Standard Precautions (Infection Control) in Healthcare microbiologystudy

Standard precautions are a set of infection control practices to be used by all staff, in all healthcare settings, at all times, for all patients whether infection is known to be present or not, to ensure the safety of patients, staff, and hospital environment.

Sources of (potential) infection include blood and other body fluids, secretions, or excretions (excluding sweat), non-intact skin or mucous membranes and any equipment or items in the care environment that could have become contaminated.

The term Universal precautions (used previously) is not applicable anymore.

Standard Precautions should be followed while handling:

• All patients, irrespective of their infection status
• All specimens (blood and body fluids)
• All needles and sharps

Components of Standard Precautions

1. Hand Hygiene
2. Personal Protective Equipment
3. Handling and disposal of sharps
4. Management and Decontamination of Linen
5. Cleaning and Decontamination of environment and patient care equipment
6. Biomedical waste management
7. Respiratory hygiene and cough etiquettes

Hand Hygiene

• Need for Hand Hygiene
  • Prevent the spread of infection between patients and HCWs
  • Prevent the spread of infection between patients/HCWs and the environment

• Indications of Hand hygiene are described by WHO’s 5 Moments of Hand Hygiene

• Moment 1 – Before touching a patient
• Moment 2 – Before clean/aseptic procedure
• Moment 3 – After body fluid exposure/risk
• Moment 4 – After touching a patient
• Moment 5 – After touching patient’s surroundings

• Types of Hand Hygiene
  • Hand rub (alcohol-based hand sanitiser)
  • Hand washing with soap and water
  • Surgical hand scrub (before any surgical procedure)

• Indications of Hand washing over handrub
  • Hands are visibly dirty, or contaminated with blood or body fluids
  • Potential exposure to spore forming organisms, (e.g., Clostridioides difficile); non-enveloped viruses
  • Handling of patients with diarrhoea
  • After using restroom
  • Before handling medication or food

Personal Protective Equipment (PPE)

PPE is specialised clothing or equipment used by HCWs to protect themselves from infection.

• Need for PPE:
  • Protect the skin and mucous membrane of HCWs from infection while handling the patients and during procedures
  • Protect the spread of infection from HCWs to patients

• PPE should be:
  • available wherever needed
  • located close to the point of use
  • stored in a clean and dry area until required
  • selected depending on the type of exposure or procedure
  • single-use only unless specified by the manufacturer
  • worn and removed in appropriate sequencing (Donning and Doffing)
  • disposed of appropriately after single use
  • decontaminated after each use (for reusable PPE)

• Types of PPE
  • Gloves
  • Gown, apron
  • Masks, respirators
  • Face mask
  • Eye protection goggles

• Donning & Doffing of PPE:

Handling and Disposal of Sharps

• Need of Management of sharps:
  • To prevent occupational exposure to HCWs (Needle stick injury)

• Examples of sharps:
  • Syringes with fixed needles
  • Blades
  • Scalpels
  • Needles

• Essential steps for handling and disposal of sharps:
  • Minimise the use of sharps, wherever possible
  • Vaccination of HCWs against Hepatitis B virus
  • Perform hand hygiene before and after handling sharps
  • Wear appropriate PPE before using sharps
  • Use of Single-use disposable needles
  • Needles must not be uncovered/unwrapped until needed
  • Needles must not be re-capped
  • Sharps must not be passed from hand to hand
  • Disposal of sharps in a designated puncture-proof container
  • Guidelines for Post-exposure prophylaxis and management must be laid out by every institute/lab for management of Needle stick injury

Management and Decontamination of Linen

• The term ‘linen’ is used for all reusable textile items used in a health care facility.
  • General purpose linen – Table cloth, drapes, curtains
  • Patient linen – Gown, pyjama, shirt
  • Bed linen – Bed sheets, pillow cover, blanket
  • HCWs linen – Uniform, coats, scrubs
  • Operation theatre linen – Surgical cap, gown, trolley covers, towels

• Classification of linen:
  • Clean linen – Washed linen, ready to be used
  • Dirty linen – Used, not visibly soiled with blood, body fluids or faeces
  • Soiled/Infectious linen – Visibly contaminated with blood, body fluids or faeces; or linen from patients with diagnosed infection

• Storage and handling of Clean linen:
  • Hand hygiene should be performed before handling clean linen
  • Clean linen must be separated from dirty linen
  • There should be a designated storage area, like a cupboard
  • Stock register should be maintained

• Storage and handling of Dirty and soiled linen:
  • Appropriate PPE must be worn before handling contaminated linen, like gloves, masks, gown
  • Dirty and soiled linen should be segregated at source in different coloured laundry bins, like green and red respectively
  • Laundry bins should not overfill
  • Contaminated linen should be transported to the laundry facility in appropriate bags
  • Contaminated linen should be dipped in 10% Lysol before washing at the source or the laundry facility
  • Hand hygiene must be performed after handling contaminated linen

Cleaning and Decontamination of Environment

• General cleanliness and hygiene should be maintained
• Cleaning protocols should be well constituted and should include responsibility for, frequency of, and method of environmental decontamination
• Housekeeping staff should be aware of cleaning protocols, their duties, schedules, area
• Hospital areas for cleaning purposes should be classified into:
• Low-risk areas
  • Registration area, corridors, offices, staff rooms
  • Regular cleaning with detergent and water
  • Occasional cleaning with disinfectants such as quaternary ammonium compounds
• Moderate-risk areas
  • Wards, laboratories, blood bank, nurse or doctors restroom
  • Regular cleaning with detergent and water
  • In between cleaning with aldehyde-based disinfectants
• High-risk areas
  • Operation theatres, Intensive care units (ICUs), Wards where invasive procedures are performed
  • Requires high standards for cleaning and disinfection
  • Frequent cleaning with aldehyde-based disinfectant

Cleaning and Disinfection of Patient Care Equipment

• Patient care equipment can be classified as:
  • Single use – Needles, syringes, surgical blade
  • Reusable – Stainless steel surgical instruments, endoscopes, laryngoscopes, rectal/vaginal probes

• Points for Cleaning and Disinfection
  • Hand hygiene must be performed before and after using patient care equipment
  • HCWs must wear appropriate PPE before using the equipment
  • No equipment should be used beyond its date of expiry
  • Single-use equipment must be discarded after use in appropriate bio-medical waste bin
  • For Reusable devices, disinfection protocol must be constituted in every healthcare facility
  • Disinfection protocol must be adhered to after using reusable equipments
  • Depending upon the policy, some equipments can be cleaned, decontaminated, and sterilised (with high-level disinfectants, autoclaves) near the site of use, such as in wards, OPDs or laboratories
  • Other equipments should be sent to Sterilising units inside the hospital, where cleaning, decontamination, sterilisation (with autoclaves, Ethylene oxide, plasma sterilisers), followed by packing and labelling is done at a large scale
  • Stock registers should be maintained for reusable equipments

Biomedical Waste Management

• Biomedical waste (BMW) is hazardous waste generated during laboratory diagnosis or treatment or other procedures or research and development pertaining to healthcare
• Biomedical waste includes potentially infectious waste, chemical waste, and radioactive waste
• BMW guideline was published in 2016 and amended in 2018

Process of Management of Biomedical Waste

• HCWs must wear appropriate PPE before handling BMW
• Hand hygiene should be performed after handling BMW
• BMW should be segregated at the point of generation
• Waste should be collected and stored in coloured-coded bins in accordance with the BMW guidelines
• Laboratory and highly infectious waste should be pretreated before disposal
• Transport from the site of generation to a central storage area in the healthcare facility in separate trolleys
• From there, BMW should be transported to a waste treatment facility within 48 hours of generation
• BMW should be treated in adherence with the BMW guidelines

Respiratory Hygiene and Cough Etiquette

• Respiratory and cough hygiene should be performed to prevent the transmission of known or suspected respiratory pathogens
• Cover the nose and mouth with a disposable tissue or the crook of the arm when sneezing or coughing
• Do not touch eyes, nose, or mouth with contaminated hands
• Hand wash or hand rub after sneezing or coughing
• Appropriately dispose of the tissue, if used
• Wear a mask if symptomatic or while taking care of suspected or diagnosed cases
• In public areas, maintain 3 feet distance from others, if symptomatic

Abbreviations

1. HCW – Health care worker
2. PPE – Personal Protective Equipment
3. WHO – World Health Organisation
4. CDC – US Centres for Disease Control and Prevention
5. BMW – Biomedical waste

References

1. WHO Standard Precautions for the Prevention and control of Infections 2022 (online) [Accessed on January 29, 2025]
2. CDC Standard Precautions for All Patient Care (Online) [Accessed on January 29, 2025]
3. National Infection Prevention and control manual (NIPCM) for England, Chapter 1: Standard Infection Control Precautions (online) [Accessed on January 29, 2025]
4. Hartmann Science Centre, Proper Handling of Personal Protective Equipment (online) [Accessed on January 29, 2025]
5. Hospital infection control manual 2019; All India Institute of Medical Sciences Raipur; 2^nd edition
6. Nizam Damani; Manual of Infection Prevention and Control; Oxford academic; 4^th Edition
7. Apurba S Sastry, Deepashree R; Essentials of Hospital Infection Control; Jaypee Brothers; 1^st Edition