STANDARD

AND
ISOLATION
PRECAUTIO
N

GROUP 4
STANDARD PRECAUTIONS
STANDARD PRECAUTIONS
• Designed for all clients in hospital.
• These precautions apply to (a) blood; (b) all body fluids, excretions, and secretions
except sweat; (c) nonintact (broken) skin;
and (d) mucous membranes.
• Designed to reduce risk of transmission of microorganisms from
recognized and unrecognized sources.
STANDARD PRECAUTIONS
2. Use of personal 4. Sharps safety
3. Respiratory
protective equipment (engineering and
1. Hand hygiene. hygiene / cough
(e.g., gloves, masks, work practice
etiquette.
eyewear). controls).

5. Safe injection
7. Clean and
practices (i.e., aseptic
6. Sterile instruments disinfected
technique for
and devices. environmental
parenteral
surfaces.
medications).
CHAIN OF
INFECTION
HAND HYGIENE
1. Perform hand hygiene

a. When hands are visibly soiled.

b. After barehanded touching of instruments, equipment, materials, and other objects likely to be
contaminated by blood, saliva, or respiratory secretions.
c. Before and after treating each patient.

d. Before putting on gloves and again immediately after removing gloves.

2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based
hand rub may be used.
PERSONAL PROTECTIVE
EQUIPMENT 

 Personal protective equipment, commonly

referred to as "PPE", is equipment worn to
minimize exposure to hazards that cause
serious workplace injuries and illnesses. These
injuries and illnesses may result from contact
with chemical, radiological, physical,
electrical, mechanical, or other workplace
hazards. Personal protective equipment may
include items such as gloves, safety glasses
and shoes, earplugs or muffs, hard hats,
respirators, or coveralls, vests and full body
suits.
PERSONAL PROTECTIVE
EQUIPMENT

 All personal protective equipment should be safely designed

and constructed, and should be maintained in a clean and
reliable fashion. It should fit comfortably, encouraging worker
use. If the personal protective equipment does not fit properly,
it can make the difference between being safely covered or
dangerously exposed.  Each worker required to use personal
protective equipment to know:
 When it is necessary
 What kind is necessary
 How to properly put it on, adjust, wear and take it off
 The limitations of the equipment
 Proper care, maintenance, useful life, and disposal of the
equipment
PERSONAL
PROTECTIVE
EQUIPMENT
RESPIRATORY HYGIENE/COUGH ETIQUETTE

 Designed to limit the transmission of respiratory pathogens spread by droplet or airborne routes.
 Patients that goes in dental settings are the ones who are the primarily target of this infection. These
patients could be undiagnosed with transmissible respiratory infections, but also apply to anyone
(including DHCP) with signs of illness including:
 Cough
 Congestion
 runny nose or increased production of respiratory secretions.
HOW TO PREVENT TRANSMISSION OF PATHOGENS?

Implement measurements and protocol in the work area:

A. Post signs at entrances with instructions to patients with symptoms of respiratory
infection to:
1. Wear mask and cover their mouths/noses when coughing or sneezing.
2. Provide a safe distance
3. Use and dispose of tissues.
4. Perform hand hygiene after hands have been in contact with respiratory secretions.
HOW TO PREVENT TRANSMISSION OF PATHOGENS?

B. Provide tissues and no-touch receptacles for disposal of tissues.

C. Provide resources for performing hand hygiene in or near waiting areas.
D. Offer masks to coughing patients and other symptomatic persons when they enter the
dental setting.

Provide space and maintain social distancing. If available, facilities can provide waiting
areas for clients with comorbidity.
STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMS
AND DEVICES 

 Instrument processing requires multiple steps using specialized equipment. Each dental practice should have
policies and procedures in place for containing, transporting, and handling instruments and equipment that may be
contaminated with blood or body fluids. Manufacturer’s instructions for reprocessing reusable dental instruments
and equipment should be readily available—ideally in or near the reprocessing area. Most single-use devices are
labeled by the manufacturer for only a single use and do not have reprocessing instructions. Use single-use
devices for one patient only and dispose of appropriately. 
 Cleaning, disinfection and sterilization of dental equipment should be assigned to DHCP with training in the
required reprocessing steps to ensure reprocessing results in a device that can be safely used for patient care.
Training should also include the appropriate use of PPE necessary for safe handling of contaminated equipment. 
STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMS
AND DEVICES 

 Patient-care items (e.g., dental instruments, devices, and equipment) are categorized as critical, semicritical, or
noncritical, depending on the potential risk for infection associated with their intended use.
 Critical items, such as surgical instruments and periodontal scalers, are those used to penetrate soft tissue or bone. They have
the greatest risk of transmitting infection and should always be sterilized using heat. 
 Semicritical items (e.g., mouth mirrors, amalgam condensers, reusable dental impression trays) are those that come in contact
with mucous membranes or non-intact skin (e.g., exposed skin that is chapped, abraded, or has dermatitis). These items have
a lower risk of transmission. Because the majority of semicritical items in dentistry are heat-tolerant, they should also be
sterilized using heat. If a semicritical item is heat-sensitive, DHCP should replace it with a heat-tolerant or disposable
alternative. If none are available, it should, at a minimum, be processed using high-level disinfection. 
STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMS
AND DEVICES 

 Note: Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles,
should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are
considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials
during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially
infectious materials. 
STERILIZATION AND DISINFECTION OF PATIENT-CARE ITEMS
AND DEVICES 

 Digital radiography sensors are also considered semicritical and should be protected with a Food and
Drug Administration (FDA)-cleared barrier to reduce contamination during use, followed by cleaning and heat-
sterilization or high-level disinfection between patients. If the item cannot tolerate these procedures then, at a minimum,
protect with an FDA-cleared barrier. In addition, clean and disinfect with an Environmental Protection Agency (EPA)-
registered hospital disinfectant with intermediate-level (i.e., tuberculocidal claim) activity between patients.
Because these items vary by manufacturer and their ability to be sterilized or high-level disinfected also vary, refer
to manufacturer instructions for reprocessing. 
 Noncritical patient-care items (e.g., radiograph head/cone, blood pressure cuff, facebow) are those that only contact intact
skin. These items pose the least risk of transmission of infection. In the majority of cases, cleaning, or if visibly soiled,
cleaning followed by disinfection with an EPA-registered hospital disinfectant is adequate. Protecting these surfaces with
disposable barriers might be a preferred alternative. 
 ENVIRONMENTAL INFECTION PREVENTION AND
CONTROL
 Policies and procedures for routine cleaning and disinfection of environmental surfaces should be included as part of the infection
prevention plan. Cleaning removes large numbers of microorganisms from surfaces and should always precede disinfection.
Disinfection is generally a less lethal process of microbial inactivation (compared with sterilization) that eliminates virtually all
recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial spores).
 Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated with pathogens,
including clinical contact surfaces (e.g., frequently touched surfaces such as light handles, bracket trays, switches on dental units,
computer equipment) in the patient-care area. When these surfaces are touched, microorganisms can be transferred to other
surfaces, instruments or to the nose, mouth, or eyes of DHCP or patients. Although hand hygiene is the key to minimizing the
spread of microorganisms, clinical contact surfaces should be barrier protected or cleaned and disinfected between patients. EPA-
registered hospital disinfectants or detergents / disinfectants with label claims for use in health care settings should be used for
disinfection. Disinfectant products should not be used as cleaners unless the label indicates the product is suitable for such use.
DHCP should follow manufacturer recommendations for use of products selected for cleaning and disinfection (e.g., amount,
dilution, contact time, safe use, and disposal). Facility policies and procedures should also address prompt and appropriate
cleaning and decontamination of spills of blood or other potentially infectious materials. Housekeeping surfaces, (e.g., floors,
walls, sinks) carry less risk of disease transmission than clinical contact surfaces and can be cleaned with soap and water or
cleaned and disinfected if visibly contaminated with blood.
 Key Recommendations for ENVIRONMENTAL INFECTION
PREVENTION AND CONTROL in Dental Settings
1. Establish policies and procedures for routine cleaning and disinfection of environmental surfaces in
dental health care settings.
 a. Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean
(e.g., switches on dental chairs, computer equipment) and change surface barriers between patients.
 b. Clean and disinfect clinical contact surfaces that are not barrier-protected with an EPA-registered
hospital disinfectant after each patient. Use an intermediate-level disinfectant (i.e., tuberculocidal claim)
if visibly contaminated with blood.
2. Select EPA-registered disinfectants or detergents / disinfectants with label claims for use in health care
settings.
3. Follow manufacturer instructions for use of cleaners and EPA-registered disinfectants (e.g., amount,
dilution, contact time, safe use, disposal).
 TRANSMISSION-BASED PRECAUTIONS ARE USED IN ADDITION TO STANDARD
PRECAUTIONS FOR CLIENTS WITH KNOWN OR SUSPECTED INFECTIONS THAT
ARE SPREAD

 ALONE OR IN COMBINATION BUT ALWAYS IN ADDITION TO STANDARD

PRECAUTIONS. 

 THERE ARE THREE CATEGORIES OF TRANSMISSION-BASED PRECAUTIONS:

1. CONTACT PRECAUTIONS
2. DROPLET PRECAUTIONS
3. AIRBORNE PRECAUTIONS

TRANSMISSION-BASED PRECAUTIONS 
CONTACT PRECAUTIONS 
 Contact Precautions are intended to prevent transmission of infectious agents which are
spread by direct or indirect contact with the patient or the patient’s environment as described. 
 Contact Precautions also apply where the presence of or other discharges from the body 
 A single-patient room is preferred for patients who require Contact Precautions.\
 In multi-patient rooms, ≥3 feet spatial separation between beds is advised 
 Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for
all interactions
 Donning PPE upon room entry and discarding before exiting the patient room 
CONTACT PRECAUTIONS
Don Medical Gloves/Gown With Every Contact Precaution Session 
 Don: Diarrhea Infections 

 Medical: Mediation Resistant Organisms

 Gloves/Gown: PPE you must always wear at all times 

 With: Wound Infections 

 Every: Eye infections 

 Contact: type of isolation precaution 

 Precaution: Pulmonary infections 

 Session: Skin infections 
  Droplet Precautions are intended to prevent transmission of
pathogens spread through close respiratory or mucous membrane
contact with respiratory secretions.
 These pathogens do not remain infectious over long distances in a
healthcare facility, special air handling and ventilation are not
required to prevent droplet transmission.
DROPLET  Infectious agents for which Droplet Precautions include B.
PRECAUTIONS pertussis, influenza virus, adenovirus, rhinovirus, N. meningitides,
and group A streptococcus (for the first 24 hours of antimicrobial
therapy).
 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).
DROPLET PRECAUTIONS

 Spatial separation of ≥3 feet and drawing the curtain

between patient beds is especially important for patients in
multi-bed rooms with infections transmitted by the droplet
route. 
 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.
AIRBORNE PRECAUTIONS 
 Airborne Precautions prevent transmission of infectious agents that remain infectious
over long distances when suspended in the air 
 The preferred placement for patients who require Airborne Precautions is in an
airborne infection isolation room (AIIR). 
 This special room will keep the pressure lower in the patient’s room than the outside
areas. 
AIRBORNE PRECAUTIONS 
Ø In settings where Airborne Precautions cannot be implemented, masking the patient,
placing the patient in a private room with the door closed, and providing N95
or higher level respirators or masks for healthcare personnel 
Ø Keep room door closed at ALL TIMES! 
Ø Limit transport unless necessary 
SYNDROMIC AND EMPIRIC APPLICATIONS OF
TRANSMISSION-BASED PRECAUTIONS 
 Diagnosis of many infections requires laboratory confirmation. Since laboratory tests,
especially those that depend on culture techniques, often require two or more days for
completion, Transmission-Based Precautions must be implemented while test results are
pending based on the clinical presentation and likely pathogens. Use of appropriate
Transmission-Based Precautions at the time a patient develops symptoms or signs of
transmissible infection, or arrives at a healthcare facility for care, reduces transmission
opportunities. While it is not possible to identify prospectively all patients needing
Transmission-Based Precautions, certain clinical syndromes and conditions carry a
sufficiently high risk to warrant their use empirically while confirmatory tests are pending. 
APPLICATION OF TRANSMISSION-BASED PRECAUTIONS
IN AMBULATORY AND HOME CARE SETTINGS 
 Although Transmission-Based Precautions generally apply in all healthcare settings,
exceptions exist. For example, in home care, AIIRs are not available. Furthermore, family
members already exposed to diseases such as varicella and tuberculosis would not use masks
or respiratory protection, but visiting HCWs would need to use such protection. Similarly,
management of patients colonized or infected with MDROs may necessitate Contact
Precautions in acute care hospitals and in some LTCFs when there is continued transmission,
but the risk of transmission in ambulatory care and home care, has not been defined.
Consistent use of Standard Precautions may suffice in these settings, but more information is
needed. 
PROTECTIVE ENVIRONMENT
 designed to protect a high-risk immunocompromised patient from human and environmental airborne pathogens. 

 positive pressure rooms intended to keep patients safe during recovery from cancer treatment or stem-cell transplant. 

 High-efficiency Particulate Absorbing (HEPA) filtration of incoming air: - directed room air flow;

 positive room air pressure relative to the corridor; 

 well-sealed rooms (including sealed walls, floors, ceilings, windows, electrical outlets) to prevent flow of air from the
outside; 
 ventilation to provide ≥12 air changes per hour; 

 strategies to minimize dust; and 

 prohibiting dried and fresh flowers and potted plants.