Transcript UNIVERSAL PRECAUTION - Akademik Ciamik 2010
Prof. Dr. Ida Parwati, PhD.
Department of Clinical Pathology Division of Infectious and Tropical Diseases Dr. Hasan Sadikin General Hospital Faculty of Medicine - Unpad
• 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
precaution • Hospital Infection is the result of a combination of factors:
Microbial source + Transmission + Susceptible host = Infection
1877,1910 1985 1987 1996 2007
History of Infection Control Precautions
Infection Control Precautions
Separates facilities, Antisepsis and disinfections ... etc
(guidelines for protecting healthcare worker because the emergence of HIV & other bloodborne pathogens)
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
:Two level approach: • Standar Precautions which apply to all clients and patients attending healthcare facilities • Transmission-based Precautions which apply only to hospitalized patients
(new pathogens; SARS, Avian Influenzae H5N1, H1N1)
Standard precautions Transmission-based precautions
• Universal precautions • Body substance isolation
•Airborne precautions •Droplet precautions •Contact precaution
Key Elements of Standard Precautions
1. Hand hygiene 2. Gloves 3. Mask, gogles, face masks 4. Gown
5. Prevention of needle stick & injuries from sharp instruments 6. Respiratory hygiene & cough etiquette 7. Environmental cleaning 8. Linens 9. Waste disposal 10. Patient care equipment
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
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
“My five moments for hand hygiene”
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
gloves PPE gowns Mask and goggles or a face shield
should be used when touching blood, body fluids, secretions, excretions, or contaminated items and for touching mucous membranes and nonintact skin.
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. 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
• 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
• For infectious agents with droplet nuclei
> 5 microns
• Examples: – Pertussis – Meningococcal meningitis • Precaution Examples: – Private room – Mask if within 3’ of patient
• Prevent infection by large droplets from – Sneezing – Coughing – Talking • Examples –
– Pertussis – Influenza
• 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
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.
• 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.
• 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