Infection Control: Standard Precautions and Personal Protective Equipment

UNIT 2: STANDARD PRECAUTIONS LESSON 1: STANDARD PRECAUTIONS

Learning Objectives

Upon completion of this lesson, you will be able to:

  • Describe the Center for Disease Control and Prevention's (CDC) list of standard precautions for all patients, regardless of illness.
  • Identify protocols for handling used sharps materials.
  • Evaluate procedures for cleaning spills of hazardous materials, including blood and blood products.
  • Describe the steps involved in handling contaminated linens and infectious waste.

Standard Precautions Overview

  • Definition: Minimum infection guidelines for all patient care in any healthcare setting, developed by the CDC.
  • Purpose: To protect both healthcare workers and patients, and to prevent the spread of healthcare-acquired infections.
  • Scope: Includes guidelines for patient contact, respiratory hygiene, and environmental cleanliness.

Standard Precautions for Patient Contact

  • Infectious Materials: All blood, body fluids, secretions, and excretions (except sweat) must be considered infectious.
    • Examples of infectious materials: blood and other body fluids, mucous membranes, non-intact skin, tissue specimens, and any item, instrument, or equipment contaminated with these materials.
  • Personal Protective Equipment (PPE): Healthcare workers must use appropriate PPE when likely to contact infectious materials.
    • Examples of PPE: gloves, masks, eyewear, gowns, and shoe covers.
  • Hand Hygiene: Must be performed frequently to avoid spreading infection, using an alcohol-based sanitizer or washing hands with soap and water.
    • When to perform hand hygiene:
      • Immediately before touching a patient.
      • Before performing an aseptic task or handling invasive medical devices.
      • Before moving from work on a soiled body site to a clean body site on the same patient.
      • After touching a patient or the immediate patient care environment (surfaces, equipment, personal items, linens inside the patient's room).
      • After contact with blood, body fluids, or contaminated surfaces.
      • Immediately after removing gloves.
  • Worker Health and Safety:
    • Healthcare workers must bandage cuts and scratches properly.
    • Patient contact should be limited if a worker has a wound or skin condition likely to seep or bleed.
    • Sick healthcare workers must avoid direct contact with patients.
  • CPR: Face shields, bag valve masks, or disposable CPR face shields should be used instead of mouth-to-mouth contact. These devices should be stored in convenient locations throughout a medical facility.

Environmental Cleanliness: Sharps

  • Disposal: Used sharps must be placed into puncture-proof, biohazardous waste containers.
  • Examples of Sharps: Needles, surgical blades, razors, and disposable instruments (e.g., from a pre-packaged suture kit).
  • Handling Precautions:
    • Needles should never be bent or broken after use.
    • Needles should never be recapped.
    • When available, safety features should be engaged before disposal.

Environmental Cleanliness: Spills

  • Immediate Action: Spills must be cleaned up and attended to immediately after donning appropriate PPE.
  • Chemical Cleaning Solutions: It is crucial to read the manufacturer's instructions and the Safety Data Sheet (SDS) before use. SDS binders are readily available in all healthcare facilities.
  • Dedicated Supplies: Healthcare facilities should have cleaning supplies specifically dedicated to spills involving blood and blood products. After use, these supplies must be rinsed thoroughly and stored away from other cleaning supplies.

Environmental Cleanliness: Linens

  • Placement: Dirty linens must be placed in designated linen bags at the point of use (e.g., patient's room or bedside).
  • Contaminated Linens: Linens contaminated with blood or other infectious body fluids must be placed in a non-permeable biohazardous linen bag (plastic or other fluid-resistant material), labeled with a biohazard symbol.
  • Handling Contaminated Linens:
    • Carefully roll linens inward to contain infectious material and prevent contamination of air, surfaces, and staff.
    • Do not shake the linens.
    • Linens must be contained before leaving the point of use (hamper lids closed completely or bags securely tied).
  • Transport:
    • Healthcare workers should wear clean gloves during transport.
    • Keep the bag away from your body to prevent contamination of clothing.
    • Transport to a designated soiled linen storage area.
  • Further Processing:
    • Linens should not be sorted or rinsed in patient care areas.
    • Laundry services are typically performed offsite or by a dedicated linen service.
    • Soiled linen bags should remain closed until picked up for processing, unless otherwise directed.

Environmental Cleanliness: Infectious Waste

  • Disposal: All infectious waste must be discarded in a biohazardous waste bag.
  • Examples of Infectious Waste: Gloves, gowns, masks, disposable eyewear, contaminated dressings, drainage bags, disposable basins and bedpans, and other disposable items that have had contact with blood or other infectious body fluids.
  • Receptacles:
    • Most biohazard trash bags are red.
    • They are located in dedicated waste receptacles with lids.
    • Biohazard trash cans are identified by an orange or red label with a biohazard symbol and should be easily accessible in all patient care areas.

LESSON 2: GOWNS

Learning Objectives

Upon completion of this lesson, you will be able to:

  • Identify who should wear gowns and when.
  • Describe when to change gowns.
  • Explain the proper protocols for disposing of gowns.

When to Wear Gowns

  • Gowns are personal protective equipment (PPE) worn during specific medical procedures.
  • Situations requiring gowns:
    • When using chemical solutions for disinfection or sterilization.
    • During procedures where splashing or spraying blood and bodily fluids is likely.
    • When caring for any patient with a highly infectious disease.

Gown Protocols

  • Changing Gowns: Healthcare workers must change gowns between patient visits. The same gown should never be worn for more than one patient.
  • Disposal of Disposable Gowns: Disposable gowns should be placed into biohazardous waste containers after use.
  • Disposal/Processing of Non-Disposable Gowns: Non-disposable gowns may be placed into biohazardous linen bags and then sent to be laundered and disinfected.

General Procedure for Gowns

(Individual agencies may have specific procedures, this is a general example.)

  1. Cleanse your hands.
  2. Unfold the gown. Put your arms through the sleeve openings and pull the gown on, ensuring the opening is in the back.
  3. Tie the gown at the back of your neck.
  4. Overlap the gown in the back and tie the waist strings.
  5. To remove the gown: Untie it at the neck and waist. Be sure to touch only the ties, as the ties are considered clean, but the gown is contaminated.
  6. Use your dominant hand to reach inside the gown at the opposite shoulder. Pull down the gown by touching only the inside, as the outside may be contaminated.
  7. Pull both arms out of their sleeves while flipping the gown inside out.
  8. Roll the gown into a bundle, being sure to touch only the inside of the gown.
  9. Place the gown in the correct container:
    • If the gown is disposable, place it in a biohazardous waste container.
    • If the gown is not disposable, place it in a biohazardous linens bag.
  10. Cleanse your hands.

LESSON 3: MASKS AND EYEWEAR

Learning Objectives

Upon completion of this lesson, you will be able to:

  • Describe when and why it is essential to wear masks and eyewear for procedures.
  • Demonstrate the proper protocols for wearing and disposing of masks and eyewear.
  • Explain how pandemics often affect CDC guidelines for conserving supplies and safeguarding healthcare workers.

When and Why to Wear Masks and Eyewear

  • Requirement: Healthcare workers must wear masks and eyewear for procedures that may produce splashes of blood or bodily fluid sprays.
  • Purpose: To protect a healthcare worker's eyes, mouth, nose, and respiratory passages from exposure to pathogens.
  • Donning Order: For procedures requiring other forms of PPE, masks and eyewear should be put on after gowns and before gloves.

Masks

  • Usage: Masks should be worn once and then discarded into biohazardous waste containers.
  • Replacement: If a mask gets wet, it must be discarded and replaced with a new mask.

Eyewear

  • Reusability: Eyewear is often reusable.
  • Cleaning: Reusable eyewear must be cleaned and disinfected before reuse.

Pandemic Guidelines

  • During pandemics (e.g., COVID-19, influenza pandemics, widespread outbreaks of other infectious respiratory illnesses) when mask supplies could become depleted, CDC guidelines outline specific steps for conserving supplies and safeguarding healthcare workers.
  • This may include guidance for extended use and limited reuse of masks.

General Procedure for Masks and Eyewear

(Individual agencies may have specific procedures, this is a general example.)

  1. Cleanse your hands.
  2. Position the mask so that it covers your mouth and nose. Ensure the bottom is secured beneath your chin.
  3. Tie the top strings behind your head, and then tie the bottom strings. If the mask has an elastic band instead of ties, pull the elastic band behind your head or ears.
  4. Most masks have a metal strip over the bridge of the nose; pinch this strip over your nose to secure the mask.
  5. Position the eyewear over your eyes and pull the elastic strap around the back of your head.
  6. To remove: Touch only the tie strings or the elastic bands, as these are considered clean. The mask and eyewear surfaces may be contaminated.
  7. Place the items in the correct container:
    • Place masks and disposable eyewear into a biohazardous waste container.
    • Place reusable eyewear into the container for cleaning and disinfection.
  8. Cleanse your hands.

LESSON 4: NON-STERILE GLOVES

Learning Objectives

Upon completion of this lesson, you will be able to:

  • Identify the best practices for donning non-sterile gloves as personal protective equipment (PPE).
  • Explain the procedure for using non-sterile gloves when other protective equipment is required.
  • Describe the process for wearing, maintaining, and disposing of non-sterile gloves.

Importance and Usage of Non-Sterile Gloves

  • Role of Gloves: Non-sterile gloves are essential PPE, but wearing gloves should never replace cleansing hands. Hands must always be cleansed first and then gloved.
  • When to wear non-sterile gloves:
    • When performing patient care that may expose workers to non-intact skin, mucous membranes, blood, or other potentially infectious bodily fluids.
    • When handling contaminated items.
    • When cleaning environmental surfaces.
    • When caring for any patient with a highly infectious disease.
  • Donning Order: If other protective equipment is required, gloves should be put on last.

Glove Maintenance and Disposal Protocols

  • Changing Gloves: Gloves should always be changed between patient visits. The same pair of gloves should never be worn for more than one procedure.
  • Reuse: Gloves must never be washed and reused, as washing can create holes and make them ineffective.
  • Removal Location: All forms of PPE, including gloves, should be removed before leaving the patient care area. Gloves should never be worn outside the patient's room or in hallways.

General Procedure for Non-Sterile Gloving

(Individual agencies may have specific procedures, this is a general example.)

  1. Remove all jewelry from your hands and wrists and cleanse your hands.
  2. Put the gloves on and pull the cuff of each glove over the sleeve of your gown.
  3. If needed, interlace your fingers to position gloves correctly on your hands and fingers.
  4. To remove the first glove: Grasp the cuff with the opposite hand. Pull the glove downward while turning it inside out. Be sure not to touch any skin to the outside of the glove.
  5. Hold the removed glove in your gloved hand.
  6. To remove the second glove: Slip the fingers of the ungloved hand beneath the cuff of the gloved hand. Pull the glove downward while turning it inside out. Be sure not to touch any skin to the outside of the glove.
  7. Dispose of the gloves in a biohazardous waste container and cleanse your hands immediately.