Which patients would the nurse implement standard precautions when providing care?

Welcome

Welcome to Module 4: Standard and Transmission-based Precautions. We are glad you're here!

What you learn in this class will help keep you, and your residents, safe. 

Module 4 will present you with information on standard precautions and transmission-based precautions.

In this CBT, you will:

• Identify standard precautions that should be take place with every resident interaction;
• Identify transmission-based protocols that should take place based on the pathogen present; and
• Identify practices to minimize transmission in shared spaces.

Standard precautions are a set of protocols that are aimed at breaking the chain of infection. These primary practices should be used during every interaction with a resident.

Standard precautions include:

• Hand hygiene
• Use of personal protective equipment (e.g., gloves, masks, eyewear)
• Respiratory hygiene / cough etiquette
• Waste disposal
• Cleaning and disinfecting

View the document to the right to learn about the CDC's recommendations on standard precautions for all patient care

One of the most important infection prevention measures is hand hygiene. It is important to understand the when, why and how to perform hand hygiene to get the maximum effect on mitigating disease transmission.

Hand hygiene should occur:

• Before and after contact with a resident
• After contact with blood, body fluids or visibly contaminated surfaces
• After contact with objects and surfaces in the residents environment
• After removing PPE
• Before performing an aseptic task (ex. wound care)
• Before and after eating
• After smoking

Routine hand hygiene can be performed using soap and water or an alcohol-based hand rub (ABHR). Some facilities will place ABHR dispensers at the door of each room, while others encourage you to carry a bottle of ABHR on you at all times.

 Be sure to read your facility policy on hand hygiene. Follow the rules set forth by your employer.

While it may seem instinctual, there IS a proper way to wash your hands.

The following steps will ensure that your hands are properly cleansed and devoid of as many pathogens as possible that may be transmissible.

1. Wet your hands with clean, running water and apply soap
2. Lather your hands by rubbing them together with the soap
3. Lather the backs of your hands, between your fingers, and under your nails
4. Scrub your hands for at least 20 seconds
5. Rinse your hands well under clean, running water
6. Dry your hands using a clean towel or air dry them

There are times that you will use ABHR (alcohol-based hand rub) more frequently than soap and water.

To use ABHR effectively, you should apply a liberal amount of ABHR and rub your hands in the same manner as if you were using soap and water until the ABHR dries. This should take around 20 seconds.

It is important to note that you MUST wash your hands with soap and water if your hands are visibly contaminated. ABHR will not be effective.

You should also be aware that ABHR DOES expire. Please be sure to check bottles of ABHR in your possession or your work area to ensure that the product is in date.

PPE Selection

Appropriate Use

Goggles

To be worn when there is potential for splash or spray from bodily fluids

Face Masks/Face Shields

To be worn when there is potential for splash or spray from body fluids

Respirators

To be worn when there is contact with airborne pathogens

Gloves

To be work when there is potential with blood or body fluids, mucous membranes, or non-intact skin

Gowns

To be worn when there is a risk of your skin or clothing being exposed to blood or body fluids

According to the CDC, the following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection:

• Cover your mouth and nose with a tissue when coughing or sneezing.
• Use in the nearest waste receptacle to dispose of the tissue after use.
• Perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic hand wash) after having contact with respiratory secretions and contaminated objects/materials.
• Healthcare facilities should ensure the availability of materials for adhering to Respiratory Hygiene/Cough Etiquette in waiting areas for patients and visitors.
• Provide tissues and no-touch receptacles for used tissue disposal.
• Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e. soap, disposable towels, etc.) are consistently available.

OSHA created guidance on how medical-waste items should be discarded. The steps used are designed to protect workers who use and create the medical waste and those who dispose of it.

Non-sharp disposable items saturated with blood or body fluids (i.e., fluid can be poured or squeezed from the item or fluid is dripping from the item) should be discarded into biohazard bags that are puncture-resistant, leak-proof, and labeled with a biohazard symbol or red in color. Such items may include used PPE and disposable rags or cloths.

A single, leak-resistant biohazard bag is usually adequate for containment of regulated medical wastes, provided the bag is sturdy and the waste can be discarded without contaminating the bags exterior.

The contamination or puncturing of the bag requires placement into a second biohazard bag. All bags should be securely closed for disposal.

The OSHA standard provides that regulated waste containing contaminated sharps be discarded in containers which are:

a) closable,

b) puncture resistant;

c) leak proof on sides and bottom; and

d) labeled or color-coded.

To prevent needle stick injuries, needles and other contaminated sharps should not be recapped, purposefully bent, or broken by hand.

The CDC has published general guidelines for handling sharps.

Transporting and storing regulated medical wastes within the health-care facility prior to terminal treatment is often necessary.

Both federal and state regulations address the safe transport and storage of on- and off-site regulated medical wastes

Transmission-based precautions are a second-level of infection control. They are used in addition to standard precautions.

Typically, transmission-based precautions are utilized for residents who may be infected with communicable diseases that are spread through direct contact, droplet-transmission, or airborne-transmission.

Contact precautions should be used when there is a risk of passing pathogens from one person to another through direct contact. This includes contact with infected skin or open wounds or body fluids.

Contact precautions should also be used when there is bedding or clothing that is contaminated with body fluids.

Contact precautions include:

• Washing your hands before entering the room
• Washing your hands after exiting the room
• Wearing proper PPE (gloves and gown) and removing the PPE when exiting the room.
• Limiting transport of residents outside of the room (Only moving the resident when it is medically necessary)
• Using disposable or dedicated patient-care equipment, like blood pressure cuffs.
• Prioritizing the cleaning and disinfection of a residents rooms on contact precautions to ensure a more frequent schedule.

Scenario: MRSA

Risk Assessment Questions

Infection Prevention Measures

Examples include:

• Does this person have an active infection?
• What type of care am I providing?
• Where am I providing care?
• What PPE should I wear?

Example:

Let's pretend he has a skin infection that has been diagnosed as Methicillin Resistant Staphylococcus Aureus. You are taking him medication.

What precautions should you take?

Droplet precautions are used to help prevent the spread of pathogens that travel short distances through respiratory droplets. You should utilize droplet precautions when a resident has a known or suspected illness that is transmitted through coughing, sneezing, and/or talking.

To help minimize the spread of droplet-transmission, utilize source control by having the resident wear a mask when others are in the room.

Droplet precautions include:

• Washing your hands before entering the room
• Washing your hands after exiting the room
• Wearing a face covering
• Mask
• Goggles
• Face shield
• Limit transport of residents outside of the room. Only move the resident when it is medically necessary.
• Should transport be necessary, the resident must wear a mask and follow respiratory hygiene and cough etiquette.

Scenario: Possible Influenza

Risk Assessment Questions

Infection Prevention Measures

Examples include:

• Does this person have a fever?
• Does this person practice respiratory etiquette?
• What type of care am I providing?
• Where am I providing care?
• What PPE should I wear?

Example:

Lets pretend that he has a fever and is not practicing respiratory hygiene.

He does not have a diagnosis yet, but all signs point to the flu.

You are tasked with bringing him lunch.

What precautions should you take?

Airborne precautions are used to help prevent the spread of pathogens that can remain suspended (and infectious) in the air for long periods of time.

You should utilize airborne precautions when a resident has a known or suspected illness such as, but not limited to:

• Tuberculosis (active cases)
• Measles
• Chicken pox

To help minimize the spread of airborne transmission, utilize source control by having the resident wear a mask when others are in the room.

Airborne precautions include:

• The door to the residents room should remain closed.
• Washing your hands before entering the room
• Washing your hands after exiting the room
• Wearing an N95 or higher-level respirator prior to entry of the room
• Respirators should be properly fit and seal-tested prior to room entry.
• Respirators should only be removed upon exit of the room with the door shut behind you
• Limit transport of residents outside of the room. Only move the resident when it is medically necessary.
• If transport or movement is necessary, instruct patients to wear a surgical mask, if possible, and observe Respiratory Hygiene/Cough Etiquette.
• Healthcare personnel transporting patients who are on Airborne Precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and infectious skin lesions are covered, per the CDC.

Scenario

Risk assessment Questions

Infection prevention measures

Examples include: 

• Does this person have a fever?
• Does this person practice respiratory etiquette?
• What type of care am I providing?
• What PPE should I wear?
• Did this person travel recently? And where to?

Example:

Let's pretend that she has a fever, is not practicing respiratory hygiene, and is a recent admission to the facility.

Prior to her admission, she has just returned from an international trip and has been diagnosed with an active TB infection.

You are tasked with taking her vital signs.

What precautions should you take?