Demonstrate the application of standard precautions to prevent the spread of infection in accordance with organisation requirements
Demonstrate the application of additional precautions when standard precautions alone may not be sufficient to prevent transmission of infection
Minimise contamination of materials, equipment and instruments by aerosols and splatter
In this topic you will learn the process of the transmission of disease. It is important that you gain an understanding of the significance of microbes and the role they play in causing infection. The risk of catching an infection can be greatly reduced if we understand the nature of microbes and what we can do to avoid catching them. Most specifically we need to ensure that our actions greatly assist in keeping our patients free from infection.
You will learn the means by which the transmission of diseases can be prevented. You will learn to be able to identify potential sources of infection in the clinic and the appropriate measures to prevent the spread of infection. Your learning will incorporate an understanding of how a patient’s medical status can impact on the control of infection. You will also learn to explain the difference between standard precautions and additional precautions.
|You should now read the essential knowledge topic on microbiology|
In the 60s, patients in hospital were nursed by a system called Barrier Nursing. This was illness specific, for example Enteric Precautions for those that had gastroenteritis and Reverse Barrier Nursing for patients with immune deficiencies. If patients didn’t have clinical signs or suspicion of infection, hand washing was the only active precaution taken.
In the 80s the human immune deficiency virus (HIV) was identified. Because people with HIV and also conditions such as Hepatitis B did not show signs of infection during the incubation stages, the concept of Universal Precautions was introduced, initially in the USA and then in other countries. Universal Precautions involved treating the blood and most other body substances of all persons as potential sources of infection, independent of diagnosis or perceived risk. It did not apply to faeces, nasal secretions, sweat, tears, urine and vomitus.
These precautions were essentially developed to protect health care workers from acquiring blood borne infections. They did not prevent droplet or airborne spread from one patient to another. There was also some confusion as to which body fluids should be considered. In the 90s terminology and practice was changed to Standard and Additional Precautions.
NSW Health has endorsed a two-tiered approach to infection control.
How do we know which method to use? Look at the table of the level of process required for specific items and procedures produced by the Department of Health on page 34 of the Infection Control Policy at http://www.health.nsw.gov.au/policies/pd/2007/PD2007_036.html
Standard precautions are to be taken when contact is possible with the blood or body fluids from any patient, irrespective of perceived risk of infection.
Additional precautions are based on the transmission of the disease. They are used in addition to standard precautions for patients known or suspected of having an infection that is of major epidemic concern, or those spread by droplet or airborne transmission or direct or indirect contact.
The main difference in general is the use of a separate room for the patient. Masks may also be required when managing patients with infection spread by the airborne route or droplet nuclei, for example, tuberculosis.
Standard precautions involve the use of the following items to prevent direct contact with potentially infectious blood and all body fluids when performing tasks where this is an anticipated risk. Equipment that should be used includes:
The type of protection used will depend on the nature of the illness.
Standard precautions apply to:
Standard precautions also apply to non-intact skin and mucous membranes
Wear gloves to protect the hands from the risk of contact with blood or body substances, contaminated items, non-intact skin and mucous membranes. They should also be worn when the operator has non-intact skin.
There are a number of types of gloves that can be used depending on the type of work practice. They range from sterile surgical gloves for surgical procedures, disposable medical gloves for non-sterile procedures, to reusable general purpose gloves for cleaning of surgical equipment.
Change gloves when torn, punctured, and in between any procedure on individual patients. Hands must be washed immediately after removing gloves. Staff members who are susceptible to latex allergy should be offered latex free gloves suitable for the task.
Wear eye protection and a mask where splashing or splatter with blood, bloody secretions or body fluid is expected or where exposure to airborne contamination is anticipated. Clean reusable eye protection regularly, and if it is soiled. Should an accident occur where the face is splashed with blood, gently rinse the mucous membrane of the eyes and mouth with running water to minimise the risk of infection via either mucosa.
Wear fluid resistant aprons or gowns when clothing is likely to be soiled with blood or body substances. Remove clothing as soon as possible if it becomes soiled with blood or body fluids before undertaking any other duties.
Click here to see a Powerpoint presentation on standard precautions prepared by the NW Department of Health
Additional precautions are used for patients that are known or suspected of being infected with highly transmissible pathogens that can cause infection.
They are particularly used when there is the possibility of air borne transmission, for example T.B., measles or chicken pox; or droplet infection for example mumps, rubella or influenza.
Additional precautions are specific to a given situation. They are applied in addition to standard precautions.
Now is a good time to refer to the Australian Government’s Dept of Health & Ageing, booklet ‘Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting.’ The following link will take you to the correct page. You will then need to scroll the chapters to refer to the information of interest to you.
Aerosols and splatter are a common occurrence in a clinical environment. Anything that applies force to a surface has the potential to create aerosols and splatter which might contain infective material.
When you wash your contaminated hands, contaminated instruments or any article that is dirty, in the sink, there is the potential for splatter to occur.
Hands should be washed in a sink allocated for hand washing only.
Dirty instruments should be washed in a sink in the dirty zone of your clinic, and once there should be held low in the sink to eliminate as much splatter as possible.
In this activity you will revise and test your understanding of the two-tiered approach to infection control. This will include standard precautions, transmission based precautions, personal protective measures and managing blood and body substance spills.
South Eastern Sydney Area Health Service: Infection control: http://www.sesahs.nsw.gov.au/albionstcentre/infection/index.asp
National Health and Medical Research Council (1996) Infection Control in the Health Care Setting Guidelines for the Prevention of Transmission of Infectious Diseases (ref. IE6) Canberra. http://www.nhmrc.gov.au/publications/synopses/ic6syn.htm
Australian Infection Control Association: http://www.aica.org.au
Infection Control Association NSW Inc: http://www.icansw.org.au/
NSW Health (2007) Infection control policy (PD2007_036) North Sydney http://www.health.nsw.gov.au/policies/PD/2007/pdf/PD2007_036.pdf
Infection Control Today Magazine: http://www.infectioncontroltoday.com/
National Resource for Infection Control (NRIC). NRIC is a project developed by healthcare professionals, aimed at being a single-access point to existing resources within infection control for both Infection Control and all other healthcare staff. (UK Department of Health, City University London). http://www.nric.org.uk/IntegratedCRD.nsf/NRIC_Home1?OpenForm
Communicable Diseases, Vaccinations & Infection Control: Page prepared by the NHMRC contains a range of information on communicable diseases, vaccinations and infection control for the community and health professionals: http://www.nhmrc.gov.au/publications/subjects/communicable.htm
The Infection Control Information Center (Sydney): http://members.ozemail.com.au/~cdcdent/
Queensland Health. The Centre for Healthcare Related Infection Surveillance and Prevention (CHRISP). CHRISP has developed resources for sterilising services to assist sterilising services staff to perform their duties safely, efficiently and in accordance with Queensland Health Infection Control Guidelines and Australian/New Zealand Standard 4187: 2003: http://www.health.qld.gov.au/chrisp/sterilising/overview.asp
Sterilising Research Advisory Council of Australia (SRACA): http://www.sraca.org.au