University Malaya Medical Centre
The U.S. Centres for Disease Control and Prevention (CDC) adopted Universal Precautions in 1985 mainly due to the HIV/AIDS epidemic and an urgent need for new strategies to protect hospital personnel from blood-borne infections. Universal precautions applied to blood, body fluids that had been implicated in the transmission of blood-borne infections (semen and vaginal secretions), body fluids from which the risk of transmission was unknown (amniotic, cerebrospinal, pericardial, peritoneal, pleural and synovial fluids) and to any other body fluid visibly contaminated with blood. Universal Precautions did not apply to faeces, nasal secretions, sputum, sweat, tears, urine or vomitus unless they contained visible blood.
The principle was applied universally to all patients regardless of their infectious status or perceived risk. However, it was perceived that the term "Universal Precautions" was ambiguous, resulting in some confusion in its interpretation and false sense of security in its application. There was concern that the use of gloves was considered to be a substitute for hand washing and that this perception could increase the risk of nosocomial transmission of infection.
In 1995, CDC adopted the term "Standard Precautions as the basic risk minimisation strategy with "Additional Precautions" where Standard Precautions may be insufficient to prevent transmission of infection, particularly by the airborne route.
Standard Precautions are work practices required for the basic level of infection control and are recommended for the treatment and care of all patients in hospitals, regardless of their diagnosis or presumed infection status and in the handling of:
- all other body fluids, secretions and excretions (excluding sweat), regardless of whether they contain visible blood
- non-intact skin
- mucous membranes
- dried blood and other body substances including saliva
RECOMMENDATIONS FOR STANDARD PRECAUTIONS ARE:
Wash hands promptly after touching infective material (blood, body fluids, secretions or excretions), infected patients or their immediate environment and contaminated articles used for patient care even when gloves are used.
Wear gloves when touching blood, body fluids, secretions, excretions, contaminated items and even before touching non-intact skin and mucous membranes. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of micro-organisms. Wash hands immediately after removing gloves.
3. ASEPTIC TECHNIQUE
Practise aseptic technique for all invasive procedures.
4. MASK, EYE PROTECTION, FACE SHIELD
Wear mask, eye goggles or a face shield to protect mucous membranes of the eyes, nose and mouth during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions.
5. GOWNS AND APRONS
Wear gowns or plastic aprons whenever contamination of clothing with blood or body fluid is anticipated.
6. PATIENT-CARE EQUIPMENT, SUPPLIES AND LINEN
Ensure that patient care equipment, supplies and linen contaminated with infective material are disinfected or sterilised between each patient use.
7. ENVIRONMENTAL CONTROL
Ensure that the hospital has adequate procedures for cleaning and disinfection of environmental surfaces, beds, bedrails, bedside equipment and other frequently touched surfaces and ensure that these procedures are being followed.
Spillages of blood and body fluids should be dealt with as quickly as possible. They should be treated with chlorine granules (e.g. Presept) or Sodium hypoclorite 1% and left for two minutes. Then, wearing gloves and apron, the spillages should be removed with disposable wipes/absorbent paper and disposed of as clinical waste and the area washed over with detergent and water.
8. OCCUPATIONAL HEALTH AND BLOODBORNE PATHOGENS
Take care to prevent injuries when using needles, scalpels and other sharp instruments or devices, when handling sharp instruments after procedures, when cleaning used instruments and when disposing of used needles.
Never recap, bend or break used needles by hand. Discard used needles, scalpel blades
and other sharps into puncture-resistant containers. Never fill the sharps bin more than
three quarters full and ensure that it is securely closed before disposal.
9. PATIENT PLACEMENT
Place a patient who contaminates the environment or who does not (or cannot be
expected to) assist in maintaining appropriate hygiene or environmental control in a
10 EXCRETA AND WASTE
Excreta should be discarded directly into the toilet. Waste contaminated with blood or
body fluid should be discarded into designated blood (colour coded) bags for incineration
ensuring that no fluid leaks from the bag.
Standard Precautions are essential because:
- Infectious patients may not manifest any signs or symptoms of infections that would be detected in the course of routine history and medical assessment;
- Infectious status is often determined only by laboratory tests that cannot be completed in time to provide emergency care
- Patients may be infectious before laboratory tests are positive or signs of disease are manifested (window period); or
- HCWs and patients may be placed at risk of cross infection from those who are asymptomatic but infectious.
Julia S. Garner, Guidelines for Isolation Precautions in Hospitals, Infection Control and Hospital Epidemiology, Jan. 1996.
National Health and Medical Research Council and the Australian National Council on AIDS, Infection Control in the Healthcare Setting, Guidelines for the Prevention of Infectious Diseases, April 1996
Members of the International Federation of Infection Control Education Working Group, Education Programme for Infection Control Basic Concepts and Training 1995
Infection Watch is aimed at stimulating discussion between hospital doctors and microbiologists. Comments are invited. For this issue, please direct them to Sr Habibah A. Molok, Infection Control Unit, University Hospital, Kuala Lumpur. Tel:7502576 or 7502012.
Back to Vads Corner
Back to Cybermed Articles