The document provides guidelines for universal and transmission-based precautions for healthcare workers. It discusses different types of precautions including airborne, droplet, and contact precautions. Airborne precautions require a private room with negative air pressure for patients with illnesses transmitted via airborne particles like tuberculosis. Droplet precautions require a private room or spatial separation of 3 feet for illnesses transmitted by droplets like influenza. Contact precautions require a private room and use of gloves and gowns for direct and indirect contact transmission of illnesses like MRSA. Handwashing and proper handling of equipment, linen and waste is also covered.

1. UNIVERSAL AND TRANSMISSION
PRECAUTIONS

2. UNIVERSAL AND TRANSMISSION
PRECAUTIONS
 It apply to blood, body fluids,
secretions, excretions non-intact skin
and mucous membranes.
Healthcare workers should assume
that all patients are potentially
infectious and use handwashing,
protective apparel and special
procedures to prevent exposure to
blood and body substances.

3. Universal precautions
Aims:
 Reduce the risk of nosocomial transmission of
infectious agents from patient to patient
 Protect healthcare workers from exposure to
patients infected with bloodborne and non-
bloodborne pathogens
Protect patients from exposure to infected
healthcare workers.

4. HAND WASHING
• Handwashing is the single most effective means of preventing the spread
of nosocomial infections. In general, handwashing is performed for
cleansing purposes after hand contamination has occurred to prevent
transmission of pathogenic microorganisms. Both time spent in scrubbing
the hands and the type of cleaning agent used will vary according to the
purpose of the handwashing procedure.
• The essential components of handwashing are
Friction – To remove visible soiling, dead skin cells and other material, which
may harbor pathogenic microorganisms. Friction is created by rubbing the
hands together briskly, especially in the area between the fingernails and
around the fingernails.
Soap – To loosen skin oils and make handwashing easier and more efficient.
Water – To rinse off loosened dirt, debris and pathogenic particles.

5. Barrier Protection:
• The type of protective apparel chosen depends
on the clinical situation and the type of patient
care interaction that is anticipated. The
selection of barrier protection should consider
the following
• Probability of exposure to blood and body
substances and its likely amount
• Probable route of transmission

6. STANDARD PRECAUTION OF WEARING
GLOVES
• Gloves are worn to prevent the healthcare worker’s hands from becoming
contaminated with blood or body substances. Gloves should be worn for
• Procedures involving direct contact with blood and body substances of
any patient.
• Procedures where contact with blood and body substances might be
expected to occur.
• Procedures involving direct or potential contact with mucous membranes
of any patient.
• Procedures involving direct or potential contact with non-intact skin of
any patient. Non-intact skin is skin that is cut, chapped, abraded, afflicted
with weeping or exudative lesions or is otherwise broken.

7. STANDARD PRECAUTION OF WEARING
GLOVESCONT…………..
• Touching or handling any instruments, equipment or
surfaces that may have been in contact with blood and
body substances
• Providing care to patients when the healthcare worker has
cuts, abrasions or other breaks on his/her hands
• Sterile gloves should be used for all sterile procedures and
for all activities involving contact with areas of the body
that are normally sterile. Gloves used in patient care should
be worn only for contact with the patient. Once used, they
must be discarded before leaving the patient’s room.
Gloves should be changed between patients.

8. STANDARD PRECAUTION OF WEARING GOWN
• During activities that involve the management
of large amounts of blood or body substances
that may be difficult to clean properly
• During procedures that may result in the
splashing or splattering of blood and body
substances

9. STANDARD PRECAUTION OF WEARING
STERILE GOWN
• After giving care to an individual patient
• After involving any procedure involving
instruments, equipment or surfaces
contaminated by blood and body substances
• Whenever gross soiling occurs

10. STANDARD PRECAUTION OF
WEARING MASK
• When splashing, splattering or spraying of blood or
body mucous is likely in order to prevent exposure to
the mucous membranes of the nose/mouth. E.g.
When performing wound irrigation, oral suctioning,
intubation, when carring for patients with open
tracheostomies, when there is evidence of
transmission from heavily colonized source etc.,
• When working with a patient on droplet precautions
• When working in a sterile field to prevent
droplets from contaminating the field

11. Sharps Disposal:
• The potential for transmission of bloodborne pathogens is
greatest when needles, scalpels, and other sharp instruments
are employed. Precautions should be taken to prevent
injuries during procedures where needles and sharp
instruments are required, when cleaning contaminated
instruments, and during disposal of contaminated needles.
Gloves and other personal protective clothing will not prevent
penetrating injuries due to accidental needle sticks or cuts
from scalpel blades and other sharp instruments.
Sharps include blades, needles, hypodermic, spinal, suture
lancets, probes, safety pins, spears, scrappers, scissors,
syringes with or without needle, broken glass medication
vials.

12. To prevent injury NSI
• Avoid rushing when handling needles and sharps.
• Use extreme care when handling contaminated needles and sharp instruments.
Obtain assistance when giving injections, starting intravenous lines, and for any
other procedure that requires the use of needles and sharp instruments when the
patient is uncooperative.
• Dispose of all needles and other sharps promptly. It is imperative that these items
not be left in patient care areas, on food trays, or inadvertently deposited in trash
containers.
• Contaminated needles should not be recapped by hand, removed from disposable
syringes by hand, or purposefully bent, broken, or otherwise manipulated by hand.
• In the event recapping is unavoidable, the one-handed scoop technique should be
used.
• Dispose of needles and sharps in the sharps disposal containers located
throughout the hospital in all patient care and treatment areas. Upon observing a
container, which is 3/4 full, or is likely to become 3/4 full remove the container,
and dispose off the container.

13. Laboratory Specimens
• Specimens from all patients are considered to be potentially infectious and are handled in
the same manner.
Procedure for handling laboratory specimens
• Always wear gloves and any other indicated barrier protection when collecting and handling
laboratory specimens.
• Place each laboratory specimen in an appropriate leak-proof primary container (e.g.,
Vacutainer tube, specimen cup, etc.). Care should be taken when collecting and handling
specimens to avoid contamination of the outside of the container.
• Secure lids tightly to prevent leakage.
• Personnel handling or transporting laboratory specimens should wear gloves if any spillage
or leakage is noted.
• Handwashing must be performed following any direct contact with blood or body
substances in the handling or transporting of laboratory specimens.

14. Disposal of Body Fluids, Faeces
• Body fluids can be flushed down the toilet.
Bedpans and urinals must be thoroughly
washed with detergents and water,
disinfected and left to dry. Preferably they
should be heat disinfected in a bedpan washer
disinfector.

15. HANDLING OF LINEN
• Soiled linen can be a source of microbial
contamination, which may infrequently
cause infection in hospital patients and
personnel. All soiled linen should be handled
in the same manner regardless of the
patient's specific diagnosis. Although the risk
of disease transmission from soiled linen is
minimal.

16. HANDLING OF LINEN……….CONT…..
• Handwashing should be performed after having
contact with all soiled linen.
• Protective barrier apparel should be used as
follows:
– Gloves should be worn for actual or potential contact
with soiled linen contaminated with blood or body
substances.
• Gowns should be worn for the management of
soiled linen if contamination of the clothing is
likely to occur

17. HANDLING OF LINEN……….CONT…..
• All soiled linen is considered potentially infectious. Used linen soiled
with blood, body fluids, secretions and excretions will be classified as
contaminated and handled as little as possible between the patient and
the linen bag to prevent gross microbial contamination of the air and the
persons handling the linen.
• Handle soiled linen as little as possible and with a minimum of agitation to
prevent gross microbial contamination of the air and of persons handling
the linen.
• Linen should not be sorted in patient care areas.
• All soiled linen should be bagged at the location where it was used.
• Place all linen in the designated leak-proof, laundry bags. Clean linen can
be transported in thick cotton bags. Handling separately and counting of
even clean linen is hazardous and should be avoided.
• Caution must be exercised to help prevent laundry bags from being
overfilled.

18. Patient Equipment
• All patient care equipment that is soiled with
blood, body fluids, secretions or excretions shall
be handled in a manner that will prevent skin and
mucous membrane exposures.
• Single use, disposable items must be disposed off
properly.
• Make sure that reusable equipment has been
cleaned and reprocessed appropriately, prior to
use on another patient.

19. Specimen Transport Guidelines
• Blood and other specimens for laboratory evaluation
should be collected with gloved hands and placed in
leak- and spill-proof containers for transport.
Containers should be checked for exterior
contamination and disinfected with hypochlorite
solution if necessary.
• Seal all containers well.
• Place specimen containers in sealed plastic bags.
• Keep the specimen container upright to reduce the
risk of leakage and cross-contamination of other
specimens.

20. TRANSMISSION PRECAUTIONS:
• Refers to three sets of precautions based on the
routes of transmission of micro-organisms for
specified patients known or suspected to be
colonized/infected with highly transmissible or
epidemiologically important pathogens by the
airborne, droplet and contact routes

21. Five main categories of
transmission
Airborne Transmission
• This mode of transmission occurs by the spreading of either
airborne droplet nuclei or dust particles containing the
microorganism.
•

22. Airborne Transmission
• Patient Placement - The patient will be required to be placed
in a private room that has the following:
• Monitored negative air pressure in relation to the
surrounding areas;
• Six (6) to twelve (12) air changes per hour;
• An appropriate discharge of air to the outdoors or monitored
high efficiency filtration of room air before the air is
circulated into other areas of the facility.
• The patient must stay in the room with the room door closed.
If a private room is not available with the above
specifications, contact FORTIS Hospitals’ infection control
nurse for advice on patient placement.

23. Droplet Transmission
• Droplets are transmitted from the host source by coughing,
sneezing, talking or during procedures such as suctioning or
bronchoscopy. Transmission occurs when droplets containing
the microorganism are propelled through the air a short
distance and contact a host's conjunctivae, nasal mucosa or
mouth. These droplets do not remain suspended, thus
special air handling and ventilation systems are not required.

24. Droplet Precautions:
• Patient Placement - If at all possible, place patient in a private
room. If a private room is not available, the patient may be
placed in a room with a patient who has an active infection
with the same microorganism, but has no other infection
(cohorting). If cohorting is not possible, maintain a spatial
separation of a minimum of three (3) feet between the
infected patient and other patients and visitors. The patient's
room door may remain open and special air handling and
ventilation is not necessary.
• Mask - Must be worn when working within three (3) feet of
the patient, in addition to

25. Droplet Precautions:
CONT…..
• Patient Transport - Patient movement and
transport must be limited to essential
purposes only.
• If movement or transport becomes necessary,
place a mask on the patient to minimize
dispersal of droplets.

26. Contact Transmission
• Direct Contact Transmission - Involves direct body
surface to body surface contact with physical transfer of
microorganisms between a susceptible host and an infected
or colonized person. Examples of this type of transmission
include: turning a patient, giving a patient a bath or other
patient care activities, which require direct personal contact.
• Indirect Contact Transmission - Involves contact
with an intermediate object (usually inanimate) and a
susceptible host. Such objects may include contaminated
instruments, needles, dressings or contaminated hands,
which have not been washed or gloves not changed between
patients.

27. Contact Transmission Precaution
• Patient Placement - If at all possible, place patient in a private
room. If a private room is not available, the patient may be
placed in a room with a patient who has an active infection
with the same microorganism, but has no other infection
(cohorting).
• Gloves and Handwashing - When providing care to the
patient, gloves shall be changed after contact with the
infective material (i.e., fecal material and wound drainage).
Always remove gloves prior to leaving the patient's
environment and wash hands promptly with an antimicrobial
agent or a waterless antiseptic agent.

28. Contact Transmission Precaution
cont……………..
• Gown - when entering the room. Always remove the gown prior to
leaving the patient's room. Once the gown has been removed make sure
that your clothing does not come in contact with potentially
contaminated surfaces.
• Patient Transport - Patient movement and transport must be limited to
essential purposes only.
• Patient Care Equipment - The use of noncritical patient care equipment
should be dedicated to a single patient whenever possible. If use of
common patient care equipment or items is unavoidable, the equipment
or items must be adequately cleaned and disinfected prior to use on
another patient

29. SUMMARY
Airborne precautions: Required for patients
suspected or known to have serious illness transported
by airborne droplet nuclei <5 microns which remain
suspended in the air and can be inhaled a distance
away, eg active, smear positive Pulmonary
Tuberculosis, Measles, Chickenpox. Airborne.
Precautions include the following:
• A single room is required with own facilities preferred
• An approved mask is worn N.B. The CDC has indicated that the surgical
mask usually worn is not adequate and that only an approved particulate
should be worn.
• The door is kept closed
• Universal Precautions apply
• Adequate handwashing

30. SUMMARY
Droplet Precautions: Use for patients known or
suspected to have serious
• illness transmitted by large particle droplets >5 microns.
These do not remain suspended in the air over approximately
1 metre eg Meningitis,, Mumps, Whooping Cough, Influenza,
Haemophilus influenzae Provide a single room if available or
cohort.
• Masks are required by all staff when within 3 feet of the
patient while the patient is considered infectious.
• Door may remain open
• Standard Precautions apply
• Adequate handwashing

31. SUMMARY
• Contact Precautions: For patients known or
suspected to have serious illness easily transmitted by
direct or indirect contact eg major skin, wound or
burns infections and infection caused by drug resistant
organisms eg MRSA, or highly resistant pseudomonas,
provide single room.
• Door may remain open
• Masks required within one metre of patient
• Long sleeved gowns within one metre
• Gloves for contact with patient and articles
• Standard Precautions apply
• Adequate handwashing

32. PROCEDURE FOR THE MANAGEMENT OF INFECTIOUS
PATIENTS -
 Equipment used on infectious patients will be disposable.
When available a sheet will be used to protect the table or
wheelchair. X-ray table, stretcher or wheelchair used for an
isolation patient will be cleaned with hospital-approved
disinfectant before reuse.
 Personnel must follow the dress code and maintain good
personal hygiene habits while working around infection.
 When handling patients with indwelling urinary catheters,
care should be taken not to elevate the urine bag above the
level of the bladder in order to reduce incidence of reflux
back into the bladder. If there is any question about
improperly placed drainage bags, notify the floor nurse on the
unit from which the patient came

33. PROCEDURE FOR THE MANAGEMENT OF INFECTIOUS
PATIENTS –cont…..
• Patient tracheostomies should not be unduly disturbed
except when suctioning is absolutely necessary, in order to
cut down on contamination and to facilitate proper breathing.
• Chest tubes, if clamped, should not be unclamped.
Remember to keep the container below the chest. Do not
raise above the chest.
• Sterile dressings should not be disturbed. If sterile dressing
falls off the wound, replace it with a new dressing, using
sterile gloves and sterile dressings to avoid contamination of
the wound site. Sterile prepackaged dressings should always
be readily available

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