Infection Control Notes: Standard Precautions and Transmission-Based Precautions

Standard Precautions

• The CDC guidelines distinguish two tiers of precautions:
  • Standard precautions: Apply to all patients, treating them as potentially infectious (e.g., HIV, hepatitis B/C).
  • Transmission-based precautions: Used for highly transmissible pathogens; $3$ types: airborne, droplet, and contact.
• Personal Protective Equipment (PPE) and practices required by standard precautions:
  • Gloves: Worn for contact with blood and body substances other than sweat.
  • Gowns, masks, eye protection/face shields: Used during procedures likely to generate splashes or sprays of blood/body fluids.
  • Ventilation devices: Used as an alternative to mouth-to-mouth resuscitation.
  • Needle safety: Prevent needle sticks; dispose of used needles properly.
  • Exposure response: Wash hands/skin immediately after exposure; report exposures for post-exposure prophylaxis (PEP).
• Pre-employment health evaluation: Assesses immunity and checks for active infections.
• Easily transmitted infections (examples): Open skin infections, respiratory tract infections (e.g., tuberculosis), unexplained vomiting/diarrhea, contagious diseases (e.g., chickenpox, measles).
  • Report contact with individuals who had severe illnesses (e.g., hepatitis, tuberculosis).
• Personal hygiene: Daily shower, clean and tied-back hair, short clean nails, simple jewelry, clean shoes.
• Oral hygiene and hand care: Keep nails short/clean; lotions prevent chapping.
• Skin and hand hygiene (most important preventive measure):
  • Reduces nosocomial infection risk by removing pathogens.
  • Perform hand decontamination: Before/after direct patient contact, before/after gloves, after touching patient care equipment/surfaces, before invasive procedures.
  • Preferred method: Alcohol-based hand rub (more effective, quicker, easier).
  • How to use alcohol-based hand rub: Apply recommended amount, rub all surfaces until dry; do not rinse.
  • When to use soap and water: When hands are visibly soiled or product buildup occurs.
• Handwashing technique (soap and water):
  • Wet hands, apply soap, rub briskly (hands pointing downward), clean under nails/between fingers/around wrists, rinse thoroughly (forearms to fingertips), dry with clean towels.
• Cleaning, disinfection, and sterilization (critical infection control):
  • Cleaning: Removal of organic materials (soil, blood); physically removes organisms.
  • Sterilization: Destruction of all microbial life (e.g., steam under pressure, chemical sterilants, dry heat).
  • Disinfection: Intermediate measure; may kill some organisms but not all.
  • Department-specific procedures: Learn which equipment needs disinfection vs. sterilization; always clean thoroughly first.
  • Keep work areas dry and clean; separate contaminated from clean items; use clearly marked puncture-resistant containers for disposal (e.g., needles).
• Handling soiled linens: Handle as little as possible, never shake, roll away from body (soiled side in), be alert for sharp objects, wear gloves if required, dispose in appropriate receptacles.
• CDC guidelines on bloodborne and other infections:
  • Part 1: Standard Precautions: Apply to all patients due to unreliable identification of germ carriers.
  • Key components: Decontaminate hands (before/after patient care, regardless of gloves), wear gloves for mucous membranes/non-intact skin, use PPE for splashes/sprays, wash hands immediately after exposure, report exposure.
  • Part 2: Transmission-Based Precautions: Three simple sets – Airborne, Droplet, Contact.
  • For all: Patient confined to room, decontaminate hands (before entering/after leaving), wear respiratory/other protection, limit patient movement, consult supervisor for specific precautions.
• Practical implementation: Reducing nosocomial infections is a shared responsibility of all healthcare workers.
• Summary of key concepts and terms:
  • Infection: Presence of a pathogen in sufficient quantity to cause harm.
  • Nosocomial infection: Infection acquired during hospitalization, not present at admission.
  • Chain of infection: $6$ links required for transmission: causative organism, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host.
    -