universal precautions, standard work precautions, healthcare worker precautions

1. Dr. Ruqaiyah Nadeem
(MBBS, M.D)
Department of Microbiology

2. “ Prevention Is Better Than Cure”
This phrase fits aptly to hospital/health care associated
infection.

3. The fundamental ethic of health care is that sick persons
must receive care. This premise carries an unstated
consequence: an occupational risk to healthcare
workers who respond to the needs of contagious
patients.

6. RESULT:Total 100 mobile phones of healthcare professional were swabbed
to check microbial flora harboured on mobile phones.
|out of 100 mobile phones 79% were found to be contaminated with microbial flora.

8. • Microbes: Living organisms that cannot be seen with
the naked eye
• Pathogen: A microbe that can cause disease
• Infection: An illness caused by pathogens or germs
− Communicable infections: Infections that can spread
from one person to another
Infection

9. Ways Infections Are Transmitted
Focus on:
• The airborne route of transmission (Tuberculosis (TB),
measles, and chickenpox)
• The direct route of transmission (Herpes and
conjunctivitis)
• The bloodborne route of transmission (HIV, Hepatitis
B, Hepatitis C)

10. Chain of Infection (cont.)
• For a person to get a communicable infection, six key
conditions must be met.
• Eliminating any one of the six key elements breaks the
chain and prevents the spread of infection.

11. Chain of Infection (cont.)

13. Breaking the Chain of Infection

14. The concept of Universal Health
Precautions emphasizes that all our
patients should be treated as
though they have potential blood
born infections, and can infect the
caring health care workers. ( CDC )
Why Standard Precautions

15. What is Standard Precautions
Standard precautions are a set of infection control
practices used to prevent transmission of diseases that
can be acquired by contact with blood, body fluids,
non-intact skin (including rashes) and mucous
membranes.
They are indicated while handling all patients,
specimens and sharps.

16. Measures to be followed
 All individuals, whether or not they appear infectious/
symptomatic or not
 All specimens (blood or body fluids) whether they
appear infectious or not
 All needles and sharps whether they appear infectious
or not

17. Components of Standard Precaution
 Hand hygiene
 Personal protective equipments
 Sharp handling
 Spillage cleaning
 Disinfection
 Waste handling

18. HAND HYGIENE

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

23. PERSONAL PROTECTIVE
EQUIPMENT

24. Personal protective Equipment
 Specialized clothing or equipment worn by an
employee for protection against infectious materials.
(Occupational safety & health Administration, OSHA)

25. Types of PPE Used in Healthcare Settings
 Gloves – protect hands
 Gowns/aprons – protect skin and/or clothing
 Masks and respirators– protect mouth/nose
 Goggles – protect eyes
 Face shields – protect face, mouth, nose, and eyes
 Head cover – to prevent falling of hair
 Surgical shoes/cover- to protect HCWs &
environment.

27.  GLOVES: use when touching blood, body fluids,
secretions, excretions, contaminated items, for
touching mucus membranes & non-intact skin
 GOWNS: use during procedures and patient care
activities when contact of clothing/ exposed skin with
blood/ body fliuds, secretions, or excretion is
anticipated.

28. STEPS TO PUT ON PPE
 Remove all personal items (jewelry, watch, phone etc)
 Put on scrub suit & rubber boots
 Move to clean area

29. Donning of PPE
Perform Hand
hygiene
Examination gloves Disposable gown
Sterile gloves (long
cuff)
Water proof
disposable apron
Head cap/ hood Face shield/ Goggles Face mask

30. Doffing of PPE
Hand hygiene
Remove gownHand hygiene
Remove head cover/
head neck covering
Hand hygiene
Remove outer pair of
gloves
Hand hygieneRemove Apron
Hand Hygiene on gloved
hands

31. Perform hand
washing
Remove inner pair
of gloves
Hand hygiene
Remove rubber
boots
Hand hygiene
Remove maskHand hygieneRemove goggles

32. Standard
precaution
Breaking the chain of transmission
Hand washing
Use of personal
protective
equipment

33.  What Type of PPE Would You Wear?
1. Suctioning oral secretions?
2. Transporting a patient in a wheel chair?
3. Responding to an emergency where blood is
spurting?
4. Drawing blood from a vein?
5. Cleaning an incontinent patient with diarrhea?
6. Irrigating a wound?
7. Taking vital signs?

34.  Suctioning oral
secretions?
 Gloves and mask/goggles
or a face shield –
sometimes gown
 Transporting a patient
in a wheel chair?
 Generally none required
 Responding to an
emergency where blood
is spurting?
 Gloves, fluid-resistant
gown, mask/goggles or a
face shield
 Drawing blood from a
vein?
 Gloves
 Cleaning an incontinent
patient with diarrhea?
 Gloves w/wo gown
 Irrigating a wound?
 Gloves, gown,
mask/goggles or a face
shield
 Taking vital signs?
 Generally none

35. PROBLEM SOLVING EXERCISE
A nurse in an ICU records pulse of a patient, records it in
case sheet and then goes back to nursing station.
While transporting the specimen, a drop of blood fell
on her palm. Then she enters the operation theater to
assist for a surgery.
Q. How many times she has to perform hand hygiene?
Q. What are the hand hygiene methods she has to
perform and for how much duration?
Q. What are the hand hygiene products to be used?

36. Answer
 Hand rub: 5 times (70-80% alcohol for 20-40secs)
 Before recording pulse
 After recording pulse
 Before drawing blood
 After drawing blood
 After recording in case sheet
 Hand wash:
 Once after blood drop fell on palm (2-4% chlorhexidine
for 40-60secs)
 Hand Scrub:
 Once before assisting surgery (4% chlorhexidine for 3-
5mins)

37. NEEDLE STICK INJURY

38. Definition
 WHO defines needle stick injuries (NSI’s) as a
penetrating stab wound from a needle (or other sharp
object) that may result in exposure to blood or other
body fluids.
 Main concern is exposure to blood or other body fluids
of person carrying infectious disease.

39. Risk of Infections
 Following a needlestick injury the healthcare workers
are at a great risk of transmission of :
 Hepatitis B virus
 Hepatitis C virus
 HIV

40. Estimated risk of infection
following needlestick injury
30%
3%
0.30%
HBV
HCV
HIV

42. PREVENT
NEEDLESTICK
INJURY
NEVER RECAP NEEDLES
DISPOSE IN WHITE
PUNCTURE-PROOF
CONTAINER
AVOID OVERFILLING
DISPOSAL CONTAINERS
HEPATITIS B VACCINATION
If unavoidable use
single hand-scoop
technique

43. First aid management
DO’s
Irrigate the site
vigorously with water for
atleast 5mins.
Report to Medical
Superintendent (MS)
 DON’T’s
Do not panic
Do not place the pricked
finger into mouth
Do not squeeze blood
from wound
Do not use antiseptics
and detergents

44. RESPIRATORY HYGIENE

45. Respiratory hygeine & cough
etiquette
 Cover the nose/mouth with single-use tissue paper
when coughing, sneezing, wiping & blowing noses
 If no tissues are available, cough or sneeze into the
inner elbow or hand
 Follow hand hygiene after contact with respiratory
secretions
 Keep contaminated hands away from mucous
membranes of eyes nose

46. In high risk areas of airborne transmission such as
pulmonary medicine OPD
 Give mask to patients with cough
 Sputum collection should be done in an open well
ventilated room.

48. SPILL MANAGEMENT

49.  Evacuate the contaminated area
 Wear a pair of heavy duty gloves
 Mark the contaminated area with chalk
 Use a pair of forceps / tongs/ pan and brush to sweep
broken glass (never pick up pieces with your hands
even if gloved)
 Discard broken glass in sharps container
 Use disposable paper towels/ absorbent material
(gauze piece, cotton, blotting paper etc) to absorb

50.  Saturate the area with 1% hypochlorite ( freshly
prepared)
 Wait for 15-20mins
 Discard absorbent material
 Wipe area with disinfectant
 Clean & disinfect forceps/tongs/brush & pan
 Remove gloves & discard
 Wash hands

51. SPECIFIC PRECAUTIONS

52. Transmission based precautions
(Specific Precautions)
CONTACT
PRECAUTIONS
DROPLET
PRECAUTIONS
AIRBORNE
PRECAUTIONS
SPECIFIC
PRECAUTIONS

53.  Patients with enteric infections & diarrhea
 Highly contagious skin lesions
 Clostridium difficile infection
 Multi drug resistant organisms(MDROs) isolated in a
hospital setting eg.
 MRSA ( Methicillin resistant S.aureus )
CONTACT PRECAUTIONS

54. CONTACT
PRECAUTIONS
ISOLATION PATIENT MOVEMENT
PPE
HAND WASHING
ENVIRONMENTAL
CLEANING

55.  It is required when disease with droplet transmission
is suspected, eg Respiratory Syncitial virus,
Mycoplasma, Parainfluenza, Pertussis, Plague,
Meningococcus, C.diphtheriae
DROPLET PRECAUTIONS

56. DROPLET
PRECAUTIONS
ISOLATION
PATIENT
MOVEMENT
PPE

57. AIRBORNE
PRECAUTIONS
PATIENT
MOVEMENT
ISOLATION
PPE
•PULMONARY
TB
•CHICKENPOX
•MEASLES
•SARS

58.  Sterilisation:
 Sterilisation is a process by which all living
microorganisms, including viable pores, are destroyed or
removed from an article, body surface or medium.
 Disinfection:
 A process that destroys or removes most if not all
pathogenic organisms but not bacterial spores.
 Asepsis:
 A process where the chemical agents ( called antiseptics)
are applied on to the body surfaces (skin), which kill or
inhibit the microorganisms present on the skin.

59. Disinfectants Uses
Ethyl Alcohol (70%) Handrubs
Isopropyl Alcohol Thermometers & small instruments
Formaldehyde Fumigation of OT, preservation of specimens
Glutaraldehyde (2%) Endoscopes, cystoscopes
Phenols ( phenol, lysol,
cresol)
Surface disinfectant
Povidone iodine Antiseptic for wounds, preoperative, before
venipuncture
Chlorine Disinfection of portable water
Common disinfectants

60. Sodium hypochlorite Household bleach. Lab
disinfectant(1%), for blood spills
(10%),disinfection of other items before
final disposal
Bacillocid ( Quaternary ammonium
compund + glutaraldehyde)
OT fumigation
Ethylene oxide Used in Central Sterile Services
Department (CSSD)
For sterilisation of various equipments
Hydrogen peroxide Ventilator disinfection, plasma
sterilisation