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UNIVERSAL HEALTH
PRECAUTIONS
an Update
Dr.T.V.Rao MD
What are Universal Precautions
Universal precaution are
control guidelines designed to
protect workers
from exposure to Di...
Universal Precautions
– Applied universally in caring for all patients
• Hand washing
• Decontamination of equipment and d...
Why Universal Precautions
DEFINITION
Standard Precautions
• Previously known by various names including “universal
precautions”
• Sstandard precauti...
History of Infection Control Precautions
Year

Infection Control Precautions

1877,1910

Separates facilities, Antisepsis ...
Every Procedure increases the
Risk of Infection to HCW
Objectives:
Participants will:

• Understand and become familiar with
universal precautions.
• Learn the importance of goo...
Why Universal health
Precautions.
The concept of Universal Health
Precautions emphasizes that all our
patients should be t...
We Do Not Know who is Infected
Human materials/Tissues considered
Highly Infectious
•
•
•
•
•
•
•

1 Blood
2 Semen
3 Vaginal secretions
4CSF
5 Synovial f...
Not Infectious unless contaminated with
Blood or Body fluids.
•
•
•
•
•
•
•

Feces,
Nasal secretions,
Sputum,
Sweat,
Tears...
Hand washing is the most
important method of disease
prevention
Bacteria and bacteria can
be spread via dirty hands
and th...
HAND WASHING
• There is no Health precaution like Hand
washing.
• Washing with simple toilet soap - reduces the
rate of tr...
How to Wash our hands
Indications for Hand Washing
• In prolonged contact with patient.
• Before taking care of Immune supressed,New born
infant...
What to be used for hand washing
• In most circumstances Non medicated soaps and
detergents are effective in removing most...
Words of Wisdom on Hand
Washing
Soap, water and
Common sense are still be
Best Antiseptics
William Osler
This I do believe !
The single most important thing that you can do to stop
the spread of any germs is to wash your hands
Use of Gloves
Use of a pair of
disposable plastic
gloves can protect
if chances of
contact with
Blood or Body
fluid is
ant...
Use of Mask, Cap, Eye Wear
• Will certainly protect
us from splashes of
Blood or Body fluids.
• Don't underestimate
the im...
UP recommends the use of
Personal Protective
Equipment
• Gloves
• Aprons
• Gowns
• Protective
eyewear
• Face shields
• Mas...
Uses of Cap and Mask
Stringent use of
Mask and Cap
can save
several Lives in
the Hospital
Use of Foot wear
•Wearing foot wear covering entire
sole protects the entry of Microbes
from the contaminated floors with
...
Use of Impervious Gown
A simple thin Plastic
apron underneath the
linen is of great help in
preventing the
soaking our inn...
Universal Precautions also
include:
• Proper handling and
disposal of needles.
• Taking precautions to
prevent injury from...
Disposal of Needles and Sharps
• All used needles and sharps should be
deposited in thick walled puncture resistant
contai...
Dealing with Used Needle
Shredding
continues to be
Important
Method
Of dealing with
used Needle
Managing Occupational Exposure to HIV
Infection
Post-Exposure Prophylaxis (PEP:

• PEP – Following occupational HIV exposu...
Post-Exposure Prophylaxis (PEP)
• Immediate steps post- exposure
• Wash exposed wound or skin with soap and water
• For ne...
Guidelines for PEP
• Ideally, initiate PEP treatment within 2
hours of exposure
• If source patient is HIV negative,
disco...
Guidelines for PEP (continued)
– Follow approved PEP regimen( suggested)
– Examples
• ZDV 200 mg 3 times daily for 4 weeks...
Dealing with Needle stick
Injuries
• Consider all Needle stick injuries as a serious
health hazard in the era of AIDS
• Al...
Avoid Needle Stick Injuries
Hazards of Needle stick
Injuries
HIV HBV and HCV viral
infections can spread by Needle
stick Injuries
Nursing staff are at...
Decontamination of Hospital
Linen
• All the linen contaminated with
Blood or Body fluids should be
soaked in 1: 100 bleach...
Spillage of Blood/Body fluids
• A common health hazard in the working
environment.
• Never wipe the spillage with working ...
Care of Endoscopes
• Endoscopes are delicate/precious
instruments.
• Follow the instruction of Manufacturers.
• It is comm...
Decontamination of Metal Instruments
• Hold all contaminated instruments with
Gloved hands.
• Subject all metal instrument...
Anesthetic Tubing's and other
Equipment's
• Since they are in intimate contact with
Human secretion need utmost attention
...
Pregnant Health Care Workers
• Not at more risk than other, Health care
workers.
• Should adopt Universal Health
Precautio...
Operating on HIV/High risk groups
• It is a concern all should be cared equally.
• HIV infected carries the risk of being ...
Caution on Operating HIV
Sero Negative Patients
•Universal precaution apply to all our
patients irrespective of Blood test...
Precaution for Invasive
Procedures
• All HCW’s who participate in invasive
procedures must routinely use appropriate
barri...
Handling Dentistry Patients
Blood, Saliva, Gingival fluid from all
Dental patients should be
considered infective, Dental,...
Caring Bleeding Patients
• Primary health care workers who handle the patients
in Emergencies, and Accidents to be trained...
Importance of Vaccination in
Hepatitis B Infection.
• We have > 400 Million carriers with Hepatitis
B infections.
• Every ...
Vaccination for HBV infection
• All HCW’s must take at least three doses of
Vaccine,
At 0 – 1 – 6 months. without disconti...
Problem of HBV vaccines in the
Developing world
• Who pays for the Vaccine.
• Many who work in unorganized sector, do not
...
Transmission-Based Precautions
• Used in addition to Standard Precautions
for Specified Patients
• Designed for the Care o...
Droplet Transmission
• For infectious agents with droplet nuclei >
5 microns
• Examples:
– Pertussis
– Meningococcal menin...
Droplet Precautions
• Prevent infection
by large droplets
from
– Sneezing
– Coughing
– Talking
• Examples
– Neisseria meni...
Airborne Transmission
• For infectious agents with droplet nuclei < 5
microns
• Examples:
– Tuberculosis
– Measles
• Preca...
Patient care equipment
• Handle equipment soiled with blood, body
fluids, secretions, and excretions in a
manner that prev...
Contact Precautions
• For protection against skin-to-skin contact and physical
transfer of microorganisms to a host from a...
Never forget to take Hepatitis B
Vaccine if You are a HCW
Majority of OSHA CDC, and NIOSH
guidelines are incorporated.
• The Programme created by Dr.T.V.Rao MD
for the Medical and Health Care Personal in
the Developing World

• Email
• docto...
Universal safety Precautions
Universal safety Precautions
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Universal safety Precautions

  1. 1. UNIVERSAL HEALTH PRECAUTIONS an Update Dr.T.V.Rao MD
  2. 2. What are Universal Precautions Universal precaution are control guidelines designed to protect workers from exposure to Diseases spread by Blood and other Body fluids.
  3. 3. Universal Precautions – Applied universally in caring for all patients • Hand washing • Decontamination of equipment and devices • Use and disposal of needles and sharps safely (no recapping) • Wearing protective items • Prompt cleaning up of blood and body fluid spills • Systems for safe collection of waste and disposal
  4. 4. Why Universal Precautions
  5. 5. DEFINITION Standard Precautions • Previously known by various names including “universal precautions” • Sstandard precautions are designed to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources to a susceptible host. • They are the basic level of infection control precaution • Hospital Infection is the result of a combination of factors: Microbial source + Transmission + Susceptible host = Infection
  6. 6. History of Infection Control Precautions Year Infection Control Precautions 1877,1910 Separates facilities, Antisepsis and disinfections ... etc 1985 UNIVERSAL PRECAUTIONS (guidelines for protecting healthcare worker because the emergence of HIV & other bloodborne pathogens) 1987 BODY SUBSTANCE ISOLATION ( focused on protecting patients and health personnel from all moist body fluids not just blood: semen, vaginal secretions, wound drainage, sputum, saliva etc 1996 STANDARD PRECAUTIONS:Two level approach: •Standar Precautions which apply to all clients and patients attending healthcare facilities •Transmission-based Precautions which apply only to hospitalized patients ISOLATION PRECAUTIONS (new pathogens; SARS, Avian Influenzae H5N1, H1N1) 2007
  7. 7. Every Procedure increases the Risk of Infection to HCW
  8. 8. Objectives: Participants will: • Understand and become familiar with universal precautions. • Learn the importance of good hygiene and hand washing. • Learn proper hand washing techniques. • Learn the proper technique for applying and removing gloves.
  9. 9. Why Universal health Precautions. The concept of Universal Health Precautions emphasizes that all our patients should be treated as though they have potential blood born infections, and can infect the caring health care workers. ( CDC )
  10. 10. We Do Not Know who is Infected
  11. 11. Human materials/Tissues considered Highly Infectious • • • • • • • 1 Blood 2 Semen 3 Vaginal secretions 4CSF 5 Synovial fluids 6 Amniotic fluid 7 All other body fluids
  12. 12. Not Infectious unless contaminated with Blood or Body fluids. • • • • • • • Feces, Nasal secretions, Sputum, Sweat, Tears, Urine / Vomitus, Saliva unless blood stained.
  13. 13. Hand washing is the most important method of disease prevention Bacteria and bacteria can be spread via dirty hands and the are too small to see with the human eye. You must wash you hands properly in order to remove them.
  14. 14. HAND WASHING • There is no Health precaution like Hand washing. • Washing with simple toilet soap - reduces the rate of transmission of common infections including the HIV.
  15. 15. How to Wash our hands
  16. 16. Indications for Hand Washing • In prolonged contact with patient. • Before taking care of Immune supressed,New born infants, patients in ICU / ICCU, Dialysis Units, Burn’s Units. • Before and after touching wounds. • When Microbial contamination of Hands, likely to occur when in contact with mucous membranes, body fluids, and other secretions contaminated with Blood, and serous fluids.
  17. 17. What to be used for hand washing • In most circumstances Non medicated soaps and detergents are effective in removing most transient contaminants. • In demanding circumstances, in handling potentially harmful infections, use Ethyl or Isopropyl alcohol. • Detergent formulations containing Chlorhexidine Povidone,or Hexachlorophene are effective in prevention of spread of infections.
  18. 18. Words of Wisdom on Hand Washing Soap, water and Common sense are still be Best Antiseptics William Osler
  19. 19. This I do believe ! The single most important thing that you can do to stop the spread of any germs is to wash your hands
  20. 20. Use of Gloves Use of a pair of disposable plastic gloves can protect if chances of contact with Blood or Body fluid is anticipated/inevitable.
  21. 21. Use of Mask, Cap, Eye Wear • Will certainly protect us from splashes of Blood or Body fluids. • Don't underestimate the importance of Use of Cap and Mask. • It equally protects our patients.
  22. 22. UP recommends the use of Personal Protective Equipment • Gloves • Aprons • Gowns • Protective eyewear • Face shields • Masks
  23. 23. Uses of Cap and Mask Stringent use of Mask and Cap can save several Lives in the Hospital
  24. 24. Use of Foot wear •Wearing foot wear covering entire sole protects the entry of Microbes from the contaminated floors with Blood and Body fluids. •Remember many of us have cracks on our feet.
  25. 25. Use of Impervious Gown A simple thin Plastic apron underneath the linen is of great help in preventing the soaking our inner clothes and exposure to harmful microbes.
  26. 26. Universal Precautions also include: • Proper handling and disposal of needles. • Taking precautions to prevent injury from scalpels, needles, and other sharp instruments.
  27. 27. Disposal of Needles and Sharps • All used needles and sharps should be deposited in thick walled puncture resistant containers. • Bending, Reshaping, should be prohibited. • Do not recap the needles to avoid needle stick injures, • All used Disposable syringes and needles should be discarded into Bleach solution at the work station before final disposal.
  28. 28. Dealing with Used Needle Shredding continues to be Important Method Of dealing with used Needle
  29. 29. Managing Occupational Exposure to HIV Infection Post-Exposure Prophylaxis (PEP: • PEP – Following occupational HIV exposure, shortcourse of ARV drugs can be used to reduce the likelihood of infection • Register occupational exposures • Ensure that HIV counselling, testing,and ARV drugs are available • Educate healthcare workers
  30. 30. Post-Exposure Prophylaxis (PEP) • Immediate steps post- exposure • Wash exposed wound or skin with soap and water • For needle or sharp injury, allow to bleed for a few seconds before washing • Inform supervisor of type of exposure and the actions taken • Assure confidentiality to the HCW • Ensure support and referral for treatment
  31. 31. Guidelines for PEP • Ideally, initiate PEP treatment within 2 hours of exposure • If source patient is HIV negative, discontinue PEP and retest at 6 weeks, 3 months, and 6 months • If source patient is HIV positive, counsel, support, and refer the HCW for continued treatment
  32. 32. Guidelines for PEP (continued) – Follow approved PEP regimen( suggested) – Examples • ZDV 200 mg 3 times daily for 4 weeks • Combivir tablet (300 mg ZDV and 150 mg lamivudine) twice daily + • Indinavir 800 mg 3 times daily for 4 weeks
  33. 33. Dealing with Needle stick Injuries • Consider all Needle stick injuries as a serious health hazard in the era of AIDS • All events of Needle stick injuries to be reported to the supervisory staff. • Wash the injured areas with soap and water. • Encourage bleeding if any. • Prophylaxis for prevention of HIV/HBV is top priority. • Anti retroviral prophylaxis, if necessary should started within 2 hours, ( if injury is from HIV positive or high risk group).
  34. 34. Avoid Needle Stick Injuries
  35. 35. Hazards of Needle stick Injuries HIV HBV and HCV viral infections can spread by Needle stick Injuries Nursing staff are at greater risk Several Injuries are preventable
  36. 36. Decontamination of Hospital Linen • All the linen contaminated with Blood or Body fluids should be soaked in 1: 100 bleach solution for 30 minutes. • Advised Autoclaving, as the most ideal procedure for decontaminating Linen
  37. 37. Spillage of Blood/Body fluids • A common health hazard in the working environment. • Never wipe the spillage with working wet mop. Always cover the spills with paper and pour 1 % Hypochlorite or Bleaching powder to decontaminate the spills with HIV/HBV virus.
  38. 38. Care of Endoscopes • Endoscopes are delicate/precious instruments. • Follow the instruction of Manufacturers. • It is commonly cleaned with 2 % Glutaraldehyde solution. • Specified time schedules to be followed to decontaminate for HIV. • Mycobacterium needs even > 2 hours for decontmination.
  39. 39. Decontamination of Metal Instruments • Hold all contaminated instruments with Gloved hands. • Subject all metal instruments to washing with soap and water. • Treat all contaminated instruments with 2% Glutaraldehyde. For at least 30 minutes. • Many consider sterilizing in Hot air oven if not sharp instruments.
  40. 40. Anesthetic Tubing's and other Equipment's • Since they are in intimate contact with Human secretion need utmost attention in decontamination. • Treat all Non disposable as highly hazardous, if used without safe practices can infect the next patient undergoing procedures. • Soaking in 2 % Glutaraldehyde is common practice in Developing world.
  41. 41. Pregnant Health Care Workers • Not at more risk than other, Health care workers. • Should adopt Universal Health Precautions with more dedication, • If neglected the Unborn is at grave risk of attaining congenital infections. • The Laboratory supervisors should monitor/ guide the HCW’s for adherence to scientific practices.
  42. 42. Operating on HIV/High risk groups • It is a concern all should be cared equally. • HIV infected carries the risk of being neglected at the time of crisis. • Law many not change for equality but motivated health workers should bring in change of attitude. • Adherence of Universal Health precaution bring in safety to all HCW. • Follow the precautions even in Non HIV patients as some of our patients are in window period and more dangerous than truly positive with Sero testing.
  43. 43. Caution on Operating HIV Sero Negative Patients •Universal precaution apply to all our patients irrespective of Blood tests we undertake. •We handle so many patients in emergency situation with out any details. •Education on Universal precautions participation of you and educating your subordinates/Juniors will make a lot of Difference in the work Environment.
  44. 44. Precaution for Invasive Procedures • All HCW’s who participate in invasive procedures must routinely use appropriate barrier precautions. • All Health care workers who perform/assist vaginal, and cesarean deliveries should wear gloves and gowns when handling, the placenta, and the new born, till blood and amniotic fluid has been removed from infants. • Amniotic fluid is rich in HIV/HBV virus, in infected mothers.
  45. 45. Handling Dentistry Patients Blood, Saliva, Gingival fluid from all Dental patients should be considered infective, Dental, workers should wear surgical mask, gloves and eye wear
  46. 46. Caring Bleeding Patients • Primary health care workers who handle the patients in Emergencies, and Accidents to be trained in basic principles of Universal Health care precautions. • Mouth to Mouth resuscitation is life saving in the Critically injured accident victims. May be neglected because of fear of HIV infection. • If the situation warrants, Bleeding from mouth can be wiped out with clean cloth, or Handkerchief, and still one can do resuscitation.
  47. 47. Importance of Vaccination in Hepatitis B Infection. • We have > 400 Million carriers with Hepatitis B infections. • Every HCW is at risk of Contacting infection. • Vaccination is safe -Genetically Engineered vaccination remains the great hope for prevention, apart from Major component of Universal precautions.
  48. 48. Vaccination for HBV infection • All HCW’s must take at least three doses of Vaccine, At 0 – 1 – 6 months. without discontinuation of the schedule. • All Health care workers many not attain equal response. • High risk HCW’s should undergo estimation of anti HB s ( antibodies ) to know whether they were well protected.
  49. 49. Problem of HBV vaccines in the Developing world • Who pays for the Vaccine. • Many who work in unorganized sector, do not get Institutional support of Vaccine. • Life, at risk if Infected with HBV • More Awareness to be brought in by Managers of the Hospitals, to promote to vaccinate their Employees.
  50. 50. Transmission-Based Precautions • Used in addition to Standard Precautions for Specified Patients • Designed for the Care of Specified Patients known or suspected to be infected by epidemiologically important pathogens spread by: airborne, droplet, or contact transmission.
  51. 51. Droplet Transmission • For infectious agents with droplet nuclei > 5 microns • Examples: – Pertussis – Meningococcal meningitis • Precaution Examples: – Private room – Mask if within 3’ of patient
  52. 52. Droplet Precautions • Prevent infection by large droplets from – Sneezing – Coughing – Talking • Examples – Neisseria meningitidis – Pertussis – Influenza
  53. 53. Airborne Transmission • For infectious agents with droplet nuclei < 5 microns • Examples: – Tuberculosis – Measles • Precaution Examples – Isolation rooms under negative pressure – N95 or HEPA respirator use
  54. 54. Patient care equipment • Handle equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of pathogens to other patients or the environment. • Clean, disinfect, and reprocess reusable equipment appropriately before use with another patient.
  55. 55. Contact Precautions • For protection against skin-to-skin contact and physical transfer of microorganisms to a host from a source • Precaution Examples: – Private room – Hand washing – Glove changes • Examples – Scabies – VRE
  56. 56. Never forget to take Hepatitis B Vaccine if You are a HCW
  57. 57. Majority of OSHA CDC, and NIOSH guidelines are incorporated.
  58. 58. • The Programme created by Dr.T.V.Rao MD for the Medical and Health Care Personal in the Developing World • Email • doctortvrao@gmail.com

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