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
 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
 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)
Standard precautions Transmission-based precautions

• Universal precautions
•Airborne precautions
• Body substance isolation
•Droplet precautions

•Contact precaution
 Key Elements of Standard Precautions

1. Hand hygiene
2. Gloves
3. Mask, gogles, face masks PPE
4. Gown
5. Prevention of needle stick & injuries from sharp instruments
6. Respiratory hygiene & cough etiquette
7. Environmental cleaning
8. Linens
9. Waste disposal
10. Patient care equipment
WHO, 2007
 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

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
“My five moments for hand hygiene”
 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
 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 should be used during patient care activities that are
goggles or a likely to generate splashes and sprays of blood, body
face shield fluids, secretions, or excretions.
Precaution for suspected Avian
Influenza :
Full Barrier Precaution
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

 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.
 Droplet Transmission
• For infectious agents with droplet nuclei >
5 microns
• Examples:
– Pertussis
– Meningococcal meningitis
• Precaution Examples:
– Private room
– Mask if within 3’ of patient
 Droplet Precautions
• Prevent infection by
large droplets from
– Sneezing
– Coughing
– Talking

• Examples
– Neisseria meningitidis
– Pertussis
– Influenza
 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
 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
 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.
 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.
 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.
 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