Standard (Universal) Precautions Community Infection Control Nurses Leicestershire, Northampton & Rutland PCT ’ s Health Protection Agency Nurses Leicestershire, Northampton & Rutland Social Care Providers Leicestershire, Northampton & Rutland 2006

Aim and Objectives Aim – To raise awareness of Standard Precautions within Infection Control Objectives – To demonstrate what is meant by the term ‘ Standard Precautions ’ – To review the principles of Standard Precautions – To demonstrate a knowledge of the chain of infection and how the application of standard precautions can prevent cross infection to patients/clients, staff and the environment

Infection Control Infection results when germs enter the body and establish themselves, multiply and cause some adverse reaction in the patient/client. The general principles of infection control are based on the use of practices and procedures that prevent or reduce the likelihood of infection being transmitted from one person to another susceptible individual.

Chain of Infection Infectious agent Campylobacter Reservoir Found in water, milk and food, commonly poultry Portal of exit Contamination of food Means of transmission On contaminated equipment, hands Portal of entry Ingestion of contaminated food Susceptible host Susceptible individual who eats contaminated food Campylobacter

Risk Factors Resident/Client Staff Relatives/friends Equipment Themselves Food Environment Patients Animals (Pets or vermin)

Host Risk Factors Age Immobility Invasive procedures/medical interventions Immune status (underlying chronic disease/other infections) Physical/Mental wellbeing Emotional wellbeing Personal hygiene

Standard Precautions Hand hygiene Personal Protective Equipment (PPE) Waste management Management of Laundry Cleaning and decontamination of re-useable medical equipment Maintenance of a clean environment Management of blood/body fluids spills Use and disposal of sharps

Hand Hygiene Which method to use? Always use liquid soap and water Before and after any clinical procedure e.g. when emptying/changing a catheter bag or when undertaking wound care After removal of gloves When hands are visibly soiled Before handling food After using the toilet After contact with any client especially a client who has diarrhoea and/or vomiting When taking a client to the toilet Staff should not use residents ’ bar soap or hand towels

Hand Washing Technique Wet hands under running water Apply one dose of soap into a cupped hand Wash hands using the 6 step technique without adding more soap or water Ensure all surfaces of the hands have been covered Rinse hands thoroughly under running water Dry hands thoroughly with a paper towel Dispose of the towel in to a foot operated lidded bin

Hand Washing Six-Step Technique

Hand Washing Important Points To decontaminate hands effectively the following need to be observed Cover any cut or abrasion with a waterproof plaster and change as necessary Keep natural nails short, clean, and unpolished Do not wear false nails, infills etc. Remove or roll up long sleeves when hand washing Remove any wrist watch, stoned ring or bracelet Use individual or pump dispensed hand cream daily

Alcohol Based Hand Rubs Can be used: Following hand washing after contact with an infected resident/client or their environment When hands are visibly clean If hands are visibly soiled they must be washed with soap and water before using alcohol hand rubs

PERSONAL PROTECTIVE EQUIPMENT (PPE) Gloves – Disposable, non-powdered latex or latex equivalent (not vinyl or plastic). To be worn if there is any possibility of contact with blood or body fluids Plastic aprons – Disposable. To be worn if there is any possibility of contact with body fluids. If gloves are indicated, aprons should also be worn Goggles/Visors – Disposable and used following a risk assessment Masks – Disposable paper and used following a risk assessment

Donning of PPE Apron – plastic, disposable Gloves – non-sterile examination gloves Then if risk assessment denotes: Mask Open mask out, tie top ties around top of head i.e. above ears, tie second ties around back of neck. Ensure close fit over bridge of nose by using the nose clip

Removal of PPE Aprons Rip the ties of the apron and remove. Dispose of as clinical waste or double bag as domestic waste. Gloves Grasp outer edge near wrist taking care not to touch the skin Peel away from hand, turning glove inside out Hold in opposite hand, and repeat process for other glove Discard as clinical waste or double bag as domestic waste Mask If a risk assessment has identified that a mask is needed, remove last by breaking the ties, taking care not to touch face. Wash hands using soap and water and/or an alcohol hand rub

Waste Bags PPE should always be worn when dealing with waste Hands should be washed after removal of PPE Should not be over filled (no more than 2/3 full) Should be tied and secured against leakage Should be labelled to identify place of origin Bags awaiting collection should be stored in a clean, lit, designated area, which is locked and inaccessible to the public, animals and vermin. Waste bins should be clean, lidded and foot operated If you have a clinical waste service, guidelines for the disposal of clinical waste should be followed

Management of Laundry Used Laundry Should be stored in a cleanable plastic container whilst waiting to be washed All soiled laundry should be placed directly into the washing machine. If this is not possible, then soiled laundry should be placed into a plastic bag until it can be placed into the washing machine. Staff should wear PPE when dealing with used laundry

Management of soiled Laundry Soiled communal laundry (i.e. pillow cases, sheets, towels etc) should be washed at a temperature of 65°C or above Soiled personal laundry/clothing should be washed separately from other clothing on the hottest temperature the fabric will allow Staff should wear PPE when dealing with all used or soiled/infected laundry Hands should be washed after handling soiled laundry and when removing PPE

Cleaning and Disinfection Cleaning Is the process that uses water and detergent to physically remove visible dirt/germs. Disinfection Is a process that uses chemical agents to reduce the number of germs that are able to cause infection (e.g. Detol, Bleach or Milton).

Management of Minor Blood Spills Disposable gloves and plastic aprons must be worn. All blood spills or splashes of blood should be dealt with immediately. Absorbent material such as a paper towel should be used to soak up any spillages. Wash the area with hot water and detergent. Gloves and aprons must be double bagged and disposed of safely. Hands must be washed following removal of PPE.

Management of Sharps Definition Sharps include needles, sharp edged or pointed surgical instruments, broken glassware or any other sharp item that may have been contaminated in use by blood or body fluids and which may cause laceration or puncture wounds. Sharp tissues such as bone or teeth may also pose a risk of injury (RCN 2001)

Use and Disposal of Sharps You are responsible for the disposal of the sharps you have used. Never re-sheath needles Dispose of syringe and needle as one unit directly into a specific sharps container Always take the sharps container to the point of use Ensure sharps containers are assembled correctly Do not leave used sharps lying around Report all sharps injuries immediately according to local policy

First Aid Action In the event of a sharps injury you should: Bleed it Wash it Cover it Report it