Download Standard Precautions

Healthcare Safety & Standard
Precautions
Standard Precautions and
Transmission-Based
Precautions
DEDE CARR, BS, LDA
KAREN NEU, MSN, CNE, CNP
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
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2
COMPETENCY 2
2. Explain the current requirements of standard
precautions and the procedures used at a variety of
healthcare facilities to support those standards.

a.
b.
c.
d.
e.
f.
Explain the purpose of standard precautions and when
they are applied.
List common pathogens.
Identify PPE (personal protective equipment) and usage.
List compliance measures for Blood borne Pathogens
Standards.
Identify types of Isolation Precautions and describe why
isolation is used in a healthcare facility.
Identify concerns and needs of clients in isolation.
3
Standard Precautions are used in the care of all
hospitalized persons regardless of their diagnosis
or possible infection status.
 They apply to blood, all body fluids, secretions
and excretions, except sweat (whether or not
blood is present or visible), non-intact (broken)
skin, and mucous membranes.
 Standard Precautions are designed to reduce the
risk of transmission of microorganisms from
recognized & unrecognized sources.
(Berman et al., p. 689)
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Hand Hygiene
Perform proper hygiene after contact with blood, body fluids,
secretions, excretions, & contaminated objects whether or not
gloves are worn.
 Perform proper hand hygiene immediately after removing
gloves and other wear or equipment.
 Before eating, drinking, smoking, applying makeup, or
changing contact lenses and after using the restroom facilities.
 Before all other activities that entail hand contact with mucous
membranes or a break in the skin.
 Before and after every patient contact.
Use a non-antimicrobial product for routine hand cleaning.
Use antimicrobial agent or an antiseptic agent for the control of
specific outbreaks. (Berman et al., p. 689)
5
Access the website to watch YouTube video for
Correct Procedure for Hand Washing
6
Use of Gloves
Wear clean gloves when touching blood, body fluids,
secretions, excretions, and contaminated items
(i.e., soiled gowns)
A. clean gloves can be unsterile unless their use is
intended to prevent entrance of microorganisms
into the body (invasive procedures.
B. Remove gloves before touching noncontaminated items and surfaces.
C. Perform proper hand hygiene immediately after
removing the gloves.
(Berman et al., p. 689)
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Mask, Eye Protection, Face Shield-PPE
Wear mask, eye protection, or a face shield if
splashes or sprays of blood, body fluids,
secretions, or excretions can be expected.
(Berman et al., p. 689)
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Gown-PPE
 Wear a clean, non-sterile gown if client care is
likely to result in splashes or sprays of blood,
body fluids, secretions, or excretions.
 The gown is intended to protect clothing.
 A Remove a soiled gown carefully to avoid the
transfer of microorganisms to others (i.e.,
clients or other healthcare workers).
 Cleanse hands after removing the gown.
(Berman et al.. 689)
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Care Equipment
Handle client care equipment that is soiled with
blood, body fluids, secretions, and excretions
carefully to prevent the transfer of
microorganisms to others and to the
environment.
 A. Make sure usable equipment is cleaned and
reprocessed correctly.
 B. Dispose of single-use equipment.
(Berman et al., p. 689)
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Linen
 Handle, transport, and process linen that is soiled
with blood, body fluids, secretions, and excretions
in a manner to prevent contamination of clothing
ad the transfer of microorganisms to others and to
the environment.
 Fold or roll linen so that the dirtiest area is inside
before disposing the linen into a bag or hamper.
Sharps, Scalpels, Needles,
 Prevent injuries from scalpels, needles, or other
equipment and place in puncture-resistant
containers.
(Berman et al., p. 689)
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Dishes
 Dishes require no special precautions.
 Soiling of dishes can largely be prevented by
encouraging clients to cleanse their hands
before eating.
 Some agencies use paper dishes for
convenience, which are disposed of in the
refuse container. (Berman et al., p. 694)
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Blood Pressure Equipment
 Blood pressure equipment needs no special
precautions unless it becomes contaminated with
infective material.
 If it does become contaminated, follow your agency’s
policy to decontaminate it.
 In some institutions as disposable cuff is used.
 The stethoscope should be cleaned between every
patient contact.
Thermometers
 Non-disposable thermometers are generally disinfected
after use. Check agency policy.
(Berman et al., pp. 694-695)
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Laboratory Specimens
 Laboratory specimens, if placed in a leak-proof
container with a secure lid with a biohazard label, need
no special precautions.
 Use care when collecting specimens to avoid
contaminating the outside of the container. Containers
that are visibly contaminated on the outside of the
container should be placed in a sealable plastic bag
before sending them to the laboratory. This prevents
personnel from having hand contact with potentially
infective material. (Berman et al., p. 694)
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(http://www.uow.edu.au/content/groups/public/@web/@health/documents/mm/uow025316.jpg, n.d.)
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Additional requirements for Standard Precautions
 Mouth pieces, resuscitation bags, or other ventilation
devices should be available for use in areas in which the
need for resuscitation is predictable.
 Pregnant health care workers are not known to be at
any greater risk of contracting HIV infection than those
who are not pregnant.


Because the infection can be transmitted perinatal route,
pregnant health care workers should be especially familiar
with and strictly adhere to precautions to minimize the risk
of acquiring HIV or Hepatitis B.
Immunization of employees is required for infectious
agents (measles, mumps, rubella) transmitted by air.
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
Transmission-based precautions are used in
addition to standard precautions for clients with
known or suspected infections that are spread in
one of three ways by:
Airborne transmission
 Droplet transmission
 Contact transmission


The three types of transmission-based
precautions can be used alone or in combination
but always in addition to standard precautions.
(Berman et al., p. 689)
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Airborne precaution are used for client known
to have or suspected of having serious illnesses
transmitted by airborne droplet nuclei smaller
than 5 microns.
 Examples of such illnesses include measles
(rubeola), varicella (chicken pox),
disseminated zoster (shingles), and
tuberculosis.
(Berman et al., p. 670)

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Airborne Precautions-use Standard Precautions as well as:

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Place the client in a private room that has a negative air
pressure (6-12 air exchanges per hour and either discharge
of air to the outside or a filtration system for the room air).
If a private room is unavailable, place client with another
who is infected with the same microorganism.
Wear a respiratory device (N59 respirator) when entering
the room of a client who is known or suspected of having
primary tuberculosis.
Susceptible people should not enter the room of a client
who has rubeola (measles) or varicella (chicken pox). If they
enter the room, they should wear a respirator.
Limit movement of the client outside the room to essential
purposes only. Place a surgical mask on the client during
transport.
(Berman et al., p. 689)
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Droplet precautions are used for clients known
or suspected to have serious illnesses by
particle droplets larger than 5 microns.
 Examples of such illnesses are diphtheria
(pharyngeal); mycoplasma pneumonia,
pertussis, mumps, rubella, streptococcal
pharyngitis, pneumonia or scarlet fever in
infants and small children; and pneumonic
plague.
(Berman et al., p. 670)
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Droplet Precautions
Use Standard Precautions as well as:
 Place client in a private room.
 If a private room is unavailable, place client with
another who is infected with the same
microorganism.
 Wear a mask if working within 3 feet of the client.
 Limit movement of the client outside the room to
essential purposes. Place a surgical mask on the
client during transport.
(Berman et al., p. 689)
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25
Contact precautions are used for client known or suspected to have
serious illnesses easily transmitted by direct client contact or by
contact with items in the client’s environment.
 According to the CDC, such illnesses include gastrointestinal,
respiratory, skin, or wound infections or colonization of multi-drugresistant bacteria; specific infections, such as C. difficile, and
enterohemorrhagic Escherichia coli 0157:H7, Shigella, and hepatitis
A, for diapered or incontinent clients; respiratory syncytial virus
(RSV), parainfluenza virus, or enteroviral infections in infants and
young children; and highly contagious skin infections, such as
herpes simplex virus, impetigo, pediculosis, and scabies.
 In addition to the preceding conditions, special contact precautions
are used for Vancomycin-resistant enterococci (VRE) infections.
 CDC recommends using an antimicrobial soap for hand washing and
no sharing of equipment among clients with or without VRE &
continued isolation until 3 cultures taken one week apart are
negative.
(Berman et al., p. 690)
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Contact Precautions: Use Standard Precautions as well as:
Place client in a private room.
If a private room is unavailable, place client with another who
is infected with the same microorganism.
Wear gloves a described in standard precautions
A. Change gloves after contact with infectious materials.
B. Remove gloves before leaving client’s room.
C. Cleanse hands immediately after removing gloves. Use an
antimicrobial agent. Note: If the client is infected with C.
difficile, DO NOT use an alcohol-based hand rub as it may
not be effective on these spores. Use soap and water.
D. After hand cleansing, do not touch possibly contaminated
surfaces or items in the room. (Berman et al., p. 689)
27
Contact Precautions
Wear a gown (see standard precautions) when entering
the room if there is possibility of contact with infected
surfaces or items, or if the client is incontinent, or has
diarrhea, a colostomy, or wound drainage not contained
by the dressing.
A. Remove the gown in the client’s room.
B. Make sure your uniform does not contact possible
contaminated surfaces.
 Limit movement of client outside the room.
 Dedicate the use of non-critical client care
equipment to a single client or to clients with the same
infecting microorganisms.
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Compromised clients (those highly susceptible to infection) are
often infected with their own microorganisms, by
microorganisms on the inadequately cleansed hands of
healthcare workers, and by non-sterile items, (food, water, air,
and client-care equipment).
Clients who are severely compromised include those who have:
 Diseases, such as leukemia, that depress the client’s resistance
to infectious microorganisms
 Extensive skin impairments, such as severe burns, which
cannot be effectively covered with dressings.
Sometimes these patients are placed in “reverse isolation” &
standard precautions with gowns, gloves, & masks are used to
protect the client from exposure to microorganisms rather
than to prevent transmission of microorganisms from the
client to others.
(Berman et al., p. 690)
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Review of Standard Precautions
Previously called Universal Precautions, standard
precautions assumes blood and body fluids of
ANY patient could be infectious and recommends
the use of personal protective equipment (PPE)
and other infection control practices to prevent
the transmission of microorganisms in any
healthcare setting.
• Decisions about what PPE to use is determined by
the type of clinical interaction with patient.
30
http://www.uow.edu.au/content/groups/public/@web/@health/documents/mm/uow025317.jpg
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32

All health care workers must apply clean or
sterile gloves, gowns, masks, and protective
eyewear according to the risk of exposure to
potentially infective materials. (CDC)
33
Gloves are worn for three reasons:
First, they protect the hands when the nurse is likely to handle
any body substances, for example, blood, urine, feces,
sputum, and non-intact skin.
Second, gloves reduce the likelihood of healthcare workers
transmitting their own endogenous microorganisms to
individuals receiving care. Healthcare workers with open
sores or cuts on their hands must wear gloves for protection.
Third, gloves reduce the chance that the healthcare worker’s
hands will transmit microorganisms from one client or
fomite to another client.
 In all situations, gloves are changed between client contacts.
(Berman et al., p. 690)
34
Gloves: The hands are cleansed each time gloves
are removed for two primary reasons:
A. The gloves may have imperfections or be
damaged during wearing so that they could
allow microorganisms entry and
B. The hands may become contaminated during
glove removal.
Access YouTube video (1.26 minutes) @
Proper Removal of Contaminated Gloves
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Gloves



Work from “clean to dirty”
Limit opportunities for “touch contamination” protect yourself, others, and the environment
 Don’t touch your face or adjust PPE with
contaminated gloves
 Don’t touch environmental surfaces except as
necessary during patient care
Discard in appropriate receptacle
 Never wash or reuse disposable gloves (CDC)
36
Gowns –
Clean or disposable impervious (water-resistant) gowns or
plastic aprons are worn during procedures when the
healthcare worker’s uniform is likely to become soiled.
Sterile gowns may be worn by the nurse when changing
dressings on a client with extensive wounds (i.e., burns).
Single-use gown technique (using a gown only once before it is
discarded or laundered) is the usual practice.
After the gown is worn, the nurse discards it (if it is paper) or
places it into a laundry hamper.
Before leaving the client’s room, the healthcare worker cleanses
his/her hands.
Use a gown during procedures and patient care activities when
contact of clothing/ exposed skin with blood/body fluids,
secretions, or excretions is anticipated. (Berman et al., p. 693)
37
Masks– Use during patient care activities likely to generate
splashes or sprays of blood, body fluids, secretions, or
excretions.
Masks – protect nose and mouth
–



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Should fully cover nose and mouth and prevent fluid penetration
Surgical masks and respirators are not the same.
Masks are used for large particles & to protect the healthcare
worker from splashes or exposure to mouth.
Respirators are used in airborne precautions to prevent
inhalation of small microorganisms, such as tuberculosis and
SARS.
(CDC)
See the YouTube video (5.37 min.) describing the:
Difference between Respirators & Surgical Masks
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Respirators
 Purpose – protect from inhalation of infectious
aerosols (e.g., Mycobacterium tuberculosis)
 PPE types for respiratory protection
 Particulate
respirators
 Half- or full-face elastomeric respirators
 Powered air purifying respirators (PAPR) (CDC)
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Goggles -Use during patient care activities likely
to generate splashes or sprays of blood, body
fluids, secretions, or excretions.
Goggles – protect eyes
* Should fit snuggly over and around eyes
* Personal glasses are not a substitute for
goggles because they do not extend around the
sides of the glasses, which the goggles do.
* Anti-fog feature improves clarity (CDC)
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Face Shields-Protect the face, nose, mouth and
eyes.
 Use during patient care activities likely to
generate splashes or sprays of blood, body
fluids, secretions, or excretions.
 Should cover the forehead, extend below the
chin and wrap around the side of the face.
(CDC)
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Key Points About PPE
• Don before contact with the patient, generally
before entering the room
• Use carefully – don’t spread contamination
• Remove and discard carefully, either at the
doorway or immediately outside patient room;
remove respirator outside room
• Immediately perform hand hygiene (CDC)
43


Watch the following YouTube video to learn
how and in what order to apply and remove
personal protective equipment:
Proper Application and Removal of PPE
Grey Bruce Health Unit Personal Protective
Equipment YouTube Video (4.42 minutes)
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Sequence* for Donning PPE
 Gown first
 Mask or respirator
 Goggles and/or face shield
 Gloves
*Combination of PPE will affect sequence – be
practical
(CDC)
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Select appropriate type
and size
 Opening is in the back
 Secure at neck and waist
 If gown is too small, use
two gowns

 Gown
#1 ties in front
 Gown #2 ties in back
(CDC)
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Place over nose, mouth,
and chin
 Fit flexible nose piece over
nose bridge
 Secure on head with ties
or elastic
 Adjust to fit
(CDC)
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Select a fit-tested respirator
Place over nose, mouth, and
chin
Fit flexible nose piece over nose
bridge
Secure on health with elastic
Adjust to fit
Perform a fit check –


Inhale – respirator should
collapse
Exhale – check for leakage around
face
(CDC
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Position goggles over
eyes and secure to the
head using the ear
pieces or headband
 Position face shield over
face and secure on brow
with headband
 Adjust to fit comfortably

(CDC)
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Don gloves last
 Select correct type and
size
 Insert hands into
gloves
 Extend gloves over
isolation gown cuffs

(CDC)
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Keep gloved hands away from face
 Avoid touching or adjusting other PPE
 Remove gloves if they become torn; perform
hand hygiene before donning new gloves
 Limit surfaces and items touched (CDC)

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“Contaminated”-Outside front of PPE


Areas of PPE that have or are likely to have been in
contact with body sites, materials, or
environmental surfaces where the infectious
organism may reside
“Clean” – inside, outside back, ties on head and
back of PPE

Areas of PPE that are not likely to have been in
contact with the infectious organism (CDC)
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Gloves
 Face Shield
 Goggles
 Gown
 Mask or Respirator

(CDC)
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At doorway, before leaving patient room or in
anteroom*
 Remove respirator outside room, after door
has been closed*
 *Ensure that hand hygiene facilities are
available at the point needed, (e.g., sink or
alcohol-based hand rub)
(CDC)

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Grasp the outside edge
near the wrist
 Peel away from hand,
turning glove inside out
 Hold in opposite gloved
hand
(CDC)

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Slide ungloved
finger under the
wrist of the
remaining glove.
 Peel off from the
inside, creating a
bag for both gloves.
 Discard. (CDC)

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Grasp the ear or head
pieces of the goggles or
face shield with
ungloved hands.
 Lift away from the face.
 Place mask or face
shield into designated
receptacle for
reprocessing or
disposal. (CDC)

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Unfasten ties
 Peel gown away
from neck and
shoulders
 Turn contaminated
outside toward the
inside
 Fold or roll into a
bundle
 Discard (CDC)

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Untie the bottom,
then top tie
 Remove from face
 Discard (CDC)

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Lift the bottom elastic
over your head first
 Then lift off the top
elastic
 Discard

(CDC)
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
Perform hand hygiene immediately after
removing PPE.
 If
hands become visibly contaminated during PPE
removal, wash hands before continuing to remove
PPE
Wash hands with soap and water or use an
alcohol-based hand rub
 *Ensure that hand hygiene facilities are
available at the point needed, e.g., sink or
alcohol-based hand rub (CDC)

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Transporting clients with infections outside their own
rooms (isolation) is avoided unless absolutely
necessary.
If the client must be moved, the healthcare worker
implements the appropriate precautions and measures
to prevent soiling of the environment.
For example, the healthcare worker ensures that any
draining wound is covered securely and places a
surgical mask on a patient with an airborne infection.
In addition, the personnel at the receiving area are
notified of any infection risk so they can maintain
necessary precautions.
(Berman et al., p. 695)
64
Clients requiring isolation precautions can
develop several problems as a result of the
separation from others and of the special
precautions taken in providing their care.
Two of the most common problems are:
 Sensory deprivation
 Decreased self-esteem related to feelings of
inferiority
(Berman et al., p. 695)
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Sensory deprivation-occurs when the
environment lacks normal stimuli for the
client, for example, communication with
others.
 Healthcare workers should be alert for
common clinical signs, such as boredom,
inactivity, slowness of thought, daydreaming,
increased sleeping, thought disorganization,
anxiety, hallucinations, and panic.
(Berman et al., p. 695)
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
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Take measures to improve the client’s sensory stimulation
during isolation.
Open the drapes or shades; make sure the environment is clean
and pleasant; remove excess supplies and equipment; listen to
the client’s concerns or interests.
Do not appear rushed when providing care.
Mealtime is a great time for conversation.
Provide comfort measures, such as repositioning, a back
massage, or a warm sponge bath to increase physical
stimulation.
If client’s condition warrants, encourage the client to walk
around in the room or sit up in a chair.
Discuss situation with family to encourage them to show
support and to avoid negative expressions. (Potter & Perry, pp. 663664)
67
Decreased Self-Esteem
 A client’s feeling of inferiority can be due to the
perception of the infection itself or to the required
precautions.
 In North America, many people place a high value on
cleanliness and the ideal of being “soiled,”
“contaminated,” or “dirty” can give clients the feeling
that they are at fault and substandard.
 The infected persons may feel unclean, rejected, lonely,
or guilty.
 Although this is obviously not true, the infected persons
may feel “not so good” as others and blame themselves.
(Berman et al., p. 695)
68
Healthcare workers can prevent these two
psychosocial problems or deal with them
positively:
 Assess individual’s needs for stimulation
 Initiate measures to help meet the need, including
regular communication with the client and
diversionary activities: toys for a child, books, TV,
or radio, music; provide a variety of foods to
stimulate the sense of taste; stimulate the visual
sense by providing a view or an activity to watch.
(Berman et al., p. 695)
69
Explain the infection and associated procedures to
help clients and their support people understand
and accept the situation.
 Demonstrate warm, accepting behavior.
 Avoid conveying to the client any sense of
annoyance about the precautions or any feelings
of revulsion about the infection. Be very aware of
your attitude and body language as you are
providing care.
 Do not use stricter precautions than are indicated
by the diagnosis or the client’s condition.

(Berman et al., p. 695)
70
It is important that healthcare workers know & understand the
following regarding isolation of clients & how to make it more
effective.
Before instituting isolation measures, nurses help clients & their family
 Understand the nature of the disease or condition,
 Purposes of isolation
 Steps for carrying out specific precautions.
 If they are able to participate in maintaining infection prevention
and control practices, the chances of reducing the spread of
infection increases.
Nurses teach the client & family to perform hand hygiene & use of
barrier protection if appropriate.
Important to teach how infectious organisms are transmitted so
client/family can understand differences between clean and
contaminated objects.
(Potter & Perry, pp. 662-663)
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72
The following slides will present information
regarding to the Bloodborne Pathogens
Standards.
OSHA
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What are bloodborne pathogens?
 Bloodborne pathogens are infectious
microorganisms present in blood that can cause
disease in humans.
 These pathogens include, but are not limited to,
hepatitis B virus (HBV), hepatitis C virus (HCV),
and human immunodeficiency virus (HIV), the
virus that causes AIDS.
 Workers exposed to bloodborne pathogens are at
risk for serious or life-threatening illnesses.
(OSHA, 2011)
74
Bloodborne Pathogens Standards state what
employers must do to protect workers who are
occupationally exposed to blood or other
potentially infectious materials (OPIM), as
defined in the standard.
 That is, the standard protects workers who can
reasonably be anticipated to come into contact
with blood or OPIM as a result of doing their
job duties.
(OSHA, 2011)

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Bloodborne Pathogens Standards require employers to:
 Establish an exposure control plan.
 Employers must update the plan annually to reflect
changes in tasks, procedures, and positions that affect
occupational exposure, and also technological changes
that eliminate or reduce occupational exposure.
 Implement the use of universal precautions.
 Identify & use engineering controls.
 Identify & ensure the use of work practice controls.
 Provide personal protective equipment (PPE), such
as gloves, gowns, eye protection, & masks. (OSHA, 2011)
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Exposure Plan
 This is a written plan to eliminate or minimize
occupational exposures.
 The employer must prepare an exposure
determination that contains a list of job
classifications in which all workers have
occupational exposure and a list of job
classifications in which some workers have
occupational exposure, along with a list of the
tasks and procedures performed by those
workers that result in their exposure. (OSHA, 2011)
77
Bloodborne Pathogens Standards requirements
of employers:
 Make available hepatitis B vaccinations to all
workers with occupational exposure.
 Make available post-exposure evaluation &
follow-up to any occupationally exposed worker
who experiences an exposure incident.
 Use labels & signs to communicate hazards.
 Provide information & training to workers.
 Maintain worker medical and training records.

(OSHA, 2011)
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Engineering Controls
 These are devices that isolate or remove the
bloodborne pathogens hazard from the
workplace.
 They include sharps disposal containers, selfsheathing needles, and safer medical devices,
such as sharps with engineered sharps-injury
protection and needleless systems. (OSHA, 2011)
79
Work Practice Controls
 These are practices that reduce the possibility
of exposure by changing the way a task is
performed, such as appropriate practices for
handling and disposing of contaminated
sharps, handling specimens, handling laundry,
and cleaning contaminated surfaces and items.
(OSHA)
80

Access the YouTube Video (10 minutes) to
learn about
81
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