INFECTION CONTROL PROCESSES
Standard Precautions
There are 2 tiers of precautions to prevent transmission of
infectious agents:
• Standard Precautions and
• isolation Precautions. (Transmission-Based Precautions).
Standard Precautions A group of infection prevention practices
that apply to all patients,
Standard Precautions are applied to the care of all patients in
all healthcare settings, regardless of the suspected or
confirmed presence of an infectious agent.
Transmission-Based Precautions are applied to the care of
patients known or suspected to be infected with highly
transmissible or epidemiologically important pathogens .
Standard Precautions
Standard Precaution provide guidelines to prevent
transmission of diseases that can be acquired by contact with
blood, body fluids, non- intact skin & mucus membrane.
Standard Precautions are based on the principle that all blood,
body fluids, secretions, excretions except sweat, nonintact skin,
and mucous membranes may contain transmissible infectious
agents.
Standard precautions :include a group of infection
prevention practices regarding :-
1. Hand hygiene
2. Personal protective equipment (PPE)
3. Aseptic techniques
4. Reprocessing of instruments/Sterile services
5. Environmental control (including cleaning and
disinfection);
6. Proper sharps and waste disposal
7. Respiratory Hygiene and Cough Etiquette
Hand hygiene
• Hand hygiene is the single most effective precaution for prevention of
infection transmission between patients and staff.
• The term “hand hygiene” includes both hand washing with either plain or
antiseptic-containing soap and water, and use of alcohol-based products
(gels, rinses) that do not require the use of water .
• Antimicrobial soap e.g. chlorhexidine is also used.
• Hand washing with plain soap is mechanical removal of soil and 90% of
transient bacteria (for 10- 15 sec.)
• Hand antisepsis is removal & destroy of transient flora using anti-microbial
soap or alcohol based- hand rub (for 60 sec.)
• Surgical hand scrub: removal or destruction of transient flora and reduction
of resident flora using anti-microbial soap or alcohol -based detergent with
effective rubbing (for 3-5 min) .
Alcohol hand rub by alcohol gel (contains70% ) is effective in killing but it dose
not act well in present of dirt.
Bacteria recovered from hands were divided into two categories
• Transient flora:
- Organisms colonizing superficial skin layers.
- Acquired by HCWs during direct contact with patient environment.
- More amenable to removal by routine hand hygiene.
• Resident flora:
- Organisms attached to deeper layers of skin.
- More resistant to removal e.g. coagulase negative staphylococci and diphtheroides.
Five (5) Moments in Hand Hygiene
Hand hygiene must be practiced : –
1. Before touching a patient.
2. Immediately before performing a clean or aseptic
procedure, including handling an invasive device for patient
care, regardless of whether or not gloves are used.
3. Promptly after contact with body fluids, excretions,
mucous membranes, non-intact skin, or wound dressings
regardless of whether or not gloves were used.
4. After touching a patient and his/her immediate
surroundings, even when leaving the patient’s side.
5. After contact with inanimate objects (including medical
equipment and furniture) in the immediate vicinity of the
patient
NOTE: Increasing hand-washing compliance by 1.5 – 2 folds would
result in a 25-50-% decrease in the incidence of healthcare associated
e.g. withdrawing blood
samples or handling a
medication
or touching a wound OR or touching a wound OR IV
IV line. line.
e.g. touching blood, body
fluid , non-intact skin, or
wound dressings or items handling of contaminated
contaminated with them equipment or laundry.
Personal Protective Equipment(PPE)
“Specialized clothing or equipment worn by an employee for
protection against infectious materials”
What are the types of PPE?
• Gloves.
• Gowns and aprons.
• Mask
• Eye goggles and face shield
• Head gear (hair cover)
• Foot protection (shoe cover)
Gloves:
• Wearing gloves reduces contamination of hands and minimizes the risk
that a HCW will become infected after :
contact with a patient’s blood or body substance and
contact with patients who are colonized or infected with pathogens
transmitted by the contact route e.g., VRE, MRSA, RSV
• Wearing gloves reduces the likelihood that staff will transmit micro-
organisms for their hands to patients when HCW has skin cuts, lesions
and dermatitis .
The type of glove :
1. Non sterile gloves:
• disposable, single use, usually not singly wrapped.
• Non sterile nitrile gloves are suitable for contact with any blood or body
substance, mucous membranes or non-intact skin is anticipated.
• • Indications:
1. Starting I.V line.
2. Handling a soiled dressing.
3. Cleaning or handling soiled equipment,
2. Sterile gloves:
§disposable, sterile, individually wrapped.
§Sterile latex gloves shall be worn for surgical procedures where
asepsis must be maintained.
• Indication:
1. Before surgery.
2. Before any invasive procedure.
3. Before wound dressing.
4. Mixing I.V. fluids and using multidose vials.
3. Heavier, reusable utility gloves are indicated for non-patient care
Aprons and Gowns
Plastic aprons: disposable are sufficient to provide protection from
contamination.
Fluid Resistant Gown: Long sleeved, disposable fluid resistant gowns
should be used for contact isolation or where there is an elevated risk
of contamination.
• Indications during procedures that :
1. generate splashes of blood or body fluid.
2. may contaminates uniforms with micro-organism or infected
materials
Gowns
Masks
• To protect staff from inhalation of infectious droplets, smoke or
other airborne hazards. Also protect them from contact with sprays
of blood or body fluids
• To prevent the spread of micro- organisms from the nasopharynx of
staff to the patient.
• Respirators are recommended to be worn during the performance of
aerosol-generating procedures (e.g., intubation, bronchoscopy,
suctioning, Laboratory handling of Mycobacterium tuberculosis such
as concentrating respiratory samples for smear and culture)
Eye/ Face shield
Eye/face protection shall be worn when there is likelihood to splash
or splatter with blood or body substance to the mucous membrane of
the mouth, nose and or eyes.
Procedures (e.g., endotracheal suctioning, bronchoscopy, invasive
vascular procedures) require either a face shield or mask and goggles
Types of eye/face protection:
Chin length plastic face shield
Goggles Note
Head gear (hair cover )
• Used to confine and contain hair in the operating theater.
Over Shoes
Should be used in operating theatre
The selection of PPE is based on the nature of the HCW-
patient interaction and/or the likely mode(s) of
transmission.
For some interactions (e.g., performing venipuncture), only
gloves may be needed;
during other interactions (e.g., intubation), use of gloves,
gown, and face shield or mask and goggles is necessary.
Respiratory hygiene/cough etiquette
The elements of Respiratory Hygiene/Cough Etiquette include
1. education of healthcare facility staff, patients, and visitors;
2. posted signs, to the population served, with instructions to patients
and accompanying family members or friends;
3. source control measures (e.g., covering the mouth/nose with a
tissue when coughing and prompt disposal of used tissues, using
surgical masks on the coughing person when tolerated and
appropriate);
4. hand hygiene after contact with respiratory secretions; and
5. spatial separation, ideally >3 feet, of persons with respiratory
infections in common waiting areas when possible.
