Professional Documents
Culture Documents
2.0 PURPOSE
• To prevent the spread of cross infection.
• To uphold standards of safe practice.
• To protect both healthcare staff and every individual in their care at all times from
the transmission of infection during care/hazardous procedures whether the risk is
known or unknown.
• To ensure maximum protection of patients, visitors and staff without the need to
divulge the individual’s diagnosis or other information that may be confidential.
• To ensure evidence based research underpins best practice.
3.0 SCOPE
The practices and procedures that are described in this guideline are to be used by all
healthcare staff, bank/agency & contracted services involved in patient care to protect
the patient and the individual providing care.
Centers for Disease Control. (CDC); the Healthcare Infection Prevention and Control
Practices Advisory Committee (HICPAC) (2007) Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings
Centers for Disease Control. (CDC); the Healthcare Infection Prevention and Control
Practices Advisory (HICPAC) Management of Multidrug-Resistant Organisms In
Healthcare Settings (2006).
All healthcare workers have responsibilities to conform and respect all aspects of health
and safety legislation. Managers have a key responsibility to ensure their department
functions within the parameters of legislation and that staff are trained and assessed in
these issues. All healthcare workers have a responsibility to ensure that they follow
instructions, in accordance with local policy and not place themselves or others in danger
(Safety, Health and Welfare Act 2005). It is the responsibility of all HCWs to ensure that
they avail of Infection Prevention and Control education and training and have access to
Infection Prevention and Control guidelines and policies.
Universal blood and body fluid precautions is a concept that emerged in the 1980s, with
protective clothing being one of a range of measures to prevent exposure to blood-borne
viruses such as human immunodeficiency virus (HIV) (UK Health Departments 1990,
Centre for Disease Control (CDC) 1988, CDC 1987). The term was replaced by Standard
Precautions in 2007 which is now used to describe the application of a range of Infection
Prevention and Control practices to prevent exposure to, and transmission of, a wide
range of micro-organisms in healthcare settings. Standard precautions, or routine
Infection Prevention and Control practice, also include hand hygiene, the safe disposal of
clinical waste, decontamination of equipment and the environment, and the safe disposal
of sharps (Wilson 2001).
ALL health care workers in ALL situations involving the care of patients or
contact with the environment must use Standard Precautions.
Because most people with blood borne viral infections such as HIV and HBV do not have
symptoms, nor can they be visibly recognised as being infected, Standard Precautions
HSE West Mid-Western Regional Hospitals, Standard Precautions Guideline, MGIP&C
09/10, Revision 02, 09/12 pg 5 of 23
are designed for the care of all persons—patients and staff—regardless of whether or not
they are infected. Standard Precautions require that health care workers assume that
the blood and body substances of all patients are potential sources of infection,
regardless of the diagnosis, or presumed infectious status.
Standard Precautions apply to blood and all other body fluids, secretions and excretions
(except sweat), non-intact skin and mucous membranes. Their implementation is meant
to reduce the risk of transmitting microorganisms from known or unknown sources of
infection (e.g., patients, contaminated objects, used needles and syringes, etc.) within
the healthcare setting. Applying Standard Precautions has become the primary strategy
to preventing nosocomial infections in hospitalised patients.
Placing a physical, mechanical or chemical barrier between microorganisms and an
individual is a highly effective means of preventing the spread of infections (i.e. the
barrier serves to break the disease transmission cycle).
The following actions create protective barriers for preventing infections in patients and
are necessary for the care of all patients and healthcare workers. These provide the
means for implementing Standard Precautions.
Infection Prevention and Control practices can be grouped in two categories:
• Standard precautions
• Additional (transmission-based) precautions.
Standard Precautions are intended to be applied to the care of all patients in all
healthcare settings, regardless of the suspected or confirmed presence of an infectious
agent. Implementation of Standard Precautions constitutes the primary strategy for the
prevention of healthcare-associated transmission of infectious agents among patients
and healthcare personnel (Refer to Appendix I).
7.5 Gloves
• Wear gloves on both hands before touching broken skin, mucous membranes,
blood or other body fluids, or soiled instruments and contaminated waste
materials—or before performing invasive procedures.
• Use physical barriers: (protective goggles, face masks and aprons) if splashes
and spills of any body fluids (secretions and excretions) are likely e.g., cleaning
instruments and other items. Change PPE between patients.
7.7 Sharps
• The prevention of sharps injuries has always been an essential element of
Standard Precautions. These include measures to handle needles and other sharp
devices in a manner that will prevent injury to the user and to others who may
encounter the device during or after a procedure.
• Adoption of work practices that minimize risk of injury.
• Assemble sharps box correctly, do not overfill.
• Position sharps box in a safe place close to point of use.
• Discard all sharps/sharp items in a sharps box immediately after use.
HSE West Mid-Western Regional Hospitals, Standard Precautions Guideline, MGIP&C
09/10, Revision 02, 09/12 pg 7 of 23
• Do not re-cap, bend, dissemble or break needles.
• The user is responsible for disposing of sharps.
• Refer to the Infection Prevention & Control Occupational Exposure Management
including Sharps Policy and Procedure, 2010.
Transmission-Based Precautions are used when the route(s) of transmission is (are) not
completely interrupted using Standard Precautions alone.
The preferred placement for patients who require Airborne Precautions is in an airborne
infection isolation room. In settings where Airborne Precautions cannot be implemented
due to limited engineering resources (e.g., physician offices), masking the patient,
placing the patient in a private room (e.g., office examination room) with the door
closed, and providing N95 or higher level respirators or masks if respirators are not
available for healthcare personnel will reduce the likelihood of airborne transmission.
Healthcare personnel caring for patients on Airborne Precautions wear a mask or
respirator, depending on the disease-specific recommendations that is donned prior to
room entry. Whenever possible, non-immune HCWs should not care for patients with
vaccine-preventable airborne diseases (e.g., measles, chickenpox, and smallpox).
A single patient room is preferred for patients who require Droplet Precautions. When a
single-patient room is not available, consultation with infection control personnel is
recommended to assess the various risks associated with other patient placement
options (e.g., cohorting, keeping the patient with an existing roommate) Healthcare
personnel wear a mask (a respirator is not necessary) for close contact with infectious
patient; the mask is generally donned upon room entry. Patients on Droplet Precautions
who must be transported outside of the room should wear a mask if tolerated and follow
Respiratory Hygiene/Cough Etiquette.
The application of Contact Precautions for patients infected or colonised with Multi Drug
Resistant Organisms (MDRO) is described in the Infection prevention & Control Isolation
Precautions Guideline 2010). Contact Precautions also apply where the presence of
excessive wound drainage, fecal incontinence, or other discharges from the body suggest
an increased potential for extensive environmental contamination and risk of
HSE West Mid-Western Regional Hospitals, Standard Precautions Guideline, MGIP&C
09/10, Revision 02, 09/12 pg 9 of 23
transmission. A single-patient room is preferred for patients who require Contact
Precautions. When a single-patient room is not available, consultation with infection
control personnel is recommended to assess the various risks associated with other
patient placement options (e.g., cohorting, keeping the patient with an existing room
mate).
Refer to Appendix III for advice on Infection Control Guideline for Prioritisation for
Isolation of Patients in the Emergency Department. Note – the febrile returning
traveller should be assessed for presence of infectious diseases endemic to the region
they have come from. If in doubt, contact a member of the Infection Prevention and
Control Team.
When there are insufficient side rooms to isolate all patients who ought to be isolated, a
risk assessment should be performed for each patient taking into consideration:
When faced with a competing need for isolation facilities, please place patients in single
rooms in the order of priority indicated in the table in Appendix IV (Prioritising use of
single-bedded rooms for isolation of common infections).
Other infections may take precedence; seek advice from the Infection Prevention and
Control Team (IP&CT).
The need for isolation in these categories overrides that needed for ‘dignity and privacy’.
It may be necessary to remove a patient from isolation to accommodate another patient
with a higher priority for isolation; in this event please contact the IP&CT.
Ayliffe GAJ, Fraise AP, Bradley C,. Ayliffe’s Control of Healthcare-Associated infection. A
Practical Handbook. 5th Edition 2009, London: Hodder Arnold
Centres for Disease Control (CDC), Jane D. Siegel, MD; Emily Rhinehart, RN MPH CIC;
Marguerite Jackson, PhD; Linda Chiarello, RN MS; the Healthcare Infection Control
Practices Advisory Committee (HICPAC) (2007) Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf Accessed on
10/12/07
Centres for Disease Control CDC (2003) Infection Control for Viral Haemorrhagic Fevers
In the African Health Care Setting, Annex 1 Standard Precautions for Hospital Infection
Control.
Communicable Diseases Network Australia. (2002) Infection Control guidelines for the
prevention of transmission of infectious diseases in the health care setting 2nd Canberra,
Department of Health and Aging, Commonwealth of Australia,.
Garner J.S. and The Hospital Infection Control Practices Advisory Committee (HICPAC).
(1996). Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiology
17(1): 53–80 and American Journal of Infection Control 24 (1): 24–52.
Gloucestershire NHS Primary Care Trust, (2008) Community Infection Prevention and
Control Policy and Procedure Isolation Policy.
Infection Control Nurses Association (ICNA) Protective Clothing, Principles and Guidance
(2002) Fitwise, Drumcross Hall, Bathgate, EH48 4JT
Infection Control Nurses Association (ICNA) Health Promotion Unit (2005) Standard
Precautions Poster.
Mid Western Regional Hospitals (MWRHs) (2010); Policy on Healthcare Risk Waste and
its Segregation & Disposal within the HSE Mid-West Area.
Mid Western Regional Hospitals (MWRHs) (2010); Guideline for the Handling and
Segregation of Linen.
HSE West Mid-Western Regional Hospitals, Standard Precautions Guideline, MGIP&C
09/10, Revision 02, 09/12 pg 12 of 23
Mid Western Regional Hospitals (MWRHs) (2010); Guidelines for Isolation Precautions.
Mid Western Regional Hospitals (MWRHs) (2010); Guidelines for Cleaning and
Disinfection of Equipment and the Environment.
National Hospitals Office (NHO) (2006) Irish Acute Hospitals Cleaning Manual.
Northern Ireland Regional Infection Prevention & Control Manual (2008) Standard
Precautions www.infectioncontrolmanual.co.ni Accessed on 17/05/2010
Royal College of Nursing. Good practice in infection prevention and control – guidance
for nursing staff. Available at http://www.rcn.org.uk/data/assets/pdf
file/0003/78654/002741.pdf
Note:
During aerosol-generating procedures on patients with suspected or proven infections transmitted
by respiratory aerosols (e.g., SARS), wear a fit-tested N95 or higher respirator in addition to gloves,
gown, and face/eye protection.
‡ The organisms listed under the column "Potential Pathogens" are not intended to
represent the complete, or even most likely, diagnoses, but rather possible etiologic
agents that require additional precautions beyond Standard Precautions until they can be
ruled out.
§ These pathogens include enterohemorrhagic Escherichia coli O157:H7, Shigella spp,
hepatitis A virus, noroviruses, rotavirus, C. difficile.