UNIVERSAL AND TRANSMISSION PRECAUTIONS

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.

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.

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.

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

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.

STANDARD PRECAUTION OF WEARING GLOVES CONT…………..

• 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.

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

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

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

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.

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.

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.

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.

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.

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

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.

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.

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.

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

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.

•

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.

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.

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

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.

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.

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.

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

SUMMARYAirborne 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

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

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

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

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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