Infection Prevention and Control Precautions
Standard Precautions represent the minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These evidence-based practices are designed to both protect and prevent spread of infection among patients and healthcare personnel.
Standard Precautions comprise the following measures:-
- Hand Hygiene
- Respiratory Hygiene (Cough Etiquette)
- Personal Protective Equipment (PPE)
- Aseptic Technique
- Needle-stick and Sharps Injury Prevention
- Cleaning and Disinfection
- Waste Disposal
Respiratory Hygiene (Cough Etiquette)
To minimise the risk of transmission of infection to others, everyone entering, visiting or working within a Health Organisation presenting with the signs and symptoms of respiratory infection should practise respiratory hygiene and cough etiquette. A Health Organisation should encourage and enable patients, visitors and Health Workers to perform respiratory hygiene and cough etiquette and provide appropriate resources to support these behaviours.
The following measures to contain respiratory secretions are recommended for all individuals;
- Cover your mouth and nose with a tissue when coughing or sneezing;
- If you don't have a tissue, cough or sneeze into your elbow;
- Use the nearest waste receptacle to dispose of the tissue after use;
- Perform hand hygiene (e.g. hand washing with soap and water, alcohol-based hand rub, or antiseptic hand wash) after having contact with respiratory secretions and contaminated objects/materials.
Healthcare facilities should ensure the availability of materials for adhering to Respiratory Hygiene/Cough Etiquette in waiting areas for patients and visitors.
- Provide tissues and no-touch receptacles for used tissue disposal.
- Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e. soap, disposable towels) are consistently available.
Personal Protective Equipment (PPE)
Appropriate PPE should be selected to prevent contamination of skin and/or clothing. Selections should be guided by the anticipated type and amount of exposure to blood and body substances and the likely transmission route of microorganisms. Further information is available at ACSQHC.
When you are selecting PPE, consider three key things;
- First is the type of anticipated exposure. This is determined by the type of activity, such as touch, splashes or sprays, or large volumes of blood or body substance that might penetrate the clothing. PPE selection, in particular the combination of PPE, also is determined by the category of isolation precautions a patient is on.
- Second is the durability and appropriateness of the PPE for the task. This will affect, for example, whether a gown or apron is selected for PPE, or, if a gown is selected, whether it needs to be fluid resistant, fluid proof, or neither.
- Third is fit. PPE must fit the individual user, and it is up to the employer to ensure that all PPE are available in sizes appropriate for the workforce that must be protected.
Aseptic technique is a set of practices aimed at minimising contamination and is used to protect the patient from infection during procedures. Sterile single-use equipment or instruments must be used according to manufacturer's instructions and in such a way that the sterility of the item is maintained. Asepsis can be explained in different levels;
Standard Aseptic technique and Medical Asepsis
Reducing pathological organisms by using non-touch technique (clean technique)
Exclusion of all microorganisms
Standard aseptic fields that promote asepsis are used when;
- Key parts are easily protected by critical micro aseptic fields [AL1] and non-touch technique e.g. protection of key parts by the use of syringe caps, sheathed needles, covers or packaging
Asepsis of the immediate procedure environment is therefore promoted by general aseptic field management.
Critical aseptic fields are used when;
- Key parts/sites are large or numerous and can’t be easily protected by covers or caps or can’t be handled with a non-touch technique
- Invasive procedures require a large aseptic working area
Management of the critical aseptic field requires sterilized equipment to be placed in the aseptic field; sterile gloves are required to maintain asepsis.
Needle-stick and Sharps Injury Prevention
Breaches in safe injection, infusion and medication vial handling practices have resulted in transmission of HIV and viral hepatitis and in some cases caused outbreaks of disease. Standard precautions, particularly aseptic technique, form the basis of safe injection practices.
Cleaning and Disinfection
Reusable equipment used in the assessment and delivery of patient care must be reprocessed between patients according to the intended use and following manufacturers recommendations, national and international standards.
The Spaulding classification system categorises medical equipment and devices according to their intended use and the subsequent level of reprocessing required to render them safe for reuse.
Reprocessing begins with processing at the point of use i.e., close proximity to the point of use of the device to facilitate subsequent cleaning steps. The point-of-use processing, includes prompt, initial cleaning steps and/or measures to prevent drying of soil and contaminants in and on the device followed by disinfection or sterilization.
Proper containment of waste can minimise the transmission of infection. Waste must be placed in appropriate containers at the point-of-care/use and stored in a designated enclosed room with access limited to authorised staff. Follow the NSW Health Clinical and Related Waste Management for Health Services Policy Directive.