Patient Precautions and Infection Control

Standard and Universal Precautions

  • Definition and Scope:

    • Standard precautions and universal precautions are terms used interchangeably to describe foundational infection control practices.

    • These protocols must be applied universally to all patients, regardless of confirmed illness, suspected microbial risk, or infectious status.

    • The primary objective is to protect healthcare workers and patients from the transmission of infectious agents across all care settings.

  • Applicable Body Substances and Surfaces:

    • Blood and blood products.

    • All body fluids, secretions, and excretions, with the explicit exception of sweat.

    • Non-intact skin.

    • Mucous membranes.

  • Rooming and Waste Disposal Standards:

    • Patients on standard precautions can technically share a room with another patient, although modern hospital infrastructure typically utilizes single-patient rooms.

    • Standard, regular waste receptacles are used for disposal; specialized containment receptacles are not required for standard precautions.

  • Respiratory Hygiene and Staff Wellness:

    • Healthcare personnel must maintain strict personal hygiene, including covering coughs and sneezes using the inner elbow.

    • Personnel who feel unwell must wear a surgical mask at all times within clinical settings, maintain physical distance from others, and practice frequent hand hygiene.

Hand Hygiene and Personal Protective Equipment Standards

  • Hand Hygiene Indications:

    • Hands must be washed prior to any direct patient contact, regardless of patient diagnosis.

    • Hands must be washed between contacts with different patients.

    • Hands must be washed immediately after exposure to blood, body fluids, secretions, or excretions.

    • Hands must be washed after coming into contact with any contaminated item or surface.

    • Hands must be washed immediately upon the removal of gloves.

  • Hand Hygiene Method Selection:

    • Visibly Soiled Hands: Requires thorough washing using soap and water.

    • Non-Visibly Soiled Hands: An alcohol-based hand sanitizer is appropriate.

    • Clostridioides difficile (C. diff) Protocol: Hands MUST be washed with soap and water regardless of whether hands appear visibly clean or dirty. Soap and water is the only method effective at removing C. diff spores; alcohol-based hand sanitizers do not destroy them.

  • Fingernail and Glove Rules:

    • Artificial fingernails are strictly prohibited for healthcare personnel, as they significantly increase the likelihood of harboring infectious organisms.

    • Gloves must be worn whenever contact with bodily fluids or contaminated surfaces is anticipated.

    • Gloves must be removed immediately after task completion, followed by immediate hand hygiene.

    • A fresh pair of gloves must be donned prior to moving to another task or procedure.

  • Supplemental Personal Protective Equipment (PPE):

    • Additional PPE must be worn if a higher potential for blood or body fluid contact or splashing exists:

      • Isolation gowns.

      • Surgical face masks.

      • Face shields or protective eyewear.

Sharps Safety and Exposure Protocols

  • Barrier Safeguards:

    • Physical barriers must be implemented to protect skin and mucous membranes whenever potential exposure to blood or bodily fluids is identified.

    • Minimum protective measures include gloves, with gowns added if fluid contact is expected, and eye protection utilized if a splash risk exists.

    • Thorough hand washing is mandatory following exposure to dirty items and immediately upon glove removal.

  • Sharps Handling and Disposal:

    • All sharp objects, including injection needles, must be disposed of immediately after use in puncture-resistant, designated sharps receptacles.

  • Occupational Needle Injury Protocol:

    • If an accidental needlestick or sharp injury occurs from an exposed needle:

      • Follow established post-exposure institutional protocols immediately.

      • Report the incident immediately to the clinical supervisor.

Airborne Precautions

  • Environmental and Room Controls:

    • Requires placement of the patient in a private isolation room.

    • The room must be equipped with a negative pressure airflow system that continuously filters room air.

    • High-Efficiency Particulate Air (HEPA) filtration systems may be brought in from central supply.

    • The room door MUST remain closed at all times; maintaining a closed system is required for the negative pressure system to function effectively.

  • Personal Protective Equipment (PPE):

    • Requires a fit-tested N95 respirator mask to provide advanced filtration.

    • Standard precautions must be maintained concurrently.

    • Doffing Protocol: The N95 respirator must be removed only after exiting the patient's room and completely closing the door.

  • Indications and Specific Pathogens:

    • Measles.

    • Chickenpox (Varicella).

    • Disseminated Herpes Zoster (Shingles).

    • Tuberculosis (TB).

Droplet Precautions

  • Personal Protective Equipment (PPE) Requirements:

    • Standard precautions combined with a surgical mask covering both the mouth and nose.

    • Eye protection must be added if there is a risk of the patient coughing directly into the caregiver's face or if splash potential exists.

    • Facilities may require either a standard surgical mask or an N95 respirator for COVID-19 depending on site-specific policy.

  • Indications and Specific Pathogens:

    • Influenza (Flu).

    • Streptococcal Pharyngitis (Strep).

    • Pertussis (Whooping cough).

    • Pneumonia.

    • Rubella.

    • Mumps.

    • Respiratory Syncytial Virus (RSV).

Contact and Contact Plus Precautions

  • Contact Precautions Requirements:

    • Requires donning an isolation gown and gloves prior to entering the patient room, in addition to standard precautions.

    • Surgical masks are not routinely required unless a concurrent respiratory indication exists.

    • Dedicated Equipment: Dedicated patient-care equipment (such as stethoscopes and blood pressure machines) must remain inside the patient's room and must not be taken from room to room to prevent cross-contamination.

    • Doffing and Disposal: All PPE must be doffed (taken off) inside the patient room before exiting into the hallway to prevent spores or infectious agents from escaping. Disposal must occur in designated room receptacles.

  • Indications for Standard Contact Precautions:

    • Methicillin-Resistant Staphylococcus aureus (MRSA).

    • Herpes Simplex Virus (HSV).

    • Scabies.

    • Vancomycin-Resistant Enterococcus (VRE).

  • Contact Plus Precautions Specifications:

    • Enacted for spore-forming organisms, specifically Clostridioides difficile (C. diff).

    • Mandatory Hand Hygiene: Hands MUST be washed with soap and water (alcohol sanitizers are ineffective against spores).

    • Environmental Disinfection: Requires cleaning patient equipment and room surfaces with specialized bleach wipes (bleach solution).

Protective Environment and Neutropenic Precautions

  • Clinical Rationale:

    • Also referred to as neutropenic precautions.

    • Implemented for severely immunocompromised patients where external microorganisms pose a critical risk to the patient.

    • The primary goal is to protect the vulnerable patient from pathogens carried by healthcare workers, visitors, or environmental sources.

  • Target Patient Populations:

    • Recent organ or stem cell transplant recipients.

    • Patients receiving immunosuppressive therapy.

    • Oncology/cancer patients.

  • Environmental and Isolation Controls:

    • Requires a private isolation room.

    • Must feature a positive airflow pressure system (air flows outward to prevent airborne contamination from entering).

    • Requires HEPA filtration systems.

    • The isolation room door must remain closed at all times.

  • PPE and Visitor Protocols:

    • Required PPE includes surgical masks, gloves, and gowns, in addition to standard precautions.

    • Symptomatic or sick visitors and healthcare personnel are strictly prohibited from entering the room or providing care.

  • Dietary and Environmental Prohibitions:

    • Dietary Prohibition: No fresh fruits or fresh vegetables are allowed on patient meal trays due to microbial/fungal contamination risks on raw produce.

    • Environmental Prohibition: No fresh cut flowers or potted plants are permitted in the patient room due to soil-borne and floral fungal spores.