Standard (Universal) Precautions

Community Infection Control Nurses Leicestershire, Northampton & Rutland PCTs Health Protection Agency Nurses Leicestershire, Northampton & Rutland Social Care Providers Leicestershire, Northampton & Rutland 2006

Aim and Objectives

Aim
To raise awareness of Standard Precautions within Infection Control Objectives To demonstrate what is meant by the term Standard Precautions To review the principles of Standard Precautions To demonstrate a knowledge of the chain of infection and how the application of standard precautions can prevent cross infection to patients/clients, staff and the environment

Infection Control

Infection results when germs enter the body and establish themselves, multiply and cause some adverse reaction in the patient/client. The general principles of infection control are based on the use of practices and procedures that prevent or reduce the likelihood of infection being transmitted from one person to another susceptible individual.

Chain of Infection
Infectious agent
Campylobacter

Susceptible host
Susceptible individual who eats contaminated food

Reservoir
Found in water, milk and food, commonly poultry

Campylobacter
Portal of entry
Ingestion of contaminated food

Portal of exit
Means of transmission
On contaminated equipment, hands Contamination of food

Risk Factors
Staff Equipment
Relatives/friends

Themselves

Resident/Client

Food

Environment

Patients

Animals (Pets or vermin)

Host Risk Factors

Age Immobility Invasive procedures/medical interventions Immune status (underlying chronic disease/other infections) Physical/Mental wellbeing Emotional wellbeing Personal hygiene

Standard Precautions
Hand hygiene Personal Protective Equipment (PPE) Waste management Management of Laundry Cleaning and decontamination of re-useable medical equipment Maintenance of a clean environment Management of blood/body fluids spills Use and disposal of sharps

Which method to use? Always use liquid soap and water Before and after any clinical procedure e.g. when emptying/changing a catheter bag or when undertaking wound care After removal of gloves When hands are visibly soiled Before handling food After using the toilet After contact with any client especially a client who has diarrhoea and/or vomiting When taking a client to the toilet
Staff should not use residents bar soap or hand towels

Hand Hygiene

Hand Washing
Technique

Wet hands under running water Apply one dose of soap into a cupped hand Wash hands using the 6 step technique without adding more soap or water Ensure all surfaces of the hands have been covered Rinse hands thoroughly under running water Dry hands thoroughly with a paper towel Dispose of the towel in to a foot operated lidded bin

Hand Washing
Six-Step Technique

Hand Washing
Important Points To decontaminate hands effectively the following need to be observed Cover any cut or abrasion with a waterproof plaster and change as necessary Keep natural nails short, clean, and unpolished Do not wear false nails, infills etc. Remove or roll up long sleeves when hand washing Remove any wrist watch, stoned ring or bracelet Use individual or pump dispensed hand cream daily

Alcohol Based Hand Rubs

Can be used: Following hand washing after contact with an infected resident/client or their environment When hands are visibly clean
If hands are visibly soiled they must be washed with soap and water before using alcohol hand rubs

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Gloves Disposable, non-powdered latex or latex equivalent (not vinyl or plastic). To be worn if there is any possibility of contact with blood or body fluids Plastic aprons Disposable. To be worn if there is any possibility of contact with body fluids. If gloves are indicated, aprons should also be worn Goggles/Visors Disposable and used following a risk assessment Masks Disposable paper and used following a risk assessment

Donning of PPE
Apron plastic, disposable Gloves non-sterile examination gloves
Then if risk assessment denotes:

Mask
Open mask out, tie top ties around top of head i.e. above ears, tie second ties around back of neck. Ensure close fit over bridge of nose by using the nose clip

Removal of PPE
Aprons Gloves
Rip the ties of the apron and remove. Dispose of as clinical waste or double bag as domestic waste.
Grasp outer edge near wrist taking care not to touch the skin Peel away from hand, turning glove inside out Hold in opposite hand, and repeat process for other glove Discard as clinical waste or double bag as domestic waste

Mask

If a risk assessment has identified that a mask is needed, remove last by breaking the ties, taking care not to touch face. Wash hands using soap and water and/or an alcohol hand rub

Waste Bags
PPE should always be worn when dealing with waste Hands should be washed after removal of PPE Should not be over filled (no more than 2/3 full) Should be tied and secured against leakage Should be labelled to identify place of origin Bags awaiting collection should be stored in a clean, lit, designated area, which is locked and inaccessible to the public, animals and vermin. Waste bins should be clean, lidded and foot operated If you have a clinical waste service, guidelines for the disposal of clinical waste should be followed

Management of Laundry
Used Laundry Should be stored in a cleanable plastic container whilst waiting to be washed All soiled laundry should be placed directly into the washing machine. If this is not possible, then soiled laundry should be placed into a plastic bag until it can be placed into the washing machine. Staff should wear PPE when dealing with used laundry

Management of soiled Laundry

Soiled communal laundry (i.e. pillow cases, sheets, towels etc) should be washed at a temperature of 65C or above Soiled personal laundry/clothing should be washed separately from other clothing on the hottest temperature the fabric will allow Staff should wear PPE when dealing with all used or soiled/infected laundry

Hands should be washed after handling soiled laundry and when removing PPE

Cleaning and Disinfection

Cleaning Is the process that uses water and detergent to physically remove visible dirt/germs. Disinfection Is a process that uses chemical agents to reduce the number of germs that are able to cause infection (e.g. Detol, Bleach or Milton).

Management of Minor Blood Spills

Disposable gloves and plastic aprons must be worn. All blood spills or splashes of blood should be dealt with immediately. Absorbent material such as a paper towel should be used to soak up any spillages. Wash the area with hot water and detergent. Gloves and aprons must be double bagged and disposed of safely. Hands must be washed following removal of PPE.

Management of Sharps
Definition Sharps include needles, sharp edged or pointed surgical instruments, broken glassware or any other sharp item that may have been contaminated in use by blood or body fluids and which may cause laceration or puncture wounds. Sharp tissues such as bone or teeth may also pose a risk of injury (RCN 2001)

Use and Disposal of Sharps

You are responsible for the disposal of the sharps you have used. Never re-sheath needles Dispose of syringe and needle as one unit directly into a specific sharps container Always take the sharps container to the point of use Ensure sharps containers are assembled correctly Do not leave used sharps lying around Report all sharps injuries immediately according to local policy

First Aid Action

In the event of a sharps injury you should: Bleed it Wash it Cover it Report it