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Standard Precautions/OSHA
Standard precautions is a set of infection control practices used to prevent transmission of diseases that
can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous
membranes. These measures are to be used when providing care to all individuals, whether or not they
appear infectious or symptomatic.
Blood-Borne Pathogens
Blood-borne pathogens are germs that can cause a blood-borne disease. These pathogens are found in
infected human blood and certain other body fluids particularly semen and vaginal secretions. They
may be passed from person to person with any exposure to infected body fluid. The most common
blood borne pathogens include the following: Human Immunodeficiency Virus (HIV), Hepatitis B virus
(HPV) and the Hepatitis C virus (HCV). Blood borne pathogens inter the body in two ways: 1) break in
skin integrity: needle stick, cuts, scrapes and breaks in skin, 2) Mucous membranes: splashes to eyes and
nose, life style issues (IV drug use)
Hand Hygiene
Hand hygiene refers to both washing with plain or anti-bacterial soap and water and the use of alcohol
gel to decontaminate. When hands are not visibly soiled, alcohol gel is the preferred method of hand
hygiene when providing health care to clients.
Hand hygiene should be performed before and after contact with a client, immediately after touching
blood, body fluids, non-intact skin, mucous membranes, or contaminated items (even when gloves are
worn during contact), immediately after removing gloves, when moving from contaminated body sites
to clean body sites during client care, after touching objects and medical equipment in the immediate
client care vicinity, before eating, after coughing or sneezing into a tissue as part of respiratory hygiene.
Personal Protective Equipment (PPE)
PPE includes items such as gloves, gowns, masks, respirators and eyewear used to create barriers that
protect skin, clothing, mucous membranes, and the respiratory tract from infectious agents. PPE is used
as a last resort when work practices and engineering controls alone cannot eliminate worker exposure.
The items selected for use depend on the type of interaction a worker will have with a client and the
likely modes of disease transmission.
Wear gloves when touching blood, body fluids, non-intact skin, mucous membranes, and contaminated
items.
Wear a surgical mask and goggles or face shield if there is a reasonable chance that a splash or spray of
blood or body fluids may occur to the eyes, mouth or nose.
Wear a gown if skin or clothing is likely to be exposed to blood or body fluids.
Remove PPE immediately after use and wash hands.
Needle stick and Sharp Injury Prevention
Safe handling of needles and other sharp devices are components of standard precautions that are
implemented to prevent health care workers exposure to blood borne pathogens. Used needles should
be discarded immediately after use and not recapped, and be placed in a leak proof, puncture resistant
sharp container that is either red in color or labeled with a bio hazardous waste label. Used sharps
containers may be taken to a collection facility such as a hospital or pharmacy.
Cleaning and Disinfection
Client care area and other areas where clients may have potentially contaminated surfaces or objects
that are frequently touched by staff and clients (door knobs, sinks, toilets, other surfaces and items in
close proximity to clients) should be cleaned routinely with EPA registered disinfectants, following the
manufacturer’s instructions for amount, dilution, and contact time.
Housekeeping surfaces such as floors and walls do not need to be disinfected unless visibly soiled with
blood or body fluids. They may be routinely cleaned with a detergent only or a detergent/disinfectant
product.
Most disinfectants are not effective in the presence of dirt and organic matter, therefore cleaning must
occur first before disinfectant. Wet a cloth with the disinfectant, wipe away dirt and organic material,
then with a clean cloth apply the disinfectant to the item and allow to air dry for the time specified by
the product manufacturer.
Some pathogens such as norvirus and Clostridium difficile are not inactivated by commercial
disinfectants routinely used in local health settings. In situations where contamination with these
pathogens is suspected, a bleach solution (1:10) is recommended for disinfecting contaminated surfaces
and items.
Some patient care items may be damaged or destroyed by certain disinfectants. Consult with the
manufacturer of the items before applying disinfectants.
Respiratory Hygiene
Clients in waiting rooms or other common areas can spread infections to others in the same area or to
staff. Measures to avoid spread of respiratory secretions should be promoted to help prevent
respiratory disease transmission. Elements of respiratory hygiene and cough etiquette include:
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Covering the nose and mouth with a tissue when coughing or sneezing or using the
crook of your elbow to contain respiratory droplets.
Using tissues to contain respiratory secretions and discarding in the nearest waste
receptacle after use.
Performing hand hygiene immediately after contact with respiratory secretions and
contaminated objects/ materials.
Asking clients with signs and symptoms of respiratory illness to wear surgical mask while
in common areas. Provide tissues and non-touch receptacles for used tissue disposal.
Contaminated Laundry
Wear gloves and an apron if needed. Treat all linen and clothing soiled with blood or body fluid as if it is
infectious, as standard precaution. Keep these items in a secured plastic bag inside a separate secured
plastic bag until washed. Double bagging means using two bags in this manner. Wash items soiled with
blood or body fluids apart from other laundry in hot water at 160 degrees for 25 minutes.
Case Example:
You are assigned to care for Mrs. Green, an 84 year old woman who lives alone in a senior
complex. You were told that Mrs. Green has diabetes and heart disease. As you enter her apartment,
you find her in bed surrounded by used tissues. She says that her grandchildren visited over the
weekend and must have given her a cold. You think to yourself, “I hope I don’t catch that cold,” as you
mentally review good infection control practices. You remember that good infection control practices
are designed to control or eliminate sources of infection and to help protect both you and your clients
from disease.
The following definitions will help you understand the difference between clean and sterile technique.
Asepsis is the term that refers to the absence of germs or pathogens which are any microorganism
capable of causing disease. Medical Asepsis is the same as clean technique and involves infection control
practices which reduce the number of germs and help control their spread.
Surgical asepsis involves the complete elimination of microorganisms from an area. This is what is used
in the operating room and known as sterile technique.
As a home health aide or personal care attendant, you are not responsible for surgical asepsis, but you
are responsible for medical asepsis.
The Development of Infection
Infections develop through the introduction of infectious agents, including bacteria, viruses, fungi and
protozoa. Mrs. Green’s cold may be caused by a virus or bacteria that were introduced over the
weekend. Six elements must be present for the development of an infection. This is called “The Chain
of Infection”
Infectious Agent
Reservoir
Host
Portal of
Entry
Modes of
Transmission
Portal of Exit
Reservoir
Infectious agents have many sources or “reservoirs” for growth. One of the most common is the body
itself. A variety of organisms lives on the surface of the skin and within body cavities, fluids and
discharges. Their presence doesn’t always cause a person to get ill, but they can be carriers. Carriers
are people or animals who show no symptoms of illness but who have infectious agents on or in their
bodies that can be transmitted to others. For instances, for tuberculosis you receive a Mantoux or a
chest x-ray to identify whether or not you are a carrier. If you are a carrier, there are certain procedures
you need to follow before providing direct care to your client.
Mrs. Green’s grandchildren were the reservoir or carriers through which received her infection.
The following are some ways to eliminate as many infectious agents as possible.
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Bathe with soap and water
Change soiled dressings
Remove standing water
Cover bottles of used solutions
Empty and rinse collection bottles/bags regularly according to your client’s care plan
As you toss away Mrs. Greene’s soiled tissues and prepare to assist her with a shower, you know you are
preventing the transmission of some germs.
Portal of Exit
After infectious agents find a site to grow and multiply, they must find a portal of exit (or escape route)
in order to enter another host and cause disease. In a human, they can exit through a variety of ways,
such as skin and mucous membranes, the respiratory tract, urinary tract, the GI tract, the reproductive
tract and blood. There are several simple ways to reduce the risk to your client of acquiring an infection
from you and to reduce your risk of acquiring an infection from your client. For example, cover your
nose and mouth when sneezing and coughing and wear a mask if you have a cold. Wear gloves and
handle urine, stool or emesis (vomit) carefully. Dispose of soiled linen properly.
Mrs. Green may have acquired her infection after her grandchildren coughed or sneezed during their
weekend visit. You also know that you lower your risk of acquiring the infection by wearing gloves as
you pick up the soiled tissues.
Transmission
There are many ways for the infectious agents to travel from the reservoir to the host. Certain diseases
are transmitted more commonly in certain ways. However, the same infectious agent may be passed by
more than one route.
The most common routes of transmission are:
1. Direct contact which involves direct physical transfer of the microorganism
2. Indirect contact which involves personal contact of a susceptible host with a contaminated
object such as a bedpan.
3. Droplet contact, such as coughing or sneezing. Droplets may travel up to 3 feet.
4. Air contact includes both droplets and dust
5. Vehicles mean transfer through contaminated objects such as liquids (including water), drugs or
other solutions, blood and food.
6. Vectors are insects (mosquitoes, fleas, ticks, lice) and animals
As you talk further to Mrs. Green, she tells you, “I kept telling my grandchildren to cover their mouths
when they coughed but they never did.” You decide that her infection was probably transmitted via
droplet contact. To reduce the further spread of Mrs. Green’s infection, you carefully and frequently
wash your hands. As you change her bedding, you wear gloves to pick up the soiled tissues and avoid
shaking the linen or other clothing.
Portal of Entry
Mrs. Green may have acquired her infection via her respiratory tract. Infectious agents can enter a body
through the same routed that they use for leaving one. The body’s main protection from disease its is
skin.. It is important for you to keep you client’s skin and mucous membranes intact. Use good hygiene
and skin care to prevent breakdown. For instance, keeping the skin moist with lotion can help prevent
cracking. Any artificial entry into the body provides another entry point. If your client has a catheter, be
sure to keep the system closes and intact. Be careful to use proper technique when changing from leg
to night drainage bag and vice versa.
Host
Whether or not a person acquires an infection depends on how susceptible or the amount of resistance
he or she has. Age, nutritional status, the presence of other disease and certain medical therapies
(medications, radiation) can place your client at a greater risk for infection.
As you consider Mrs. Green, you are aware that both her age and her diabetes may have enhanced her
susceptibility to an infection.
You can help Mrs. Green and other clients like her by using strict aseptic techniques. Be aware of the
body sites where an infection is most likely to develop, including the urinary tract, respiratory tract,
blood stream and any wounds. Encourage and provide good nutrition and adequate rest in order to
build up your client’s defenses.
Symptoms of Infection
Signs and symptoms of an infection may be local (in one area of the body) or systemic (throughout the
body)
Case Example
You are assigned care for a new client, Mr. Redden who is 79 years old. He was recently discharged
from the hospital following heart surgery. Your supervisor tells you that he has an infection in a surgical
wound. Once again, you recall the information you learned in your infection control class and decide
that your client has a localized infection.
Localized Infections
Localized infections are most common in areas of the skin mucous membrane breakdowns such as
wounds, bedsores or mouth lesions. Redness and swelling are caused from inflammation. When the
nurse changes his dressing you may notice green, yellow or brown drainage from the open wound. You
expect that Mr. Redden may complain of pain or tenderness around the site or tightness because of
swelling.
Systemic Infections
Systemic infections usually result in fever, fatigue, (feeling tired) and malaise. These clients may have
swollen lymph nodes. The infection may cause a loss of appetite, nausea and vomiting; and it may result
in more lethargy and energy loss. The fever may lead to increased heart and respiratory rates.
Individual body systems may also produce specific signs. For instance, if the lungs are involved, a
productive cough may develop.
In your older clients, an infection may not display the typical signs and symptoms because they have a
reduced inflammatory and immune response or because their medications may mask or hide the signs
and symptoms. The only symptoms you see may be atypical ones such as confusion, incontinence or
agitation.
Basic Rules of Standard Precautions
Standard precautions are a method of infection control by which human blood and body fluids are
treated as though they are infected. When following standard precautions, you treat each client as
though he or she has a potentially infectious disease.
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Where e gloves when there is a chance of being in contact with the client’s blood, semen,
vaginal secretions or other body fluids.
Wear gloves when the skin of your hands is broken or irritated
Wash hands before applying gloves and immediately after removing gloves.
Wash hands immediately after being contaminated with blood or other body fluids.
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Clean up blood or body fluid spills immediately with bleach and water solution (1:10); remember
to prepare solution daily.
Do not handle used “sharps” such as needles.
Ask client to place used “sharps” in puncture-resistant container or Biohazard waste container.
Wear personal protective equipment as required.
Avoid splashing when disposing of contents of bedpan, urinal, or commode; if splashing occurs,
clean area immediately
Wear gloves when disposing of soiled sanitary napkins or tampons
Do not eat, drink apply cosmetics or handle contact lenses in areas where exposure to blood or
other potentially infectious material is possible.