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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