UNIVERSAL PRECAUTIONS Chapter 30 Siobhan MacDermott

Introduction This chapter explores the principles of universal precautions in controlling the spread of infection and describes relevant procedures. Part 1 – Hand Hygiene Part 2 – Disposal of Linen Part 3 – Environmental Cleaning

PART 1: Hand Hygiene

Background In 2003, the UK National Institute of Clinical Excellence (NICE) launched a new clinical guideline on the prevention of healthcare associated infections (HAI) in primary and community care. The guidelines outlined ways of avoiding infection which included hand washing, the use of gloves and aprons, disposal of sharps safely and educating patients and their carers about infection.

Hand Hygiene Hand hygiene is a term that usually applies to either hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis. Hand washing has long since been described as the single most effective way of preventing the spread of infection (Gould 1994). Hands are considered the route most commonly responsible for the transmission of such infection in hospitals.

Hand Washing Hands should be washed before and after patient contact, which includes any contact with the patient's skin, dressing or equipment. (NICE 2003, Pratt et al 2001). Hands should be washed: Between every patient contact when skin to skin contact has occurred between the healthcare worker and the patient Before each clinical procedure that involves patient contact After contact with any blood/body fluids or contaminated items After removal of gloves Before and after entering isolation cubicle Before all aseptic procedures Before all invasive procedures

Effective handwashing technique includes 3 stages: Preparation Washing Rinsing and drying (NICE 2003) Effective Handwashing

Handwashing Preparation Hand jewellery should be removed before hand washing. Cuts and abrasions should be covered with waterproof dressings. Fingernails should be kept short, clean and free from nail polish. Guidelines for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16

Handwashing Procedure Wet hands under tepid running water and apply soap or antimicrobial preparation. Rub hands together for a minimum of seconds, with careful attention to finger tips, thumbs and the area between fingers. (NICE 2003)

Remember to rub all skin areas (5 strokes backwards and forwards) using the following approach (Ayliffe et al 1978): Palm to palm. Right hand over back of left with fingers interlaced. Change hands and repeat. Palm to palm with fingers interlaced. Clasped hands with back of fingers against apposing palms; change hands and repeat. Rotate right hand around left thumb - then change hands and repeat. Fingers tips to clean centre of palms. Rotate right hand around left wrist - then change hands and repeat. Rinse and dry hands thoroughly with disposable towel. Remember that proper hand washing should take at least seconds.

Q. Demonstrate your handwashing technique to your learning group – have you remembered everything? Check back to the printed text for more information, if needed

Alcohol Rubs Alcohol rubs or gels are particularly useful in: Areas where frequent handwashing is required e.g. Intensive Care Outside isolation cubicles Places with an inadequate supply of handwashing facilities (Kaplan and McGuckin 1986)

Gloves The role of gloves in universal precautions is to reduce the risk of cross infection to healthcare workers. Gloves should always be single use only and be changed between contact with different patients. Gloves must be disposed of immediately following procedure as clinical waste (DOH 2003). Hand washing is considered necessary following the use of gloves because hands can become contaminated on removal of gloves, or gloves can puncture or leak (Korniewicz et al 1994).

PART 2: Disposal of Linen

Disposal of Linen Guidelines for the Safe Handling of Soiled Linen/Disposal of Hospital Linen Never shake linen, as this will disperse skin scales Wear gloves and plastic apron when changing soiled bed linen and discard apron afterwards (McCullagh 1998) Use the national correct colour coded system for linen bags, as per hospital/local policy (McCullagh 1998) Heavily soiled linen should be placed in a water soluble, or soluble stitched bag otherwise known as an alginate bag, prior to a linen bag. These bags are then placed directly into suitable washing machines without opening, thus reducing the risk of contamination.

Procedure for Disposal of Linen Wash hands after contact with soiled linen. Bring the linen skip to the bedside and do not carry soiled linen. (McCullagh 1998) Display a colour coded chart indicating the correct disposal of different types of linen.

PART 3: Environmental Cleaning

Environmental Cleaning The aim of environmental cleaning or disinfection is to reduce the number of microbes present and remove any substances that might encourage growth or interfere with disinfection or sterilisation processes (Parker 1999). Warm/hot water and detergent are usually sufficient to reduce environmental contamination. Disinfectants such as alcohol or chlorine-releasing agents help to reduce the number of pathogens present, but should not be used indiscriminately. Local/hospital disinfection policies must be adhered to. Hospital/ward environments should be kept uncluttered and easy to clean (May 2000).