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Standard Transmission based precaution.pptx
- 1. Standard and Transmission Based Precautions UdaySharma MSc. Microbiology BPKIHS, Dharan, Nepal
- 2. • Contents – Introduction –Components – Transmission Based precautions
- 3. Standard Precautions • Minimuminfection prevention practice • Applies to all patient care, regardless of suspected or confirmed infection status of the patient • In any setting where health care is delivered
- 4. • 1970; CDCpublished an Isolation manual entitled ‘Isolation Techniques for use in Hospitals to assist general hospitals with isolation precautions’ • It was a category system of isolation precautions • 1983; CDC published ‘Guideline for Isolation Precaution in Hospitals’; introduced disease specific isolation precautions • It expanded the old a ‘Blood Precautions’ to ‘Blood and Body fluid Precautions’
- 5. • In 1985,largely because of HIV epidemic. Universal precaution approach was introduced • Applied to blood and body fluids like CSF, synovial fluid, peritoneal fluid, amniotic fluid, semen and vaginal fluid • To all the patients • But not to feces, nasal secretions, sputum, sweat, tears, urine and vomitus unless they contained visible blood
- 6. • In Jan.1, 1996, the CDC published a Guideline for Isolation Precautions in Hospitals • It synthesizes the major features of Universal Precautions and Body Substance Isolation in a single set of precautions • To be used for the care of all patients regardless of their presumed infection status; Standard Precautions
- 7. Components of StandardPrecautions • Hand Hygiene • Use of Personal Protective Equipment • Respiratory Hygiene / Cough Etiquette • Sharp Safety • Safe injection practices • Environmental Cleaning • Sterilization and Disinfection of patient care equipment • Safe Waste Disposal
- 8. Hand Hygiene • Majorcomponent of the standard precautions • Strict adherence to hand hygiene is recommended 5 moments of hand hygiene
- 9. Indications of usinghandwash Indications of hand-rub Visible dirt During routine clinical rounds and handling the patients Contaminated with blood or body fluids If the hands are not visibly dirty Potential exposure to spore forming pathogens Not contaminated with blood or body fluids Handling patient having diarrhea (4% chlorohexidine handwash is preferred) After using restroom Before handling medication or food
- 11. Personal protective equipment(PPE) • Wearable equipment to protect HCWs from exposure to infectious agents • Selection of the PPE: – Nature of the patient interaction – Anticipated exposure • Understanding the risk: – Risk recognition – Risk assessment
- 12. • Types ofPPE – Gloves; are a disposable barriers to hands – They include: • Examination gloves • Sterile gloves • Heavier, reusable gloves
- 13. • Masks andrespirators – Masks prevent splashes or sprays of body fluids, respiratory secretions and chemicals from reaching the mouth and nose – Also block respiratory secretions from HCWs mouth to patient – Respirators filter particles or microorganisms from the air, (e.g. N95, FFP2, KN95, etc.)
- 14. • Gowns – Area physical barrier that protects clothing and skin – Used when contamination by splashes or sprays are likely • Aprons • Eye protection • Head covering • Rubber boots
- 15. Respiratory Hygiene/Cough Etiquette •SARS outbreaks in 2003 highlighted the need for prompt implementation of infection control measures at the first point of encounter within a healthcare setting • Applies to any person with signs of illness including cough, congestion, rhinorrhea, or increased production of respiratory secretions
- 16. Sharp safety • Primarilyassociated with occupational transmission of HBV, HCV, and HIV, but they may be implicated in the transmission of more than 20 other pathogens • After a per-cutaneous exposure, the risk of acquiring – HIV: 0.3% – HCV: 1.8% (0% to 7%) – HBV: 6%-30%
- 17. • Needles shouldbe – Never be recapped or single hand scooping technique be used – Never be tried to bend or break – Never left on inappropriate places – Discarded in puncture-proof containers
- 18. Safe Injection Practices •Use of aseptic technique to avoid contamination of sterile injection equipment • Avoidance of medications from a syringe to multiple patients • Appropriate disposal of injection equipment after use • Use single-dose vials for parenteral medications whenever possible
- 19. • Avoidance ofadministration of medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use • Bags or bottles of intravenous solution not to be used as a common source of supply for multiple patients • Infection control practices for special lumbar puncture procedures: (During myelograms, lumbar puncture and spinal or epidural anesthesia)
- 20. Environmental Cleaning • Veryimportant of frequently touched surfaces • The frequency or intensity of cleaning; based on the patient’s level of hygiene and the degree of environmental contamination
- 21. • Spillage management: •Attended immediately with the use of PPE • Marking of the spill area and use of signage • Containment and removal of most of the organic matters with an absorbent towel • For spills containing; (>10 cm); 0.5 % Sodium hypochlorite • For small spills; (<10 cm); 0.05 % Sodium hypochlorite • Contact time: 10 minutes
- 22. Signage and SpillKit to manage the spillage
- 23. Sterilization and disinfectionof patient care equipment • Disinfect or sterilize reusable equipment before using on another patient • Should be done according to manufacturer instructions • Single use device/patient care items do not need reprocessing
- 25. Safe Waste Disposal •Out of the total waste generated in the HCFs, 80% is general, non-hazardous waste and remaining 15% is hazardous • 15% is considered hazardous which are infectious – 3% is pharmaceutical or chemical waste – 1% is sharps or needles – <1% is radioactive
- 26. • The sixkey steps to implement HCW management system – Waste minimization – Waste segregation at the source – Waste collection and storage – Waste transportation – Waste treatment and disposal – Monitoring and evaluation
- 27. Color coding ofthe bins for waste segregation: Green Bin Blue Bin Red Bin Yellow bin Black Bin Non- Hazardous Biodegradable waste Non-hazardous non- Biodegradable waste Pathological waste Chemical waste Radioactive waste Sharp waste Infectious waste Pharmaceutical waste Cytotoxic waste
- 28. Waste segregation binsin our department
- 29. Transmission based precautions •Second tier of infection control measures; Sometimes also called isolation precaution • Used in addition to standard precautions • Used based on clinical observation when certain pathogens are suspected and continued until the pathogen is ruled out • Laboratory tests especially culture results take time – should not be waited for to start transmission based precautions
- 30. Types of TransmissionBased Precautions • Based on the mode of transmission of the suspected or known pathogen • Three main modes: – Contact – Droplet – Airborne
- 31. Contact transmission • Mostcommon mode • From one infected or colonized person to another via – Direct contact transmission: involves both a direct body- surface to body-surface contact and physical transfer of microorganisms between an infected or colonized person and a suitable host – Indirect contact transmission: involves a contaminated intermediate (e.g. Fomites or contaminated hands)
- 32. • Agents transmittedthrough contact transmission • MRSA, CRE and VRE • MDR non fermenting gram negative bacilli (Pseudomonas, Acinetobacter, etc.) • Agents of conjunctivitis (adenovirus, gonococcus, chlamydia) • Group A streptococcal or staphylococcal or HSV lesions • Skin infestations like scabies • Agents of diarrhea like Cholera, Rota virus, Clostridiodes difficle • Enterically transmitted hepatitis viruses
- 33. • Control measures: –Hand hygiene • strict adherence • 4% chlorohexidine handwash is preferred while handling diarrhea patients
- 34. – Use ofPPE • Gloves and gown; put on before entering and removed before leaving the patient area • Surgical mask and eye wear in case of potential splashes or sprays of body fluids • Hand hygiene before donning and after doffing of the PPE • Containment of the PPE after use
- 35. – Patient placement •Single isolation room – Rooms with bathroom and anteroom are preferred – Patient notes and bedside; outside the room – Donning and doffing; done outside the room – Door closed and use of sign on the door
- 36. • Cohorting – Whensingle room is not available – Patients with similar infections – Spatial separation ( 3 feet distance and privacy curtains, visual cue like colored curtains, color tape or mat, bed spreads or indicator boards or labeled patient case file used to indicate restricted access or special precautions if needed)
- 37. • Transfer ofpatients – Limited only to medical-necessary purpose – Infected area covered – Contaminated PPE should be removed and prior to transport – Put on clean PPE to assist the patient, once reached the destination
- 38. – Patient equipmentand environmental cleaning • Use disposable or dedicated patient-care equipment • Clean and disinfect equipment before use on other patients • Rooms of patients cleaned at least once a day and prior to be used by another patient • PPE while cleaning and proper discarding after use
- 39. Droplet Transmission • Dropletsare expelled into the air when people cough, talk or sneeze • Can also spread via hands • Special air handling and ventilation are not needed
- 41. – Agents • Diptheroides •Bordetella pertussis (whooping cough) • Hemophilus influenza type B virus • Neisseria meningitidis • Group A streptococci • Rhinovirus, rubella virus, mumps and adenovirus
- 42. – Control measures •Hand hygiene – Some agents transmissible by droplets are also often transmitted by hand – Adherence to five moments of hand
- 43. – Use ofPPE • Use of masks and Protective eye wear or goggles according to need • Instruction to the patients; – To use tissues when sneezing or coughing or elbow • In outpatient setting – Segregation of the patients with respiratory symptoms – Fast tracked attendance to these cases
- 45. – Patient placement •Single-patient rooms are preferred • In case of limited single rooms; prioritize the patients with excessive cough and sputum production. • Placing a patient on droplet precaution in an area with immunocompromised patients should be avoided • Physical separation (at least 3 feet apart)and use of privacy curtains
- 46. – Patient transportoutside of a room • Patient instructed to wear a mask and follow respiratory hygiene and cough etiquette • If the patient cannot tolerate a mask, Health care person should put on a mask for and patient provided with tissues
- 47. Airborne Transmission • Patientsare placed on Airborne precautions when they have known or suspected infections transmitted over long distances through the air. • Organisms that require Airborne Precautions include Mycobacterium tuberculosis, the measles virus, and the varicella zoster virus (chickenpox).
- 48. • Control measures –Patient placement in an Airborne infection isolation room – negative pressure (6—12 air exchanges per hour) – direct exhaust of air to the outside, away from places where people walk or congregate and any air intake openings – a door kept closed when not required to enter or exit
- 49. • If AIIRis not available: – Room should have a good cross-ventilation (two or more windows that open) to the outdoors. – An exhaust fan in one window to assist moving room air to the outdoors – Door to the hallway closed, except for when HCP enter and exit the room.
- 50. • Use ofPPE • Special care while transporting the patient
- 51. • References: • Guidelinesfor Isolation Precautions in Hospitals Hospital Infection Control Advisory Committee Julia S. Garner, RN, MN; the Hospital Infection Control Practices Advisory Committee • openwho.org • Essentials of hospital infection control, Apurba S Sastry, Deepashree R • National Health Care Waste Management Standards and Operating Procedures-2020; Government of Nepal, MoHP, Department of Health Services
Editor's Notes
- #8 Compliance with hand hygiene recommendations remains suboptimal around the world, with an average of 59.6% compliance levels in ICUs up to 2018; high income and low income countries 64.5% vs 9.1%. Hand hygiene improvement programs can prevent up to 50% avoidable infections acquired during health care delivery and generate economic savings on average 16 times the cost of implementation.
- #16 Covering sneezes and coughs and placing masks on coughing patients are proven means of source containment that prevent infected persons from dispersing respiratory
- #21 (e.g., bedrails, bedside tables, commodes, doorknobs, sinks, surfaces and equipment in close proximity to the patient)
- #32 Should be followed when there is definitive or suspected evidence of presence of a certain pathogen that is transmitted by direct or indirect contact
- #33 Carbapenem resistant enterobactericiae vancomycin resistant enterococci
- #40 Droplets are more than 5 micrometer diameter size while droplet nuclei is less than 5 micrometer size
- #49 AIIR is specially designed with special air handling and ventilation systems to prevent transmission