Standard Precautions

Standard Precautions are the basic practices that apply to all patient care, in all care settings regardless of the patient’s suspected or confirmed infectious state. These practices protect healthcare personnel and prevent healthcare personnel or the healthcare environment from transmitting an infection to patients, visitors, or other healthcare workers.

Hand Hygiene

• Avoiding unnecessary hand contact with surfaces to reduce the risk of transferring pathogens among patients and healthcare workers.
• Use an alcohol-based hand rub unless hands are visibly soiled. Alcohol-based hand rubs are generally less irritating to hands and are effective in the absence of a sink. When hands a visibly soiled, soap and water scrubbing for at least 20 seconds is recommended. Perform appropriate hand hygiene:
  • Before having direct contact with patients
  • After contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings.
  • After contact with a patient’s intact skin (e.g., when taking a pulse or blood pressure or lifting a patient)
  • If hands will be moving from a contaminated-body site to a clean-body site during patient care.
  • After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient
  • Immediately after glove removal.
• If C. difficile or Bacillus anthracis are suspected wash hands with soap and water. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.
• Do not wear artificial fingernails or extenders if direct contact with patients at high risk for infection and associated adverse outcomes.

Personal Protective Equipment (PPE)

Wear PPE, whenever contact with blood or body fluids could be anticipated;

• Gloves
• Use of gloves is recommended when:
  • anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin and other potentially infectious material;
  • having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route e.g., VRE, MRSA, RSV;559, 727, 728 or
  • handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces.
• Don gloves after hand hygiene and before touching the patient’s intact skin or surfaces and articles in close proximity to the patient (e.g., medical equipment, bed rails). Remove gloves and wash hands before leaving the patient room.
• Gowns
  • Wear a gown whenever your clothing could have direct contact with the patient or potentially contaminated environmental surfaces or equipment in close proximity to the patient.
  • Don gown upon entry into the room or cubicle. Remove gown and observe hand hygiene before leaving the patient-care environment
• Mouth, nose, eye protection
  • Select appropriate combinations of masks, goggles, face shields to best protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that could generate splashes or sprays of blood, body fluids, secretions and excretions.
  • During aerosol-generating procedures (e.g., bronchoscopy, suctioning of the respiratory tract, endotracheal intubation) in patients who are not suspected of being infected with an agent for which respiratory protection is otherwise recommended (e.g., M. tuberculosis, SARS or hemorrhagic fever viruses), wear one of the following: a face shield that fully covers the front and sides of the face, a mask with attached shield, or a mask and goggles (in addition to gloves and gown).
• Respiratory hygiene/cough etiquette
  • Educate healthcare personnel on the importance of source control measures to contain respiratory secretions to prevent droplet and fomite transmission of respiratory pathogens, especially during seasonal outbreaks of viral respiratory tract infections (e.g., influenza, RSV, adenovirus, parainfluenza virus) in communities
  • Implement the following measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at the point of initial encounter in a healthcare setting (e.g., triage, reception and waiting areas in emergency departments, outpatient clinics and physician offices)
  • Post signs at entrances and in strategic places (e.g., elevators, cafeterias) within ambulatory and inpatient settings with instructions to patients and other persons with symptoms of a respiratory infection to cover their mouths/noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after hands have been in contact with respiratory secretions.
  • Provide tissues and no-touch receptacles (e.g., foot-pedal-operated lid or open, plastic-lined waste basket) for disposal of tissues
  • Provide resources and instructions for performing hand hygiene in or near waiting areas in ambulatory and inpatient settings; provide conveniently-located dispensers of alcohol-based hand rubs and, where sinks are available, supplies for handwashing
  • During periods of increased prevalence of respiratory infections in the community (e.g., as indicated by increased school absenteeism, increased number of patients seeking care for a respiratory infection), offer masks to coughing patients and other symptomatic persons (e.g., persons who accompany ill patients) upon entry into the facility or medical office 126, 899 898 and encourage them to maintain special separation, ideally a distance of at least 3 feet, from others in common waiting areas
  • Some facilities may find it logistically easier to institute this recommendation year-round as a standard of practice.
• Patient placement
  • include the potential for transmission of infectious agents in patient-placement decisions. Place patients who pose a risk for transmission to others (e.g., uncontained secretions, excretions or wound drainage; infants with suspected viral respiratory or gastrointestinal infections) in a single-patient room when available
  • Determine patient placement based on the following principles: Route(s) of transmission of the known or suspected infectious agent Risk factors for transmission in the infected patient Risk factors for adverse outcomes resulting from an HAI in other patients in the area or room being considered for patient-placement Availability of single-patient rooms Patient options for room-sharing (e.g., cohorting patients with the same infection)
• Patient-care equipment and instruments/devices
  • Establish policies and procedures for containing, transporting, and handling patient-care equipment and instruments/devices that may be contaminated with blood or body fluids
  • Remove organic material from critical and semi-critical instrument/devices, using recommended cleaning agents before high level disinfection and sterilization to enable effective disinfection and sterilization processes
  • Wear PPE (e.g., gloves, gown), according to the level of anticipated contamination, when handling patient-care equipment and instruments/devices that is visibly soiled or may have been in contact with blood or body fluids
• Care of the environment
  • Establish policies and procedures for routine and targeted cleaning of environmental surfaces as indicated by the level of patient contact and degree of soiling.
  • Clean and disinfect surfaces that are likely to be contaminated with pathogens, including those that are in close proximity to the patient (e.g., bed rails, over bed tables) and frequently-touched surfaces in the patient care environment (e.g., door knobs, surfaces in and surrounding toilets in patients’ rooms) on a more frequent schedule compared to that for other surfaces (e.g., horizontal surfaces in waiting rooms)
  • Use EPA-registered disinfectants that have microbiocidal (i.e., killing) activity against the pathogens most likely to contaminate the patient-care environment. Use in accordance with manufacturer’s instructions
  • Review the efficacy of in-use disinfectants when evidence of continuing transmission of an infectious agent (e.g., rotavirus, C. difficile, norovirus) may indicate resistance to the in-use product and change to a more effective disinfectant as indicated
  • In facilities that provide health care to pediatric patients or have waiting areas with child play toys (e.g., obstetric/gynecology offices and clinics), establish policies and procedures for cleaning and disinfecting toys at regular intervals
  • Use the following principles in developing this policy and procedures:
    • Select play toys that can be easily cleaned and disinfected
    • Do not permit use of stuffed furry toys if they will be shared
    • Clean and disinfect large stationary toys (e.g., climbing equipment) at least weekly and whenever visibly soiled If toys are likely to be mouthed, rinse with water after disinfection; alternatively wash in a dishwasher
    • When a toy requires cleaning and disinfection, do so immediately or store in a designated labeled container separate from toys that are clean and ready for use
  • Include multi-use electronic equipment in policies and procedures for preventing contamination and for cleaning and disinfection, especially those items that are used by patients, those used during delivery of patient care, and mobile devices that are moved in and out of patient rooms frequently (e.g., daily)
  • No recommendation for use of removable protective covers or washable keyboards.
• Textiles and laundry
  • Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces, and persons
  • If laundry chutes are used, ensure that they are properly designed, maintained, and used in a manner to minimize dispersion of aerosols from contaminated laundry
• Safe injection practices
  • Use aseptic technique to avoid contamination of sterile injection equipment
  • Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient
  • Use fluid infusion and administration sets (i.e., intravenous bags, tubing and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient’s intravenous infusion bag or administration set
  • Use single-dose vials for parenteral medications whenever possible
  • Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use
  • If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile
  • Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer’s recommendations; discard if sterility is compromised or questionable.
• Infection control practices for special lumbar puncture procedures
  • Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space (i.e., during myelograms, lumbar puncture and spinal or epidural anesthesia)
• Worker safety
  • Adhere to federal and state requirements for protection of healthcare personnel from exposure to bloodborne pathogens

Minimizing Potential Exposures

• Use respiratory hygiene and cough etiquette to reduce the transmission of respiratory infections within the facility.
  • Signage and handouts describing the importance of hand-washing and respiratory hygiene.
  • Instruct symptomatic patients and visitors to contain respiratory secretions with
    • use and dispose of tissues
    • proper hand washing / alcohol antiseptic rub
    • masks
• Triage symptomatic patients on entry
  • provide appropriate monitoring and separate accommodations,
  • ample hygiene supplies
    • sanitary hand rub, tissues, masks, waste disposal

Environmental Cleaning and Disinfection

• Use EPA-registered disinfectants that have microbiocidal activity against the pathogens most likely to contaminate the patient-care environment.
• Clean and disinfect surfaces in close proximity to the patient and frequently touched surfaces in the patient care environment on a more frequent schedule compared to other surfaces.
• Promptly clean and decontaminate spills of blood or other potentially infectious materials.

Injection and Medication Safety

• Use aseptic technique when preparing and administering medications.
• Disinfect the access diaphragms of medication vials before inserting a device into the vial.
• Use needles and syringes for one patient only (this includes manufactured prefilled syringes and cartridge devices such as insulin pens).
• Enter medication containers with a new needle and a new syringe, even when obtaining additional doses for the same patient.
• Ensure single-dose or single-use vials, ampules, and bags or bottles of parenteral solution are used for one patient only. Use fluid infusion or administration sets (e.g., intravenous tubing) for one patient only.
• Dedicate multi-dose vials to a single patient whenever possible. If multi dose vials are used for more than one patient, restrict the medication vials to a centralized medication area and do not bring them into the immediate patient treatment area (e.g., operating room, patient room/cubicle).
• Wear a face mask when placing a catheter or injecting material into the epidural or subdural space (e.g., during myelogram, epidural or spinal anesthesia).

Risk Assessment with Appropriate Use of Personal Protective Equipment, e.g., gloves, gowns, face masks, respirators, goggles and face shields, can be effective barriers to transmission of infections but are secondary to the more effective measures such as administrative and engineering controls.

• Ensure proper selection and use of personal protective equipment (PPE) based on the nature of the patient interaction and potential for exposure to blood, body fluids and/or infectious material
• Ensure that healthcare personnel have immediate access to and are trained and able to select, put on, remove, and dispose of PPE in a manner that protects themselves, the patient, and others.

Minimizing Potential Exposures

• Use respiratory hygiene and cough etiquette to reduce the transmission of respiratory infections within the facility.
  • Signage and handouts describing the importance of hand-washing and respiratory hygiene.
  • Instruct symptomatic patients and visitors to contain respiratory secretions with
  • use and dispose of tissues
  • proper hand washing
  • masks
• Triage symptomatic patients on entry
  • provide appropriate monitoring and separate accommodations,
  • ample hygiene supplies
    • sanitary hand rub, tissues, masks, waste disposal

Reprocessing of Reusable Medical Equipment

• Maintain separation between clean and soiled equipment to prevent cross contamination
• Ensure training and competency of reprocessing personnel
• Consult and adhere to manufacturers’ reprocessing procedures

References:

CDC. Hand Hygiene In Healthcare Setting. Retrieved on 12/3/2022, from: https://www.cdc.gov/handhygiene/providers/guideline.html

CDC. Infection Control Basics. Standard Precautions for All Patient Care. Retrieved on 12/3/2022, from: https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html

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