1. 34 Infection Control Lesson 2:
Universal Precautions and Aseptic Techniques

2. Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
Perform the steps to follow concerning standard precautions.
Define medical asepsis.
Perform the correct procedure for hand washing.

3. History of Precautionary Guidelines
1970 – CDC published a manual of isolation techniques for hospitals (Updated in 1975)
1985 – Universal precautions developed to help prevent the transmission of hepatitis B, human immunodeficiency virus (HIV), and other diseases resulting from bloodborne pathogens

4. History of Precautionary Guidelines
1996 – CDC developed and published new guidelines for isolation precautions in hospitals called standard precautions
1985 and again in 1988 – guidelines for hand hygiene and antisepsis were published by the Association for Professionals in Infection Control (APIC)

5. History of Precautionary Guidelines
1996 – HICPAC (Healthcare Infection Control Practices Advisory Committee) recommended that antimicrobial soap or waterless antiseptic agents be used for hand hygiene when leaving rooms of patients with multidrug-resistant organisms (MDROs)

6. Standard Precautions
Standard precautions combine the major features of universal precautions and body substance isolation precautions into one set of recommendations.

7. Universal Precautions
A method used in infection control that treats all human blood and body fluids as if infected with high risk diseases such as HIV or hepatitis B
Bloodborne pathogens such as staph, strep, and malaria can also cause disease

8. Requirements of Bloodborne Pathogen Standards
Employees
Must follow universal precautions to impede contact with infectious material
Must consider all body fluids contagious If unable to differentiate between body fluids
All blood and infectious material must be handled with precautions such as gloves, mask, gowns, and workplace controls to limit exposure

9. Standard Precautions: A Summary
Standard Precautions apply to:
Blood
All body fluids, for example:
Amniotic fluid
Tissue specimens
Pericardial fluid
Non-intact skin
Mucous membranes

10. Critical Thinking Question
Which bodily fluid does not require the use of standard precautions?

11. Following Standard Precautions
Medical professionals should:
Wear protective equipment (goggles, masks, gowns)
Wear gloves
Change gloves between patients or if gloves are contaminated
Wash hands frequently or when contaminated

12. Following Standard Precautions
Avoid contact with contaminated linens or equipment
Be careful with sharp instruments
Dispose of and care for needles, scalpels, etc. properly
Do not recap or handle used needles
Avoid direct mouth-to-mouth resuscitation
Use hazardous waste containers for contaminated material

13. Personal Protective Equipment
Standard Precautions encourage the use of PPE
PPE includes, when appropriate:
Gloves
Gowns
Masks
Eye protection

14. Hand Sanitizing and Hygiene
One of the best means of reducing the spread of microorganisms in a health care facility and at home
Hand hygiene recommendations include:
Not wearing artificial fingernails or extenders when having direct contact with high-risk patients such as those in intensive care or operating rooms
Natural fingernails should be kept short: less than one quarter inch long

15. CDC Guidelines for Respiratory Hygiene/Cough Etiquette
Signs posted reminding people to cover their mouth or nose when coughing and to dispose of tissues appropriately
Perform hand hygiene after contact with respiratory secretions
Use a mask when appropriate
Provide at least three feet of space between persons with respiratory infections whenever possible

16. CDC Safe Injection Practices
Use of aseptic technique
Use of single use items (needles, syringes and whenever possible single dose vials for parenteral medication
No multidose vials should be kept in the immediate treatment area
Not using bags or bottles of intravenous (IV) solutions among several patients

17. CDC Safe Injection Practices
Use of masks for insertion of catheters or injection of material into spinal or epidural spaces during lumbar puncture procedures

18. Transmission Based Precautions
Used in addition to standard precautions to further interrupt the spread of pathogens in hospitals
Fall into three categories
Airborne precautions
Droplet precautions
Contact precautions

19. Airborne Precautions
Designed to reduce the transmission of certain diseases, such as TB, measles, or chickenpox
Used for patients who are known to be infected with microorganisms that are transmitted via airborne droplet nuclei (smaller than 5 microns)
Often involve patient isolation in a private room and if hospitalized and require the use of mask and gown by all health care personnel who come in contact with the patient

20. Airborne Precautions Hand washing and gloves are required as well
The transport of the patient should be as limited as possible with the patient wearing a mask during transport
All reusable patient care equipment should be cleaned and disinfected before use on another patient
Disposable items should be used if available

21. Droplet Precautions
Used for patients suspected of being infected with organisms spread by droplets during sneezing, coughing, and talking
A mask should be worn if caregiver is within three feet of an infected patient
Gown and gloves are worn if there is a chance of coming into contact with blood or body fluids of suspected patients

22. Droplet Precautions Transport of the patient should be limited
All reusable equipment should be cleaned and disinfected

23. Contact Precautions
Used when infections are difficult to treat and the likelihood of microorganism transmission among patients and health care providers is high
Conditions such as intestinal infections, hepatitis, open wounds, respiratory infections, are all treated using contact precautions
Precautions include isolating patients, wearing gowns and gloves
If there is a chance of coming in contact with body fluids, mask and eyewear should be worn

24. Latex Sensitivities
Before touching a patient while wearing latex gloves, ask the patient if there is a history of latex sensitivity
High-risk patients such as those with congenital defects and indwelling catheters must always be assessed for latex sensitivity
Patients with allergies to bananas, chestnuts, kiwi, and avocados may have cross sensitivity to latex

25. Latex Sensitivities
Symptoms to latex sensitivity include contact dermatitis, swelling, itching, rhinitis, and may include anaphylaxis in some cases

26. OSHA’s Goals and Guidelines
Aims to minimize exposure to hepatitis B and HIV
Guidelines require an exposure control program be implemented in appropriate facilities
Program includes:
Exposure determination
Method of compliance
Postexposure evaluation

27. Items that Employers Should Have to Ensure Worker Safety
Availability of gloves (sterile and nonsterile of various sizes)
Safety needles
Disposable cannula
Sharps containers
Sinks and running water
Biohazard containers

28. Disposal of Infectious Waste
Check to be sure the infectious waste container is lined
Discard waste into container
Contain all liquid before disposing into container
Do not put contaminated glass into the container
When the container is full, close the bag appropriately

29. Disposal of Infectious Waste
Make sure all contents are contained within the bag and that bags are not overstuffed
Do not mix infectious trash with everyday trash
Do not put sharps in the bag unless contained appropriately
Store full bags appropriately

30. Physical and Chemical Barriers
Used to maintain infection control
Prevent:
Nosocomial infections
Health-care associated infection (HAI)
The environment is referred to as medical and surgical asepsis

31. Medical Asepsis Medical asepsis Surgical asepsis
The destruction of organisms after they leave the body.
Surgical asepsis
The practice of creating and maintaining a sterile environment in which organisms are destroyed before entering the body.

32. Critical Thinking Question
Is medical asepsis practiced in a surgical environment?

33. Medical Asepsis Hygiene Habits
Hand hygiene – hands are the easiest way to transfer infection; they are the first stage of infection control – Practice:
Hand washing with disinfectant soap, warm running water, and friction:
After eating
After using the restroom
Between patients
Jewelry should be removed
Fingernails should be neat
Wearing gloves when appropriate

34. Practices of Medical Asepsis Hygiene Habits
Covering the mouth when sneezing or coughing
Using disposable equipment or cleaning nondisposable equipment
Using only clean or sterile supplies
Wearing protective clothing if necessary
Discarding any item that falls on the floor and cannot be cleaned
Disposing of waste properly – all wet or damp dressings should be placed in waterproof bags

35. Utilizing Medical Asepsis
When taking:
Oral, aural, and rectal temperatures
Vaginal or throat cultures or smears
Stool, urine, or sputum samples
When giving medication
When cleaning treatment rooms

36. Critical Thinking Question
Can you name another situation in which medical asepsis would be used?

37. Medical Asepsis in the Facility
In addition to personal hygiene and equipment cleanliness, practice:
Proper ventilation
Keeping exam rooms clean
Emptying trash cans

38. Medical Asepsis in the Facility
In addition to personal hygiene and equipment cleanliness, practice:
Replacing sharps containers appropriately
Looking for insect infestation
Separating well patients from sick patients in seating areas

39. Steps to Proper Hand Washing
Remove jewelry
Stand at sink without allowing clothing to touch sink
Turn on warm water with foot or knee pedal or faucet, using a paper towel
Wet hands and place 1 teaspoon liquid soap into palm (or lather with bar soap); lather using a circular motion and friction
Keep hands pointed down below elbow level for the entire process

40. Steps to Proper Hand Washing
Use nail cleaner to clean under fingernails
Rinse hands with fingers pointed down
If hands are heavily soiled, reapply soap and wash them again
Dry with paper towel and discard
Use clean towel to turn off the faucet if knee pedal is not available

41. Alcohol-Based Hand Rubs
Recently approved by CDC
Alternative to hand washing with water and soap, unless:
Hands are visibly soiled
Professional has used the restroom or eaten
Jewelry should be removed
2 to 3 mL should be placed in palm and vigorously worked into hands and wrists for 15 to 30 seconds

42. Personal Protective Equipment
Gowns, gloves, masks
Worn in order to:
Protect patient from the worker
Protect the worker from the patient
Prevent contamination of samples
Not all PPE is appropriate for every situation
Maintain medical asepsis while removing PPE

43. Procedure for Applying Gloves
Perform hand hygiene
Choose the appropriate size gloves for your hands
Hold a glove at the wrist opening and insert fingers, pulling the glove up to wrist
Apply the second glove in the same manner, checking for holes and other flaws
If any flaws are found, discard the gloves and obtain new gloves

44. Procedure for Removing Gloves
Grasp the glove covering your nondominant hand at the palm and pull it away
Pull the glove off and hold it in the palm of the gloved dominant hand
While holding the soiled glove in your gloved hand, slide the index finger of the ungloved hand below the cuff of the remaining glove and peel it down, inverting it over the first glove – Both gloves will be in a ball and inside out

45. Procedure for Removing Gloves
Dispose of the gloves in a biohazard container
Perform hand hygiene

46. Steps to Performing Isolation Techniques
Review orders and agency protocols regarding isolation procedures
Assemble the necessary equipment that is appropriate for the type of protection required
Remove lab coat and jewelry
Perform hand hygiene
Apply the appropriate disposable apparel
Apply the cap to cover hair and ears completely

47. Steps to Performing Isolation Techniques
Apply the gown over outer garments as follows:
Hold the gown in front of the body and place arms through the sleeves
Pull the sleeves on, covering the wrists
Tie the gown securely at the neck and the waist
Apply the mask by:
Placing the top of mask over the bridge of the nose and pinch the metal strip to secure a snug fit on the nose, tying it if needed

48. Steps to Performing Isolation Techniques
Apply protective eyewear
Apply nonsterile gloves and pull up over the cuffs of the gown to cover the wrists completely

49. Putting on An Isolation Gown

50. Steps to Remove Barrier Protections
Untie waist of the gown
Remove gloves
Wash hands
Untie the neck of the gown
Remove the gown by pulling it down from the shoulders
Turn the gown inside out and remove arms from the sleeves – The inside of the gown is not contaminated

51. Steps to Remove Barrier Protections
Holding it away from the body with contaminated area on the inside, fold and place it in biohazard container
Remove and discard protective eyewear and mask

52. Questions? 52