Standard Precautions

DR. ANTO
Universal Precautions
Rules of universal precautions
1) Consider ALL patients potentially infectious.
2) Assume ALL blood and body fluids and tissue to be potentially
infectious.
3) Assume ALL unsterile needles and other sharps to be similarly
contaminated.
Standard Precautions
These precautions should be followed in all patient care situations.
All staff should be informed of the need to report exposure to blood
or potentially infectious body fluids to the duty doctor
without any delay.

Certain standard precautions should be taken in all healthcare

settings as
1) Wash hands before and after all patient or specimen
contact.

2) Handle the blood of all patients as potentially

infectious.

3) Wear gloves for potential contact with blood and

body fluids.

4) Prevent needle stick/sharp injuries.

5) Wear personal protective equipment (PPE) while

handling blood or body fluids.
6) Handle all linen soiled with blood and/or body
secretion as potentially infectious.

7) Process all laboratory specimens as potentially

infectious.

8) Wear a mask for TB and other contagious respiratory

infections (HIV is not air-borne).

9) Correctly process instruments and patient care

equipment.

10) Maintain environmental cleanliness.

11) Follow proper waste disposal practices.

Hand Washing
Hand washing means vigorous rubbing of hand with soap and water
or with any antiseptic agents
Types
1. Social hand wash
2. Procedure hand wash
3. Surgical hand wash

Purpose
1. To remove dirt and debris
2. To decontaminate the hands
3. To prevent cross infection
4. To break the chain of infection

Most common mode of transmission of pathogens is via HANDS

“Hand washing is the single most important
means of preventing the spread of infection”
When?
-Before and after duty
-Before each invasive procedures.
-Before and after using gloves
-After touching of blood or body fluid
-Before and after touching patients
-Before touching invasive devices
-After toileting, urination
Social hand washing (10 -15 sec)
Indications
1. Before handling food
2. After visiting toilet
3. Before and after nursing the patient (Bathing and bed making)
4. It can be used in community and public places

Procedure hand washing or hygienic hand washing (30sec -1mt)

Indications
1. Before each invasive procedures
2. Before attending Immuno compromised patients
3. Before and between caring for high risk patients
4. Before and after use of gloves
5. After touching of blood or body fluid
Methods of Hand Washing
1. Wet hands with running water.
2. Obtain soap or detergent that contains antimicrobial agents spread all area of the
hands.
3. Vigorous rubbing of hands (all area) about 30 sec to 1 min.
4. Wash hands thoroughly with running water.
5. Rinse and dry.
6. Turn off water with using paper towel or use elbow to close the tap handle.

Steps of Procedure Hand Washing

1. Palm to Palm
2. Right palm over left dorsum and left over right dorsum.
3. Palm to palm finger interlocked.
4. Back of finger to opposing palms with finger interlocked.
5. Rotational rubbing of right thumb clasped in left palm and vice versa
6. Rotational rubbing, backwards and forwards with clasped fingers of right hand in
left palm and vice versa.
7. Rotational rubbing of right wrist and vice versa. Dry thoroughly.
3. Surgical Hand Wash (3-5mts)

Indications
1. Prior to all operative procedures
2. Prior to treatment of all burns cases
3. Before insertion of all invasive devices (cardiac catheterization, Insertion of all
lines especially arterial and central venous Catheterization).

Method
1. Hands are washed up to the elbow freely using disinfectant
2. Scrubbing of fingers, space between fingers and nails ,brush used to scrub the
nails
3. wash hands thoroughly with running water .after wash the tap should be
closed with elbow
4. Keep the hand finger upright position.
5. Dry the hand with sterile towel
Hand hygiene (hand washing or alcohol-based hand rub)
Hand hygiene before and after contact with every patient is the single most
important means of preventing the spread of infection

When hands are visibly dirty or contaminated, wash them with antibacterial or
plain soap and running water, then dry them using single-use paper towels .

DO NOT use alcohol-based hand products when hands are visibly soiled

When hands appear clean (i.e. are not visibly soiled), clean them with an alcohol-
based hand product for routine decontamination, then dry them using single-use
paper towels

DO NOT use alcohol- based hand products after exposure of non intact skin to
blood or body fluids; in such cases, wash hands with antibacterial or plain soap
and running water, then dry them using single-use paper towels .
DISINFECTION
AND

STERILIZATION
Sterilization
Sterilization is a process where all microbes are removed from a defined
object, inclusive of bacterial endospores.

Methods of Sterilization Used

i. Steam autoclave
ii. Hot air oven

Disinfection
Disinfection is a process where most microbes are removed from a defined object or
surface, except bacterial endospores.

Classification of disinfectants:
5.2.1 High level disinfectants: glutaraldehyde 2%, ethylene oxide.
5.2.1 Intermediate level disinfectants: alcohols, chlorine compounds, hydrogen
peroxide,chlorhexidine.
5.2.2 Low level disinfectants: benzalkonium chloride(0.025% Lizol)
STERILIZATION RECOMMENDATIONS
Hot Air Oven 160 Cel for 1 hr, 180 0C for 30 min

Autoclave Gravity-Displacement:
• 30 min holding time at 121 Cel
• 1.1 kg/cm2 or 15 lb/in2 (PSI)

Prevacuum :
• 3 min holding time at 134 Cel
• 2.2 kg/cm2 or 32 lb/in2 (PSI)
Disinfectant solutions: are used to inactivate any infectious agents that may
be present in blood or other body fluids.

They must always be available for cleaning working surfaces, equipment that cannot be
autoclaved, non disposable items, and for dealing with any spillages involving pathological
specimens or other known infectious material.

Needles and instruments should routinely be soaked in a chemical disinfectant for 30

minutes before cleaning.

Disinfection decreases the viral and bacterial burden of an instrument, but does not clean
debris from the instrument or confer sterility.

Purpose of disinfection is to reduce the risk to those who have to handle the instruments
during further cleaning. · Reusable needles must always be used with great care.
After use, they should be placed in a special container of disinfectant before being cleaned
and sterilized.

Thick gloves should be worn when needles and sharp instruments are being cleaned. · There
are many disinfectant solutions, with varying degrees of effectiveness. Most widely
available is sodium hypochlorite solution (commonly known as bleach ), which is a
particularly effective antiviral disinfectant solution.
To ensure effective disinfection, follow the manufacturer’s instructions or any other
specific guidelines that have been given and dilute the concentrated solution to the
correct working strength.

All disinfectants have a “contact time”, which means that they must be left in
contact with an infectious agent for a certain period of time to ensure that it is
completely inactivated.

However, some disinfectants are themselves inactivated by the presence of organic

material, so higher concentrations of disinfectant and longer contact times must be
used in certain situations, such as a large spill of infected blood.

Linen soiled with blood should be handled with gloves, and should be collected and
transported in leak-proof bags. ·

Wash the linen first in cool water, then disinfect with a dilute chlorine solution.
Then wash it with detergent for 25 minutes at a temperature of at least 71°C.
General guidelines for sterilization disinfection of equipment and instruments
1. Critical instruments / equipment's ( that are those penetrating skin or mucous
membrane ) Should undergo sterilization before and after use .e.g surgical instruments and
implants

2. Semi – critical instruments / equipment's ( that are those in contact with intact mucous
membrane without penetration) should undergo high level disinfection before use and
intermediate level disinfection after use .e.g. nasal speculum , proctoscope , vaginal
speculum , endoscopes

3. Non – critical instruments / equipment's ( that are those in contact with intact skin and
no contact with mucous membrane ) require only intermediate or low level disinfection
before and after use .e.g. Ecg electrodes ,stethoscope , Bp apparatus, bed pan .

Disinfection of the instruments for non – invasive procedures

Immediately after use the instruments (like vaginal speculum . Proctoscope , nasal
speculum and instruments used for laryngeal and tracheal examination ) should be
immersed in suitable disinfectant fluid ( 2% gluteraldehyde I,e. cidex) for atleast 20
minutes . After disinfection , they may be washed / rinsed with water and preferably
autoclaved .
Decontamination
The objective of decontamination is to protect individuals who handle surgical instruments
and other items which have been in contact with blood or body fluids, from serious diseases.

Once instruments and other items have been decontaminated, they can be safely further
processed. This consists of cleaning and finally either sterilization or high-level disinfection.

Decontamination Tips:

Use a plastic container for decontamination to help prevent

Dulling of sharps (for example, scissors) due to contact with metal containers.

Rusting of instruments due to a chemical reaction (electrolysis) that can occur

between two different metals (that is, the instrument and container) when placed in water.

Do not soak metal instruments that are electroplated (that is, not 100 percent
stainless steel) even in plain water for more than an hour because rusting will
occur.
WHO recommends 0.5 percent chlorine solution to be used for decontaminating
instruments before cleaning them. The objective of decontamination is to protect
individuals who handle surgical instruments and other items which have been in
contact with blood or body fluids, from serious diseases. Once instruments and
other items have been decontaminated, they can safely be further processed. This
consists of cleaning and finally either sterilization or high-level disinfection.

Fumigation or Fogging
Bacillocid Fumigation:

Fumigation can be done using 2 percent Bacillocid (100 ml in 5 litres of water).

The room must be kept closed for 6 hours before use by housekeeping personnel.

Fumigation is done only in the high-risk areas like ICU, PICU, NICU, Labour room;
OT ,wards are excluded for fumigation (done only if required).

Surface cleaning for the wards may be done using 2 percent Bacillocid (100 ml in 5
litres of water).
Personal protective equipments (PPE)
Gloves
Protective eye wear
Mask
Apron
Gown
Boots/ shoe covers
Cap/ hair cover
Appropriate facilities for hand hygiene in all patient care area such as
liquid hand wash, large wash basin with elbow operated taps, tissue
paper/ hand dry, hand rubs etc. be available to all health care
providers.
Use of Personal Protective Equipments :

a) Mask-Protection from air bone infections or situation which lead

any splash or sprays of blood and body fluid.

b) Glove –Use glove when we are touching the hand with blood and
body fluids, secretions any wound, or any other contaminated
items.

c) Apron-Any Chances of splash or contamination on soiling.

d) Goggles –During positive cases (OT &LR).

e) Boots-If necessary.

f) Caps are worn whenever indicated.

Blood and body fluid spillage
Prepare 1% hypochloride solution (200 ml 5% hypochloride in
800 ml of water)
Wear gloves pour 1% hypochloride on the spillage
Cover it with a piece of paper or cloth
Keep it there for 10 – 20 minutes
Wipe the spillage using the covered paper or cloth
After wiping discard the same in the yellow cover
If it is a large spillage, after covering the spillage with paper or
cloth
Mop it with Separate mop (mop should be dipped in 1 %
hypochloride for 30 minutes

Cover the area immediately with any absorbent material like

tissue paper, old newspaper,
and gauze piece.
BIOMEDICAL WASTE MANAGEMENT
Hospital waste is a potential reservoir of pathogenic microorganisms and requires
appropriate, safe and reliable handling. The main risk associated with infection is sharps
contaminated with blood.

There should be a person or persons responsible for the organization and management of
waste collection, handling, storage and disposal. Waste management should be conducted
in coordination with the infection control team.

Steps in the management of hospital waste include:

• Generation
• Segregation/separation
• Collection
• Transportation, storage
• Treatment
• Final disposal
Principles of Waste Management

Develop a waste management plan that is based on an assessment of the current situation
and which minimizes the amount of waste generated.

Segregate clinical (infectious) waste from nonclinical waste in dedicated containers.

Transport waste in dedicated trolleys.

Store waste in specified areas with restricted access.

Collect and store sharps in sharps containers. Sharps containers

should be made of plastic or metal and have a lid that can be closed. Mark the storage
areas with a biohazard symbol.

Ensure that the carts or trolleys used for the transport of

segregated waste collection are not used for any other purpose – they
should be cleaned regularly.

Identify a storage area for waste prior to treatment or being

taken to final disposal area.
Treatment of hazardous and clinical/infectious waste
Each healthcare facility should identify a method for the treatment of clinical/infectious
waste.
This may consist of transportation of infectious waste to a centralized waste treatment
facility or on-site treatment of waste.

a. The biomedical waste of a hospital should be outsourced to an authorized

contractor for the management and handling of biomedical waste as designated by
the State Pollution Control Board.

b. Biomedical waste refers to any waste which is generated during the diagnosis,
treatment or immunization of human beings or animals, or in research activities
pertaining to or producing or testing of biological components including
categories mentioned in Biomedical Waste Management Rules 1998 or 2011.

c. Proper segregation and collection of biomedical waste from all patient care areas
of the hospital should be implemented and monitored. The Biomedical Waste
Treatment Facility should be outsourced to an Authorized Contractor.

d. Use appropriate PPE when segregating, packing, transporting, and storing

biomedical waste.

e. Biomedical waste should be transported in a closed container.

HIC PROTOCOL for biomedical waste disposal should be followed as defined in the State
Guidelines. Different categories of waste are disposed of in different color coded bags as
defined by the Pollution Control Board.
There are different types of microbes:
bacteria.
fungi.
algae.
protozoa.
viruses.

It allows the bacterium to produce a dormant and highly resistant cell

to preserve the cell's genetic material in times of extreme
stress. Endospores can survive environmental assaults that would
normally kill the bacterium.