The Infection Control Manual
Document: IC_PP 02.2.00
Standard Precautions
Policy
Standard Precautions are the primary strategy for prevention and control of healthcare-associated infection and are followed in the care of ALL patients in the hospital regardless of their diagnosis or presumed infection status.
Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in health care facilities. Standard Precautions apply to: Blood All body fluids, secretions, and excretions except sweat and tears Non-intact skin Mucous membranes
Responsibilities
CH Employees/Staff Supervisor/ Department Management Infection Control Department Must follow the requirements of Standard Precautions. Ensures implementation of Standard Precautions and employee knowledge and compliance. Assures adequate supply of personal protective equipment (PPE) Educates staff on Standard Precautions policy. Serves as a resource for questions. Provides consultation regarding personal protective equipment, patient placement, and implementation of Standard Precautions. Occupational Health Serves as a resource for questions. Provides education to new employees on Standard Precautions policy during pre-placement screening.
Procedures
Hand Hygiene
Performing hand hygiene is the single most important measure to reduce the risk of transmitting microorganisms from one person to another or from one site to another on the same patient. Refer to Section 2.02.01 Hand Hygiene for more detailed information.
Childrens Hospital, Boston, 2007. All rights reserved. Publication Date 08/05/07
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Infection Control Policy and Procedure Manual Document: IC_PP 02.2.00
Personal Protective Equipment (PPE)
Gloves
Gloves are worn for two important reasons in the healthcare environment: 1. To protect healthcare workers by providing a barrier to prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, nonintact skin and contaminated equipment/devices; To protect the patient by reducing the likelihood that microorganisms present on the hands of personnel will be transmitted to patients in the course of their care.
2.
Wear clean gloves when
Touching blood, body fluids, secretions, excretions, nonintact skin, and mucous membranes Performing invasive procedures, including venipuncture Touching objects or surfaces contaminated with blood, body fluids, secretions, or excretions
Change gloves and treat hands between tasks and procedures on the same patient after contact with material that may contain an increased concentration of organisms (such as stool). Remove gloves promptly after use. Perform hand hygiene immediately after removing gloves to avoid transfer of organisms.
Gown
Wear a clean, non-sterile yellow precaution gown to protect skin and to prevent soiling of clothing during activities that may generate splashes or sprays of blood or body fluids. Remove the soiled gown promptly after use and wash hands. Gowns should not be reused.
Face Protection
Wear a mask in combination with eye protection, or a face shield to protect mucous membranes of the eyes, nose, or mouth during activities that may generate splashes or sprays of blood and or body fluids. Remove soiled face protection promptly after use and wash hands. Personal eyeglasses are not considered to be adequate eye protection unless fitted with side shields.
Other Protective Apparel
Surgical caps or hoods and shoe covers are required when gross contamination of the head and/or feet can be reasonably anticipated, such as in the Operating Room.
Emergency Ventilation Devices
Use mouthpieces or resuscitation bags as an alternative to mouth-to-mouth resuscitation.
Childrens Hospital, Boston, 2007. All rights reserved. Publication Date 08/05/07
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Nursing Policy and Procedure Manual Document: IC_PP 02.2.00
Environmental Control
Linen
Clean linen must be covered during transport and stored in a designated area. All used linen is considered potentially infectious and therefore managed in a manner that prevents skin or mucous membrane exposure, contamination of clothing, and transfer of microorganisms to other patients or environments. It is placed in plastic bags designated for soiled linen.
Dishes, Glasses, Cups and Eating Utensils
Disposable dietary trays are not required for infection control. The use of regular dishes and silverware poses no risk for transmission of microorganisms given current dishwashing practices. The combination of hot water and detergents used in dishwashers within health care facilities is sufficient to decontaminate dishes, glasses, cups, and eating utensils.
Safe Handling and Disposal of Sharps
To prevent injuries, use extreme caution when handling needles, scalpels, and other sharp instruments or devices.
Use available safety devices (e.g., sheathed or protected needles, needleless devices) appropriately to prevent accidental needlesticks or punctures. DO NOT RECAP used needles or otherwise manipulate them using both hands. If recapping is absolutely necessary, use either a one-handed scoop technique or a mechanical device designed for holding the needle sheath. Do not remove used needles from disposable syringes by hand. Do not bend, break, or otherwise manipulate used needles by hand. Place disposable syringes and needles, scalpel blades, and other sharp items promptly in appropriate puncture-resistant containers.
Routine and Terminal Cleaning
Routine cleaning and disinfecting procedures are the same for all patient rooms, regardless of patients precaution status. All horizontal surfaces, including bedside equipment (bed rails, bedside tables, carts, commodes, faucet handles, etc.) are cleaned and disinfected with a hospital-approved detergent/disinfectant at least daily and whenever visibly soiled. Walls, blinds, ceilings, and curtains are cleaned according to an established schedule and whenever visibly soiled.
Patient Care Equipment and Articles
Reusable patient care items processed by the Central Processing Department (CPD) must be rinsed after use to remove bodily secretions in a designated soiled utility room. Once the equipment has been rinsed, place it in a designated red container for pick-up by CPD. Used equipment in the patients immediate area (i.e., IV poles, monitors, infusion pumps, etc.) is cleaned and disinfected between uses on different patients.
Disposal of Medical Waste
Disposable items must be sorted at the point of generation and placed in the appropriate waste containers to prevent injury or accidental exposure. Refer to the Safety Manual, Hazardous Waste Management Plan Regulated Medical Waste for further information.
Childrens Hospital, Boston, 2007 All rights reserved Publication Date 08/05/07
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Infection Control Policy and Procedure Manual Document: IC_PP 02.2.00
Emergency Spill Management
Blood and body fluid spills should be cleaned up immediately using appropriate personal protective equipment and disinfectant. Refer to Infection Control Policy: Management of Blood and Body Fluid Spills in this manual and the Emergency Spill Response Chart reference tool for further information.
Patient Room Assignment and Roommate Selection
Attention to patient placement and roommate selection is an important part of physician and nursing management in infection control. When two or more patients are infected or colonized with the same infectious agent (ex. RSV, rotavirus), cohorting (grouping of patients) may be appropriate. (Refer to Patient Cohorting Guidelines below). The decision to cohort does not negate the need for ongoing assessment of signs and symptoms of infectious diseases that may necessitate reevaluation of patient placement. Careful, appropriate application of strategies for prevention of transmission of infection (i.e., use of gowns, gloves, and hand hygiene) should eliminate risk for a roommate. However, consideration of other special risk factors should be included in the decision making process for roommate selection. Patient age, mobility, ability to practice good hygiene and to contain and control secretions and excretions should all be considered in roommate selection. For example, a mobile toddler with a communicable illness such as RSV is not an appropriate roommate for an uninfected baby. Examples of roommate pairings that should be avoided are listed at the end of this section.
Patient Cohorting Guidelines
Guidelines Patients who do not have infections or patients that are not considered infectious are the optimal patients to place together in double/multiple occupancy rooms Examples/Diagnoses Surgical (pre- and post-op) patients who do not have complex underlying disease and are anticipated to have a short stay, seizures unrelated to infection, or infections/conditions requiring Standard Precautions only. RSV, rotavirus, influenza, parainfluenza
Patients with the same infectious disease who have had a laboratory test result that confirms that they have the same agent causing their infection may be placed in the same room. One may place potentially infectious patients together based upon clinical diagnosis. Health care workers should then treat the two patients with the appropriate precautions (i.e., contact), and not assume that the patients being cohorted are infected with the same pathogen. Private room placement of a patient who is either colonized or infected with multi-drug resistant organisms is optimal. If this is not feasible, consult with Infection Control. Patients who are immunocompromised should have roommate selection based on evidence of
Patients with bronchiolitis or young infants (<2 months of age) with R/O sepsis
VRE, MRSA, Burkholderia cepacia complex in patients with CF Hem/Onc, HIV, congenital immune deficiency
Childrens Hospital, Boston, 2007. All rights reserved. Publication Date 08/05/07
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communicable illness and common factors. Patients who should not be roomed together except under extraordinary circumstances:
A patient with chronic cardiac disease should never be in the same room with a patient infected with RSV. A mobile toddler with either GI or upper respiratory infection (e.g., rotavirus, RSV bronchiolitis, croup, etc.) should not be roomed with an uninfected baby under 12 months of age. An uninfected baby under 6 months of age should not be roomed with any patient with either GI or upper respiratory infection. An immunocompromised patient should not be roomed with a patient with evidence of a communicable infection. Patients with cystic fibrosis should not be roommates unless they live in the same household.
Bibliography
Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. AM J INFECT CONTROL 1996; 24:24-52. CDC. Guidelines for Preventing Health-Care-Associated Pneumonia. MMWR 2004; 53 (No. RR-3).
Related Content
Safety Manual, Hazardous Waste Management Plan Regulated Medical Waste Emergency Spill Response Chart -Administrative and Clinical Area reference tool Emergency Spill Response Chart -Research Emergency Spill Response Chart - Waltham
Document Attributes
Title Author Reviewed/ Revised by Copyright Approved Standard Precautions G. Potter-Bynoe G. Potter-Bynoe Infection Control
Childrens Hospital, Boston, 2007
Signature on File
Date of Origin Dates Reviewed/ Revised Last Modified
02/2000 01/03, 10/04 08/05/07
Donald Goldmann, MD Infection Control Committee, Pulmonary Medicine
Signature on File
Eileen M. Sporing, M.S.N., R.N. Senior Vice President for Patient Care Operations, Chief Nursing Officer
Childrens Hospital, Boston, 2007 All rights reserved Publication Date 08/05/07
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