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STANDARD

PRECAUTIONS
DR .AKARSH SHARMA
INTRODUCTION

 •Standard precautions are meant to reduce the risk of transmission of


blood borne and other pathogens from both recognized and
unrecognized sources. They are the basic level of infection control
precautions which are to be used, in care of all patients.
• Standard safety precautions are the basic infection prevention and control
measures necessary to reduce the risk of transmission of infectious agent from
both unrecognized and unrecognized sources of infection
What is Standard precautions ?

 The tenets of Standard Precautions are that all patients are colonized or
infected with microorganisms, whether or not there are signs or symptoms,
and that a uniform level should be used in the care of all patients.
The elements of Standard Precautions

 The elements of Standard Precautions include:


 Hand hygiene.
 Use of personal protective equipment (e.g., gloves, masks, eyewear).
 Respiratory hygiene / cough etiquette.
 Sharps safety (engineering and work practice controls).
 Safe injection practices (i.e., aseptic technique for parenteral medications).
 Sterile instruments and devices.
 Clean and disinfected environmental surfaces.
HAND HYGIENE .
 . HAND HYGIENE •
 Hand hygiene is a major elements of standard precautions and one of the
most effective methods to prevent transmission of pathogens associated
with health care.
 •Hand hygiene is considered an important practice in reducing the
transmission of infectious agents which cause HAIs.
HAND HYGIENE

 • When hands are visibly dirty with biologic material from patient care, hands
should be washed with soap and water.
 • In intensive care units and other locations in which virulent or resistant organisms
are likely to be present, antimicrobial agents ( eg chlorhexidine gluconate,
chloroxylenol ) may be used.
 • Effective hand washing requires at least 20 seconds of vigorous scrubbing with
special attention to the area around nail beds and between fingers, where there
is high bacterial burden.
 HAND HYGIENE •
 If hands are not visibly soiled, health care providers are strongly
encouraged to use alcohol-based, waterless antiseptic agents for routine
hand clean.
 Rub hands together ,rub the product over all surfaces of hands and fingers
until hands are dry.
5 moments of hand hygiene

 before touching a patient,


 before clean/aseptic procedures,
 after body fluid exposure/risk,
 after touching a patient, and
 after touching patient surroundings.
STEPS OF HAND HYGIENE

 Step 1 - Wet your hands and apply enough soap


 Step 2 - Rub your palms together.
 Step 3 - Rub the back of each hand
 Step 4 - Rub both your hands while interlocking your fingers
 Step 5 - Rub the back of your fingers.
 Step 5 - Rub the tips of your fingers
 Step 6 - Rub your thumbs and the ends of your wrists.
 Step 7 - Rinse both hands properly with water.
 Comparing Hand Hygiene Methods Hand cleansing with Alcohol-Based Product
 1. After contact with body fluids, excretions, mucous membranes, non intact skin,
or wound dressings as long as hands are not visibly soiled.
 2. After contact with a patient’s intact skin (as after taking pulse or blood
pressure or lifting a patient.
 3. After contact with inanimate objects in the patient’s immediate vicinity.
 4. Before caring for patients with severe neutropenia or other forms of
severe immune suppression.
 5. Before donning sterile gloves when inserting central catheters.
 6. Before inserting urinary catheters or other devices that do not require a
surgical procedure
 7.After removing gloves
 Hand Washing
 1. When hands are visibly dirty or contaminated with biologic material from
patient care.
 2. When healthcare workers do not tolerate waterless alcohol product
PERSONAL PROTECTION
EQUIPMENT
. Personal protection equipment is any safety equipment which workers wear
to prevent injury in the workplace.
Training is required by OSHA regulations . (The Occupational Safety and Health
Act of 1970 authorizes the Occupational Safety and Health Administration to
set standards for safety in the workplace and enforce them through a system
of inspections, citations and fines.
Employers and employees must adhere to a set of general duties described in
the act as well as any specific standards set by OSHA.)
 Use of gloves in situations involving possible contact with blood or body
fluids, mucous membranes, non-intact skin (e.g., exposed skin that is
chapped, abraded, or with dermatitis) or OPIM.
 Use of protective clothing to protect skin and clothing during procedures or
activities where contact with blood or body fluids is anticipated.
 Use of mouth, nose, and eye protection during procedures that are likely to
generate splashes or sprays of blood or other body fluids.
 Wear protective clothing that covers skin and personal clothing during
procedures or activities where contact with blood, saliva, or OPIM is
anticipated.
 Wear mouth, nose, and eye protection during procedures that are likely to
generate splashes or spattering of blood or other body fluids.
 Remove PPE before leaving the work area.
 Hand hygiene is always the final step after removing and disposing of PPE.
Training should also stress preventing further spread of contamination while
wearing PPE by:
 Keeping hands away from face.
 Limiting surfaces touched.
 Removing PPE when leaving work areas.
 Performing hand hygiene.
 The application of Standard Precautions and guidance on appropriate
selection and an example of putting on and removal of personal
protective equipment is described in detail in the 2007 Guideline for
Isolation Precautions-
 During the delivery of healthcare, avoid unnecessary touching of surfaces
in close proximity to the patient to prevent both contamination of clean
hands from environmental surfaces and transmission of pathogens from
contaminated
 When hands are visibly dirty, contaminated with proteinaceous material, or
visibly soiled with blood or body fluids, wash hands with either a
nonantimicrobial soap and water or an antimicrobial soap and waterands
to surfaces
 If hands are not visibly soiled, or after removing visible material with non
antimicrobial soap and water, decontaminate hands in the clinical
situations described in . The preferred method of hand decontamination is
with an alcohol-based hand rub. Alternatively, hands may be washed with
an antimicrobial soap and water. Frequent use of alcohol-based hand rub
immediately following hand washing with non antimicrobial soap may
increase the frequency of dermatitis.
Perform hand hygiene ~ in the
following clinical situations
 Before having direct contact with patients
 After contact with blood, body fluids or excretions, mucous membranes,
non intact skin, or wound dressings
 After contact with a patient’s intact skin (e.g., when taking a pulse or blood
pressure or lifting a patient)
 After contact with inanimate objects (including medical equipment)
 After removing gloves
Eyes

 Needed when an employee work presents the potential of causing eye


injury from physical ,chemical,or radiation agents
 Examples .
 Lasers
 Flying particals / dust
 Electrical work
 tools
Types of Eye Protection

 Non prescription safety glasses


 Prescription safety glasses
 Chemical goggles- protect your eyes , facial area immediately surrounding
the eyes from impact ,dust and splashes.
 Laser and welding googles protect the eyes from harmfull light.
GLOVES

 • Gloves provide an effective barrier for hands from the microflora


associated with patient care.
 •Gloves should be worn when a health care worker has contact with any
patient’s secretions or excretions and must be discarded after each patient
care contact.
 GLOVES Wear when touching blood, body fluids, secretions, excretions,
mucous membranes, non intact skin.
 Change between tasks and procedures on the same patient after contact
with potentially infectious material.
 Remove after use, before touching non-contaminated items and surfaces,
and before going to another patient. Perform hand hygiene immediately
after removal.
 Gloves must be: Worn when exposure to blood and/or other body fluids is
anticipated/likely.
 Changed immediately after each patient and/or following completion of
a procedure or task.
 Changed if a perforation or puncture is suspected; and Appropriate for
use, fit for purpose and well-fitting to avoid excessive sweating and
interference with dexterity
 Those with a latex allergy can use vinyl, nitrile.
 Discharge single used gloves after used
 Store in a clean area
GOWNS AND APRONS

 GOWNS AND APRONS •


 Wear an apron or gown to protect skin and prevent soiling of clothing
during procedures and patient care activities that are likely to generate
splashing or sprays of blood, body fluids, secretions or excretions, or cause
soiling of clothing.
 • Select a gown or apron (i.e., long or short sleeves) that is appropriate for
the activity and the amount of fluid likely to be encountered. If an apron is
used, staff should ensure they are “bare-below-the-elbows”.
 • Remove the used gown as promptly as possible and roll it up carefully
and discard appropriately.
 • Perform hand hygiene immediately after removal
PREVENTION OF NEEDLE STICK AND INJURIES
FROM OTHER SHARP INSTRUMENTS

 The most important aspect of reducing the risk of blood borne infection is
avoidance of percutaneous injury.
 Extreme care is essential in all situations in which needles, scalpels, and
other sharp objects are handled.
 Used needles should not be recapped. Instead, they are placed directly
into puncture resistant containers in the vicinity of their use.
 All used disposable syringes and needles, scalpel blades, and other sharp
items should be placed in appropriate puncture-resistant containers
located close to the area where they are used.
 Sharps containers should be disposed of according to state and local
regulated systems
 All should be aware of the risk of injury whenever sharps are exposed. When
using or working around sharp devices,everyone should take precautions
while using sharps, during cleanup, and during disposal.edical waste rules.
PREVENTION OF NEEDLE STICK AND
INJURIES
 Use care when:
 1. Handling needles, scalpels, and other sharp instruments or devices.

 2. Cleaning used instruments.

 3. Disposing of used needles and other sharp instruments.


 Consider sharp items (e.g., needles, scalers, burs, lab knives, and wires) that
are contaminated with patient blood and saliva as potentially infective
and establish engineering controls and work practices to prevent injuries.
 Do not recap used needles by using both hands or any other technique
that involves directing the point of a needle toward any part of the body.
 Use either a one-handed scoop technique or a mechanical device
designed for holding the needle cap when recapping needles (e.g.,
between multiple injections and before removing from a non-disposable
aspirating syringe).
 Place used disposable syringes and needles, scalpel blades, and other
sharp items in appropriate puncture-resistant containers located as close as
possible to the area where the items are used.
FACIAL PROTECTION

 Needed when work presents the potential of causing facial injury from
physical chemical or radiation agents.

 FACE SHIELD
 WELDING SHIELD
 (EYES, NOSE, AND MOUTH) •
 When the health care provider is involved in an activity in which body fluids
may be sprayed or splashed, appropriate barriers must be used.
 If a splash to the face may occur, goggles and facemask are warranted.
 If the health care worker is handling material that may soil clothing or is
involved in a procedure in which clothing may be splashed with biologic
material, a cover gown should be worn.
CONTINUE

 Facial protection (eyes, nose, and mouth)


 1. Wear a surgical or procedure mask and eye protection (eye visor,
goggles) or
 2. a face shield to protect mucous membranes of the eyes, nose, and
mouth during activities that are likely to generate splashes or sprays of
blood, body fluids, secretions, and excretions.
Gown

 1. Wear to protect skin and prevent soiling of clothing during activities that
are likely to generate splashes or sprays of blood, body fluids, secretions, or
excretions.
 2. Remove soiled gown as soon as possible, and perform hand hygiene.
 Gowns are collected and segregated before sending it to laundary .
TYPES OF LINEN

 Linen for housekeeping – this includes curtains, drapes, table cloths , etc
 Patient linen – bed linen , body linen ,ot linen
 Staff linen – Doctors and Medical staffs apron , gown etc.
Linens

.Linens Handle, transport, and process used linen in a manner which:


  Prevents skin and mucous membrane exposures and contamination of
clothing.
 Avoids transfer of pathogens to other patients and or the environment.
Handling of patient care equipment and
linen

 •Handle equipment soiled with blood, body fluids, secretions, and


excretions in a manner that prevents skin and mucous membrane
exposures, contamination of clothing, and transfer of pathogens to other
patients or the environment.
 Clean, disinfect, and reprocess reusable equipment appropriately before
use with another patient.
WASTE DISPOSAL

 Ensure safe waste management. 

Treat waste contaminated with blood, body fluids, secretions and excretions
as clinical waste, in accordance with local regulations.
Human tissues and laboratory waste that is directly associated with specimen
processing should also be treated as clinical waste.
Discard single use items properly.
ENVIRONMENTAL CONTROL

 •Ensure that the health service has adequate procedures for the routine
care, cleaning and disinfection of environmental surfaces, beds, bedrails,
bedside equipment and other frequently touched surfaces, and that these
procedures are being followed.
 •Use adequate procedures for the routine cleaning and disinfection of
environmental and other frequently touched surfaces.
 Policies and procedures for routine cleaning and disinfection of
environmental surfaces should be included as part of the infection
prevention plan.
 Cleaning removes large numbers of microorganisms from surfaces and
should always precede disinfection.
 Disinfection is generally a less lethal process of microbial inactivation
(compared with sterilization) that eliminates virtually all recognized
pathogenic microorganisms but not necessarily all microbial forms (e.g.,
bacterial spores)
 Emphasis for cleaning and disinfection should be placed on surfaces that
are most likely to become contaminated with pathogens, including clinical
contact surfaces (e.g., frequently touched surfaces such as light handles,
bracket trays, switches , computer equipment) in the patient-care area.
 When these surfaces are touched, microorganisms can be transferred to
other surfaces, instruments or to the nose, mouth, or eyes of DHCP or
patients.
 Although hand hygiene is the key to minimizing the spread of
microorganisms, clinical contact surfaces should be barrier protected or
cleaned and disinfected between patients.
Respiratory hygiene and cough etiquette

 • Education of health workers, patients and visitors.


 •Covering mouth and nose when coughing or sneezing.
 • Hand hygiene after contact with respiratory secretions.
 • Spatial separation of persons with acute febrile respiratory symptoms.
 Implement measures to contain respiratory secretions in patients and
accompanying individuals who have signs and symptoms of a respiratory
infection, beginning at point of entry to the facility and continuing
throughout the visit.
 a. Post signs at entrances with instructions to patients with symptoms of
respiratory infection to—
 i. Cover their mouths/noses when coughing or sneezing.
 ii. Use and dispose of tissues.
 iii. Perform hand hygiene after hands have been in contact with respiratory
secretions.
 b. Provide tissues and no-touch receptacles for disposal of tissues.
 c. Provide resources for performing hand hygiene in or near waiting areas.
 d. Offer masks to coughing patients and other symptomatic persons when
they enter the dental setting.
 e. Provide space and encourage persons with symptoms of respiratory
infections to sit as far away from others as possible. If available, facilities
may wish to place these patients in a separate area while waiting for care.
Sterile Instruments and Devices

 Instrument processing requires multiple steps using specialized equipment.


Each dental practice should have policies and procedures in place for
containing, transporting, and handling instruments and equipment that
may be contaminated with blood or body fluids.
 Manufacturer’s instructions for reprocessing reusable dental instruments
and equipment should be readily available—ideally in or near the
reprocessing area. Most single-use devices are labeled by the
manufacturer for only a single use and do not have reprocessing
instructions.
 Use single-use devices for one patient only and dispose of appropriately.
 Cleaning, disinfection and sterilization of dental equipment should be
assigned to DHCP with training in the required reprocessing steps to ensure
reprocessing results in a device that can be safely used for patient care.
 Training should also include the appropriate use of PPE necessary for safe
handling of contaminated equipment.
 Patient-care items (e.g., dental instruments, devices, and equipment) are
categorized as critical, semicritical, or noncritical, depending on the
potential risk for infection associated with their intended use.
 Critical items, such as surgical instruments and periodontal scalers, are
those used to penetrate soft tissue or bone.
 They have the greatest risk of transmitSemicritical items (e.g., mouth mirrors,
amalgam condensers, reusable dental impression trays) are those that
come in contact with mucous membranes or non-intact skin (e.g., exposed
skin that is chapped, abraded, or has dermatitis).
 These items have a lower risk of transmission. Because the majority of
semicritical items in dentistry are heat-tolerant, they should also be sterilized
using heat.
 If a semicritical item is heat-sensitive, DHCP should replace it with a heat-
tolerant or disposable alternative. If none are available, it should, at a
minimum, be processed using high-level disinfection ting infection and
should always be sterilized using heat
 Clean and reprocess (disinfect or sterilize) reusable equipment
appropriately before use on another patient.
 Clean and reprocess reusable equipment according to manufacturer
instructions. If the manufacturer does not provide such instructions, the
device may not be suitable for multi-patient use.
 a. Have manufacturer instructions for reprocessing reusable
instruments/equipment readily available, ideally in or near the reprocessing
area.
 Assign responsibilities for reprocessing of equipment with appropriate
training.
 Wear appropriate PPE when handling and reprocessing contaminated
patient equipment.
 Use mechanical, chemical, and biological monitors according to
manufacturer instructions to ensure the effectiveness of the sterilization
process. Maintain sterilization records in accordance with state and local
regulations.
SAFE INJECTION PRACTICES

 Safe injection practices are intended to prevent transmission of infectious


diseases between one patient and another, or between a patient and
DHCP during preparation and administration of parenteral (e.g.,
intravenous or intramuscular injection) medications.
 Safe injection practices are a set of measures DHCP should follow to
perform injections in the safest possible manner for the protection of
patients
 DHCP most frequently handle parenteral medications when administering
local anesthesia, during which needles and cartridges containing local
anesthetics are used for one patient only and the dental cartridge syringe is
cleaned and heat sterilized between patients
 Other safe practices described here primarily apply to use of parenteral
medications combined with fluid infusion systems, such as for patients
undergoing conscious sedation.
 Unsafe practices that have led to patient harm include
 1) use of a single syringe — with or without the same needle — to
administer medication to multiple patients,
 2) reinsertion of a used syringe — with or without the same needle — into a
medication vial or solution container (e.g., saline bag) to obtain additional
medication for a single patient and thenusing that vial or solution container
for subsequent patients, and
 3) preparation of medications in close proximity to contaminated supplies
or equipment.
KEY RECOMMENDATIONS

 Prepare injections using aseptic technique2 in a clean area.


 Disinfect the rubber septum on a medication vial with alcohol before piercing.
 Do not use needles or syringes* for more than one patient (this includes
manufactured prefilled syringes and other devices such as insulin pens).
 Medication containers (single and multidose vials, ampules, and bags) are
entered with a new needle and new syringe, even when obtaining additional
doses for the same patient.
 Use single-dose vials for parenteral medications when possible.
 Do not use single-dose (single-use) medication vials, ampules, and bags or
bottles of intravenous solution for more than one patient.
 Do not combine the leftover contents of single-use vials for later use.
CONCLUSION

 Standard precautions are the work practices required to achieve a basic


level of infection prevention and control
 .  Standard precautions are the minimum infection prevention and control
practices that must be used at all times for all patients in all situations.
  Transmission-based precautions are used when standard precautions
alone are not sufficient to prevent the spread of an infectious agent.
 Transmission-based precautions are based upon the mode of transmission
of the infectious agent.
THANK YOU

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