What are 3 standard precautions you should use when in contact with blood or other body fluids?
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Introduction1. Occupational Health Programme2. Hand Hygiene3. Personal Protective Equipment4. Respiratory Hygiene and Cough Etiquette5. Safe Use and Disposal of Sharps6. Management of a Blood and/or Body Fluid Spillage7. Management of Blood and Body Fluid Exposures8. Management of Laundry & Linen9. Environmental Hygiene10. Client-Care Equipment / Medical Devices11. Resident / Patient Placement, Movement and Transfer12. Safe Injection Practices13. Infection Control Practices for Lumbar PunctureAppendicesAppendix 3.0 Occupational Health Service - An Introduction to the Occupational Health Service (Leaflet)Appendix 3.1 Hand Hygiene using an Alcohol Hand Rub (Poster)Appendix 3.2 Hand Hygiene for Healthcare Workers (Poster)Appendix 3.3 Hand Hygiene for Staff (Leaflet)Appendix 3.4 Hand Care for Healthcare Staff (Leaflet)Appendix 3.5 Hand Hygiene for Residents and Visitors (Leaflets)Appendix 3.6 Donning and Removal of Personal Protective Equipment (HPSC)Appendix 3.7 Glove Usage Pyramid (Poster)Appendix 3.8 Respiratory Hygiene and Cough Etiquette (Poster HPSC)Appendix 3.9 Action following Blood and Body Fluid Exposure Poster (HSE South)Appendix 3.10 Safe Injection Practices (HPSC)Continuing Education ActivityUniversal precautions were introduced by the Centers for Disease Control (CDC) in 1985, mostly in response to the human immunodeficiency virus (HIV) epidemic. Universal precautions are a standard set of guidelines to prevent the transmission of bloodborne pathogens from exposure to blood and other potentially infectious materials (OPIM). This activity reviews universal precautions and highlights the role of the interprofessional team in their application. Objectives:
Access free multiple choice questions on this topic. IntroductionUniversal precautions were introduced by the Centers for Disease Control (CDC) in 1985, mostly in response to the human immunodeficiency virus (HIV) epidemic.[1][2][3] Universal precautions are a standard set of guidelines to prevent the transmission of bloodborne pathogens from exposure to blood and other potentially infectious materials (OPIM). OPIM is defined by the Occupational Safety and Health Administration (OSHA) as:
Universal precautions do not apply to sputum, feces, sweat, vomit, tears, urine, or nasal secretions unless they are visibly contaminated with blood because their transmission of Hepatitis B or HIV is extremely low or non-existent. In 1987, the CDC introduced another set of guidelines termed Body Substance Isolation. These guidelines advocated avoiding direct physical contact with “all moist and potentially infectious body substances,” even if blood is not visible. A limitation of this guideline was that it emphasized handwashing after removing gloves only if the hands were visibly soiled. In 1996, the CDC Guideline for Isolation Precautions in Hospitals, prepared by the Healthcare Infection Control Practices Advisory Committee (HICPAC), combined the major features for Universal Precaution and Body Substance Isolation into what is now referred to as Standard Precautions. These guidelines also introduced three transmission-based precautions: airborne, droplet, and contact. All transmission-based precautions are to be used in conjunction with standard precautions.[4][5][6] FunctionStandard Precautions Standard precautions apply to the care of all patients, irrespective of their disease state. These precautions apply when there is a risk of potential exposure to (1) blood; (2) all body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood; (3) non-intact skin, and (4) mucous membranes. This includes hand hygiene and personal protective equipment (PPE), with hand hygiene being the single most important means to prevent transmission of disease.[7][8][9][10] Personal protective equipment serves as a barrier to protect the skin, mucous membranes, airway, and clothing. It includes gowns, gloves, masks, and face shields or goggles. The following list of standard precautions is not all-inclusive and contains some of the most commonly used recommendations for healthcare workers. Hand Hygiene Handwashing with soap and water for at least 40 to 60 seconds, making sure not to use clean hands to turn off the faucet, must be performed if hands are visibly soiled, after using the restroom, or if potential exposure to spore-forming organisms. Hand rubbing with alcohol applied generously to cover hands completely should be performed, and hands rubbed until dry. Hand Hygiene Indications
Gloves Must be worn when touching blood, body fluids, secretions, excretions, mucous membranes, or non-intact skin. Change when there is contact with potentially infected material in the same patient to avoid cross-contamination. Remove before touching surfaces and clean items. Wearing gloves does not mitigate the need for proper hand hygiene. Mask, Goggles/Eye Visor, and/or Face Shield Wear a mask and eye protection or face shield during procedures that may spray or splash blood, body fluids, secretions, or excretions. Gown Wear to protect skin or clothing during procedures that may spray or splash blood, body fluids, secretions, or excretions. Needles and Other Sharps Do not break, bow, or directly manipulate used needles. Recapping is not recommended, but if necessary, “use a one-handed scoop technique only.” Discard all used sharps in appropriate puncture-resistant containers. Transmission-based Precautions Airborne Precautions These precautions are used in patients with known or suspected infection with pathogens that are spread by airborne transmission, i.e., “airborne droplet nuclei (small-particle residue {5 um or smaller in size} of evaporated droplets that may remain suspended in the air for long periods of time) or dust particles containing the infectious agent.” Patient Placement Patients should be placed in a negative pressure isolation room that allows a minimum of 6 to 12 air changes per hour. For patients with active infection with the same pathogen and no other infection, it is permissible to place patients in the same room together (cohorting). Doors to the room must remain closed at all times. “When a private room is not available, and cohorting is not desirable, consultation with infection control professionals is advised before patient placement.” PPE Respirators that filter at least 95% of airborne particles must be worn over the nose and mouth, i.e., N95 respirator or powered air-purifying respirator (PAPR) with a high-efficiency particular air (HEPA) filter. Transport When necessary, patients being transported out of their rooms should wear a surgical mask. Droplet Precautions These precautions are used in patients with known or suspected infection with pathogens spread by droplet transmission. “Droplets are particles of respiratory secretions +/- 5 microns. Droplets remain suspended in the air for limited time periods. Transmission is associated with exposure within three to six feet (one to two meters) of the source.” Patient Placement Private rooms are preferred; however, they may be placed in a semi-private room with another patient having the same active infection and no other infection (cohorting). When a private room or cohorting is not available, the infected patient should be placed at least 3 feet away from other patients and visitors. The doors to the room may be left open, and no special air handling is required. PPE Surgical masks should be worn while within 6 feet of the patient. Transport When necessary, patients being transported out of their rooms should wear a surgical mask. Contact Precautions These precautions are used in patients with known or suspected infection or colonization with pathogens spread by direct and indirect patient contact. Indirect patient contact occurs when physical contact is made with items or surfaces in the patient’s environment. Patient Placement Private rooms are preferred; however, they may be placed in a semi-private room with another patient having the same active infection and no other infection (cohorting). “When a private room is not available, and cohorting is not achievable, consider the epidemiology of the microorganism and the patient population when determining patient placement. Consultation with infection control professionals is advised before patient placement.” PPE Gloves and gowns should be donned before entering the patient's room and removed before leaving. Hand hygiene should be performed immediately afterward. Care should be taken not to touch any potentially contaminated surface upon leaving the room.[11][12] Transport Maintain contact precautions at all times. Patient Equipment When possible, patients should have dedicated equipment that remains in the room with them, e.g., a single-patient-use blood pressure cuff. If single-patient-use items are not available, they should be cleaned and disinfected before use on another patient. Issues of ConcernAirborne precautions should be used for the following infections and conditions for the minimum duration listed:
Droplet precautions should be used for the following infections and conditions for the duration listed:[13]
Contact precautions should be used for the following infections and conditions for the duration listed:
Clinical SignificanceOccupational exposure to blood and other potentially infectious materials (OPIM) is of such great concern that multiple government agencies have instituted guidelines and regulations regarding universal precautions. Knowledge and implementation of standard precautions are vital to limiting the spread of infectious diseases.[14][15] Their use requires the healthcare provider to be proactive in anticipating the types of exposure they may encounter with each patient, e.g., a trauma patient with arterial bleeding would require donning gloves, a mask with a face shield, and a gown. Regarding transmission-based precautions, the healthcare provider should be aware that some diseases require more than one type of transmission-based precautions, e.g., disseminated herpes zoster requires contact, airborne, and standard precautions. Other IssuesProper Donning and Removal of PPE Donning of PPE The CDC recommends that PPE be donned in the following sequence: (1) gown, (2) mask or respirator, (3) goggles or face shield, and (4) gloves. Removal of PPE The safe removal of PPE also follows a specific sequence that requires special attention to areas that are now considered contaminated: (1) gloves should be removed by first grasping the palm of the other hand and peeling off the first glove, keep hold of the removed glove in the gloved hand, slide the fingers of the ungloved hand under the remaining glove and peel it off over the first glove, (2) goggles or face shield should be removed by lifting from behind the head, (3) gowns should be untied and removed by pulling away from the neck and shoulders, turning the gown inside out and only touching the inside, (4) mask or respirator should be removed by reaching behind the head and grasping the bottom ties then the top ties and removing without touching the front. Alternatively, the gloves and gown may be removed at the same time by grasping the gown from the front and pulling away from the body, rolling the gown into a bundle, and removing the gloves at the same time using the inside of the gown. Hand hygiene should be performed after removal of all PPE and anytime during removal if they become contaminated. Enhancing Healthcare Team OutcomesAll healthcare workers, including nurse practitioners, are responsible for the prevention of infectious disorders. In 1996, the CDC Guideline for Isolation Precautions in Hospitals, prepared by the Healthcare Infection Control Practices Advisory Committee (HICPAC), combined the major features for Universal Precaution and Body Substance Isolation into what is now referred to as Standard Precautions. These guidelines also introduced three transmission-based precautions: airborne, droplet, and contact. All transmission-based precautions are to be used in conjunction with standard precautions. Every hospital has an interprofessional team that ensures proper adoption of the universal guidelines. Audits should randomly be performed, and healthcare workers who do not follow the guidelines should be reprimanded and sent for remedial education on infection prevention.[16][17] Review QuestionsReferences1.Yasin J, Fisseha R, Mekonnen F, Yirdaw K. Occupational exposure to blood and body fluids and associated factors among health care workers at the University of Gondar Hospital, Northwest Ethiopia. Environ Health Prev Med. 2019 Mar 09;24(1):18. [PMC free article: PMC6408855] [PubMed: 30851726] 2.Larson C, Oronsky B, Varner G, Caroen S, Burbano E, Insel E, Hedjran F, Carter CA, Reid TR. A practical guide to the handling and administration of personalized transcriptionally attenuated oncolytic adenoviruses (PTAVs). Oncoimmunology. 2018;7(9):e1478648. [PMC free article: PMC6140583] [PubMed: 30228948] 3.Brooks C, Ballinger C, Nutbeam D, Mander C, Adams J. Nursing and allied health professionals' views about using health literacy screening tools and a universal precautions approach to communication with older adults: a qualitative study. Disabil Rehabil. 2020 Jun;42(13):1819-1825. [PubMed: 30669896] 4.King KC, Strony R. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 11, 2021. Needlestick. [PubMed: 29630199] 5.Centers for Disease Control and Prevention. Ebola Virus Disease. Resources and Guidance from the CDC. Insight. 2015 Winter;40(1):11-8. [PubMed: 26364436] 6.Goodman MS, Griffey RT, Carpenter CR, Blanchard M, Kaphingst KA. Do Subjective Measures Improve the Ability to Identify Limited Health Literacy in a Clinical Setting? J Am Board Fam Med. 2015 Sep-Oct;28(5):584-94. [PMC free article: PMC4987705] [PubMed: 26355130] 7.Ndu AC, Arinze-Onyia SU. Standard precaution knowledge and adherence: Do Doctors differ from Medical Laboratory Scientists? Malawi Med J. 2017 Dec;29(4):294-300. 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[PubMed: 18399366] 13.Moriceau G, Gagneux-Brunon A, Gagnaire J, Mariat C, Lucht F, Berthelot P, Botelho-Nevers E. Preventing healthcare-associated infections: Residents and attending physicians need better training in advanced isolation precautions. Med Mal Infect. 2016 Feb;46(1):14-9. [PubMed: 26654322] 14.Porto JS, Marziale MH. Reasons and consequences of low adherence to standard precautions by the nursing team. Rev Gaucha Enferm. 2016 Jun;37(2):e57395. [PubMed: 27253597] 15.Ritchie L, McIntyre J. Standardising infection control precautions. Nurs Times. 2015 Sep 16-22;111(38):17-20. [PubMed: 26513984] 16.What is the bloodborne pathogens standard? HDA Now. 2013 Winter;:20. [PubMed: 23556281] 17.Peponis T, Cropano MC, Larentzakis A, van der Wilden MG, Mejaddam YA, Sideris CA, Michailidou M, Fikry K, Bramos A, Janjua S, Chang Y, King DR. Trauma team utilization of universal precautions: if you see something, say something. Eur J Trauma Emerg Surg. 2017 Feb;43(1):145-150. [PubMed: 27084540] What are 3 universal precautions when dealing with body fluids?Universal precautions include vigorously washing hands before and after exposure to blood and other body fluids. Healthcare providers should also always wear gloves, masks, goggles, other personal protective equipment (PPE) and use work practice controls to limit exposure to potential bloodborne pathogens.
What are standard precautions for blood and body fluids?Blood and body fluid precautions involve the use of protective barriers such as gloves, gowns, masks, and eye protection. These reduce the risk of exposing the skin or mucous membranes to potentially infectious fluids.
What are the three 3 types of additional precautions?Types of Additional Precautions. There are three categories of additional precautions: contact precautions, droplet precautions, and airborne precautions.
What are some universal precautions in the handling of blood or blood soiled by products?Universal precautions include:
Using disposable gloves and other protective barriers while examining all patients and while handling needles, scalpels, and other sharp instruments. Washing hands and other skin surfaces that are contaminated with blood or body fluids immediately after a procedure or examination.
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