Standard Precautions

Day 1
Basic Infection Prevention and
Control Course for Nurses

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 Standard Precautions
• Applies to:
– Blood
– All body fluids, secretions and excretions
except sweat, regardless whether they contain
visible bloof
– Non-intact skin
– Mucous Membranes

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 USE STANDARD
PRECAUTIONS for the care of
ALL PATIENTS

Treat all body fluids as if they were infectious

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 Standard Precaution
HAND HYGIENE

So Why All the Fuss About Hand

Hygiene?
Most common mode of
transmission of pathogens is via
hands!
 Infections acquired in healthcare
 Spread of antimicrobial resistance
FAALTURA 2008
 The Inanimate Environment Can
Facilitate Transmission
X represents VRE culture positive sites

~ Contaminated surfaces increase cross-transmission ~

Abstract: The Risk of Hand and Glove Contamination after Contact with a
VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
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Principles of Handwashing
Handwashing:
• single most important and
effective measure to preventing
transmission of infection
• removes transient microbes
• prevents the transfer of
microbes to patients, staff or
equipment
• wash using soap and running
water
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 Specific Indications
for Hand Hygiene
• Before:
– Patient contact
– Donning gloves
– Inserting urinary catheters, peripheral
vascular catheters, or other invasive devices
that don’t require surgery
• After:
– Contact with a patient’s skin
– Contact with body fluids or excretions, non-
intact skin, wound dressings
– Removing gloves
Guideline for Hand Hygiene in Health-care
FAALTURA 2008 Settings. MMWR 2002;
vol. 51, no. RR-16.
 Recommended Hand
Hygiene Technique
• Handrubs – If hands are not visibly soiled, decontaminate
them with Alcohol-based waterless handrub located in
strategic locations throughout the hospital
– Apply to palm of one hand, rub hands together
covering all surfaces until dry
– Volume: based on manufacturer
– If hands are not visibly soiled, use an alcohol-based
handrub for routinely decontaminating hands.
• Handwashing
– Wet hands with water, apply soap, rub hands
together for at least 15 seconds
– Rinse and dry with disposable towel
– Use towel to turn off faucet
– When hands are visibly dirty, contaminated, or soiled,
wash with non-antimicrobial or antimicrobial soap and
water.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16. FAALTURA 2008
 Guidance for the Selection and Use of
Personal Protective Equipment (PPE) in
Healthcare Settings
“specialized clothing or equipment worn
by an employee for protection against
infectious materials” (OSHA)

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 Types of PPE Used in
Healthcare Settings

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Use in Healthcare Settings
PPE Use in Healthcare Settings:
How to Safely Don, Use, and
Remove PPE

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 Key Points About PPE
• Don before contact with the
patient, generally before
entering the room
• Use carefully – don’t
spread contamination
• Remove and discard
carefully, either at the
doorway or immediately
outside patient room;
remove respirator outside
room
• Immediately perform hand
hygiene FAALTURA 2008
E Use in Healthcare Settings
 Sequence* for Donning PPE
• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves

*Combination of PPE will affect sequence – be practical

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Use in Healthcare Settings
 How to Don a Gown
• Select appropriate type and size
• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two
gowns
– Gown #1 ties in front
– Gown #2 ties in back

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Use in Healthcare Settings
 How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit

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Use in Healthcare Settings
 How to Don a Particulate
Respirator
• Select a fit tested respirator
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with elastic
• Adjust to fit
• Perform a fit check –
– Inhale – respirator should collapse
– Exhale – check for leakage around face
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Use in Healthcare Settings
 How to Don Eye and Face
Protection
• Position goggles over eyes
and secure to the head using
the ear pieces or headband
• Position face shield over face
and secure on brow with
headband
• Adjust to fit comfortably

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Use in Healthcare Settings
 How to Don Gloves
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation
gown cuffs

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Use in Healthcare Settings
 Do’s and Don’ts of Glove Use
• Work from “clean to dirty” • Change gloves
• Limit opportunities for – During use if torn and when
“touch contamination” - heavily soiled (even during
protect yourself, others, and use on the same patient)
the environment – After use on each patient
– Don’t touch your face • Discard in appropriate
or adjust PPE with
contaminated gloves
receptacle
– Never wash or reuse
– Don’t touch
disposable gloves
environmental surfaces
except as necessary
during patient care
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Use in Healthcare Settings
Steps in Proper Sterile Gloving (Open)

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 Sequence for Removing PPE
• Gloves
• Face shield or goggles
• Gown
• Mask or respirator

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Use in Healthcare Settings
 Where to Remove PPE
• At doorway, before leaving patient room or
in anteroom*
• Remove respirator outside room, after door
has been closed*
* Ensure that hand hygiene facilities are available at
the point needed, e.g., sink or alcohol-based hand
rub
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Use in Healthcare Settings
 How to Remove Gloves (1)
• Grasp outside edge near
wrist
• Peel away from hand,
turning glove inside-out
• Hold in opposite gloved
hand

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Use in Healthcare Settings
 How to Remove Gloves (2)
• Slide ungloved finger
under the wrist of the
remaining glove
• Peel off from inside,
creating a bag for both
gloves
• Discard

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Use in Healthcare Settings
 Remove Goggles or Face Shield
• Grasp ear or head
pieces with ungloved
hands
• Lift away from face
• Place in designated
receptacle for
reprocessing or disposal
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Use in Healthcare Settings
 Removing Isolation Gown
• Unfasten ties
• Peel gown away from
neck and shoulder
• Turn contaminated
outside toward the
inside
• Fold or roll into a
bundle
Use in Healthcare Settings • Discard
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 Removing a Mask
• Untie the bottom, then
top, tie
• Remove from face
• Discard

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Use in Healthcare Settings
 Removing a Particulate Respirator
• Lift the bottom
elastic over your
head first
• Then lift off the top
elastic
• Discard

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Use in Healthcare Settings
Respiratory or Cough Etiquette

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 Respiratory Protection
• Purpose – protect from inhalation of
infectious aerosols (e.g., Mycobacterium
tuberculosis)
• PPE types for respiratory protection
– Particulate respirators
– Half- or full-face elastomeric respirators
– Powered air purifying respirators (PAPR)

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Use in Healthcare Settings
 Elements of a Respiratory
Protection Program
• Medical evaluation
• Fit testing
• Training
• Fit checking before use

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Use in Healthcare Settings
 Respiratory Hygiene/
Cough Etiquette
TARGET:
Patient and family member but applies to any
person with signs of colds and other
respiratory infection (ex. Cough,
congestion, rhinorrhea, increased
production of respiratory secretion etc.)

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 Respiratory Hygiene/
Cough Etiquette
• Absence of fever does not always
exclude respiratory infection (ex.
Pertussis and colds)
• Patient who has asthma, allergic
rhinitis or COPD also may have cough
and sneezing, although these patient
are not infectious, cough etiquette
measures always applies.

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 Respiratory Hygiene/
Cough Etiquette
RECOMMENDATION
• Instruct symptomatic person to
cover mouth/nose when
sneezing/coughing.
• Use tissue and dispose not to
touch receptacle.
• Observe hand hygiene after
soiling of hands with respiratory
secretion.
• Wear surgical mask if tolerated
or maintain spatial separation
> 3 feet if possible. FAALTURA 2008
 Respiratory Hygiene/
Cough Etiquette
ELEMENTS:
• HC personnel are advised to observe DROPLET
PRECAUTION (wear surgical mask) and hand
hygiene when examining patient with S & Sx of a
respiratory condition.
• HC personnel who have a respiratory infection are
advised to avoid patient contact when they are
actively coughing and producing respiratory
secretion.
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 What Type of PPE Would You
Wear?
• Giving a bed bath? • Drawing blood from a
• Suctioning oral vein?
secretions? • Cleaning an incontinent
• Transporting a patient in a patient with diarrhea?
wheel chair? • Irrigating a wound?
• Responding to an • Taking vital signs?
emergency where blood is
spurting?
FAALTURA 2008
Use in Healthcare Settings
 What Type of PPE Would You Wear?
• Giving a bed bath?
• Generally none
• 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
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• 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
PPE Use in Healthcare Setting