UNIVERSAL PRECAUTION

INTRODUCTION
Universal precautions refers to the practice, in medicine, of avoiding contact with patients'
bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles,
and face shields. The infection control techniques were essentially good hygiene habits, such
as hand washing and the use of gloves and other barriers, the correct handling of
hypodermic needles, scalpels, and aseptic techniques. Following the AIDS outbreak in the
1980s, the US CDC formally introduced them in 1985–88. Every patient was treated as if
infected, and therefore precautions were taken to minimize risk.
In 1987, the practice of universal precautions was adjusted by a set of rules known as body
substance isolation. In 1996, both practices were replaced by the latest approach known as
standard precautions. Use of personal protective equipment is now recommended in all
health care settings.
DEFINITION

 Previously known by various names including “universal precautions”

 Standard precautions are designed to reduce the risk of transmission of bloodborne
and other pathogens from both recognized and unrecognized sources to a
susceptible host.
 They are the basic level of infection control precaution
 Hospital Infection is the result of a combination of factors: Microbial source +
Transmission + Susceptible host =Infection

History of Infection Control Precautions

year Infection control precautions

1877,1910 Separates facilities, Antisepsis and disinfections ... etc
1985 UNIVERSAL PRECAUTIONS (guidelines for protecting healthcare
worker because the emergence of HIV & other Bloodborne
pathogens)
1987 BODY SUBSTANCE ISOLATION ( focused on protecting patients and
health personnel from all moist body fluids not just blood: semen,
vaginal secretions, wound drainage, sputum, saliva etc
1996 STANDARD PRECAUTIONS :Two level approach:
• Standar Precautions which apply to all clients and patients
attending healthcare facilities
•Transmission-based Precautions which apply only to hospitalized
patients
2007 ISOLATION PRECAUTIONS (new pathogens; SARS, Avian Influenzae
H5N1, H1N1)
 Every procedure increases the Risk of Infection to HCW

Objectives:
Participants will:

 Understand and become familiar with universal precautions.

 Learn the importance of good hygiene and hand washing.
 Learn proper hand washing techniques.
 Learn the proper technique for applying and removing gloves.
Why Universal health Precautions.
The concept of Universal Health Precautions emphasizes that all our patients should be
treated as though they have potential blood born infections, and can infect the caring
health care workers. ( CDC )
Human materials/Tissues considered Highly Infectious
1. Blood
2. Semen
3. Vaginal secretions
4. CSF
5. Synovial fluids
6. Amniotic fluid
7. All other body fluids
Not Infectious unless contaminated with Blood or Body fluids.

 Feces,
  Nasal secretions,
 Sputum,
 Sweat,
 Tears,
 Urine / Vomitus,
 Saliva unless bloodstained.
Hand washing is the most important method of disease prevention
Bacteria and bacteria can be spread via dirty hands and the are too small to see with
the human eye. You must wash you hands properly in order to remove them.
HAND WASHING

 There is no Health precaution like Handwashing.

 Washing with simple toilet soap - reduces the rate of transmission of common
infections including the HIV.

Indications for Hand Washing

 In prolonged contact with patient.
 Before taking care of Immune supressed, New born infants, patients in ICU / ICCU,
Dialysis Units, Burn’s Units.
  Before and after touching wounds.
 When Microbial contamination of Hands, likely to occur when in contact with
mucous membranes, body fluids, and other secretions contaminated with Blood, and
serous fluids.
What to be used for hand washing

 In most circumstances Non medicated soaps and detergents are effective in

removing most transient contaminants.
 In demanding circumstances, in handling potentially harmful infections, use Ethyl or
Isopropyl alcohol.
 Detergent formulations containing Chlorhexidine, Povidone, or Hexachlorophene are
effective in prevention of spread of infections.

Use of Gloves
Use of a pair of disposable plastic gloves can protect if chances of contact with Blood or
Body fluid is anticipated/inevitable.

Use of Mask, Cap, Eye Wear

 Will certainly protect us from splashes of Blood or Body fluids.
 Don't underestimate the importance of Use of Cap and Mask.
 It equally protects our patients.

UP recommends the use of Personal Protective Equipment

 Gloves
 Aprons
 Gowns
 Protective eyewear
 Face shields
 Masks
Uses of Cap and Mask

 Stringent use of Mask and Cap can save several Lives in the Hospital
Use of Foot wear

 Wearing foot wear covering entire sole protects the entry of Microbes from the
contaminated floors with Blood and Body fluids.
 Remember many of us have cracks on our feet.
Use of Impervious Gown

 A simple thin Plastic apron underneath the linen is of great help in preventing the
soaking our inner clothes and exposure to harmful microbes.
Universal Precautions also include:
  Proper handling and disposal of needles.
 Taking precautions to prevent injury from scalpels, needles, and other sharp
instruments.
Disposal of Needles and Sharps

 All used needles and sharps should be deposited in thick walled puncture resistant
containers.
 Bending, Reshaping, should be prohibited.
 Do not recap the needles to avoid needle stick injures,
 All used Disposable syringes and needles should be discarded into Bleach solution at
the work station before final disposal.
Dealing with Used Needle

 Shredding continues to be Important Method Of dealing with used Needle

Managing Occupational Exposure to HIV Infection
Post-Exposure Prophylaxis (PEP:

 PEP–Following occupational HIV exposure, short-

 course of ARV drugs can be used to reduce the likelihood of infection
 Register occupational exposures
 Ensure that HIV counselling, testing, and ARV drugs are available
 Educate healthcare workers
Immediate steps post- exposure

 Wash exposed wound or skin with soap and water

 For needle or sharp injury, allow to bleed for a few seconds before washing
 Inform supervisor of type of exposure and the actions taken
 Assure confidentiality to the HCW
 Ensure support and referral for treatment
Guidelines for PEP

 Ideally, initiate PEP treatment within 2hours of exposure

 If source patient is HIV negative,
 discontinue PEP and retest at 6 weeks,
 3 months, and 6 months
 If source patient is HIV positive, counsel, support, and refer the HCWfor continued
treatment
- Follow approved PEP regimen( suggested)
- Examples

 ZDV 200 mg 3 times daily for 4 weeks

  Combivir tablet (300 mg ZDV and 150 mg lamivudine) twice daily +
 Indinavir 800 mg 3 times daily for 4 weeks
Dealing with Needle stick Injuries

 Consider all Needle stick injuries as a serious health hazard in the era of AIDS
 All events of Needle stick injuries to be reported to the supervisory staff.
 Wash the injured areas with soap and water.
 Encourage bleeding if any.
 Prophylaxis for prevention of HIV/HBV is top priority.
 Anti retroviral prophylaxis, if necessary should started within 2 hours, ( if injury is
from HIV positive or high risk group).
Hazards of Needle stick Injuries

 HIV HBV and HCV viral infections can spread by Needlestick Injuries Nursing staff are
at greater risk Several Injuries are prevent able
Decontamination of Hospital Linen

 All the linen contaminated with Blood or Body fluids should be soaked in 1: 100
bleach solution for 30 minutes.
 Advised Autoclaving, as the most ideal procedure for decontaminating Linen
Spillage of Blood/Body fluids

 A common health hazard in the working environment.

 Never wipe the spillage with working wet mop .Always cover the spills with paper
and pour1 % Hypochlorite or Bleaching powder to decontaminate the spills with
HIV/HBV virus.
Care of Endoscopes

 Endoscopes are delicate/precious instruments.

 Follow the instruction of Manufacturers.
 It is commonly cleaned with 2 %Glutaraldehyde solution.
 Specified time schedules to be followed to decontaminate for HIV.
 Mycobacterium needs even > 2 hours for decontmination.
Decontamination of Metal Instruments

 Hold all contaminated instruments with Gloved hands.

 Subject all metal instruments to washing with soap and water.
 Treat all contaminated instruments with2% Glutaraldehyde. For at least 30minutes.
 Many consider sterilizing in Hot air oven if not sharp instruments.

Anesthetic Tubing's and other Equipment's

  Since they are in intimate contact with Human secretion need utmost attention in
decontamination.
 Treat all Non disposable as highly hazardous, if used without safe practices can infect
the next patient undergoing procedures.
 Soaking in 2 % Glutaraldehyde is common practice in Developing world.
Pregnant Health Care Workers

 Not at more risk than other, Health care workers.

 Should adopt Universal Health Precautions with more dedication,
 If neglected the Unborn is at grave risk of attaining congenital infections.
 The Laboratory supervisors should monitor/ guide the HCW’s for adherence to
scientific practices.
Operating on HIV/High risk groups

 It is a concern all should be cared equally.

 HIV infected carries the risk of being neglected at the time of crisis.
 Law many not change for equality but motivated health workers should bring in
change of attitude.
 Adherence of Universal Health precaution bring in safety to all HCW.
 Follow the precautions even in Non HIV patients as some of our patients are in
window period and more dangerous than truly positive with Sero testing.
Caution on Operating HIV Sero Negative Patients

 Universal precaution apply to all our patients irrespective of Blood tests we

undertake.
 We handle so many patients in emergency situation with out any details.
 Education on Universal precautions
Precaution for Invasive Procedures

 All HCW’s who participate in invasive procedures must routinely use appropriate
barrier precautions.
 All Health care workers who perform/assist vaginal, and cesarean deliveries should
wear gloves and gowns when handling, the placenta, and the new born, till blood
and amniotic fluid has been removed from infants.
 Amniotic fluid is rich in HIV/HBV virus, in infected mothers.
Handling Dentistry Patients

 Blood, Saliva, Gingival fluid from all Dental patients should be considered infective,
 Dental, workers should wear surgical mask, glove sand eye wear.

Caring Bleeding Patients

  Primary health care workers who handle the patient in Emergencies, and Accidents
to be trained in basic principles of Universal Health care precautions.
 Mouth to Mouth resuscitation is life saving in the critically injured accident victims.
May be neglected because of fear of HIV infection.
 If the situation warrants, Bleeding from mouth can be wiped out with clean cloth, or
Handkerchief, and still one can do resuscitation.
Importance of Vaccination in Hepatitis B Infection.

 We have > 400 Million carriers with Hepatitis B infections.

 Every HCW is at risk of Contacting infection.
 Vaccination is safe -Genetically Engineered vaccination remains the great hope for
prevention, apart from Major component of Universal precautions.
Vaccination for HBV infection

 All HCW’s must take at least three doses of Vaccine, At 0 – 1 – 6 months. Without
 discontinuation of the schedule.
 All Health care workers many not attain equal response.
 High risk HCW’s should undergo estimation of anti HB s ( antibodies ) to know
whether they were well protected.
Problem of HBV vaccines in the Developing world

 Who pays for the Vaccine.

 Many who work in unorganized sector, do not get Institutional support of Vaccine.
 Life, at risk if Infected with HBV
 More Awareness to be brought in by Managers of the Hospitals, to promote to
vaccinate their Employees.
Transmission-Based Precautions

 Used in addition to Standard Pre cautions for Specified Patients

 Designed for the Care of Specified Patients known or suspected to be infected by
epidemiologically important pathogens spread by: airborne, droplet, or contact
transmission
Droplet Transmission

 For infectious agents with droplet nuclei>5 microns

 Examples:
– Pertussis
– Meningococcal meningitis
 Precaution Examples:
– Private room
– Mask if within 3’ of patient
Droplet Precautions
Prevent infection by large droplets from
– Sneezing
– Coughing
– Talking
• Examples
- Neisseria meningitidis
– Pertussis
- Influenza
Airborne Transmission

 For infectious agents with droplet nuclei < 5microns

 Examples:
- Tuberculosis
- Measles
 Precaution Examples
– Isolation rooms under negative pressure
– N95 or HEPA respirator use
Patient care equipment

 Handle equipment soiled with blood, body fluids, secretions, and excretions in a
manner that prevents skin and mucous membrane exposures, contamination of
clothing, and transfer of pathogens toother patients or the environment.
 Clean, disinfect, and reprocess reusable equipment appropriately before use with
another patient
Contact Precautions

 For protection against skin-to-skin contact and physical transfer of microorganisms to

a host from a source
 Precaution Examples:
- Private room
- Hand washing
- Glove changes
 Examples
- Scabies
- VRE

SUMMERRY
 Universal Standard Precautions are designed for the care of all persons, patients.
health care personnel regardless of whether or not they are infected. Treat all human blood,
body fluids and other potentially infectious materials as if they are infectious There are 3
major Blood- bome pathogens: Hepatitis B. Hepatitis C and HIV. The most common mode of
transmission of pathogens is the hands. Wear proper Protection Equipment Barrier in
exposure situation .Safe handling and disposal of Sharp. Standard Precautions breaks the
chain of infection thus minimizing transmission of infection within the Healthcare
environment.

CONLCUSION
Universal precautions should be used whenever there may be occupational
exposure to blood or other potentially infectious material to prevent contact with patients'
blood or other potentially infectious maternal.

BIBLIOGARPHY