Standard precautions

Infectious diseases are not just a problem out in the general community, but also in healthcare settings such as hospitals.

Healthcare associated infections (HAIs)

Healthcare associated infections (HAIs) are infections that are acquired in healthcare settings. HAIs are the most frequent adverse event in healthcare and according to the World Health Organization, affect at least 10% of patients globally (WHO, 2011). HAIs result in increased illness, length of hospital stay, antimicrobial resistance, financial costs for the healthcare facility and the patient, as well as mortality.

In order to protect themselves and their patients from HAIs, health personnel in healthcare facilities must always adhere to standard precautions. Standard precautions are the basic IPC practices that should be applied to every patient, every procedure, and any place in order to break the chain of infection.

Hand Hygiene

Hand hygiene is perhaps the most fundamental element of infection prevention and control. We use our hands for everything, and so they come into contact with everything. Hand hygiene involves hand washing, either with soap and water or decontamination with alcohol based hand sanitiser (ABHS). Soap and water facilitate the removal of potentially infectious agents, whilst ABHS either kills or inactivates infectious agents. In healthcare, there are “Five Moments of Hand Hygiene” (WHO, 2009), describing when we should perform hand hygiene:

1. Before touching a patient
2. Before clean/aseptic procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings

Essentially the key emphasis is on performing hand hygiene before and after any procedure, as well as before and after each patient consultation or contact with the environment.

Decontaminating the environment

Like our hands, patient surroundings must also be cleaned frequently. Patients may contaminate their surroundings, such as whenever they sneeze, bleed or vomit. Even when just lying in bed, patients may shed potentially infectious pathogens into the environment. For this reason, surfaces that are frequently touched or within close proximity to patients must be cleaned more frequently and thoroughly, and body fluid spills must be cleaned immediately and carefully. Reusable equipment must also be cleaned frequently and thoroughly. There are three ‘levels’ of decontamination with the level required depending on the nature of the use of the equipment. This is known as the Spaulding Classification Scale:

1. Cleaning: The removal of obvious stains such as soil and organic matter. Must always precede further cleansing, as infectious agents can reside within the stain subsequently protected from further levels of cleaning.
2. Disinfection: Inactivation of non-sporing infectious agents either via heat or chemical means.
3. Sterilisation: The destruction of all infectious agents, also via heat or chemical means.

Once the equipment has been appropriately decontaminated, it must be stored appropriately in order to prevent contamination before next use.

Not all equipment is reusable, and must be disposed of appropriately. Waste disposal procedures must be strictly followed, particularly with sharps such as needles. Needles disposed of incorrectly could potentially prick someone, potentially exposing them to blood-borne diseases such as HIV, hepatitis B or hepatitis C. For this reason, anything sharp must be handled with extreme care during use and disposal.

Personal protective equipment

Personal protective equipment (PPE) provides physical barriers to protect the wearer from contact with potential infectious agents. The type of PPE required varies with the situation. For example, where there is a risk of body fluid splash or spray, masks and goggles will be necessary. This is because the eyes, nose and mouth are potential points of entry for infectious agents. PPE used whilst interacting with one patient must be removed carefully before consulting another. This ensures that an infectious agent from one patient cannot be spread to the next. In this way, PPE not only protects the wearer but also others.

Standard precautions such as these are essential in preventing and minimising HAIs. Without them, both patients and healthcare personnel are placed at unnecessary and avoidable risk.

Your Task

Do you think health workers should still take these precautions even when patients are not showing signs or symptoms of infectious disease? Why?

References

World Health Organization (WHO). (2011). Report on the Burden of Endemic Healthcare Associated Infection Worldwide. Retrieved from http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf?ua=1