Download Infection Control Precautions - NHS Greater Glasgow and Clyde

NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Sept 08
Page 1 of 10
Policy Objective
To provide healthcare workers with details of their roles and responsibilities in
preventing and minimising the risk of transfer of bloodborne pathogens and other
micro-organisms from infectious body fluids from both recognised and unrecognised
sources of infection.
Healthcare Worker (HCW)
A Healthcare Worker (HCW) is any employee of NHS Greater Glasgow, whether
permanent, locum, agency or contracted, full or part-time. This includes students,
voluntary workers, those on work experience and all carers.
CONTENTS
RESPONSIBILITIES .....................................................................................................2
1
1.1
1.2
1.3
1.4
2
HEALTHCARE WORKERS (HCWS)..............................................................................2
MANAGERS ................................................................................................................2
INFECTION CONTROL TEAMS ......................................................................................2
HEALTH & SAFETY, OCCUPATIONAL HEALTH: ..........................................................2
STANDARD PRECAUTIONS.........................................................................................3
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
HAND HYGIENE ..........................................................................................................4
PERSONAL PROTECTIVE EQUIPMENT (PPE)................................................................4
OCCUPATIONAL EXPOSURE PREVENTION ...................................................................6
BLOOD AND BODY FLUID SPILLAGES .........................................................................6
PATIENT EQUIPMENT ..................................................................................................7
ENVIRONMENT ...........................................................................................................7
CLINICAL WASTE .......................................................................................................7
LINEN .........................................................................................................................8
PATIENT PLACEMENT .................................................................................................8
3
EVIDENCE BASE ........................................................................................................8
4
AUDIT ........................................................................................................................9
5
BACKGROUND INFORMATION.................................................................................10
5.1
DEFINITION & RATIONALE .......................................................................................10
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
STANDARD PRECAUTIONS
1
Sept 08
Page 2 of 10
RESPONSIBILITIES
1.1
Healthcare Workers (HCWs)
All HCWs must:
o Follow the requirements of this Standard Precautions Policy.
o Report, using the Incident Reporting System, if there is personal contamination
with blood, body fluid or faeces.
o Prior to undertaking any procedure consider if there is any possible risk from blood
exposure and wear appropriate personal protective clothing to prevent such
contamination.
1.2
Managers
o Ensure HCW compliance with this Policy.
o Undertake a risk assessment of the potential blood and body fluid contamination to
HCWs from procedures or incidents in their area.
o Ensure HCWs under their supervision are aware of, and have access to, this policy.
o Ensure HCWs have access to personal protective clothing to prevent exposure.
1.3
Infection Control Teams
o Act as resource for information and support.
o Provide education opportunities on this policy.
o Monitor the implementation of this Standard Precautions Policy in the clinical
settings.
o Assist managers to audit the implementation of this policy.
o Regularly review and update this policy.
1.4
Health & Safety, Occupational Health:
o Act as a resource for information and support.
o Consult with managers, supervisors, Infection Control Teams (ICTs) and HCWs
regarding personal protective equipment.
o Analyse and evaluate data from occupational exposures to provide data to feedback
to HCWs and managers on personal exposure injuries.
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
2
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Sept 08
Page 3 of 10
STANDARD PRECAUTIONS
Standard precautions are the precautions necessary to reduce the risk of transmission of
micro-organisms from both recognised and unrecognised sources of infection.
Standard precautions expand the coverage of Universal Precautions by recognising
that any body fluid may contain infectious micro-organisms and acknowledging that on
occasion additional precautions may be required [Refer to the Transmission Based
Precautions Policy]. (For more detailed information refer to: 5 Background
Information).
ALL health care workers in ALL situations involving the care of patients or
contact with the environment must use Standard Precautions.
Prior to any procedure the HCW must consider any potential exposures from blood and
body fluids and use personal protective equipment to prevent any direct contact.
There are 9 elements to Standard Precautions. These are detailed
from 2.1 – 2.9.
The first version of this document approved in 2003 referred to 11 elements. New
national guidance has amalgamated the three PPE sections into 1. Accordingly this
updated document has followed. There is no substantive change to any content.
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
2.1
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Sept 08
Page 4 of 10
Hand Hygiene
o Wash hands immediately after contact with blood, body fluids, secretions,
excretions and items contaminated with body fluids – whether or not gloves were
used.
o Wash hands immediately after the removal of gloves.
o Decontaminate hands between each direct patient contact.
o It may be necessary to change gloves and wash hands between tasks on the same
patient.
o Hand hygiene with an alcohol hand gel or rub is acceptable when the procedure is
clean and the hands have been in contact with patients but not when contaminated
with blood, body fluids, secretions, excretions and items contaminated with body
fluids.
Refer to the Hand Hygiene policy.
2.2
Personal Protective Equipment (PPE)
PPE is defined as all equipment which is intended to be worn, or held by a person at
work and which protects the worker against one or more risks to the worker’s health or
safety. (HSE 1992). This also includes equipment worn to protect the patient from
micro - biolgocial agents.
In healthcare PPE can be divided as follows:
2.2.1
2.2.1
PPE to protect the hands and arms,
2.2.2
PPE to protect the trunk and feet
2.2.3
PPE to protect the face / mucous membranes
PPE to protect the hands and arms – GLOVES / GAUNTLETS
o Wear gloves (clean, non-sterile gloves are adequate) when in contact with blood,
body fluids, secretions, excretions and contaminated items / equipment.
o Put on clean gloves just before direct contact with mucous membranes and nonintact skin.
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Sept 08
Page 5 of 10
o Change gloves between all procedures including those performed on the same
patient.
o Remove gloves promptly after use, and perform hand hygiene before touching noncontaminated items and environmental surfaces, and before going to another
patient.
o Consider the use of gauntlet type glove for any procedure, which may contaminate
the forearm.
o Decontaminate hands immediately after removal of gloves.
Refer to the Personal Protective Equipment Policy.
2.2.2
PPE to protect the trunk and feet – APRON / GOWN / FOOTWARE
o Wear a clean plastic apron to protect uniform from soiling during procedures and
patient care activities that are likely to generate splashes or sprays of blood or body
fluids. Select an apron or gown that will offer the most appropriate protection.
o Wear a clean plastic apron to protect uniform from contamination with microorganisms when bed-making, any direct patient care, or direct contact with the
environment of an isolated patient.
o
Remove a used apron immediately after a procedure, then promptly perform hand
hygiene to avoid transfer of micro-organisms to other patients or the environment.
o
Use protective footwear, e.g. Wellington boots or clogs in theatre, to prevent
contamination of the feet specifically in theatre or when splashing of the feet with
blood and body fluids is possible.
o
Remove contaminated footwear after procedure is completed.
Refer to the Uniform Policy.
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
2.2.3
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Sept 08
Page 6 of 10
PPE to protect the mucous membranes of the face - MASK, EYE
PROTECTION AND OR FACE SHIELD
o
A mask, eye protection or face shield must be worn to protect mucous membranes of
the mouth, eyes and nose if there is a risk of splash or spray of blood or other body
fluid.
2.3
Occupational Exposure Prevention
o
All cuts and abrasions must be covered with a waterproof dressing.
o
Take care to prevent injuries when using needles, scalpels and other sharp instruments
or devices.
Use gloves when handling sharps. If a sharp injury occurs gloves will wipe
the outer surface of the needle and reduce the amount of blood transferred.
Do not resheath needles. (If you cannot comply with this regulation contact a
member of the ICT).
Never manipulate any sharp that involves directing the point of a needle
toward any part of your body.
Dispose of sharps immediately into an approved sharps container (BS7320).
Take a sharps container to the point of use.
Use sharps boxes that are less than 3/4 full.
Refer to the GGHB needlestick injury guidelines.
Use devices such as Pocket Mask or other ventilation devices as an alternative
to mouth-to-mouth resuscitation.
HCWs with skin conditions should seek the advice of the Occupational Health
Dept. especially if they have any exfoliative skin conditions.
Refer to the Occupational Health Policy.
2.4
Blood and Body Fluid Spillages
o Disinfect all blood and body fluids spillages immediately wearing appropriate
protective clothing (gloves, apron and if risk of splash goggles).
o
Chlorine releasing agents will inactivate bloodborne viruses.
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Sept 08
Page 7 of 10
o Chlorine releasing granules must not be used directly on urine spillages as chlorine
gas can be released.
o
Decontaminate
spillages
as
per
the
instructions
contained
within
the
Decontamination Policy.
(Refer to: Spillage section of the Decontamination Policy).
2.5
Patient Equipment
o Patient care equipment should be decontaminated as stated in Decontamination
Policy.
o Patient-related equipment, e.g. pumps, drip stands, etc., must be kept clean.
o Wear protective clothing when handling contaminated patient care equipment.
-
Do not reuse single-use equipment.
-
Do not reuse single-patient equipment on more than one patient.
Refer to the Decontamination Policy
2.6
Environment
o Ensure that all clinical areas are clean.
o Particular attention must be paid to cleaning of horizontal surfaces, floors, beds,
bedside equipment and other frequently touched surfaces.
o If the environment is not visibly clean the domestic supervisor should be informed.
2.7
Clinical Waste
o Segregate waste according to the Clinical Waste Policy.
o Seal all containers in line with the policy. (Refer to: Clinical Waste Policy).
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
2.8
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Sept 08
Page 8 of 10
Linen
o Always wear a plastic apron (and gloves where linen soiled) if handling used linen.
o Discard linen soiled with blood / body fluids, or from a patient in isolation, directly
into a red alginate bag and then a secondary bag (clear plastic or laundry bag) to
prevent further contamination.
Never place linen (soiled/used or clean) on the floor. (Refer to: Laundry Policy)
2.9
o
Patient Placement
Place a patient who could contaminate the environment, with blood body fluid or
faeces in a single room.
o If the patient is clinically unsuitable for isolation nursing a risk assessment must be
undertaken by the clinical team in conjunction with a member of the ICT.
o Babies and children will be isolated if they have symptoms suggestive of an infectious
disease which can spread person to person. The ICT will advise as necessary.
o If a single room is not available, consult with a member of the ICT.
Refer to the Transmission Based Precautions Policy
3
EVIDENCE BASE
The Johns Hopkins Hospital Interdisciplinary Clinical Practice Manual. www.hopkinsheic.org
Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for
isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53-80, and
Am J Infect Control 1996;24:24-52. http://www.cdc.gov/ncidod/hip/isolat/isolat.htm
Advisory Group on Infection. Scottish Infection Manual. The Scottish Office.
Department of Health. 1998.
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
4
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Not
Achieved
Not
Applicable
Sept 08
Page 9 of 10
AUDIT
Area being audited
Criteria
Achieved
There is a local risk assessment of the potential
exposures to blood and body fluids in the area. As a
consequence of which appropriate protective
clothing is available and accessible for all staff.
HCWs understand the term Standard Precautions
(Ask 2 HCWs different disciplines).
Hand hygiene is observed after dirty procedures once
gloves are removed. (Observe 2 procedures) {If
gloves are not used standard not achieved}.
Gloves are available throughout the area.
Eye protection is available in the area (Ask 2 HCWs
where it is).
HCWs are clear when they would use eye protection
(Ask 2 HCWs).
HCWs use protective clothing to prevent uniform
contamination during dirty procedures (Observe 2
procedures).
HCWs do not reuse single use equipment (Ask 2
HCWs).
The environment is clean (Visit 2 near patient areas).
Linen is discarded as per the policy (Observe twice).
HCWs know what to do should a sharps injury
occur. (Ask 2 HCWs).
HCWs can detail measures that indicate they take
actions to prevent exposures. (Ask 2 HCWs)
Patients who require isolation are isolated.
HCWs know how to decontaminate spillages.
(Ask 2 HCWs).
Total
Date: /
/
General comment on performance:
Agreed action plan:
Signed Manager:
Signed ICN
Send audit result to:
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS
NHS GREATER GLASGOW
CONTROL OF INFECTION COMMITTEE POLICY
STANDARD PRECAUTIONS
5
Effective
from
Review
date
Page
Sept 04
Replaces
2003 Version
Sept 08
Page 10 of 10
BACKGROUND INFORMATION
Following the recognition of the risk of transmission of HIV and other bloodborne
viruses in the UK in the mid 1980s, Universal Precautions were introduced. Universal
Precautions became the mainstay of the prevention of bloodborne virus cross-infection
from healthcare worker (HCW) to patient, patient to HCW, and patient to patient via
HCW. Universal Precautions were necessary because of the difficulty in identifying
all persons who are infected with bloodborne viruses. Precautions in addition to
Universal
Precautions
have
always
been
recommended
for
patients
with
communicable disease such as tuberculosis or alert organisms such as MRSA.
To clarify any confusion with the situation, in 1996 the Centres for Disease Control
introduced the two new terms – Standard Precautions and Transmission Based
Precautions. Standard Precautions replace the term Universal Precautions and are
designed to prevent the transfer of bloodborne viruses and other micro-organisms that
may be in blood or other body fluid. Transmission Based Precautions is the second
category that includes all the additional precautions necessary for specific pathogens to
prevent the transfer of infections. (See Transmission Based Precautions Policy).
5.1
Definition & Rationale
Standard
Precautions
includes
Universal
Precautions
Transmission
based
precautions
Definition
The precautions necessary to reduce
the risk of transmission of microorganisms from both recognised and
unrecognised sources of infection including blood borne viruses.
Standard precautions expand the
coverage of Universal Precautions
by recognising that any body fluid
may contain infectious microorganisms.
The precautions in addition to
Standard Precautions necessary to
prevent spread of infections from the
airborne, droplet or a combination of
contact, airborne and droplet routes.
Rationale
The minimum level of infection control
precautions applicable in all situations to prevent
the transfer of bloodborne viruses and other
organisms that may cause cross-infection.
Standard Precautions will not prevent the spread
of micro-organisms spread via airborne, droplet or
combination of airborne/droplet and contact
routes. In addition none of the transmissible
spongiform encephalopathies, e.g. vCJD will be
inactivated by the standard decontamination
methods, e.g. autoclaving at 134° for 4 minutes.
Designed to prevent transmission of important
pathogens for which additional precautions are
necessary to the Standard Precautions advocated
for all patients and in all clinical situations.
STANDARD PRECAUTIONS HAVE REPLACED UNIVERSAL PRECAUTIONS