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SECTION 3
STANDARD PRECAUTIONS
Introduction
1. Hand Hygiene
2. Personal Protective Equipment
3. Respiratory hygiene/Cough etiquette
4. Safe use and disposal of sharps
5. Blood and Body Fluid Spills Management
6. Management of Blood and Body Fluid Exposures.
7. Management of Laundry & Linen
8. Environmental Hygiene
9. Client-Care Equipment/Medical Devices
10. Patient Placement, Movement & Transfer
11. Safe Injection Practices
12. Infection Control Practices for Lumbar Puncture
Appendices
Appendix 3.0 WHO 5 Moments for Hand Hygiene Poster
Appendix 3.1 Six Step Hand Hygiene Technique for Healthcare Workers Poster
Appendix 3.2 Alcohol Hand Hygiene Poster. HSE South Cork& Kerry (2010)
Appendix 3.3 Hand Hygiene for Staff. HSE South Cork & Kerry (2010)
Appendix 3.4 Hand Care for Healthcare Staff leaflet. HSE South Cork & Kerry
Appendix 3.5 Hand Hygiene for Residents and Visitors. HSE South Cork & Kerry (2010)
Appendix 3.6 WHO Glove Pyramid. (Adapted by HSE South Cork & Kerry (2011)
Appendix 3.7 Respiratory Hygiene and Cough Etiquette. HPSC (2010)
Appendix 3.8 Action following Blood and Body Fluid Exposure Poster. HSE South Cork
& Kerry
Appendix 3.9 Prevention and Protection Protocols for Blood and Body Fluid Exposure
HSE South Cork & Kerry (2011).
Appendix 3.10 Safe Injection Practices (HPSC)
Developed by
In conjunction with
Date developed
Approved by
Reference number
Revision date
Responsibility for
review
Patricia Coughlan, Liz Forde, Máire Flynn, Niamh McDonnell
------------------------------August 2012
Cork and Kerry Infection Prevention and Control Committee
Kerry Infection Prevention and Control Committee
IPCG 3 / 2012
Revision number
0
2015 or sooner if new evidence becomes available
Infection Prevention and Control Nurses
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 1 of 36
Introduction
Standard Precautions have been designed to reduce the risk of cross infection from
both recognized and unrecognized sources of infection. It is not always possible to
identify people who may be a source of infection thus Standard Precautions are
advocated for the care of all patients/clients at all times. Standard Precautions are the
foundation for preventing transmission of infection during patient/client care in all
healthcare settings. (Siegel 2007)
Standard Precautions apply to:
 blood
 all body fluids, secretions and excretions (except sweat), regardless of whether
or not they contain visible blood;
 non-intact skin and
 mucous membranes.
Standard Precautions are work practices required for a basic level of infection
control and prevention. They can be applied as Standard principles by
 ALL healthcare practitioners to the care of
 ALL clients
 ALL the time
They include:
1. Hand Hygiene
2. Personal protective clothing
3. Respiratory hygiene/Cough etiquette
4. Safe use and disposal of sharps
5. Blood and Body Fluid Spills Management
6. Management of Blood and Body Fluid Exposures.
7. Management of Laundry & Linen
8. Environmental Hygiene
9. Client-Care Equipment/Medical Devices
10. Resident/Client Placement, Movement & Transfer
11. Safe Injection Practices
12. Infection Control Practices for Lumbar Punctures
It is recommended that all healthcare workers receive education and training
on


Standard Precautions including
Hand hygiene which is recommended as mandatory in The Guidelines for Hand
Hygiene in Irish Health Care Settings(2005)
(HIQA 2009, NICE 2012)
To ensure Standard Precautions are adhered to it is necessary to have adequate
supplies of liquid soap, paper towels, alcohol hand rub products, protective clothing,
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 2 of 36
and sharps containers available in all settings where healthcare is being delivered.
(NICE 2012)
Occupational Health
An overview of the Occupational Health Programme in the context of infection
prevention and control is given in section 1.0 of these guidelines.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 3 of 36
1. Hand Hygiene
Hand Hygiene is the single most important measure in preventing and
reducing cross infection and is the responsibility of all individuals involved in
the provision of health care.
The term “Hand Hygiene” refers to hand decontamination with either
1. Alcohol based products (gels, foams or rubs) that do not require the use of
water.
2. Plain liquid soap and water
3. Antiseptic soap and water.
Preparation for Hand Hygiene
1. Hand care is important, because skin that is intact (no cuts or abrasions) is a
natural defence against infection.

All cuts and abrasions must be covered with a water-resistant occlusive
dressing and changed as necessary.

Water- resistant dressings must be available.
2. To minimise “chapping” of hands, use warm water and pat hands dry rather than
rubbing them.
3. Healthcare workers with damaged skin of their hands e.g. weeping dermatitis or
persistent exfoliative skin lesions should not carry out direct patient/client care
and should seek medical/occupational advice.
4. Jewellery should be restricted to one flat/wedding ring.
5. Finger nails should be kept short, smooth, clean and free of nail varnish and false
nails.
6. Nail brushes for staff hand hygiene are not recommended.
7. Shirts and uniforms should have short or turned up sleeves. Cardigans are not
permitted during direct care.
Guidelines on Infection Prevention and Control 2012
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Community and Disability Services.
Standard Precautions
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When?
My Five Moments for Hand hygiene in Healthcare settings
Definitions
Patient Zone
The patient zone is defined as including the patient and some
surfaces/items in his /her surroundings that are temporarily and
exclusively dedicated to him/her i.e all items touched directly or
indirectly by the patient or touched by the HCW while delivering
care. This area becomes contaminated by the patients own
microbiological flora
Healthcare zone
All surfaces outside of the patient’s zone including other patients,
their zones and the wider healthcare environment. It is expected to
be contaminated by a wide variety of microorganisms including
multi drug resistant organisms
Performance of Hand Hygiene between these two geographically distinct
areas helps prevent the transmission of microorganisms.
Critical sites
Point of care
Sites within the patient zone which are associated with a higher
risk of infection. For example medical devices i.e. PEG site or risk of
exposure to body fluids i.e. taking blood sample or handling
incontinence wear.
Exactly where the care action takes place and is defined as the
place where the three elements come together; the patient, the
HCW and the care or treatment involving the patients.
Moments for Hand Hygiene in Out Patients, GP, Clinics, Home –based and
Long term care facilities
Definitions & Key differences
Patient Zone
Healthcare zone
Critical sites
Point of care
Where residents are semi independent and live in a community they will
have shared living space or rooms and will move about within the facility.
Therefore there is no distinct difference between the patient and
healthcare zone.
The patient zone will only apply where the resident is cared for
exclusively in a dedicated space with dedicated equipment e.g. bedside.
In the home setting the patient and their home is considered the patient
zone.
In out patients the patient him/her self is considered the patient zone as
the space and equipment used is not exclusively dedicated to the patient
for any prolonged period.
In home care what the HCW brings into the home in considered the
healthcare zone
In residential the healthcare zone only applies where the resident is
cared for exclusively in a dedicated space with dedicated equipment e.g.
bedside.
Sites with in the patient zone which are associated with a higher risk of
infection. For example medical devices i.e. PEG site or risk of exposure to
body fluids i.e. taking blood sample or handling incontinence wear.
Exactly where the care action takes place and is defined as the place
where three elements come together;the patient, the HCW and the care
or treatment involving the patients
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 5 of 36
MOMENTS FOR HAND HYGIENE IN LONG TERM CARE FACILTY
1.
2.
3.
4.
4 Moments for Hand
Hygiene
Before touching a resident
Before Clean/Aseptic
Procedures
After contact with body
fluids
After touching a resident
5 Moments for Hand
Hygiene
1. Before touching a patient
2. Before Clean/Aseptic
Procedures
3. After contact with body
fluids
4. After touching a patient
5. After touching the patients
surroundings
In LTCF
 where residents are mainly cared for in a dedicated space with dedicated
equipment the five moments for hand hygiene apply.
 where residents are semi autonomous, they may have their own room or shared
accommodation but also move within the facility, the four moments for hand
hygiene apply only to situations where healthcare is delivered to residents e.g.
vital sign checks.
 the four or five moments for hand hygiene recommendations do not cover any
social contacts with or among LTCF residents unrelated to healthcare delivery
i.e. shaking hands.
My Moments for Hand Hygiene in the Outpatients Setting
In outpatient settings Moment Five after touching the patient’s surroundings only
applies, where the patient is placed for a certain amount of time in a dedicated space
with dedicated equipment e.g. dental care settings, wound care clinics. In this case the
surfaces and items in the patients surroundings will become contaminated and
therefore require cleaning and decontamination once the patient has left.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
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Vaccination Clinics
Moments for Hand Hygiene
in Clinics
4 Moments
1. Before touching a patient
2. Before Clean/Aseptic
Procedures
3. After contact with body
fluids
4. After touching a patient
Dental Clinics
Moments for Hand hygiene
5 Moments
1. Before touching a patient
2. Before Clean/Aseptic
Procedures
3. After contact with body
fluids
4. After touching a patient
5. After touching the patients
surroundings
Hand hygiene should also be performed in a range of other situations including
 When hands are visibly contaminated with dirt, soil or organic material.
 Before and after each work shift or work break.
 Before putting on and after removing protective clothing.
 After using the toilet, nose blowing, covering a sneeze, or whenever hands
become visibly soiled.
 Before eating, drinking or preparing food for oneself or a client.
 After handling raw food and before handling cooked or ready to eat food.
 After cleaning duties.
 After handling waste food or waste bins.
 On entering and before leaving clinical areas.
 On entering and leaving client’s homes.
How?
Hands can be cleaned by using an alcohol hand rub product or by washing with
soap and water. A six step technique is advised for both products as outlined in the
posters in appendix 3.1
Guidelines on Infection Prevention and Control 2012
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Community and Disability Services.
Standard Precautions
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Alcohol Hand Rub (AHR) products – are the preferred method for hand hygiene in
all clinical areas, because of their superior microbiocidal activity, reduced drying of the
skin, and convenience. They should only be used on visibly clean hands (WHO 2009)
In the following circumstances, liquid soap must be used
 When hands are visibly soiled
 In clinical situations where there is potential for the spread of alcohol-resistant
organisms such as Norovirus, Clostridium difficile or organisms that cause
diarrhoea (SARI 2005 , NICE 2011)
(AHR products are becoming available which have greater efficacy against viruses)
Points to remember when using alcohol hand rub products
1. Alcohol hand rub technique is performed in the same way as handwashing except
that all surfaces need only be covered once.(Refer to Six Step Technique)
2. Apply an adequate volume to ensure the hand rub comes in contact with all
surfaces of the hands.
3. Rub hands covering all surfaces once using the six step technique then continue
rubbing hands until dry minimum 20-30 seconds.
4. Alcohol products with added emollients may result in an excessive build up of
emollients; therefore hands should be washed with soap and water after several
consecutive applications of alcohol hand rub.
Note: The use of alcohol based hand rubs have introduced a risk of fire and poisoning
however the benefits outweigh the risk provided adequate control measures are put in
place. Please refer to Technical Services Department HSE (Cork & Kerry) Fire & Safety
Note on Alcohol Based Hand –Rub. HN12.2 Circulated September 2009.
Handwashing
Handwashing should always be carried out when hands are visibly soiled and should be
performed as follows:
 Wet hands under warm running water up to the wrists.
 Apply the cleanser/liquid soap. Lather it evenly covering all areas of the hands,
including the thumbs, fingertips, and palms and in between the fingers, rubbing
backwards and forwards at every stroke for several strokes. Ref to Six Step
Technique
 Do not place hands under running water whilst lathering solution.
 Rinse off thoroughly under running water.
 Dry thoroughly with a paper towel patting your hands, taking special care
between the fingers.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 8 of 36
Refer to the Hand Hygiene for Staff HSE South (Long term care and Community
Services) 2010 in Appendix 3.3
Products to use for hand hygiene
Alcohol hand rubs are the preferred product for hand hygiene in clinical settings
when hands are visibly clean. For optimal compliance with hand hygiene, handrubs
should be readily available; products should be available at point of care, either
through dispensers which are easily accessible at the point of care or in small bottles
for staff to carry on their person.
Optimal concentration of alcohol is 60-70%. Products with added emollients are
recognized as superior.
Liquid soap should be used for all routine/social handwashing and is acceptable for
general social contact and most clinical care activities. Disposable cartridge type refills
in closed wall mounted units with an integral nozzle are preferred. If non-disposable
reservoirs are used, these must never be topped up, the inside of the containers must
be washed and dried before re-filling. Bar soap is not recommended.
Bactericidal liquid soaps Chlorhexidine 4% w/v (e.g. Hibiscrub/Hydrex) can be
used as an antiseptic handwash:
 Before carrying out invasive procedures
 In the event of an outbreak of an infection as advised by IPCN.
Clinical Hand Hygiene Facilities in healthcare settings should comply with
HTM64 Sanitary appliances, contact your local IPCN for advice.
Hand Hygiene in the Home
In the home setting, choosing the appropriate method of hand hygiene will be
influenced by the assessment of
1. what is appropriate for the episode of care,
2. the available resources and
3. what is practically possible.
In order to ensure that hand hygiene is carried out in a client's home, the following
practice options are suggested:
 Where clean running water and liquid soap are available and access to the sink
is clear, kitchen towel maybe used, where this is not available healthcare
workers should carry paper towels to use in the client's home.
 When soap is not available, the healthcare worker should carry a supply of liquid
soap and hand towels.
 If access to hand washing facilities is limited or unsuitable, the healthcare
worker should carry an alcohol hand rub.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 9 of 36

Alcohol hand rubs should be used in homes where clients require high levels of
care such as care of invasive devices particularly when hand hygiene facilities
are not available at the point of care in the home. (Refer to Fire & Safety Note
on Alcohol Based Hand –Rub. HN12.2)
Hand Hygiene and Skin Care
Health care workers are required to clean their hands frequently to reduce the
transmission of micro-organisms. Hand hygiene up to 30 times a shift is not unusual.
Proposed methods for reducing adverse effects of hand hygiene agents





Handcare should be carried out by all healthcare staff to keep hands in good
condition and prevent skin damage.
A hand lotion or cream should be used to help replace the skins oils lost through
frequent hand hygiene. (Epi-shield is the skin protector currently recommended
by the Occupational Health Department - HSE South)
Use of products, which cause or exacerbate rashes, cracking or soreness of the
hands, should be stopped immediately and seek occupational health advice.
Avoid the prolonged use or inappropriate use of gloves e.g. gloves worn when
making beds which are not contaminated with blood or body fluids.
Health care management should promote the use of good quality hand hygiene
products including alcohol hand rub with added emollients, good quality paper
towels, nitrile gloves, perfume free detergents and hand lotions/creams.
Please refer to Appendix 3.4 “Hand Care for Healthcare Staff” available from HSE
South Occupational Health Department
Hand Hygiene for Residents/Clients
Clients and residents should be informed of
 The importance of practicing hand hygiene
 The timing i.e. after toileting and before meals. HCWs should assist those
residents unable to perform hand hygiene independently (e.g. using hand
wipes).
 When it is appropriate to use liquid soap and water or alcohol handrub.
Please refer to the leaflet Hand Hygiene for Residents and Visitors (Long term
care and Community Services, HSE South 2010) appendix 3.5
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Community and Disability Services.
Standard Precautions
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2. Personal Protective Equipment
Protective clothing forms a key part of Standard Precautions in preventing the
transmission of infection thus protecting the client and healthcare worker. It is
recommended that all healthcare workers should wear protective clothing when
anticipated contact with blood, body fluids, secretions and excretions (with the
exception of sweat).
However, protective clothing can create a false sense of security and even increase the
risk of cross-infection if used incorrectly e.g. failure to carry out hand hygiene
following removal of gloves.
Refer to Section 6.0 Transmission based Precautions for poster on Donning
and Removal of PPE
2.1 Gloves
Gloves reduce the risk of contamination but do not eliminate it; therefore
gloves are not a substitute for performing hand hygiene.
Gloves should be worn for the following:
 All activities that have been assessed as carrying a risk of exposure to blood,
body fluids, secretions (except sweat) and excretions;
 For direct contact with non intact skin or mucous membranes
 For handling sharp or contaminated instruments and equipment,
 For invasive procedures.
See Appendix 3.6 Adapted WHO Glove pyramid
For the prevention of cross-infection:
 Gloves should be single use and well fitting.
 Sterile gloves should be worn if contact with sterile body sites is anticipated
 Gloves should be discarded as per waste segregation policy.
 Change gloves between caring for different residents/clients or between
different care/treatment activities for the same residents/client.
 Hand hygiene should be carried out before donning gloves for a clean or aseptic
procedure (Moment 2)
 Hand Hygiene should be carried out immediately after removing gloves.
 If wearing a disposable plastic apron, remove and discard gloves first.
Types of Gloves
 Gloves that conform to European Community Standards must be available
 Nitrile or Latex gloves must be available for healthcare delivery. For further
details see Policy on the Prevention and Management of Latex Allergy (HSE
2011).
 Disposable gloves are not advised routinely for household cleaning. Household
gloves offer better protection when working with chemical agents for cleaning.
 Disposable gloves should be used for cleaning of spillages of body fluids and in
the event of an outbreak or on the advice of infection prevention and control.
 Powdered and polythene gloves are not recommended for healthcare delivery.
Guidelines on Infection Prevention and Control 2012
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Community and Disability Services.
Standard Precautions
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2.2
Aprons/Gowns
Disposable plastic aprons should be worn when there is a risk that clothing or uniform
may become exposed to sprays or splashes of blood, body fluids, secretions (except
sweat) or excretions.Gowns are worn to protect the HCW exposed body parts and
prevent contamination of clothing with blood, body fluids, secretions (except sweat) or
excretions where an apron will not suffice.
Aprons and gowns are single use and should be discarded after the procedure or
episode of care and hand hygiene carried out.
2.3
Facial Protection – face /mouth/eye protection
A fluid repellent mask and protective eye wear or a face shield to protect the mucous
membranes of the eyes, nose and mouth should be worn during any procedure or
patient/client care activity where there is a risk of blood and/or body fluids splashing
onto the face e.g. irrigation of a wound or suctioning.
Masks
A fluid repellent, single use surgical mask should be used for procedures likely to
generate splashes of blood or body fluids.
When using a mask
 Ensure they are well fitting and fit for purpose.
 They should only be used once and changed if wet as masks are ineffective
when wet.
 They should cover both the nose and mouth.
 Avoid touching it while being worn.
 Remove the mask directly after the procedure or episode of case and handling
the ties only.
 Hand hygiene should be carried after removing the mask.
A high filtration facemask should be worn for care of the residents requiring Airborne
Precautions e.g. pulmonary tuberculosis or as advised by infection control.
Eye Protection or Face Shields
Protective eyewear for healthcare workers should be optically clear, anti-fog, close
fitting and shielded at the sides. Goggles provide protection from splashes or sprays,
and are available to fit over prescription glasses.
Cleaning Reusable Facial Protection
Reusable facial protection should be cleaned according to manufacturer’s instructions
after use.
2.5 Footwear
Healthcare workers should wear enclosed footwear that can protect them from injuries
with sharp objects if sharps are accidentally dropped.
2.6 Storage of PPE
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
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All PPE should be stored in a clean dry area, in original packaging until required.
When in use, glove and apron dispensers should be considered within areas where
care is provided.
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HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
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3. Respiratory Hygiene and Cough Etiquette
The following practices to contain respiratory secretions are recommended:Cover
nose/mouth using disposable one-use tissues when coughing, or sneezing to
contain respiratory secretions.
 Dispose of tissue in the nearest bin after use.
 Perform hand hygiene (e.g. hand washing with soap and water or alcohol based
hand rub) after contact with respiratory secretions and contaminated
objects/materials.
 Keep hands away from mucous membranes of the eyes and nose.
Healthcare facilities should ensure the availability of materials for adhering to
respiratory hygiene in areas for residents/clients and visitors.


Provide tissues and non-touch bin for used tissue disposal.
Where sinks are available, ensure that supplies for hand washing (i.e. soap,
disposable towels) are consistently available. If a sink is not available, provide
conveniently located dispensers of alcohol-based hand rub.
Refer to Appendix 3.7 Respiratory Hygiene and Cough Etiquette.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 14 of 36
4. Safe Use and Disposal of Sharps
Everyone is personally responsible for the safe use and disposal of their own
sharps
1. Sharps trays with integral sharps bins are recommended for carrying sharps to
and from the place of use. The bin size should correspond to tray.
2. Ensure the bins size and aperture is of appropriate size for disposal of sharps in
use.
3. Needles and syringes should be discarded as a single unit immediately after use
into an approved sharps container.
4. Sharps must not be passed directly from hand to hand and handling should be
kept to a minimum.
5. Needles should not be recapped, bent, broken or disassembled before disposal.
6. Sharps containers should be located in a safe position that avoids spillages, is at
a height that enables safe disposal of sharps, is away from public areas and is
out of reach of patient/clients, visitors and children e.g. wall mounted at a
height that enables safe disposable by all staff.
7. The sharps containers must be sealed when ¾ full. Do not overfill. Sealed
containers must be disposed of in an approved manner.
8. If appropriate use temporary closure mechanism when sharps bins are not in
use i.e. when taking a sharps tray to and from the place of use.
9. The sharps container must be assembled and closed correctly and signed for by
the person doing so. Date and location must be identified.
10. Sharps containers should be removed for disposal only when the above
information is present.
11.Sharps safety devices are recommended for use if a risk assessment has
indicated that they will provide safer systems of work practices for HCW, carers
and clients. (EU Council Directive 2010). Sharps safety devices include
needleless devices and retractable devices.
12.Where safety devices are introduced they must be accompanied by appropriate
training and education for the users.
13.Sharps tray should be emptied and cleaned after each procedure.
Please refer to:
HSE South: Prevention and Protection Protocols for Blood and Body Fluid Exposure for
Healthcare Workers (2010). Appendix 3.9
See Section 20.0 Appendix Safe Disposal of Sharps in the Home Section HCRW
Management.
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Community and Disability Services.
Standard Precautions
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5.
Management of a Blood and/or Body Fluid Spillage
Consider that blood and body fluids are part of the person and need to be dealt with
appropriate dignity and respect.
Principles of spills management
 Blood and body fluid spillages should be dealt with immediately or as soon as it is
safe to do so.
 Other persons should be kept away from the spillage until the area has been
cleaned and dried.
 Care should be taken if there are sharps present and should first be disposed of
appropriately into a sharps container.
 Spills should be removed before the area is cleaned.
 Area should be well ventilated if using chlorinating agents.
 Adding liquids to spills increases the size of the spill and should be avoided.
 The scientific evidence to support the use of a chlorinating agent on a blood
spillage is inconclusive as its' effectiveness where there is a large bio-burden i.e.
faeces or clotted blood has not been fully established (CDC, 2003).
 Chlorinating agents should be used as per manufacturer’s instructions, in a well
ventilated area and are generally only recommended on a small spill.
 Chlorinating agents should not be placed directly on spillages of urine.
 Chlorinating agents are not suitable for use on soft furnishings.
 It is recommended that supplies of personal protective equipment, paper towels
and healthcare risk/yellow waste bags are available for spills management.
 If non-disposable cloths/mops are used to clean spillage area they must be
thermally or chemically disinfected.
Blood Spillage
1. Wear appropriate personal protective equipment.
2. Sprinkle with a chlorinating agent e.g. chlorine granules (e.g. Klorosept,
Presept)and leave for 2-3 minutes according to manufacturers instructions
or
Cover with disposable paper towels.
3. Remove the sodden material and dispose as per Waste Segregation Policy
4. Clean area with detergent and warm water.
5. Disinfect using a chlorine releasing solution of 1,000ppm or equivalent according
to manufacturers instructions, rinse and dry
6. Dispose of protective clothing as per Waste Segregation Policy.
7. Wash and dry hands.
Body
1.
2.
3.
4.
5.
fluid spillage e.g. faeces, urine
Wear appropriate personal protective equipment.
Cover spillage with disposable paper towels.
Remove sodden material and dispose as per Waste Segregation Policy.
Clean area with detergent and warm water
Disinfect as appropriate using a chlorine releasing solution of 1,000ppm or
equivalent according to manufacturers’ instructions, rinse and dry.
6. Dispose of protective clothing as per Waste Segregation Policy.
7. Wash and dry hands
Contaminated clothing should be changed as soon as possible.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 16 of 36
6. Management of Blood and Body Fluid Exposures
Completed in liaison with the HSE Occupational Health Department for Cork & Kerry
Such
1.
2.
3.
4.
exposures include:
All sharps/needle stick injuries from contaminated sharps of needles.
Contamination of abrasions or rashes with blood or body fluids
Human scratches/bites causing a break in the skin and/or bleeding.
Splashes of blood/body fluids onto mucous membranes (e.g. into mouth/lips,
nares or eyes).
5. Aspiration or ingestion of blood, blood components or other body fluids
These incidents shall be dealt with as follows:
1. Bleeding from the wound should be encouraged immediately.
2. The wound should be washed with soap and warm running water.
3. Do not scrub or use a nailbrush.
4. Do not suck the wound.
5. The wound should be covered with a waterproof dressing. Skin, eyes or mouth
should be washed out immediately with copious amounts of water.
6. The incident should be reported immediately to the person in charge and an
accident form completed.
7. According to local policy the person who sustained the wound should see his/
her general practitioner or attend a hospital Accident and Emergency
Department immediately. Using the ‘Blood Body Fluid Exposure Report’ the
situation will then be assessed and arrangements made for blood samples to be
taken from the person exposed. Consent needs to be requested by the GP from
the source whose blood was involved in the incident, and arrangements made
for their blood samples to be taken also.
8. All blood samples should be sent immediately to the Microbiology laboratory and
the form marked ‘Urgent, Inoculation injury’.The laboratory should be
informed that the blood is coming.
9. Monitoring of sharps injuries, post exposure prophylaxis and investigation of the
mechanism of injury should be carried out by the Line Manager in conjunction
with Occupational Health/Infection Control/Quality Safety and Risk in order to
improve practice.
10.When you attend Accident and Emergency you should be referred to
occupational health for follow up. If you are referred to your G.P, it is important
to ensure that you contact occupational health who will complete your follow up
of exposure of your injury.
Please refer to Appendix 3.8 Blood/Body Fluid Exposure Report Poster available from
the Occupational Health Departments HSE South
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 17 of 36
7. Management of Laundry and Linen
The risk of infection from used linen is minimal if handled properly.
 Handle, transport, and process used linen soiled with blood, body fluids,
secretions, and excretions in a manner that prevents skin and mucous
membrane exposures and contamination of staff clothing, and that avoids
transfer of micro-organisms to other residents/clients and the environment.
 Ensure that laundry is free from sharps and foreign objects.
 Staff must not manually sluice soiled or infected linen. Linen soiled with blood or
body fluids should be placed in orange alginate stitched bags or water soluble
bags.
 Hand hygiene must be carried out following the handling of used linen
Please refer to Section 9.0 Laundry.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 18 of 36
8.
Environmental Hygiene
The healthcare environment must be visibly clean, free from dust and spillages and
acceptable to the residents /clients their visitors and staff.
Each healthcare setting should have adequate procedures for the routine care and
cleaning of the environment. This will include cleaning schedules which outline clear
responsibilities of staff involved in cleaning, a roster of cleaning duties, the frequency
of cleaning required and the products to be used in specific areas.
Please refer to Section 8.0 Decontamination.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 19 of 36
9.
Client-Care Equipment/Medical devices
All client care equipment should be visibly clean. Handle used client-care equipment
soiled with blood, body fluids, secretions, and excretions in a manner that prevents
skin and mucous membrane exposures, contamination of clothing, and transfer of
microorganisms to other clients and environments.
 Ensure that another client does not use the equipment until it has been cleaned
and reprocessed appropriately.
 Ensure that single-use items are not reprocessed.
Symbol denotes single use item, do not re- use. Use once only.
Please refer to Section 8.0 - Decontamination
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 20 of 36
10. Resident/client Placement, Movement and Transfer
Consider the potential for transmission of infection in resident/client placement
decisions. Local risk assessment of the individual or groups and the environment will
be required prior to placement
For example a single room maybe indicated for
 A resident with draining wounds which cannot be contained
 A resident who is at increased risk of infection, e.g. open wounds, indwelling
devices placement in place.
For further advice please contact your local Infection Prevention and Control Nurse and
see section 17.0 Admissions Transfers & Discharges.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 21 of 36
11. Safe Injection Practices
Recent outbreaks of HBV and HIV in the out patient setting in the United States have
been associated with breaches in infection control practices when using equipment for
injection. Therefore it is essential to adhere to safe injection practises for
administration of injections, this includes
1. Aseptic Technique
a) Use of aseptic technique when preparing injections to avoid contamination of
sterile injection equipment.
b) Aseptic technique includes separation of clean and dirty areas. A clean area
should be identified where injections are prepared. Preparation of medication
on the surfaces where used equipment is disposed of is to be avoided.
2. Using single use sterile syringe and needle for each injection given.
3. Single dose vials are recommended where possible.
4. Multi-dose vials
a) Where multi-dose vials are used do not access in the immediate resident
/client treatment area.
b) Prepare the injection in a preparation area and then bring to the resident
/client area.
c) Any multi dose vials accessed at the bedside or when the resident /client is
present must be disposed of.
d) A sterile needle and syringe must be used each time the vial is accessed.
5. Fluid infusions and administration sets. e.g. intravenous bags, tubing and
connectors
a) Are single use items i.e. use for one resident/client and discard after one
use.
b) Do not use fluid infusion bags to draw up mixing solutions for medications
vials or flushing solutions for intravenous catheters (e.g., normal
saline/sterile water) for multiple patients.
c) A needle or syringe should be considered as contaminated once it has been
used to enter or connect to a residents/client intravenous infusion bag or
administration set.
6. Blood Glucose Monitoring
a) Fingerstick devices should never be used for more then one person. A single
use disposable device with a retractable needle is recommended.
b) In long term care settings glucose monitoring devices should not be used for
more then one person. In health centre and day centers encourage clients to
bring their own devices. If they must be shared then cleaning and
disinfection must be carried out between each use as per manufacturer’s
instructions.(Refer to Blood Glucose Monitoring Section 11.5)
c) Where insulin pens are used these must be dedicated to an individual and
never shared and labeled with residents/client details.
See Appendix 3.10 Safe injection poster
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 22 of 36
12. Infection Control Practices of Lumbar Puncture
Due to the risk of droplet transmission of orophargyneal flora of the HCW when
carrying out spinal procedures such as lumbar puncture it is recommended that a
surgical face mask is worn for the procedure.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 23 of 36
References & Bibliography
Centre for Disease Control and prevention (2003) Guidelines for Environmental Infection Control in Health-Care
Facilities Recommendations of Centre for Disease Control and the Healthcare infection Control Practices Advisory
Committee
http://www.cdc.gov/ncidod/hip/enviro/Enviro_guide_03.pdf
Health Information and Quality Authority (2009). National Standards for the Prevention and Control of Healthcare
Associated Infection.
Health Protection Scotland Infection Control Team (2008) Standard Infection Control Precautions
http://www.hps.scot.nhs.uk/haiic/ic/StandardinfectioncontrolPrecautions-sicps.aspx
Health Services Executive (2011) Policy for the Prevention and Management of Latex Allergy June 11 v(2) HSE
European Council Directive 2010/32/EU of 10th May 2010.Official Journal of the European Union, No. L134 of 1 June
2010, Implementing the frame work agreement in prevention from sharps injuries in hospital and healthcare sector.
http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2010:134:0066:0072:EN:PDF
National Institute for Clinical Excellence (2003) Infection Control: Prevention of healthcare-associated infection in
primary and community care. http://www.nice.org.uk/pdf/Infection_control_fullguideline.pdf DRAFT 2011
National Clinical Guideline Centre (2012) Infection Control: Prevention of healthcare-associated infection in primary and
community care http://www.nice.org.uk/nicemedia/live/12146/57641/57641.pdf
Siegel, J.D., Rhinehart, E., Jackson, M., Chiarello, L. and the Healthcare Infection Control practices Advisory Committee
(2007) Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.
Available from http:// www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf
Strategy for Antimicrobial Resistance in Ireland (SARI) Infection Control Subcommittee (2005) Guidelines for Hand
Hygiene in Irish Healthcare Settings’. Health Protection and Surveillance Centre (HPSC) Dublin.
World Health Organisation (2009) WHO Guidelines on Hand Hygiene in Healthcare. First Global Patient Safety
Challenge. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
World Health Organisation (2012) Hand Hygiene in Outpatient and Home –based care and Long-term care facilities.
Geneva.
Guidelines on Infection Prevention and Control 2012
HSE South (Cork and Kerry)
Community and Disability Services.
Standard Precautions
Page 24 of 36
Appendix 3.0 WHO 5 Moments for Hand Hygiene
Appendix 3.1 Six Step Hand Hygiene Technique for Healthcare Workers
Appendix 3.2 Alcohol Hand Hygiene Poster (2011)
Appendix 3.3 Hand Hygiene Leaflet for staff
Appendix 3.4 Hand Care for Healthcare Staff Leaflet
Appendix 3.5 Hand Hygiene leaflet for Residents and Visitors
Appendix 3.6 WHO Glove Pyramid
Appendix 3.7 Respiratory Hygiene and Cough Etiquette
Appendix 3.8 Action following a Blood and Body Fluid Exposure HSE South
Appendix 3.9 Prevention and Protection Protocols for Blood and Body
Fluids Exposure HSE South (2011)
Appendix 3.10 Safe Injection Practices