cleaned and disinfected,
must be used whenever work processes or environments could
cause foot injuries or spillage of blood or body fluids.
■ Personal footwear should be changed when entering clean areas
such as OTs, labour rooms, ICU.
HAIR COVERS
■ Long hair must be secured with a rubber band and hair cover
worn to protect the hair and to protect the patient from falling hair.
Source :National Guidelines for Infection Prevention and Control in Healthcare Facilities

“Contaminated” and “Clean” Areas of PPE
Contaminated
■ the outside front and sleeves of the isolation
gown
■ outside front of the goggles, mask, respirator
and face shield regardless of whether there is
visible soil.
■ Also, the outside of the gloves are contaminated.

■ Clean:
■ These are the parts that will be touched when
removing PPE.
■ Inside the gloves;
■ Inside and back of the gown, including the ties
■ The ties, elastic, or ear pieces of the mask,
goggles and face shield.

Note: Combining transmission based precautions, like contact and droplet precautions is needed for some
infectious diseases such as COVID-19.
Where respiratory aerosol generating procedures (AGP) are performed on COVID-19 case, combined contact,
droplet and airborne precautions are needed; refer to the CEC YouTube channel.
Donning PPE
for combined contact and droplet precautions in addition to
standard precautions
Clinical Excellence Commission 47

Sequence for donning PPE
48
1. Perform hand hygiene
2. Put on gown/apron
3. Put on mask
4. Put on eye protection
6. Put on gloves

Remove items before hand hygiene
49
Remove rings, watches, etc.
that will interfere with effective
hand hygiene, and roll up your
sleeves
NSW Health Infection Prevention and Control Policy
Note: Nail polish, artificial and false
nails must not be worn in clinical
environments.
Artificial or false nails continue to
demonstrate increased opportunity
for transmitting pathogenic
microorganisms.

Perform hand hygiene
50
Clean hands with:
• alcohol based hand rub (ABHR) in
either liquid, foam or gel form; or
• antiseptic liquid hand wash and
running water; or
• (plain) liquid soap and running water
and dry with single use towels
National Hand Hygiene Initiative
Note: manufacturers of ABHR
solutions state the amount of
solution delivered per pump
dispenser action and how much
solution is required per hand
hygiene moment.

51
3. Put on mask
6. Put on gloves

Put on Gown or Apron
52
1. Open the gown
without it touching
any surfaces such
as floor or wall
2. Ties
secured at
the waist at
the back
3. Thumb
hooks (some
gowns) over
the thumb
1. Bare below elbows
2. Open the apron
without it touching
any surfaces such as
floor or wall
3. Ties
secured at
the waist at
the back
Gowns & aprons come in different shapes and colours.
Local supply and availability may vary.
Note: the tie for both styles is secured at the back

53
3. Put on mask
6. Put on gloves

Surgical masks for droplet precautions
54
1. Handle the mask
by the straps only
2. Secure loops behind the ears 3. Mould the nose piece to fit
your face

P2/N95 masks for airborne precautions
1. Put on a P2 or N95 mask to cover
your nose and mouth.
Note: Do not be confused with fit testing and fit checking. Fit checking is a safety measure
performed at the time of donning the P2/N95 mask prior to the airborne exposure risk.
2. You should perform a fit check immediately after donning
the mask. Breathe in and out to check that air is not
escaping and the mask fits you well.

P2/N95 masks for airborne precautions
Fit-checking-chart-2020.pdf

57
3. Put on mask
6. Put on gloves

Eye protection
58
Ensure eye protection
• is secure
• doesn’t need adjustment after applying
Note: Eye protection is designed to protect the
wearer from exposure to splash and fluid from blood
and body substances. Prescription glasses are not
designed for this purpose. Protecting your prescription
glasses will protect your eyes from exposure risks.

Note: take a moment and observe for any isolation signage communicating infection
control precautions. Use this opportunity to confirm the appropriate PPE is in place.
Depending on your work location (e.g. in the client’s home) this slide may not be relevant.
You are now ready to enter
the patient’s room or zone

60
3. Put on mask
6. Put on gloves

61
National Hand Hygiene Initiative
Clean hands with:
• alcohol based hand rub (ABHR) in
either liquid, foam or gel form; or
• antiseptic liquid hand wash and
running water; or
• (plain) liquid soap and running water
and dry with single use towels
Note: Did you know all
manufacturers of ABHR solutions
state the amount of solution
delivered per pump dispenser action
and how much solution is required
per hand hygiene moment?

62
3. Put on mask
6. Put on gloves

63
Note: When wearing
a gown the gloves
should cover the cuffs
of the gown.
Gloves
■ don immediately before touching the patient

You have now completed
the steps to don PPE

Additional information
• Head covers are used only in theatre/procedural settings to protect the patient & environment
from health workers’ skin and hair particles – NOT considered PPE
• Shoe covers are used in some theatre settings to reduce contamination of theatre floor &
protect the shoes of staff – NOT considered PPE
• Powered-Air Purifying Respirator (PAPR) – a battery-powered blower that provides positive
airflow through a filter, cartridge, or canister to a hood or face piece; may be used if a health
worker has to stay in the patient’s room continuously for a long period (more than 1 hour) to
perform multiple procedures, or for additional comfort and visibility.

Remember when the PPE is on:
• Avoid touching your face, including the mask
• Avoid touching or adjusting other PPE during care
provision
• Change gloves when torn or heavily contaminated
• Limit surfaces and items touched to prevent accidental
contamination of gloves
• Masks are not worn around the neck or under the chin.
Note: remember, when changing
gloves, hand hygiene still needs
to be performed.

Doffing (Removing) PPE
Note: Combining transmission based precautions, like contact and droplet precautions is
needed for some infectious diseases such as COVID-19.
Where respiratory aerosol generating procedures (AGP) are performed, combined
contact, droplet and airborne precautions are needed; refer to the CEC YouTube channel.
for combined contact and droplet precautions
in addition to standard precautions

• Remove and discard PPE:
o Away from the immediate patient environment
o Into general waste unless heavily contaminated by blood and
or body substances
• If the patient/client is in a single room:
o remove gloves and gown – before leaving the patient’s room
– hand hygiene
o eye protection and mask – is removed immediately outside
patient’s room/zone,
o for airborne precautions, remove mask after the door to
patient’s room has been closed (on exit)
• Hand hygiene facilities (soap and water, or alcohol based
hand rub) should be readily available for use at the
location of doffing PPE.
Note: some environments may
have designated areas for
donning and doffing of PPE.
Regardless, it is important that
you move away from the
immediate patient environment
before removing PPE.
Doffing (Removing) PPE

Sequence for Removing PPE
■ The sequence for removing PPE aims to limit opportunities for self contamination and
further environmental contamination. When using reusable eye protection perform hand
hygiene after cleaning.
1. Remove gloves OR Remove gown and gloves in one step
3. Remove gown Perform hand hygiene
4. Perform hand hygiene Remove eye protection
5. Remove eye protection Remove mask
6. Remove mask Perform hand hygiene
Hand hygiene must be performed if hands become
contaminated at any step, and always after
removing gloves
Removing gown and
gloves in one step is
only performed if you
have had training.
CEC YouTube
channel

Remove gloves
70
Care is taken to avoid contaminating the hands
1. Dirty to dirty –
pinch outside of
glove
2. Peel first glove
off and hold it
with your
gloved hand
3. Clean to clean
– slip clean
finger UNDER
the remaining
glove
4. Peel glove off,
rolling it over
the top of the
held glove
5. Dispose of
gloves in the
correct waste
bin