NBCOT: Standard Precautions (Table 3-1, 3-2)

What are the Standard Precautions?

A group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting where HC is delivered. Includes: Hand hygiene, use of gloves, gown, mask, eye protection, face shield, depending on the anticipated exposure, and safe injection practices. All equipment or items in the patient environment likely to have been contaminated with infectious body fluids must be handled in a manner to prevent transmission of infectious agents (wear gloves for direct contact, contain heavily soiled equipment, properly clean/disinfect or sterilize reusable equipment before use on another patient). Intended to protect both HCP and patient by ensuring that HCP's don't carry infectious agents to patients on their hands or via equipment during patient care.

Worker Safety Precautions

Adhere to federal and state requirements for protection of HCP's from exposure to bloodborne pathogens. OSHA!

ID'ing Potential Conflicts in Assessment - Professional Colleagues:

1

ID'ing Potential Conflicts in Assessment - OTA:

1) Am I competent to carry out the data collection I am responsible to perform? 2) Am I receiving adequate training/supervision to carry out the assigned portions of the assessment process? 3) Have I accurately reported the data and contributed to the overall assessment process?

ID'ing Potential Conflicts in Assessment - OT:

1) Am I competent to do this assessment? Do I have the necessary knowledge, skills and attitudes to select, administer and interpret the results of each eval? 2) Am I competent to supervise other OT personnel in the collection of data for this assessment? Am I sure that all delegated tasks are being carried out properly by competent individuals? 3) Have I accurately documented the services provided? Is the summary assessment an accurate reflection of the separate evaluations?

When should hand hygiene be performed?

1) Before having direct contact with patients 2) After contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings 3) After contact with a patient's intact skin (ex: Taking BP, transferring patient) 4) If hands will be moving from a contaminated body site to a clean body site during patient care. 5) After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient. 6) After removing gloves.

What does PPE stand for?

Personal Protective Equipment. Includes gloves, gowns, mouth/nose/eye protection, face shield.

What are the two types of major precautions that make up the standard precautions? Based on what principle?

Universal Precautions (UP) and Body Substance Isolation (BSI). Based on the principle that all blood, body fluids, secretions, excretions (EXCEPT sweat), nonintact skin and mucuous membranes may contain transmissible infectious agents.

Principles of Use for Mouth, Nose, Eye Protection

Use PPE to protect mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed.

What hand hygiene should be performed if contact with spores (e.g. C. difficile, B. anthracis) is likely to have occurred?

Wash hands with non/antimicrobial 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.

Principles of Use for Gowns

Wear a gown that is appropriate to the task to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions or excretions is anticipated. 1) Wear a gown for direct pt. contact if pt. has uncontaminated secretions or excretions. 2) Remove gown and perform hand hygiene before leaving the patient's environment. 3) Do not reuse gowns, even for repeated contacts w/same patient. 4) Routine donning of gowns upon entrance into a high-risk unit (ICU, NICU, hematopoietic stem cell transplantation [HSCT] unit) is not indicated.

What does hand hygiene consist of?

1) During HC delivery, avoid unnecessary touching of surfaces in close proximity to the patient to prevent both contamination of clean hand from environmental surfaces and transmission of pathogens from contaminated hands to surfaces. 2) When hands are visibly dirty, contaminated with proteinaceous material, or soiled with blood/body fluids, wash hands with either a non/antimicrobial soap and water. 3) If hands are not visibly soiled, or after removing visible material with nonantimicrobial soap and water, decontaminate hands, preferably with an alcohol-based hand rub. Alternatively, hands may be washed with an antimicrobial soap and water. Frequent use of alcohol-based hand rub following hand-washing with nonantimicrobial soap may increase frequency of dermatitis.

Respiratory Hygiene/Cough Etiquette

1) Educate HCP's on importance of source control measures to contain respiratory secretions to prevent droplet and fomite transmission of respiratory pathogens, especially during seasonal outbreaks of viral RTI's (e.g. flu, RSV, adenovirus, para-flu virus) in communities. 2) Implement measures (seasonally or year-round for standard practice) to contain respiratory secretions in patients and accompanying individuals who have signs/sx of a respiratory infection, beginning at the point of initial encounter in a HC setting (e.g. triage, reception, waiting areas in ER, outpatient clinics, physician offices).

Patient-care equipment and instruments/devices

1) Establish policies and procedures for containing, transporting, and handling patient-care equipment and instruments/devices that may be contaminated with blood or body fluids. 2) Remove organic material from critical and semicritical instrument/devices, using recommended cleaning agents before high-level disinfection and sterilization to enable effective disinfection and sterilization processes. 3) Wear PPE according to level of anticipated contamination when handling patient-care equipment and instruments/devices that are visibly soiled or may have been in contact with blood or body fluids.

Care of Environment

1) Establish policies/procedures for routine and targeted cleaning of environmental surfaces as indicated by the level of patient contact and degree of soiling. 2) Clean/disinfect surfaces likely to be contaminated with pathogens, including those in close proximity to the patient (e.g. bed rails, over bed tables) and frequently touched surfaces in pt-care environment (e.g. door knobs, surfaces in/surrounding toilets in pt's rooms) on a more frequent schedule compared to that for other surfaces (e.g. horizontal surfaces in waiting room). 3) Use EPA-registered disinfectants that have microbiocidal activity against the pathogens most likely to contaminate the pt-care envi. Use in accordance w/manufacturer's instructions. 4) In facilities that provide HC to pediatric patients or have waiting areas with child play toys (e.g. OBGYN offices, clinics), establish policies/procedures for cleaning/disinfecting toys at regular intervals. 5) Include multiuse electronic equipment in policies and procedures for preventing contamination and for cleaning and disinfection, especially items used by patients, those used during delivery of patient care, and mobile devices that are moved in/out of patient rooms frequently (daily). *No recommendations provided for use of removable protective covers or washable keyboards, issue is unresolved.

Textiles and Laundry Precautions

1) Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces and persons. 2)

Textiles and Laundry Precautions

1) Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces and persons. 2) If laundry are used, ensure they're properly designed, maintained, and used in a manner to minimize dispersion of aerosols from contaminated laundry.

ID'ing Potential Conflicts in Assessment - Individual Being Assessed (Pt, Family, Caregiver, etc.):

1) Has the consumer been informed about the purpose of the assessment, how it will be administered, and by whom? Does this person understand how the results will be used? 2) Has the individual been informed about how this service will be billed? 3) Has the person been given the opportunity to decide if the assessment should be done? 4) Are the individual's goals the basis for developing and carrying out the assessment process?

ID'ing Potential Conflicts in Assessment - Payer:

1) Is the assessment a necessary and billable service? 2) If there is not coverage by 3rd-party reimbursement, does the client know this? Has the individual given consent before the initiation of the evaluations? 3) Will the therapist and the billing office request fair compensation for the services and request payment only for the services provided?

ID'ing Potential Conflicts in Assessment - Employer (Facility, Agency, Company):

1) Is the assessment consistent with the facility's mission? 2) Will there ben accurate billing for services? 3) How will the interpretation and recommendations of the therapist be used?

ID'ing Potential Conflicts in Assessment - Professional Colleagues:

1) Is the referral consistent with the client's goals and needs? 2) Is this assessment necessary? 3) Are you communicating the results of the assessment clearly so that other members of the service delivery team have useful info? 4) Have copyrighted eval materials been used according to the laws regulating their use? 5) Is it necessary to pay fees to use the eval tool? Have they been paid? 6) Must the practitioner obtain permission to use the materials? 7) Is there specific training and supervision required to conduct the eval? 8) Does the person carrying out the eval hold the appropriate credentials to do so? 9) Have you used the correct forms/procedures in conducting the eval and reporting the results? 10) If it's a standardized eval, have you followed the procedures exactly?

ID'ing Potential Conflicts in Assessment - Community/Society:

1) Is this assessment consistent with the concepts of due process, reparation for wrongs that have been done (physical or emotional), and the fair and equitable distribution of OT services to individuals needing those services?

What following principles should be included in policies/procedures for cleaning/disinfecting toys at regular intervals?

1) Select play toys that can be easily cleaned/disinfected 2) Don't permit use of stuffed furry toys if they'll be shared 3) Clean/disinfect large stationary toys (e.g. climbing equipment) at least weekly and whenever visibly soiled. 4) If toys are likely to be mouthed, rinse with water after disinfection; alternatively wash in a dishwasher. 5) When a toy requires cleaning/disinfection, do so immediately or store in a designated labeled container separate from toys that are clean and ready for use.

Measures to contain respiratory secretions in patients and accompanying individuals with signs/sx of respiratory infection

1) Signs at entrances/strategic places (e.g. elevators, cafeterias) within ambulatory and inpatient settings with instructions to patients and other persons with sx of a respiratory infection to cover mouth/nose when coughing/sneezing, use/dispose of tissues, perform hand hygiene. 2) Provide tissues and no-touch receptacles (e.g., foot pedal-operated lid or an open, plastic-lined waste basket) for tissue disposal 3) Provide resources/instructions for performing hand hygiene in/near waiting areas in ambulatory and inpatient settings; provide conveniently located dispensers or alcohol-based hand rubs and, where sinks are available, supplies for hand washing. 4) During periods of increased prevalence of respiratory infections in community (e.g. as indicated by increased school absenteeism, increased # of pt's seeking care for respiratory infection), offer masks to coughing patients and other sx persons (e.g. those accompanying ill patients) upon entry into facility or medical office and encourage them to maintain special separation (~3 ft.) from others in common waiting areas.

What are the principles of use for PPE?

1) Wear PPE when the nature of the anticipated patient interaction indicates that contact with blood or body fluids may occur. 2) Prevent contamination of clothing and skin during process of removing PPE. 3) Before leaving the patient's room or cubicle, remove and discard PPE.

Principles of Use for Gloves

1) When reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur. 2) Wear gloves with fit and durability appropriate to task (wear disposable medical exam gloves for providing direct patient care, or reusable utility gloves for cleaning the environment or medical equipment) 3) Remove after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination. 4) Do not wear the same pairs of gloves for the care of more than 1 patient. Do not wash gloves for the purpose of reuse (this practice is assoc. w/transmission of pathogens). 5) Change gloves during patient care if the hands will move from a contaminated body site (e.g. perineal area) to a clean body site (e.g. face).

What are Aerosol Generating Procedures? What protection principles are involved?

AGP include bronchoscopy, suctioning of respiratory tract [if not using in-line suction catheters], endotracheal intubation. During these procedures in patients whoa re not suspected of being infected with an agent for which respiratory protection is otherwise recommended (e.g. TB, SARS, hemorrhagic fever viruses), wear (1) a face shield that fully covers the front and sides of the face, (2) a mask with attached shield, (3) a mask and goggles IN ADDITION to gloves and gown.

What does fomite mean?

An object (e.g. dish, article of clothing, equipment) that may be contaminated with infectious organisms and serve in their transmission.

How are Standard Precautions applied?

Application during patient care is determined by the nature of the HCP-patient interaction and the extent of anticipated blood, body fluid or pathogen exposure.

What is the basic assumption of the standard precautions?

Assume that every person is potentially infected or colonized with an organism that could be transmitted in the HC setting and apply the infection control practices during the delivery of care.

Should you wear artificial fingernails or extenders?

No. Especially not if duties include direct contact with patients at high risk for infection and associated adverse outcomes (e.g. ICU, OR). Develop an organizational policy for non-natural nails by HCP who have direct contact with patients outside of the groups specified above.