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 Transmission-based precautions
Universal precautions
Body substance isolation
Airborne precautions
Droplet precautions
Contact precaution
Key Elements of Standard Precautions
1. Hand hygiene
2. Gloves
3. Mask, gogles, face masks
4. Gown
5. Prevention of needle stick & injuries from sharp instruments
6. Respiratory hygiene & cough etiquette
7. Environmental cleaning
8. Linens
9. Waste disposal
10. Patient care equipment

WHO, 2007
PPE

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
Discard if 2/3 full

HBV : 27 37% ( 30%)
HCV : 3 10 % (3,0 %)
HIV : 0,2 0,4% (0,3%)
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