CHAPTER

2
STANDARD
SAFETY
MEASURES
 STANDARD PRECAUTION

“Standard precautions are meant to reduce the risk of transmission of

bloodborne and other pathogens from both recognized and unrecognized
sources. They are the basic level of infection control precautions which
are to be used, as a minimum, in the care of all patients.”
—World Health Organization

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 ISOLATION

Isolation is defined as any of the various

interventions usually termed as “isolation
precautions” adopted within a HCF (health care
facility) for the control of infection and for the
prevention of communicable diseases from a
patient to other patients, health care personnel or
visitors.

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 ROUTINE MEASURES (STANDARD PRECAUTIONS)

The standard or the routine precautions are implicated for all types of patients in a
healthcare setting irrespective of the type of patient either suspected or with a
confirmed infection.
Universal Precautions (UP)
The universal precautions concept was formulated in response to the human
immunodeficiency virus (HIV) emergence in 1985 with an aim to prevent
infections transmitted by blood and other substances infected with HIV, initially
with the purpose to protect the healthcare workers and later to be applied to all
different kinds of patients as well.
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Body Substance Isolation (BSI)
The BSI was developed in 1987, as an extension to the universal
precautions because of the addition of the additional precautions, e.g., to
avoid contact with the moist and infectious body substances with or
without visible blood, as well as, a special emphasis on the hand
hygiene was observed.

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 WHO—Key components of standard
precautions
❑Health policy

❑Health hygiene

❑Personal Protective Equipments

❑Respiratory hygiene and cough etiquette

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 Additional Measures
(Transmission-based Precautions)
1. Contact Precautions
This type of isolation precautions are adopted in order to prevent the
transmission of the microbes via coming in contact with either the
patient directly or with the patient’s environment wherein the infection
is infested.
2. Droplet Precautions
These types of precautions are implemented to prevent the spread of
infections transmitted through the infection laden respiratory secretions
via the droplets as a medium of transmission in the air, on coming in
close contact with the other respiratory or mucous membranes.
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3. Airborne Precautions

The airborne precautions play a role in inhibiting the transmission of

infection suspended in air droplets/ nuclei. The infected air particles can
reach long distances and are the dried forms of the respiratory droplets.

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 EPIDEMIOLOGY AND INFECTION PREVENTION—CDC
GUIDELINES

DIPHTHERIA

Epidemiology

As per CDC, the HCP (Health Care Personnel) are not at substantially
higher risk than the general adult population for acquiring diphtheria,
however, the medical care is needed in the United States for the sporadic or
imported cases.

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 Prevention of Transmission of C. diphtheriae in Healthcare
Settings Involves

❑Encouraging vaccination of HCP against diphtheria in compliance

with routine adult vaccine schedules.
❑Rapidly diagnosing and treating patients with clinical infection,
❑Administering PEP (post exposure prophylaxis) to persons exposed to
diphtheria,
❑Excluding potentially infectious HCP from work.

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 GROUP A STREPTOCOCCUS (GAS)
Epidemiology
The healthcare associated transmission of GAS has been documented
from patients to HCP and from HCP to patients worldwide.
Prevention of transmission of GAS in healthcare Settings Involves
❑In addition to using Standard precautions, placing patients with
known or suspected GAS infection in recommended transmission-
based precautions according to their clinical manifestations of GAS
disease,
❑Rapidly diagnosing and treating patients with clinical infection,

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 MENINGOCOCCAL DISEASE
Epidemiology
In rare instances, it has been transmitted from patients to healthcare
personnel through contact with the respiratory secretions of the patients
with meningococcal disease and handling isolates of N. meningitidis.
Prevention of Transmission of N. meningitidis in Healthcare Settings
Involves
❑In addition to using Standard Precautions, placing patients with
known or suspected meningococcal disease in Droplet Precautions.
❑Rapidly diagnosing and treating patients with clinical infection.

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 Pertussis
Epidemiology
The greatest risk of severe morbidity and mortality is for the
nonimmunized infants and children while the other patients and HCP
are also at an equivalent level of risk worldwide.
Prevention of Transmission of B. pertussis in Healthcare Settings
Involves
❑In accordance with the AICP (Advisory Committee on Immunization
Practices), the HCP must be vaccinated against pertussis.
❑In addition to using Standard Precautions, placing patients with
known or suspected meningococcal disease in Droplet Precautions.

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 RABIES
Epidemiology
The transplantations among humans can lead to rabies transmission though.
AICP maintains the guidelines for rabies vaccination of certain high-risk
groups like:
❑Persons performing the rabies laboratory diagnostic testing,
❑The frequent entrants in to the high density bat environments,
❑The ones who work with potentially rabid mammals.

Prevention of Transmission of Rabies in Healthcare Settings Involves

❑Using Standard precautions for patients with suspected or confirmed
clinical infection, to prevent contact with potentially infectious body fluids
and secretions,
❑Rapidly diagnosing and treating patients with clinical infection.

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 PERSONAL PROTECTIVE EQUIPMENT
(PPE)
“The PPE is a “Specialized clothing or equipment,
worn by an employee for protection against the
infectious materials”.

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TYPES OF PPE

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SEQUENCE OF PPE

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Putting on and removing an
isolation gown

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 PROPER WAY TO PUTTING AND
REMOVING AN ISOLATION GOWN.

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 Do’s and Don’ts for wearing gowns in nonsurgical healthcare settings
Do’s Don’ts

Do perform hand hygiene before and after putting any PPE. Don’t reuse the gown for the same or different patient.

Do wear a gown if, you may come in contact with blood or Don’t push or roll gown sleeves up your forearm.
body fluids, are caring for a patient on contact precautions,

Don’t push or roll gown sleeves up your forearm. Don’t allow contaminated gowns to hang out of the garbage.

Do secure the gown at the base of the neck and at the waist. Don’t wear a contaminated gown outside of the patient care
area

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Masks and Respirators

Many different types of masks can be used to cover the mouth and nose.
The masks and the respirator masks if worn accurately offers protection
to the wearer from infectious droplets and air particles.

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 Types of Mask
Procedure Masks/Isolation Masks: The characteristic features of a
procedure mask are as follows:
❑ It is a disposable mask.
❑Protects from the infectious droplets.
❑Also available with a built-in face shield for protection against
splashes.

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N95 respirator mask : The characteristic features of the N95 respirator
mask are as follows: It is a type of specialized masks called particulate
respirators.
❑It protects the wearer from very small (0.3 microns) floating air
particles.
❑It is a tight fitting face cover without any gapping..
❑It provides more protection than an isolation mask.
❑More difficult to breathe through than procedure masks.

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N95 respirator mask

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STEPS FOR PUTTING UP RESPIRATOR

FIT TEST

PUTTING ON A SEAL CHECK

RESPIRATOR

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Protective Eyewear
The eye protection is necessary for the procedures involving generation
of splashes, sprays of blood and body fluids while dealing with the
patients or biomedical waste management. It includes the following:
❑Goggles
❑Safety glasses
❑Face shields
❑Masks with attached shield.

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Gloves
Types of gloves are depicted in:
❑Sterile gloves: Used while performing all sterile procedures, e.g.,
vaginal delivery, invasive radiological procedure, etc.
❑Nonsterile gloves: Used in situations possessing the risk of contact
with infectious material like blood, body fluids or infection. For
example, nitrile, latex, or medical vinyl gloves.
❑Nonmedical gloves: Used for works like food handling,
housekeeping procedures during cleaning and disinfection, e.g., vinyl
gloves.
❑Utility gloves: Used for cleaning of instruments manually and
decontamination with harsh chemicals. For example, facility,
maintenance and central sterile processing.

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How to Put on NonSterile Gloves?

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HOW TO REMOVE GLOVES

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How to don sterile gloves?

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How to remove sterile gloves?

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 Contact and Droplet Precautions—Covid-19
Personal Protective Equipment (PPE)
❑Put on eye protection: Face shield, or Goggles
❑Put on gloves: Ensure gloves are placed over the cuff of the gown.
❑Perform hand hygiene:
▪ Alcohol-based handrub: Rub hands for 20–30 seconds, or
▪ Water and soap: Wash hands for 40–60 seconds.

❑Put on gown
❑Put on the mask
▪ Medical mask, or
▪ Respirator masks (N95, FFP3, or equivalent). Only use if performing aerosol generating
procedures.

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