6 Lec - Infection control utilities including universal precautions.pptx

Infection control utilities including universal precautions Prof Esam • Universal Precautions is defined as an approach to infection control. • Concept of universal precautions: all human blood and certain human body fluids are treated as if known to be infectious for human immunodeficiency virus...

Infection control utilities including universal precautions Prof Esam • Universal Precautions is defined as an approach to infection control. • Concept of universal precautions: all human blood and certain human body fluids are treated as if known to be infectious for human immunodeficiency virus (HIV), hepatitis virus types B (HBV), and other bloodborne pathogens. • The CDC introduced its universal precautions document in 1986. This was later expanded in scope and referred to as standard precautions. • However, The Occupational Safety and Health Administration’s (OSHA’s) bloodborne pathogen standard retains the term universal precautions. • In 1983, CDC published a document entitled "Guideline for Isolation Precautions in Hospitals" that contained a section entitled "Blood and Body Fluid Precautions." The recommendations in this section called for blood and body fluid precautions when a patient was known or suspected to be infected with bloodborne pathogens. • In 1987, CDC published a document entitled "Recommendations for Prevention of HIV Transmission in Health-Care Settings". • The 1987 document recommended that blood and body fluid precautions be consistently used for all patients regardless of their bloodborne infection status. This extension of blood and body fluid precautions to all patients is referred to as "Universal Blood and Body Fluid Precautions" or "Universal Precautions." • Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. • Universal precautions are intended to prevent parenteral, mucous membrane, and nonintact skin exposures of health-care workers to bloodborne pathogens. • Immunization with HBV vaccine is recommended as an important adjunct to universal precautions for health-care workers who have exposures to blood. Body Fluids to Which Universal Precautions Apply • Universal precautions apply to blood and to other body fluids containing visible blood. • Occupational transmission of HIV and HBV to healthcare workers by blood is documented. • Blood is the single most important source of HIV, HBV, and other bloodborne pathogens in the occupational setting. • Infection control efforts for HIV, HBV, and other bloodborne pathogens must focus on preventing exposures to blood and delivery of HBV immunization. • Universal precautions also apply to semen and vaginal secretions. • Although both of these fluids have been implicated in the sexual transmission of HIV and HBV, they have not been implicated in occupational transmission from patient to health-care worker. • Exposure to semen in the usual health-care setting is limited, and the routine practice of wearing gloves for performing vaginal examinations protects healthcare workers from exposure to potentially infectious vaginal secretions. Universal precautions also apply to tissues and to the following fluids: • cerebrospinal fluid (CSF) • synovial fluid • pleural fluid • peritoneal fluid • pericardial fluid • and amniotic fluid Body Fluids to Which Universal Precautions Do Not Apply • • • • • • • Feces Nasal secretions Sputum Sweat Tears Urine Vomitus unless they contain visible blood. Precautions for Other Body Fluids in Special Settings • Human breast milk has been implicated in perinatal transmission of HIV, and HBsAg has been found in the milk of mothers infected with HBV . • However, occupational exposure to human breast milk has not been implicated in the transmission of HIV nor HBV infection to health-care workers. • Moreover, the health-care worker will not have the same type of intensive exposure to breast milk as the nursing neonate. • Whereas universal precautions do not apply to human breast milk, gloves may be worn by health-care workers in situations where exposures to breast milk might be frequent, for example, in breast milk banking. • Universal precautions do not apply to saliva. General infection control practices already in existence -including the use of gloves for digital examination of mucous membranes and endotracheal suctioning, and handwashing after exposure to saliva -- should further minimize the minute risk, if any, for salivary transmission of HIV and HBV. • Gloves need not be worn when feeding patients and when wiping saliva from skin. • Special precautions, are recommended for dentistry. Occupationally acquired infection with HBV in dental workers has been documented, and few possible cases of occupationally acquired HIV infection involving dentists have been reported. • During dental procedures, contamination of saliva with blood is predictable, trauma to health-care workers' hands is common, and blood spattering may occur. • Infection control precautions for dentistry minimize the potential for nonintact skin and mucous membrane contact of dental health-care workers to bloodcontaminated saliva of patients. • The use of gloves for oral examinations and treatment in the dental setting may also protect the patient's oral mucous membranes from exposures to blood, which may occur from breaks in the skin of dental workers' hands. Use of Protective Barriers • Protective barriers reduce the risk of exposure of the health-care worker's skin or mucous membranes to potentially infective materials. • For universal precautions, protective barriers reduce the risk of exposure to blood, body fluids containing visible blood, and other fluids to which universal precautions apply. • Examples of protective barriers include gloves, gowns, masks, and • Gloves should reduce the incidence of contamination of hands, but they cannot prevent penetrating injuries due to needles or other sharp instruments. • Masks and protective eyewear or face shields should reduce the incidence of contamination of mucous membranes of the mouth, nose, and eyes. • Universal precautions are intended to supplement rather than replace recommendations for routine infection control, such as handwashing and using gloves to prevent gross microbial contamination of hands. The risk of nosocomial transmission of HIV, HBV, and other bloodborne pathogens can be minimized if health-care workers use the following general guidelines: • Take care to prevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles. • Do not recap used needles by hand; do not remove used needles from disposable syringes by hand; and do not bend, break, or otherwise manipulate used needles by hand. • Place used disposable syringes and needles, • Locate the puncture-resistant containers as close to the use area as is practical. • Use protective barriers to prevent exposure to blood, body fluids containing visible blood, and other fluids to which universal precautions apply. • The type of protective barrier(s) should be appropriate for the procedure being performed and the type of exposure anticipated. • Immediately and thoroughly wash hands and other skin surfaces that are contaminated with blood, body fluids containing visible blood, or other body fluids to which universal precautions apply. • Tansmission-based precautions (TBP) for contact-, droplet-, and airborne-transmissible diseases augment SP with additional controls to interrupt the route(s) of transmission that may not be completely interrupted using SP alone. Conclusion • Universal precautions are applicable to all patients, while standard precautions provide an additional layer of protection for those at higher risk of transmitting certain infections. • Together, they create a comprehensive and effective strategy for reducing the risk of healthcare-associated diseases.