Universal Precautions Infection Control Guidelines

Universal Precautions Infection Control Guidelines

1. Hand Washing
Hands must be washed:
a. Before and after coming in contact with any patient
b. After handling clinical specimens
c. After handling any contaminated material or surfaces
d. Before leaving the work place
e. Immediately after removing surgical gloves

2. Protective Clothing
a. Gowns / Aprons
A surgical gown/ plastic apron is used for procedures where excessive dissemination of blood and body fluids is unlikely to occur. However, in procedures likely to result in excessive dissemination of blood for example, major arterial surgery a gown with non permeable front and sleeves is used. Surgical gowns must be worn while performing the following procedures:

• All surgical operations
• Intubation
• Haemodialysis
• Endoscopy
• Bronchoscopy
• Dental Procedures
• Child birth
• A gown with non permeable front and sleeves is used while performing these procedures:
• Procedures that produce splattering of blood and body fluids
• Inserting arterial access
• A plastic apron may be used while performing these procedures:
• Suctioning and extubation
• Handling soiled linen waste or equipment
• CPR

b. Gloves
Gloves must be worn when performing a procedure on a patient or handling any contaminated material.
Sterile gloves are worn when performing aseptic procedure. In the operating theatres, the scrubbed team wears sterile disposable gloves, but when performing procedures in high risk patients, it is advisable to wear two pairs of gloves (double). Cuts or lesions on hands are covered with a waterproof dressing.

• Wear sterile gloves while performing:
• All surgical operations
• Inserting arterial access
• Haemodialysis
• Endoscopy
• Bronchoscopy
• Intubation
• Childbirth

Wear non sterile gloves when handling blood, body fluids or non intact skin of all patients and also when handling items or surfaces contaminated with blood and body fluids.
Non sterile gloves are used when performing the following procedures:

• Contact with blood] body fluids, mucous membranes or non intact skin
• Drawing blood
• Suctioning and extubation
• Handling soiled linen waste or equipment
• CPR
• Dental procedures

c. Masks
A surgical mask should be worn during procedures where splashes of blood or body fluids are expected. Masks must be worn with all of the following procedures:

• Inserting arterial access
• Suctioning and extubation
• Handling soiled linen, waste or equipment
• Intubation
• CPR
• Haemodialysis
• Endoscopy
• Bronchoscopy
• Dental procedures
• All surgical operations
• Childbirth

d. Face shield or goggles
Face shields or the operators and their assistants to protect the eyes, whenever they perform procedures where aerosols or splashes of blood and body fluids may occur should wear goggles. When blood stained, goggles must be cleaned using paper cloths soaked in 0.1% hypochlorite solution (1000 ppm available chlorine). A face shield or goggles must be worn while performing the following procedures:

• Inserting arterial access
• Suctioning and extubation
• Handling soiled linen, waste or equipment
• Intubation
• CPR
• Haemodialysis
• Endoscopic
• Bronchoscopy
• Dental procedures
• Operative procedures that produce splattering of blood and body fluids
• Child birth

3. Waste Management
a. Infected Waste
Infected waste is places in double yellow bags and disposed of according to laid policies
b. Disposal of sharps
All needles, syringes, scalpel blades and other sharps should be discarded immediately by the user, without re-sheathing into sharps disposable bin. The sharps bin should be handled and disposed of, according to the laid policy.
c. Non disposable linen and theatre clothing
Contaminated or infected linen should be placed in hot water soluble bags, into red/green linen bag, sealed and sent for washing. It is washed at very high temperature (80 degrees C for 30 minutes)
d. Laboratory specimens
Specimens must be collected into securely capped, leak proof specimen containers. The outside of the specimen container should be free of contamination by blood or other body fluids. The specimen should be placed in the specimen bag separate from the request form.
e. CSSD Equipment and Instruments
Reusable items should be places in the CSSD bin and sent directly to the CSSD. If heavily blood stained it should be sent to the CSSD in a polythene plastic bag.
f. heat sensitive Equipment
Heat sensitive equipment such as flexible endoscopes, should be cleaned carefully and rinsed with a detergent and water. Gloves must be worn and care taken to avoid splashing. The equipment should then be soaked in 2% glutaraldehyde for 20 minutes.
g. Anesthetic Equipment
Anesthetic equipment that has been in direct contact with the patient’s upper respiratory tract, such as facemasks and endotracheal tubes (if not disposable) must be disinfected after use for each patient according to laid policies.
h. Diathermy Equipment
The surfaces of diathermy machine, the leads and the diathermy plates should, if blood stained, be cleaned with sodium hypochlorite solution 0.1 % (1000 ppm available chlorine)
i. Spillage of Blood
Wear gloves and apron. Cover with a paper cloth, 1% hypochlorite solution (10,000 ppm available chlorine) and leave for 5 minutes clear using paper cloth and place soiled material into a disposable yellow bag.

4. Vaccination
The infection control team implements a programme of Hepatitis B vaccination of all staff that may come into contact with blood or body fluids. Response to vaccine is checked after vaccination. Anti HbsAg titre is expected to be >100 mlU/ml.

5. Inoculation injuries and splashes
Particular care must be taken to avoid at all cost accidental inoculation with blood/ body fluids contaminated sharps. Accidental inoculation injury must be treated immediately by encouraging bleeding under running water plus liberal washing with Betadine or Hibiscrub as follows:

• Squeeze the wound to make it bleed.
• Wash the injury site for five minutes in running water, and then wash with Betadine or Hibiscrub.
• Splashes on eyes are thoroughly irrigated with water or normal saline.
• Splashes in the mouth should be washed out using copious amounts of water.
• Splashes on skin should be washed with water and Hibiscrub or Betadine.
• Accidents have to be reported to the infection control doctor and the nursing officer on duty. The infection control doctor can be contacted at Bleep No. 247 and the Infection Control Nursing Officer Bleep No. 175. Outside normal working hours the Nursing Officer in duty at Bleep 009 may be contacted.
• Fill in the All report form.
• Proceed to staff health clinic ( SHC ) or accident & emergency (A&E) for further action.
• All reports to be sent to the D.G.
• Blood is collected from the victim for — HIV antibodies, HCV antibodies, HbsAg antibodies, VDRL.
• Blood is collected from the patient for HIV antibodies, HCV antibodies, HbsAg antibodies, VDRL.

Note: The Incidence Report is kept confidential by the infection Control Nursing Officer in coordination with the Infection Control Doctor.

If the patient is found to be

• HIV positive:
• The victim should be referred to the appropriate clinic.
• HbsAg positive:
• Victim is immune = give a booster vaccine
• Victim is not immune = give immunoglobulin and HBV vaccine.

If the victim was found to be

• HIV/HBV or HCV positive:
• Refer to the appropriate clinician.
• HIV/HBV or HCV positive:
• Repeat the tests three and six months later
• VDRL positive:
• Do confirmatory tests and if positive, refer to the appropriate clinician.

6. Patients with Inoculation — Risk Infections
a. Identification:
The clinician care for the patient will determine whether there is a definite or high probability of an infection risk requiring precautions. The following are considered high risk patients. They should be treated as if they harbour a blood borne pathogen, regardless of serological results.

• Patients known to have a blood borne infectious disease.
• Suspected clinical cases
• Patients who had multiple blood transfusions
• Homosexuals
• Heterosexuals with multiple partners
• Patients with sexually transmitted diseases
• Prisoners
• Drug addicts
• Patients coming from countries where HIV is highly prevalent and undiagnosed jaundice patients.
• Children of HbsAg, HCV or HIV positive mother.

b. Policy
The surgeon must notify the person in charge of the operating theatre that a patient with an inoculation risk infection requires operative procedure. Of heavy blood spillage is anticipated, the patient should be placed at the end of the operating list.
c. Operating theatre procedures

• All staff working in the theatre is made aware that the patient has an inoculation risk infection
• Only the minimum numbers of staff are present in the theatre
• The staff appropriate protective clothing (see below)
• Disposable linen is used wherever possible
• Disposable waste is carried out in accordance with this policy.
• Accidents or injuries to staff are reported promptly according to this policy.

d. Protective Clothing
The normal theatre outfit with boots must be worn.
Circulating Staff
They should also wear disposable plastic apron and disposable gloves.
Scrubbed Team
They should also wear disposable sterile gowns with non permeable front and sleeves. Gloves (two pairs), goggles and mask.
e. Non Disposable Linen and the theatre clothes
Contaminated or infected linen should be placed in the appropriate water soluble laundry bag, which is then placed in an ordinary red bag and labeled “Danger of Infection” and sent for laundry. It is washed at very high temperature (80 degree C). Grossly contaminated, heavily blood soaked linen must be placed in double yellow bags and sent for incineration.
f. CSSD Equipment and Instruments
Reusable items should be rinsed and placed in the CSSD bin. If heavily blood stained it should be placed in a CSSD bag.
g. Suction Apparatus
Tubing should be incinerated. Use a closed system suction apparatus whenever possible. If a closed system is not available, jars should be carefully emptied into the sluice and then filled with 1% hypochlorite and left overnight. The contents should then be emptied into the sluice, rinsed and sent to CSSD.
h. Heat Sensitive Equipment
Heat sensitive equipment such as flexible endoscopes, should be cleaned carefully and rinsed with a detergent and water. Gloves must be worn and care taken to avoid splashing. The equipment should then be soaked in 2% glutaraldehyde for 60 minutes.
i. Anesthetic equipment
Anesthetic equipment that has been in direct contact with the patient’s upper respiratory tract, such as facemasks and endotracheal tubes must be disinfected after use for each patient according to laid policies.
j. Diathermy equipment
The surfaces of the diathermy machine, the leads and the diathermy plates should, if blood stained, be cleaned with sodium hypochlorite solution 0.1% (1000 ppm)
k. Laboratory Specimens
Specimens taken during surgery must be collected into securely capped, leak proof specimen containers. The outside of the specimen container should be free of contamination by blood or other body fluids. The specimen must be placed individually in self sealing plastic bags; the request form should indicate the diagnosis and bear a “Danger of Infection” label and must be kept separate from the specimen in a double compartment bag.
l. Spillage of Blood
Wear gloves and apron. Cover with a paper cloth, gently tour 1% hypochlorite solution (10,000 ppm available chlorine) and leave for 5 minutes. Clear using paper cloth and place soiled material into a disposable yellow bag.

Aseptic technique

Purpose

1. To prevent contamination of wounds and other susceptible sites by ensuring that only sterile objects and fluids come into contact with these sites thus minimizing the risk of infection.
2. To maximize patient comfort by limiting / preventing the iatrogenic effects of hospitalization.
3. To reduce the cost of hospitalization.

Policy

1. The risk of nosocomial infection should be minimized, if not prevented, for patients receiving health-care. Special care must be taken when attending to patients who are immunocompromised. Those susceptible are neonates / elderly, patients with severe debilitating or malignant disease, and those receiving immunosuppressive drugs / the use of broad — spectrum antibiotics.
2. Aseptic Technique should be implemented in any surgical / invasive procedure that by passes the body’s natural defenses, e.g. the skin and mucous membranes; or when handling equipment such as intravenous cannulae and urinary catheters during the procedures.
3. Hand washing should be performed according to policy and procedure on Hand Washing.
4. Bactericidal alcohol hand-rub should be used as an additional measure, when necessary, in eliminating performer’s resident skin flora. E.g. Staphylococcus aureus, immediately before/during the procedure.
5. A non-touch technique is essential to ensure that hands, even though they have been washed, do not contaminate the sterile equipment or the patient. This can be achieved either by the use of forceps or sterile gloves.
6. Sterile packs should be checked for integrity, i.e. undamaged, intact and dry; and observe the recommended shelf life [expiry date]. If autoclave tape is used check that it has changed colour from blue to black. (Please check the autoclave tape manufacturers any other colour code instructions on this)
7. All fluids and materials to be used must be sterile. Manufacture’s instructions on solutions/disinfectants should be followed.
8. The trolley used for aseptic procedures should not be used for any other purpose. Unless the surface becomes physically contaminated, daily washing cleaned with spirit before and after each use.
9. An impermeable disposable apron should he worn as to prevent nurses’ clothing becoming contaminated with pathogenic microorganisms, which may subsequently be transferred to other patients in their care; and to avoid the transfer of potentially pathogenic microorganisms from nurse to patient.
10. Air movement should be kept to a minimum before and during the procedure in order to minimize airborne contamination.
11. The spread of airborne infection is most likely to occur in a open space and, ideally, the procedure should be performed in a properly large, ventilated room.

a. If the procedure is to be carried our at the patient’s bed-side, time should be given for dust to settle i.e. ward cleaning should have ceased at least 30 minutes before, and the curtains drawn at least 10 minutes before the dressing is begun.
b. During the procedure, no non-sterile equipment or outreached arm should cross the sterile field.
c. Wounds should be exposed for the shortest time possible; and wounds should be dressed before contaminated wounds; Colostomies and infected wounds should be dressed last.
Equipment

1. Trolley washed with soap & water & wiped with 70% spirit.
2. Sterile dressing pack
3. Sterile drape, if necessary
4. Appropriate sterile cleaning solution, as required.
5. Bactericidal hand-rub solution.
6. Adhesive tape.
7. Disposable sterile gloves.
8. Disposable plastic apron.
9. Disposable bag.

Procedure

1. Explain the procedure to the patient. If the patient is a child, explain the procedure to the parents also and ask them to wait away from the areas until the procedure is over.
2. Screen the bed area and position the patient comfortably.
3. Assemble all equipment needed on the bottom shelf of the trolley.
4. Attach disposable bag on side of trolley, below the level of the top shelf,
5. Put on a disposable plastic apron.
6. Wash and dry hands.
7. Open the outer wrap of the sterile dressing pack and slide the contents on to the top shelf of the trolley.
8. Ensure that outside wrapper is not in contact with the sterile field.
9. Open the sterile field touching only the corners of the wrapper.
10. Using a pair of forceps from the pack, arrange the contents within the sterile field.
11. Place the forceps at the edge of the sterile field.
12. Check solution concentration, and expiry date.
13. Pour cleansing solution into gallipot.
14. Avoid splashing solution that may contaminate the underlying sterile field.
15. Use the hand - rub
16. If appropriate, put on sterile gloves, touching only the inside wrist cuff.
17. Carry out the procedure, as required. Should sterile fluid/instrument become contaminated during the procedure, it must be replaced.
18. On NO account should it be used/ returned to the sterile field.
19. Make the patient comfortable. Draw back the curtains as applicable.
20. Place non - disposable equipment in the polyethylene bag and send to CSSD.
21. Dispose of Waste in appropriate colour coded clinical waste bag for incineration.
22. Clean the trolley with 70% sprit. Ensure it remains dry and physically clean.
23. Wash and dry hands.
24. Document the procedure in the patient’s notes.