Previously known by various names including “universal precautions”, standard precautions are designed to reduce the risk of microorganism transfer from both recognised and unrecognised sources to a susceptible host.
Hospital Infection is the result of a combination of factors:
Microbial source + Transmission + Susceptible host = Infection
Standard precautions use the following include
- Aseptic practice
- Personal protective equipment
- Safe handling and disposal of infectious material, particularly sharps
- Environmental control.
- Asepsis [noun] is the state of being free from disease-causing contaminants (such as bacteria, viruses, fungi, and parasites).
- When performing invasive procedures it is essential to promote or induce asepsis to prevent undue contamination of a person, object or area by microorganisms to prevent infection.
- Ideally, a field is “sterile” — free of all biological contaminants, not just those that can cause disease, putrefaction, or fermentation — but that is a situation that is difficult to attain.
- However, elimination of infection is the goal of asepsis, not sterility.
- This basic practice is the single most effective form of infection control. It is vital, and essential to reducing the spread of infection within hospitals yet it is also the most commonly breached precaution against hospital infection. Human hands carry a plethora of resident and transient flora.
- Resident microbes are always present on the skin, where they are generally non-pathogenic. However, these microorganisms are of concern when performing invasive procedures, or dealing with the immunosuppressed patient. They may be reduced or inhibited by washing with an antimicrobial solution.
- Transient microbes include potentially pathogenic organisms, usually from patients and the hospital environment. They contaminate the hands of hospital staff during daily activities. These microbes can be readily passed from one person to another via hand contact, and can survive on the skin for up to 24 hours. Routine hand-washing will remove transient microbial flora.
- In many hospitals alcohol gel has been introduced to complement hand washing. Alcohol gel can substitute for a hand wash prior to contact with a clean, external patient body surface if the hands are already clean. Examination gloves are an important component of hand hygiene procedures when in contact with patient body fluids or blood products.
- Hands should always be washed:
- Before significant patient contact, interventional procedures, or eating and drinking. Significant contact includes the examination of a patient or wound, and any form of contact with invasive devices such as catheters, cannulae or drains.
- After performing activities likely to cause significant contamination, such as direct contact with bodily secretions or excretions, wounds, mucous membranes or drain sites.
- Between examining patients (even if you are on a busy ward round!).
- Remember: Disinfect your stethoscope periodically as a matter of course, and especially after examining patients with surgical wounds, chronic skin conditions or long term IV lines and other medical devices, or additional precautions for transmissible or epidemiologically important organisms (e.g. MRSA, VRE)
- Hand Hygiene Australia – http://www.hha.org.au/
- WHO infection control http://www.who.int/topics/infection_control/en/
- Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting (2004) http://www.health.gov.au/internet/main/publishing.nsf/Content/icg-guidelines-index.htm
Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |