Standard Precautions in Healthcare

Standard Precautions and Infectious Agent Transmission

• Standard precautions are operating procedures that apply in healthcare to minimize the risk of infection regardless of the perceived infectious risk.
• The approach of standard precautions is based on the understanding that all blood and body substances should be considered potentially infectious and all surgical instruments could be potentially contaminated with microorganisms.
• Standard precautions include:
  • Hand washing
  • Use of PPE
  • Safe systems for handling blood and body fluid contamination
  • Sharps awareness and implementation of environmental controls
  • Appropriate processing of RMD
  • Medical condition management
  • Education and training
  • Aseptic technique
  • Vaccination

Chain of Infection

• The spread of microbial infection requires three factors:
  • A source of infecting microorganisms at a sufficient level to cause infection
  • Susceptible host or hosts
  • A means for transmitting the infectious agent to the susceptible host or hosts
• The means of transmission may involve one or many steps and is often referred to as the chain of infection.
• Ways to spread infection:
  • Air
  • Contact
  • Ingestion
  • Injection
  • Inhalation
• Chain of infection consists of:
  • Infectious agent
  • Susceptible host
  • Reservoir
  • Portal of entry
  • Portal of exit
  • Mode of transmission

Reservoir and Hospital Staff

• Reservoir refers to a collection of microbes.
• Hospital staff can constantly try to minimize the reservoir by:
  • Cleaning and disinfecting the environment and equipment
  • Treating patients with antimicrobial drugs
  • Applying various hygienic measures

Immune Condition and HAI

• Patients in hospital are often immunocompromised, having poor health and their immune system may not be functioning well.
• HAI refers to patients who become infected by microbes while in hospital.

Breaking the Chain of Infection

• Breaking the chain of infection can be achieved by decontaminating potentially infected RMD and ensuring that only properly decontaminated RMD are used on patients.

Housekeeping and Infection Control

• Cleaning and disinfecting the CSSD itself and properly managing waste streams are important parts of breaking the infection chain.
• Best practices for cleaning equipment include:
  • Labeling or color-coding equipment
  • Storing cleaning equipment in a dedicated storage room
  • Cleaning and inspecting equipment regularly
  • Training staff responsible for cleaning
  • Recording cleaning activities and monitoring quality
• Waste management involves:
  • Using bins or containers to receive waste and segregate it into appropriate waste streams
  • Placing waste from the decon zone in appropriate bags or bins with sharps waste in a dedicated sharps bin
  • Sealing and disinfecting the exterior of the waste container before taking it out to the waste collection point

CDC Top HAI Causing Pathogens

• Coagulase-negative staphylococci
• Staphylococcus aureus
• Enterococcus species
• Candida species
• Escherichia coli
• Clostridium difficile
• Pseudomonas aeruginosa
• Klebsiella pneumoniae
• Enterobacter species
• Acinetobacter baumannii
• Klebsiella oxytoca
• Vancomycin resistant staphylococcus aureus
• Methicillin resistant staphylococcus aureus
• Tuberculosis (TB)

Managing the Central Sterile Supply Department' Environment

• The important step to maintain the CSSD environment is to control the traffic through the main three zones and to strictly maintain the proper heating, ventilation, and air conditioning (HVAC) systems.
• The three zones are:
  • Decontamination zone (negative pressure, 10 air changes per hour, 18°C to 20°C temperature, and 30% to 70% humidity)
  • Preparation & Packaging zone (positive pressure, 10 air changes per hour, 20°C to 23°C temperature, and 30% to 70% humidity)
  • Sterilization zone (positive pressure, 4 air changes per hour, 20°C to 24°C temperature, and up to 70% humidity)

Asepsis

• Asepsis can be defined as the absence of microorganisms that cause disease.
• Aseptic technique includes any activity or procedure that prevents infection or breaks the chain of infection.
• Types of aseptic techniques:
  • Medical asepsis (clean technique to reduce the number of microorganisms and minimize their spread)
  • Surgical asepsis (sterile technique to eliminate the presence of all microorganisms or prevent their introduction to an area)