Download Standard Precautions - Thalassemia Center

STANDARD
PRECAUTIONS
Infection Control TeamThalassemia Center
-Dr. Maisam
-SN Samar
-SN Suhair
INTRODUCTION:
In the year 1990, the Centers for Disease
Control & prevention (CDC) and
Occupational Safety & Hospital
Administration (OSHA) formulated new
guidelines for Isolation precautions in
Hospitals known as Standard Precautions.
Definition:
All
blood and body fluids, secretions, excretions
except sweat with or without visible blood are to
be handled as infectious to blood borne
pathogens regardless of the infectious state/
diagnosis of the patient.
 It also applies to non-intact skin and mucous
membrane.
Hand Hygiene:
The hands of staff are the most common
vehicle by which micro-organisms are
transmitted between patients and hands.
Remember: Hand washing is the Single
most important measure in preventing the
transmission of infection.
Objective of Hand washing:
Hand washing removes dirt, transient
and some resident microorganisms as
quickly and completely as possible,
from hands, wrists and forearms.
Definition:
Hand washing – vigorous, brief rubbing together of
all surfaces of the hands for 10 – 15 seconds.
classified in two ways :
v Mechanical removal of microorganisms by
the use of basic soaps or detergents, to suspend
the flora from the skin and allow them to be
rinsed off.
v Chemical removal of microorganisms by
using anti microbial products to kill or inhibit
the growth of microorganisms.
Types of hand washing:
v
v
v
v
Social Hand washing
Hygienic hand washing or Antiseptic
hand washing
Surgical Hand washing
Alcohol hand rub
Efficacy of Hand Hygiene
Preparations in Killing Bacteria
Good
Better
Plain Soap
Antimicrobial
soap
Best
Alcohol-based
hand rub
CDC
Bacterial Reduction
Ability of Hand Hygiene Agents to
Reduce Bacteria on Hands
%
99.9
Time After Disinfection
log
0 60
180 minutes
3.0
99.0
2.0
90.0
1.0
Alcohol-based handrub
Antimicrobial soap
(4% Chlorhexidine)
0.0
0.0
Baseline
Plain soap
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.
Light patches indicate
germs carried on the
hands
• Your hands carry
many germs even
if you can’t see
them.
• Many people don’t
wash their hands
because they look
clean or because
they are wearing
gloves
Alcohol Hand rub Solutions:
Alcohol hand rubs can be applied more quickly
(15 – 20 seconds) without the need for a hand
wash basin and will remove both transient and
resident bacteria.
Should not be used if your hands are visibly soiled.
Its useful during aseptic technique, outside isolation
rooms, in intensive care settings where hands may
need washing frequently and ,where access to hand
washing facilities may be difficult.



Ethyl Alcohol
62%
moisturizer
Vit E
Personal Protective Equip. (PPE):
Many excretions and secretions of the body
are a major source of hospital acquired
infections.
Protective clothing should be worn for any
direct contact with these body fluids. This
helps to interrupt the transmission of microorganisms between patients and staff.
Gloves:
Gloves should be worn for any activity where blood
and body fluid or substances may contaminate the
hands
Hands must be washed after removal because
gloves may be punctured and your hands are easily
contaminated as the gloves are taken off.
To prevent transmission of infection gloves must be
discarded after each procedure.
Masks & Eye Protection:
Eye protection and mask should be worn for
any activity where there is a risk of body fluid
splashing into the face.
Gowns or Aprons:
Since the front of the body is the part
frequently contaminated by body fluid, plastic,
disposable aprons provide adequate
protection ,(e.g. dealing with body fluid spills,,
dressing wounds).
Gowns protect the skin of the health care
worker from contamination by infected body
fluid and reduce the risk of cross-infection to
other patients via your clothing.
Work practice controls :
Refers to practical technique that reduce the
likelihood of contamination by
changing the way a task is performed.
Proper Hand washing - Gloves Are Not A
Substitute For Hand washing .
Handling of used needles, & Contaminated
sharps.
One hand scoop method
Retractable Needle
Safety shield
Work practice controls :
Collection & laundering of
soiled/contaminated linen.
Collecting and transporting
specimens
Collection and disposal of waste
Blood / Body Fluid Spill
Management
Care of Linen:
Used linen is an infection risk for all those who are
involved in its handling especially if it is
contaminated with blood or body fluid substances.
Render the linen “safe” by heat disinfection
(usually the linen is thermally disinfected at the
highest temperature the material will withstand
65º C for at least 10 minutes or 71 º C for at least
3 minutes).
Waste Disposal:
YELLOW BAG :
For Disposing Pathological Wastes
Blood and Body Fluids
Catheters
Wound
Syringes
IV Tubings /Sets
IV Dressings
Central Lines
Gloves
Dressings
Suction Tubings Blood Transfusion sets
Sealed Sharp Safe
Boxes
Redivac Drains
Nasogastric Tubes
Sanitary pads
Soiled Diapers Secretions / Excretions
Laboratory specimens
Waste Disposal:
BLACK BAG : For Disposing all types of
General Wastes (non pathological wastes ):
Papers
Tissue papers
Paper Towels
Wrappers of hospital supplies
Bottles
Tin cans; Food wastes
Communication Controls:
Refers to information systems that reduce
exposure to blood borne pathogens.
Labeling and color marking of items or
areas helps to communicate the potential
hazards in the environment.
Eg: Bio-hazardous labels to mark
contaminated equipment.
Engineering Controls:
Sharp Safe containers
Safe needle devices
Needle less IV
connectors
Sharp injury
Sharp Safe Policy:
 Used sharps should be handled as little as possible to
minimize the risk of injury.
 Needles must not be re-sheathed. If a needle and syringe needs to
be disassembled then it should first be re-sheathed using a single
handed technique.
 Sharps must be discarded immediately after use into a designated
sharps container.
 Sharps must never be carried in the hand to the point of disposal,
but either carried in a tray or a sharps container brought to the point
of use.
 They should not be passed by hand between staff.
 Needles should not be removed from syringes but discarded as a
single unit.
 The bins must never be more than ¾ filled.
 Bins must be securely closed and labeled with the date, before
being sent for disposal.
What to do…







In the Event of a Sharps Injury:
Wash the area thoroughly with soap and water.
Cover with a waterproof dressing.
Inform your In Charge or Supervisor.
Document the injury on an incident form. If known
– note the details of the patient on whom the
object has been used.
Report to the Employee Health Department (staff
clinic) or Emergency room.
Conjunctiva/ Mucous Membrane:
If splashed with blood/ body fluids irrigate with
copious amounts of water; follow steps 4 – 6
above
Concentration of HBV in Body Fluids
High
Blood
Serum
Wound exudates
Moderate
Semen
Vaginal Fluid
Saliva
Low/Not Detectable
Urine
Feces
Sweat
Tears
Breast Milk
CDC
Transmission based precautions:



Air borne
Droplet
Contact
Additional Precaution:

NEUTROPENIC PRECAUTIONS
Methods of transmission:
Airborne route – this involves the transmission of
infecting organisms in airborne droplet nuclei (5 nm
or smaller in size) whose residue of evaporated
droplets contained microorganisms remain
suspended in the air for long periods of time, or dust
particles containing the infectious agent (e.g.
Mycobacterium tuberculosis and varicella virus).
Droplet route – the infectious agent may come in
contact with conjunctiva, nasal mucosa or the mouth
of a susceptible host (e.g. Droplets are generated
from the source person primarily during coughing,
sneezing and during procedures such as suctioning
and bronchoscopy).
Contd…..
Contact transmission – This is the most important and frequent
means of transmission and can be sub-divided into the following
groups:
Direct Contact – direct physical transfer of organisms through
direct personal contact (e.g. via hands).
Indirect contact – contact of susceptible host with a
contaminated object (e.g. contaminated equipment, instruments).
Other routes of transmission:
Vehicle transmission – this involves the transmission of
infecting organisms via contaminated items (e.g. Food, water,
medications).
Vector borne transmission – the transmission of infection via
insects (mosquitoes, rats, and other vermin).
NEUTROPENIC PATIENTS:

Immunocompromised patients vary in their
susceptibility to hospital acquired infections, depending
on the severity and duration of immunosuppression.

Thalassemia Center policyHandling Patients Who Are Mildly Immunocompromised
Post Bone Marrow Transplantation
Environmental hygiene:
Cleaning and disinfection of the environment:
 Concurrent cleaning – all surfaces should be
cleaned using the approved disinfectant.
 Terminal cleaning – after discharge of the patient
with infection, room should be disinfected using
approved disinfectant.
 Blood spill kit and Mercury spill kit:
These are available with the domestic staff
and they are trained to use these kits.
Environmental hygiene, contd:
CSSD (central sterilization splay department):
Items that undergo sterilization are sent to CSSD
(situated outside the hospital complex).
After the sterilization process the items are
Packed and returned to the respective areas,
ready for use.
 EMC (Equipment Maintenance Center):
All equipments are sent to EMC for cleaning
and disinfection .

SINGLE PATIENT USE DEVICES
Environmental hygiene, contd :


Screening of water supply is done on weekly
basis through Engineering Dept.
Environmental screening is done as per
schedule e.g. Air-conditioning.
Screening and Immunization:
New Employees:
All new employees are screened by Staff
Clinic for Hep B and HIV.
Chest X-ray will be done to rule out
pulmonary Tuberculosis.
PREVENTION
IS PRIMARY!
Protect patients…protect healthcare personnel…
promote quality healthcare!