Standard Precautions - Infection Control
Standard Precautions - Infection Control
Standard precautions were developed by the Centers for Disease Control and Prevention (CDC) to provide the widest possible protection against the transmission of infection. CDC officials recommend that health care workers handle all blood, body fluids (including secretions, excretions, and drainage), tissues, and contact with mucous membranes and broken skin as if they contain infectious agents, regardless of the patient's diagnosis.
Standard precautions encompass much of the isolation precautions previously recommended by the CDC for patients with known or suspected blood-borne pathogens as well as the precautions previously known as body substance isolation. They are to be used in conjunction with other transmission-based precautions: airborne, droplet, and contact precautions.
Standard precautions recommend wearing gloves for any known or anticipated contact with blood, body fluids, tissue, mucous membrane, and nonintact skin. (See Choosing the right glove.) If the task or procedure being performed may result in splashing or splattering of blood or body fluids to the face, a mask and goggles or face shield should be worn. If the task or procedure being performed may result in splashing or splattering of blood or body fluids to the body, a fluid-resistant gown or apron should be worn. Additional protective clothing, such as shoe covers, may be appropriate to protect the caregiver's feet in situations that may expose him to large amounts of blood or body fluids (or both), such as care of a trauma patient in the operating room or emergency department.
Airborne precautions are initiated in situations of suspected or known infections spread by the airborne route. The causative organisms are coughed, talked, or sneezed into the air by the infected person in droplets of moisture. The moisture evaporates, leaving the microorganisms suspended in the air to be breathed in by susceptible persons who enter the shared air space. Airborne precautions recommend placing the infected patient in a negative-pressure isolation room and the wearing of respiratory protection by all persons entering the patient's room.
Droplet precautions are used to protect health care workers and visitors from mucous membrane contact with oral and nasal secretions of the infected individual.
Contact precautions use barrier precautions to interrupt the transmission of specific epidemiologically important organisms by direct or indirect contact. Each institution must establish an infection control policy that lists specific barrier precautions.
Equipment
Gloves • masks • goggles, glasses with side pieces, or face shields • gowns or aprons • resuscitation masks • bags for specimens • Environmental Protection Agency (EPA)–registered tuberculocidal disinfectant or diluted bleach solution (diluted between 1:10 and 1:100, mixed fresh daily), or both, or EPA-registered disinfectant labeled effective against hepatitis B virus (HBV), hepatitis C virus (HCV), mycobacteria (including tuberculosis), and human immunodeficiency virus (HIV), provided that the surface hasn't been contaminated
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with agents or volumes of or concentrations of agents for which higher level disinfection is recommended.
Implementation
Wash your hands immediately if they become contaminated with blood or body fluids, excretions, secretions, or drainage; also wash your hands before and after patient care and after removing gloves. Hand washing removes microorganisms from your skin. If your hands aren't visibly soiled, or it isn't possible to wash your hands, an alcohol-based hand rub can be used for routine decontamination.
Wear gloves if you will or could come in contact with blood, specimens, tissue, body fluids, secretions or excretions, mucous membrane, broken skin, or contaminated surfaces or objects.
Change your gloves and wash your hands or use a hand sanitizer between patient contacts to avoid cross-contamination.
Wear a fluid-resistant gown, face shield, or goggles and a mask during procedures likely to generate splashing or splattering of blood or body fluids, such as surgery, endoscopic procedures, dialysis, assisting with intubation or manipulation of arterial lines, or any other procedure with potential for splashing or splattering of body fluids.
Handle used needles and other sharp instruments carefully. Don't bend, break, reinsert them into their original sheaths, remove needles from syringes, or unnecessarily handle them. Discard them intact immediately after use into a puncture-resistant disposal box. Use tools to pick up broken glass or other sharp objects. Use safety devices according
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to the instructions provided by the manufacturer. Activate all safety mechanisms on sharp devices immediately after use, even if the sharps disposal container is very close. Evaluate your work practices to make sure you're working safely, both for your own protection and for the protection of your patients and coworkers. These measures reduce the risk of accidental injury or infection. When available, use a needleless I.V. system.
Immediately notify your employee health provider of all needle-stick or other sharp object injuries, mucosal splashes, or contamination of open wounds or nonintact skin with blood or body fluids to allow investigation of the incident and appropriate care and documentation.
Properly label all specimens collected from patients, and place them in plastic bags at the collection site. Attach requisition slips to the outside of the bag.
Place all items that have come in direct contact with the patient's secretions, excretions, blood, drainage, or body fluids—such as nondisposable utensils or instruments—in a single impervious bag or container before removal from the room. Place linens and trash in single bags of sufficient thickness to contain the contents.
While wearing the appropriate personal protective equipment, promptly clean all blood and body fluid spills with detergent and water followed by an EPA-registered tuberculocidal disinfectant or diluted bleach solution (diluted between 1:10 and 1:100, mixed daily), or both, or an EPA-registered disinfectant labeled effective against HBV and HIV, provided that the surface hasn't been contaminated with agents or volumes of or concentrations of agents for which higher-level disinfection is recommended.
Disposable food trays and dishes aren't necessary.
If you have an exudative lesion, avoid all direct patient contact until the condition has resolved and you've been cleared by the employee health provider.
If you have dermatitis or other conditions resulting in broken skin on your hands, avoid situations where you may have contact with blood and body fluids (even though gloves could be worn) until the condition has resolved and you've been cleared by the employee health provider.
Special considerations
Standard precautions, such as hand hygiene and appropriate use of personal protective equipment, should be routine infection control practices.
Keep mouthpieces, resuscitation bags, and other ventilation devices nearby to eliminate the need for emergency mouth-to-mouth resuscitation, thus reducing the risk of exposure to body fluids.
NURSING ALERT Because you may not always know what organisms may be present in every clinical situation, you must use standard precautions for every contact with blood, body fluids, secretions, excretions, drainage, mucous membranes, and nonintact skin. Use your judgment in individual cases about whether to implement additional isolation precautions, such as airborne, droplet, or contact precautions or a combination of them. What's more, if your work requires you to be exposed to blood, you should receive the HBV vaccine series.
Complications
Failure to follow standard precautions may lead to exposure to blood-borne diseases or other infections and to all the complications they may cause.
Documentation
Record any special needs for isolation precautions on the nursing care plan and as otherwise indicated by your facility. Document patient and family teaching about isolation precautions.
Standard precautions were developed by the Centers for Disease Control and Prevention (CDC) to provide the widest possible protection against the transmission of infection. CDC officials recommend that health care workers handle all blood, body fluids (including secretions, excretions, and drainage), tissues, and contact with mucous membranes and broken skin as if they contain infectious agents, regardless of the patient's diagnosis.
Standard precautions encompass much of the isolation precautions previously recommended by the CDC for patients with known or suspected blood-borne pathogens as well as the precautions previously known as body substance isolation. They are to be used in conjunction with other transmission-based precautions: airborne, droplet, and contact precautions.
Standard precautions recommend wearing gloves for any known or anticipated contact with blood, body fluids, tissue, mucous membrane, and nonintact skin. (See Choosing the right glove.) If the task or procedure being performed may result in splashing or splattering of blood or body fluids to the face, a mask and goggles or face shield should be worn. If the task or procedure being performed may result in splashing or splattering of blood or body fluids to the body, a fluid-resistant gown or apron should be worn. Additional protective clothing, such as shoe covers, may be appropriate to protect the caregiver's feet in situations that may expose him to large amounts of blood or body fluids (or both), such as care of a trauma patient in the operating room or emergency department.
Airborne precautions are initiated in situations of suspected or known infections spread by the airborne route. The causative organisms are coughed, talked, or sneezed into the air by the infected person in droplets of moisture. The moisture evaporates, leaving the microorganisms suspended in the air to be breathed in by susceptible persons who enter the shared air space. Airborne precautions recommend placing the infected patient in a negative-pressure isolation room and the wearing of respiratory protection by all persons entering the patient's room.
Droplet precautions are used to protect health care workers and visitors from mucous membrane contact with oral and nasal secretions of the infected individual.
Contact precautions use barrier precautions to interrupt the transmission of specific epidemiologically important organisms by direct or indirect contact. Each institution must establish an infection control policy that lists specific barrier precautions.
Equipment
Gloves • masks • goggles, glasses with side pieces, or face shields • gowns or aprons • resuscitation masks • bags for specimens • Environmental Protection Agency (EPA)–registered tuberculocidal disinfectant or diluted bleach solution (diluted between 1:10 and 1:100, mixed fresh daily), or both, or EPA-registered disinfectant labeled effective against hepatitis B virus (HBV), hepatitis C virus (HCV), mycobacteria (including tuberculosis), and human immunodeficiency virus (HIV), provided that the surface hasn't been contaminated
P.123
with agents or volumes of or concentrations of agents for which higher level disinfection is recommended.
Implementation
Wash your hands immediately if they become contaminated with blood or body fluids, excretions, secretions, or drainage; also wash your hands before and after patient care and after removing gloves. Hand washing removes microorganisms from your skin. If your hands aren't visibly soiled, or it isn't possible to wash your hands, an alcohol-based hand rub can be used for routine decontamination.
Wear gloves if you will or could come in contact with blood, specimens, tissue, body fluids, secretions or excretions, mucous membrane, broken skin, or contaminated surfaces or objects.
Change your gloves and wash your hands or use a hand sanitizer between patient contacts to avoid cross-contamination.
Wear a fluid-resistant gown, face shield, or goggles and a mask during procedures likely to generate splashing or splattering of blood or body fluids, such as surgery, endoscopic procedures, dialysis, assisting with intubation or manipulation of arterial lines, or any other procedure with potential for splashing or splattering of body fluids.
Handle used needles and other sharp instruments carefully. Don't bend, break, reinsert them into their original sheaths, remove needles from syringes, or unnecessarily handle them. Discard them intact immediately after use into a puncture-resistant disposal box. Use tools to pick up broken glass or other sharp objects. Use safety devices according
P.124
to the instructions provided by the manufacturer. Activate all safety mechanisms on sharp devices immediately after use, even if the sharps disposal container is very close. Evaluate your work practices to make sure you're working safely, both for your own protection and for the protection of your patients and coworkers. These measures reduce the risk of accidental injury or infection. When available, use a needleless I.V. system.
Immediately notify your employee health provider of all needle-stick or other sharp object injuries, mucosal splashes, or contamination of open wounds or nonintact skin with blood or body fluids to allow investigation of the incident and appropriate care and documentation.
Properly label all specimens collected from patients, and place them in plastic bags at the collection site. Attach requisition slips to the outside of the bag.
Place all items that have come in direct contact with the patient's secretions, excretions, blood, drainage, or body fluids—such as nondisposable utensils or instruments—in a single impervious bag or container before removal from the room. Place linens and trash in single bags of sufficient thickness to contain the contents.
While wearing the appropriate personal protective equipment, promptly clean all blood and body fluid spills with detergent and water followed by an EPA-registered tuberculocidal disinfectant or diluted bleach solution (diluted between 1:10 and 1:100, mixed daily), or both, or an EPA-registered disinfectant labeled effective against HBV and HIV, provided that the surface hasn't been contaminated with agents or volumes of or concentrations of agents for which higher-level disinfection is recommended.
Disposable food trays and dishes aren't necessary.
If you have an exudative lesion, avoid all direct patient contact until the condition has resolved and you've been cleared by the employee health provider.
If you have dermatitis or other conditions resulting in broken skin on your hands, avoid situations where you may have contact with blood and body fluids (even though gloves could be worn) until the condition has resolved and you've been cleared by the employee health provider.
Special considerations
Standard precautions, such as hand hygiene and appropriate use of personal protective equipment, should be routine infection control practices.
Keep mouthpieces, resuscitation bags, and other ventilation devices nearby to eliminate the need for emergency mouth-to-mouth resuscitation, thus reducing the risk of exposure to body fluids.
NURSING ALERT Because you may not always know what organisms may be present in every clinical situation, you must use standard precautions for every contact with blood, body fluids, secretions, excretions, drainage, mucous membranes, and nonintact skin. Use your judgment in individual cases about whether to implement additional isolation precautions, such as airborne, droplet, or contact precautions or a combination of them. What's more, if your work requires you to be exposed to blood, you should receive the HBV vaccine series.
Complications
Failure to follow standard precautions may lead to exposure to blood-borne diseases or other infections and to all the complications they may cause.
Documentation
Record any special needs for isolation precautions on the nursing care plan and as otherwise indicated by your facility. Document patient and family teaching about isolation precautions.
