Infection Prevention and Control

Standard Precautions, Hand Hygiene, &

Use of PPE

Christine Mukashema Infection Prevention and Control Manager,

King Faisal Hospital, Kigali1

Standard Precautions

• Not the same as universal precautions (UP)

• Combine the concepts of UP and body fluids isolation

• Apply to:– Blood – including dried blood– ALL other body fluids, secretions, excretions, EXCEPT sweat– Non-intact skin– Mucous membranes– All patients

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• Represent the “standard of care” required

• Are the first level of precautions

• Reduce the risk of transmission of micro-organisms from both recognised and unrecognised sources

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Standard Precautions

Transmission of infection

Requires 3 elements:

• A source of infecting micro-organisms

• A susceptible host, and

• A means of transmission

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Standard Precautions• Interrupt the means of transmission by providing

a system of barriers to transmission: – Adequate hand hygiene

– Appropriate use of personal protective equipment

– Prevention of needle stick and sharps injuries

– Disinfection of patient care equipment

– Environmental control

– Linen management

– Waste management

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HAND HYGIENE

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Definitions

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Hand hygiene A general term

Hand washing Washing hands with plain soap and water

Hand antisepsis/ disinfection

Any action using an antiseptic agent

Skin Bacteria

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Resident Transient • Normally live on skin• Low pathogenic value• Not usually associated with cross transmission

• Do not normally live on skin• High pathogenic value• Often associated with cross transmission

Types of Hand Washing

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Social Antiseptic/surgical• When hands are visibly dirty• Before eating• Before giving medications• After bedmaking• Before and after significant patient contact

If hands are not visibly dirty alcohol rub can be used

• Before and after duty• Before and after aseptic procedures• Before and after wearing gloves• After handling bedpans and other contaminated articles• Entering and leaving high risk areas

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Other Aspects of Hand Hygiene

• Use of alcohol rubs• Nails• General skin care

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Barriers to Compliance • Inaccessibility of hand hygiene supplies

• Skin irritation from hand hygiene agents

• Intensity of patient care

• Priority of patient care,

• Interference with HWC/pt relationship

• Wearing of gloves

• Forgetfulness

• Lack of knowledge of the guidelines, and

• Lack of information on the importance of hand hygiene. 14

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Hand washing technique audit

Hand washing technique audit

PERSONAL PROTECTIVE EQUIPMENT (PPE)

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PPE- Principles• Assess risk of exposure to blood, body fluids, excretions

or secretions• Choose items of PPE according to risk • Use PPE correctly and effectively• Use PPE at all times where contact with patient’s

blood, body fluids, excretions and secretions may occur• Avoid any contact between used PPE and surfaces,

clothing or people outside the patient care area• Discard used PPE in appropriate disposal container • Do not share PPE • Completely and thoroughly wash hands when ever you

remove PPE 17

PPE - Gloves• All staff must wear non-sterile disposable gloves

whenever there is CONTACT or a REASONABLE ANTICIPATION of contact with blood, body fluids, mucosa, non-intact skin or other potentially infectious material

• Change between tasks on the same patient after contact with infectious material

• Remove immediately after completion of the task for which you are wearing them, BEFORE touching items that are not contaminated

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Wash your hands IMMEDIATELY after removal of gloves

PPE – Gowns/Aprons

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Clean non-sterile gown or apron

whenever contact or protective precautions are required

Plastic apron must be worn instead of a gown

whenever there is REASONABLE ANTICIPATION of procedures likely to generate splashes or sprays of blood, body fluids, tissue, secretions, or excretions

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PPE – Gowns/Aprons

If using in contact or protective precautions:

If soiled, moist or due to be changed:

• Hang appropriately for re-use• Change gown daily if

not moist/visibly soiled

• Roll into a ball in a motion directed away from the body • Discard gown into an

appropriate receptacle

PPE – Facial Protection

• Mask use in isolation:1. Airborne precautions – N95 particulate respirator

mask2. Droplet precautions – surgical mask

• Protection against blood and/or body fluid splash, either: 1. Surgical mask & goggles2. Face shield

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MURAKOZE

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