UNIVERSAL PRECAUTION - Akademik Ciamik 2010

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STANDARD PRECAUTION
Prof. Dr. Ida Parwati, PhD.
Department of Clinical Pathology
Division of Infectious and Tropical Diseases
Dr. Hasan Sadikin General Hospital
Faculty of Medicine - Unpad
DEFINITION
Standard Precautions
• Previously known by various names including “universal
precautions”
• Standard precautions are designed to reduce the risk of
transmission of bloodborne and other pathogens from
both recognized and unrecognized sources to a
susceptible host.
• They are the basic level of infection control precaution
• Hospital Infection is the result of a combination of
factors: Microbial source + Transmission + Susceptible
host = Infection
History of Infection Control Precautions
Year
Infection Control Precautions
1877,1910
Separates facilities, Antisepsis and disinfections ... etc
1985
UNIVERSAL PRECAUTIONS (guidelines for protecting healthcare
worker because the emergence of HIV & other bloodborne
pathogens)
1987
BODY SUBSTANCE ISOLATION ( focused on protecting patients and
health personnel from all moist body fluids not just blood: semen,
vaginal secretions, wound drainage, sputum, saliva etc
1996
STANDARD PRECAUTIONS:Two level approach:
•Standar Precautions which apply to all clients and patients
attending healthcare facilities
•Transmission-based Precautions which apply only to hospitalized
patients
2007
ISOLATION PRECAUTIONS (new pathogens; SARS, Avian Influenzae
H5N1, H1N1)
Standard precautions
• Universal precautions
Transmission-based precautions
•Airborne precautions
• Body substance isolation
•Droplet precautions
•Contact precaution
Key Elements of Standard Precautions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Hand hygiene
Gloves
PPE
Mask, gogles, face masks
Gown
Prevention of needle stick & injuries from sharp instruments
Respiratory hygiene & cough etiquette
Environmental cleaning
Linens
Waste disposal
Patient care equipment
WHO, 2007
Definitions of Hand hygiene
• Hand-washing
– Washing hands with plain soap and water
• Antiseptic hand-wash
– Washing hands with water and soap or other detergents
containing an antiseptic agent
• Alcohol-based hand-rub
– Rubbing hands with an alcohol-containing preparation
• Surgical hand hygiene/antisepsis
– Hand-washing or using an alcohol-based hand-rub before
operations by surgical personnel
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
“My five moments for hand hygiene”
This I do believe !
The single most important thing that you can do to stop
the spread of any germs is to wash your hands
PPE
PPE
Working Condition
gloves
should be used when touching blood, body fluids,
secretions, excretions, or contaminated items and for
touching mucous membranes and nonintact skin.
gowns
should be used during procedures and patient care
activities when contact of clothing and/or exposed skin
with blood, body fluids, secretions, or excretions is
anticipated. Aprons are sometimes used as PPE over
scrubs, such as in hemodialysis centers when
inserting a needle into a fistula.
Mask and
goggles or a
face shield
should be used during patient care activities that are
likely to generate splashes and sprays of blood, body
fluids, secretions, or excretions.
Precaution for suspected Avian
Influenza :
Full Barrier Precaution
Activities at risk of sharp injury
•
•
•
•
Needle re-capping
Body fluids aliquoting
Open the tubes
Throw the sharps not to sharp container
• HBV : 27 – 37% ( 30%)
• HCV : 3 – 10 % (3,0 %)
• HIV : 0,2 – 0,4% (0,3%)
Discard if 2/3 full
Transmission-Based Precautions
• Used in addition to Standard Precautions for
Specified Patients
• Designed for the Care of Specified Patients
known or suspected to be infected by
epidemiologically important pathogens spread by:
airborne, droplet, or contact transmission.
Droplet Transmission
• For infectious agents with droplet nuclei >
5 microns
• Examples:
– Pertussis
– Meningococcal meningitis
• Precaution Examples:
– Private room
– Mask if within 3’ of patient
Droplet Precautions
• Prevent infection by
large droplets from
– Sneezing
– Coughing
– Talking
• Examples
– Neisseria meningitidis
– Pertussis
– Influenza
Airborne Transmission
• For infectious agents with droplet nuclei < 5
microns
• Examples:
– Tuberculosis
– Measles
• Precaution Examples
– Isolation rooms under negative pressure
– N95 or HEPA respirator use
Airborne Precautions for Avian
Influenza
• Respiratory Protection
– N95 respirator
• Patient in isolation/cohorting
• Patient Transport
– Limit patient movement
and transport,
place a surgical mask
on the patient
• Airborne isolation room, if available
– Air exhaust to outside or
re-circulated with HEPA filtration
Linens
• Handle, transport, and process used
linen in a manner which:
• Prevents skin and mucous membrane
exposures and contamination of clothing.
• Avoids transfer of pathogens to other
patients and or the environment.
Waste disposal
• Ensure safe waste management.
• Treat waste contaminated with blood, body
fluids, secretions and excretions as clinical
waste, in accordance with local regulations.
• Human tissues and laboratory waste that is
directly associated with specimen processing
should also be treated as clinical waste.
• Discard single use items properly.
Patient care equipment
• Handle 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 pathogens to
other patients or the environment.
• Clean, disinfect, and reprocess reusable
equipment appropriately before use with
another patient.
Contact Precautions
• For protection against skin-to-skin contact and physical
transfer of microorganisms to a host from a source
• Precaution Examples:
– Private room
– Handwashing
– Glove changes
• Examples
– Scabies
– VRE

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