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Universal Precautions
Hand
washing!
Universal Precautions
Procedures for this module & objectives
Note that throughout the presentation there are Read More notations in
green which allow you to click a link for additional online information.
You may come upon medical terms that are unfamiliar to you. Please
consult an online or hard copy medical dictionary for clarification.
Objectives
At the conclusion of this module, you should be able to:
Universal Precautions
Putting the term in context
Healthcare-Associated Infections
(HAI)
32%
22%
15%
14%
are
are
are
are
HAI
What would a medical term be without a Greek
derivation? Healthcare-Associated Infections
(HAI) are also known as Hospital-Acquired
Infections and as Nosocomial Infections (from
the Greek words for disease & to take care of).
Those in the profession will know what youre
talking about no matter which term you use,
but if you need to sound impressive,
nosocomial wins hands down. Those should be
washed hands.
Types of HAI
Bloodborne pathogens (including HIV/AIDS,
Hepatitis B & C)
MRSA (Methicillin-Resistant Staphylococcus
Aureus)
Pneumonia
Influenza
Norovirus
Varicella (chickenpox), mumps, Clostridium
difficile (C. diff), TB, & a host of others.
If you would like to see a more complete list, visit
the CDC at
http://www.cdc.gov/ncidod/dhqp/id.html .
Bloodborne pathogens:
The Big Three
Much of the driving force for the
recommendations & regulations regarding
HAI has stemmed from concern over these
three diseases (though they certainly
arent the only infections with the
potential to circulate in healthcare
settings):
HIV/AIDS
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Transmission of HAI
Communicable diseases, that is those diseases which are
transmitted to a recipient from a host, make their
leap through one or more of the following pathways:
Example of an HAI
transmission
Norovirus has made the headlines several times for
sickening passengers on cruise ships, kids at
school, and residents of nursing homes. Take a
guess at the means of transmission for this
highly contagious disease. Go onguess:
A. Direct contact
B. Indirect contact
C. Vector
D. Fecal-oral
E. Droplet
F. Airborne
Example
(continued)
CDC: Recommendations
In the 1983 the CDC authored the Guidelines for Isolation
Precautions in Hospitals. Later in the decade, and particularly
in response to the HIV/AIDS epidemic, universal
precautions were instigated to prevent the spread of
pathogens responsible for diseases such as HIV/AIDS, HBV &
HCV transmitted in blood, other bodily fluids containing
visible blood, semen, & vaginal secretions.
The precautions also apply to tissues, cerebrospinal, synovial,
pleural, peritoneal, pericardial, and amniotic fluids. Saliva is
included if visibly contaminated with blood.
Read more at:
http://www.cdc.gov/ncidod/dhqp/bp_universal_precautions.ht
ml
.
CDC
(continued)
(
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf , retrieved 12/1/09)
OSHA: Regulation
Its one thing to receive good advice but quite another to be
required to adopt it. Do you think that everyone started
wearing seat belts when they first came out? Hmm?
(Quick quiz: Which state does not have a seat belt law for
adults? Hint: The official state motto is Live free or die.
How interesting.)
The Occupational Safety & Health Administration
(OSHA) is all about regulating (issuing rules & enforcing
them) standards of occupational health including those
related to injuries, fatalities, & illnesses. It is an agency of
the U.S. Department of Labor. If you dont think they
mean business, you ought to take even a brief look at
their website: http://www.osha.gov/index.html. Please do.
OSHA
(continued)
Review of Terms
This & the following couple of slides have a review of terms to set
the stage for laying out what it actually means to practice universal
precautions. If you would like to delve into the OSHA Standard
1910.1030 for a complete glossary and enumerated subparagraphs
from here to eternity, you will find them at
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_tabl
e=STANDARDS&p_id=10051
. Put your feet up; its a long read.
Agencies
CDC
OSHA
Occupational Safety & Health Administration government agency that implements & enforces
regulations concerning safety in the workplace.
Review of Terms
Practice of Infection Control
Universal
Precautions
Body
Substance
Isolation
(BSI)
Standard
Precautions
http://wonder.cdc.gov/wonder/prevguid/p0000419/p0000419.asp#head00200
6000000000
)
Review of Terms
Infectious Materials
Bloodbor Bloodborne pathogens are pathogenic microorganisms
ne
that are present in human blood and can cause disease in
pathoge humans. (http://www.osha.gov/SLTC/etools/hospital/hazards/univprec/univ.html,
retrieved 12/1/09)
ns
OPIM
Universal Precautions
Taking precautions to protect your patients AND yourself.
Administrative
Considerations
Whether your employer calls their program
Standard Precautions in deference to the CDC or
Universal Precautions as promoted by OSHA, you
should become familiar with these worksite
procedures:
Confidentiality
It should go without saying (and that is a pun as
well as the truth) that whatever you might learn
about a patients health status is private &
protected information not to be shared beyond
the circle of those involved in the patients care.
The U.S. Department of Health & Human Services
would like to tell you more at their site devoted
to health information privacy, specifically
regarding the Health Insurance Portability &
Accountability Act (HIPAA). It is found at:
http://www.hhs.gov/ocr/privacy/
Vaccinations (http://www.immunize.org/catg.d/p2017.pdf)
Influenza
Hepatitis B
Measles, mumps, rubella (MMR)
Varicella (chickenpox)
Tetanus, diphtheria, pertussis (Tdap or variants as indicated)
NOTE: Your school program and/or your eventual employer may require
more vaccinations than those listed above. Certainly you will require
additional vaccinations if you work/study abroad or with potential
exposure to other diseases. (Check out http://wwwnc.cdc.gov/travel/ if
you intend to travel.)
Hand washing with antimicrobial soap (soap with antiseptic agent) & water
Not all of these are interchangeable, meaning that there are some situations in
which one method is preferred over the other. An individual must also consider
any history of allergic reaction to various products & the potential for contact
dermatitis resulting from chronic use of a product.
Hand hygiene:
Antiseptic agents
Table excerpted from the CDCs Guidelines for Hand Hygiene in Health-Care Settings , p. 45 retrieved 12/1/09 at
http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf.
Wet your hands with clean running water and apply soap. Use
warm water if it is available.
Rub hands together to make a lather and scrub all surfaces.
Continue rubbing hands for 15-20 seconds. Need a timer? Imagine
singing "Happy Birthday" twice through to a friend.
Rinse hands well under running water.
Dry your hands using a paper towel or air dryer. If possible, use
your paper towel to turn off the faucet.
Always use soap and water if your hands are visibly dirty.
Gloves
Masks
Gowns & other apparel
Eye, face, mouth, & inhalation protection
*Naturally the CDC has recommendations on when to use PPE. The Yale-New Haven
Hospital (http://www.med.yale.edu/ynhh/infection/precautions/intro.html)
offers more on the use of PPE along with instruction on how to don (put on) the
equipment & remove the equipment. This is presented in the following slides.
**A presentation of Transmission-Based Precautions follows the PPE information.
PPE: Gloves
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual
at http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
Procedures involving direct contact with the blood and body substances of
any patient.
PPE: Gloves
Retrieved 12/1/09 from the Yale-New Haven Hospital Infection Control Manual
at http://www.med.yale.edu/ynhh/infection/precautions/intro.html.
PPE: Gloves
2.
3.
Dry hands thoroughly with a paper towel. Use the towel to turn off the faucet.
4.
Remove the packet of gloves from the outer wrapper. Place this packet on a
clean, dry, flat surface.
5.
Unfold the packet as if opening a book. Position the packet so that the cuffed
ends of the gloves are nearest to you.
6.
Grasp the center flaps and open. Both gloves must have folded cuffs. Position
the packaging so that it lies flat.
7.
Use one hand to glove the other. Grasp the edge of the right glove cuff with the
fingers of the left hand, and slip the right hand into this glove. Pull it on by
holding onto the cuff, but do not touch the outside of the glove.
8.
Adjust both gloves so they fit properly. Make sure there are no gaps between the
fingertips and the ends of the gloves.
9.
Inspect the gloves for nicks and tears before and during the procedure. Obtain a
new pair of sterile gloves if there is a break in aseptic technique or if a nick or
tear occurs.
PPE: Gowns
PPE: Gowns
Transmission-Based
Precautions
The three categories of Transmission-Based Precautions come into effect
when Standard Precautions are insufficient to interrupt the route(s) of
transmission. (This means that Standard Precautions AND the indicated
Transmission-Based Precautions should be in effect.) The categories are:
Contact precautions
Droplet precautions
Airborne precautions
Apply when infectious agents may be suspended in the air over long distances
Preferred placement for patient in airborne infection isolation room
Caregiver wears mask or respirator as indicated by disease-specific recommendations
Transmission-Based Precautions
One example
CDC: 2007 Guidelines for Isolation Precautions, p. 121, retrieved 12/1/09 from
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf.