Standard Precautions

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Standard Precautions

Introduction

Standard precautions are precautions that have been put into effect by the U.S. Centers for Disease Control and Prevention (CDC) aimed at reducing the risk of transfer of disease-causing viruses or bacteria (generally called pathogens) from the blood or other moist regions of the body—such as mucous membranes and damaged skin—that can harbor pathogens. Essentially, standard precautions involve good hygiene. This includes proper handwashing and, in a hospital, other practices, such as the proper use of protective equipment, environmental controls, and handling of used linen.

History and Scientific Foundations

The standard precaution criteria established by the CDC in January 1996 are an extension of guidelines that were known as universal precautions. Universal precautions were recommended in 1987 following the recognition that acquired immunodeficiency syndrome (AIDS, also cited as acquired immune deficiency syndrome) could be contracted by the transfer of blood that was contaminated with the human immunodeficiency virus (HIV).

Universal precautions applied to people known or suspected of having a blood-borne infection. Standard precautions are wider in their scope, and apply to all body fluids (except sweat) of all patients whether or not they are recognized as having an infection.

Applications and Research

Handwashing

One of the fundamental standard precautions is hand-washing. Hands must be washed after direct contact with blood or other body fluids of a patient, or after contact with items, such as fluid-soaked linen, whether or not gloves have been worn. This ensures that pathogens that may have contacted the skin through tiny tears or an imperfection in a glove are killed.

Handwashing should be done immediately after contact with a patient and before moving on to another patient. Handwashing may also need to be done during the time with one patient, if different tasks are performed, for example, after probing inside the mouth and before examining other parts of the body.

For routine handwashing, use of ordinary household soap is acceptable, since the soap's ingredients and the friction from rubbing the hands together for a sufficient length of time (at least 30 seconds) will produce the desired antimicrobial effect. But, increasingly in hospital wards, an alcohol solution is being used. This is because the alcohol solution is effective more quickly, an important consideration in the time-constrained day of healthcare providers. In addition, washing the hands with soap many times every day can be harsh on skin, even to the point of causing breaks in the skin that can become infected.

Gloves

Healthcare providers should wear gloves when coming into contact with blood and other body fluids. Fresh gloves must be worn for each patient, otherwise the gloves can become a route of patient-to-patient transfer of microbes. Similar to handwashing, gloves should be worn and removed immediately before and after contact with a patient, and need to be disposed of in a designated container.

Gown

A hospital gown worn over clothing protects against splashing or spraying of blood and other body fluids. The choice of a gown depends to a large extent on the infection that a person might be exposed to. For example, a gown made out of plastic or other water-repellent material should be used when dealing with an infection suspected of being severe such as Ebola. A gown that became soaked with Ebola virus-laden blood could result in transfer of the virus to the healthcare provider. In contrast, cotton gowns can be appropriate in other cases.

A gown should be removed as soon as possible after seeing a patient and always before moving to another patient. Since the removal of a gown involves the hands, handwashing should be done only after a gown is removed and put in a designated container.

Patient-Care Equipment

Equipment that becomes contaminated with blood or other body fluid must be decontaminated before re-use. Equipment that is meant for one-time use must be disposed of properly after that use and should never be reused. Needles and other sharp object must be disposed of after use in rigid containers to minimize the chances of accidental injury during their disposal.

Environmental Control

Microorganisms can stick to surfaces and, in some cases, can remain capable of causing an infection for hours. If a contaminated surface is touched by someone, the infectious microbes can be transferred to that person or someone else that person contacts. Thus, an important standard precaution is the disinfection of surfaces such as beds, bedrails, toilets and toilet assist rails, and equipment near a patient's bed. The disinfection needs to be done at regular intervals with an approved disinfectant, and all disinfections should be recorded on paper or electronically.

Linen

Soiled bedding needs to be cleaned to completely remove blood and body fluids. It should be washed in hot water to kill living bacteria that may have clung to the fabric. Another standard precaution involving linen relates to the transport of the linen from the bedside to the hospital laundry. Soiled linen should be transport in a closed and waterproof container to lessen the chances that microbes could leak out or become airborne.

Impacts and Issues

Standard precautions are an efficient way of minimizing the chances of the transfer of infectious microorganisms from patient to patient, and from patients to healthcare providers. However, diligence is required.

Unfortunately, diligence is not always practiced. A number of studies from the United States and Europe conducted since 2000 have revealed a dismal record of compliance with handwashing among healthcare providers. Even though the benefits of handwashing are well-established, fewer than 50% of healthcare providers regularly wash their hands after finishing with one patient and before seeing another patient. The common explanation is a lack of time. In an effort to increase compliance with handwashing, some hospitals have installed alcohol-based handwashing stations at patient's bedsides. The pressure of being caught in noncompliance with handwashing precautions can be a powerful incentive to practice proper hygiene.

WORDS TO KNOW

AUTOCLAVE: An autoclave is a device that is designed to kill microorganisms on solid items and in liquids by exposure to steam at a high pressure.

HYGIENE: Hygiene refers to the health practices that minimize the spread of infectious microorganisms between people or between other living things and people. Inanimate objects and surfaces such as contaminated cutlery or a cutting board may be a secondary part of this process.

PATHOGEN: A disease causing agent, such as a bacteria, virus, fungus, etc.

UNIVERSAL PRECAUTION: Universal precaution refers to an infection control strategy in which all human blood and other material is assumed to be potentially infectious, specifically with organisms such as Human Immunodeficiency Virus (HIV) and Hepatitis B Virus. The precautions are aimed at preventing contact with blood or the other materials.

The need for standard precautions pertaining to equipment is highlighted by the observation that prions— proteins whose abnormal folding causes a severe, progressive damage to brain cells that is the basis of transmissible spongiform encephalopathies, such as Creutzfeldt-Jakob disease—can remain capable of causing disease even when surgical instruments have been sterilized using the combination of chemicals and the high pressure and high heat that is known as autoclaving. The World Health Organization has recommended that surgery on patients suspected of having a prion-related disease should be done using disposable instruments, or instruments should be incinerated before being used again.

A real-world example of this danger occurred in 2003 in New Brunswick, Canada, where seven patients likely contracted Creutzfeldt-Jakob disease (CJD) from surgical equipment that was contaminated with prions. An investigation revealed that the instruments had originally been used in neurosurgery on a patient who subsequently developed CJD. While the instruments were treated according to the required protocol, this was not sufficient to decontaminate them.