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)

Isolation precaution Airborne precautions Droplet precautions Standard precautions Transmission-based precautions Universal precautions Airborne precautions Body substance isolation Droplet precautions Contact precaution

Key Elements of Standard Precautions Hand hygiene Gloves 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 PPE 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 Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, alcohol-based handrub, or surgical hand hygiene/antisepsis. Handwashing refers to washing hands with plain soap and water. Handwashing with soap and water remains a sensible strategy for hand hygiene in non-healthcare settings and is recommended by CDC and other experts. Antiseptic handwash refers to washing hands with water and soap or other detergents containing an antiseptic agent. Alcohol-based handrub refers to the alcohol-containing preparation applied to the hands to reduce the number of viable microorganisms. Surgical hand hygiene/antisepsis refers to an antiseptic handwash or antiseptic handrub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora. Antiseptic detergent preparations often have persistent antimicrobial activity. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. 6

“My five moments for hand hygiene”

The single most important thing that you can do to stop This I do believe is self-explanatory! The single most important thing that you can do to stop the spread of any germs is to wash your hands 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 Examples Sneezing Coughing Talking Examples Neisseria meningitidis Pertussis Influenza The next type of Precaution is Droplet Precautions. Droplet Precautions are intended to prevent infection by large droplets that are released when an infected person sneezes, coughs, or talks. Examples of infectious diseases that are spread this way include: Neisseria meningitidis, Pertussis, and Influenza. It is probable that person-to-person transmission of avian influenza occurs primarily via droplets.

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