1. STANDARD PRECAUTION Prof. Dr. Ida Parwati, PhD.
Department of Clinical Pathology
Division of Infectious and Tropical Diseases
Dr. Hasan Sadikin General Hospital
Faculty of Medicine - Unpad

2. DEFINITION Standard Precautions
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 infection control precaution
Hospital Infection is the result of a combination of factors: Microbial source + Transmission + Susceptible host = Infection

3. History of Infection Control Precautions
Year
Infection Control Precautions
1877,1910
Separates facilities, Antisepsis and disinfections ... etc
1985
UNIVERSAL PRECAUTIONS (guidelines for protecting healthcare worker because the emergence of HIV & other bloodborne pathogens)
1987
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
1996
STANDARD PRECAUTIONS:Two level approach:
Standar Precautions which apply to all clients and patients attending healthcare facilities
Transmission-based Precautions which apply only to hospitalized patients
2007
ISOLATION PRECAUTIONS (new pathogens; SARS, Avian Influenzae H5N1, H1N1)

4. Isolation precaution Airborne precautions Droplet precautions
Standard precautions
Transmission-based precautions
Universal precautions
Airborne precautions
Body substance isolation
Droplet precautions
Contact precaution

5. Key Elements of Standard Precautions
Hand hygiene
Gloves
Mask, gogles, face masks
Gown
Prevention of needle stick & injuries from sharp instruments
Respiratory hygiene & cough etiquette
Environmental cleaning
Linens
Waste disposal
Patient care equipment
PPE
WHO, 2007

6. 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
Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, alcohol-based handrub, or surgical hand hygiene/antisepsis.
Handwashing refers to washing hands with plain soap and water. Handwashing with soap and water remains a sensible strategy for hand hygiene in non-healthcare settings and is recommended by CDC and other experts.
Antiseptic handwash refers to washing hands with water and soap or other detergents containing an antiseptic agent.
Alcohol-based handrub refers to the alcohol-containing preparation applied to the hands to reduce the number of viable microorganisms.
Surgical hand hygiene/antisepsis refers to an antiseptic handwash or antiseptic handrub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora. Antiseptic detergent preparations often have persistent antimicrobial activity.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. 6

7. “My five moments for hand hygiene”

10. The single most important thing that you can do to stop
This I do believe is self-explanatory! The single most important thing that you can do to stop the spread of any germs is to wash your hands
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

11. PPE PPE Working Condition gloves
should be used when touching blood, body fluids, secretions, excretions, or contaminated items and for touching mucous membranes and nonintact skin.
gowns
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.
Mask and goggles or a face shield
should be used during patient care activities that are likely to generate splashes and sprays of blood, body fluids, secretions, or excretions.

12. Precaution for suspected Avian Influenza :
Full Barrier Precaution

13. 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

14. Transmission-Based Precautions
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.

15. Droplet Transmission
For infectious agents with droplet nuclei > 5 microns
Examples:
Pertussis
Meningococcal meningitis
Precaution Examples:
Private room
Mask if within 3’ of patient

16. Droplet Precautions Prevent infection by large droplets from Examples
Sneezing
Coughing
Talking
Examples
Neisseria meningitidis
Pertussis
Influenza
The next type of Precaution is Droplet Precautions. Droplet Precautions are intended to prevent infection by large droplets that are released when an infected person sneezes, coughs, or talks.
Examples of infectious diseases that are spread this way include: Neisseria meningitidis, Pertussis, and Influenza. It is probable that person-to-person transmission of avian influenza occurs primarily via droplets.

17. Airborne Transmission
For infectious agents with droplet nuclei < 5 microns
Examples:
Tuberculosis
Measles
Precaution Examples
Isolation rooms under negative pressure
N95 or HEPA respirator use

18. 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

19. Linens 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.

20. Waste disposal 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.

21. 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.

22. Contact Precautions
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