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Standard Precautions of Infection Control

In 1996 the Centers for Disease Control and Prevention (USA) and the Hospital Infection Control Practice Advisory Committee (HICPAC) described Standard Precautions. The principle underlying Standard Precautions is that it is not always possible to identify people who may spread infection to others, therefore precautions to prevent the spread of infection must be followed at all times. They are designed to minimize the risk of transmission of infectious agents, particularly blood-borne viruses. They apply to:

  • Blood
  • All body fluids, secretions, excretions (except sweat), whether or not they are visibly bloody (e.g. saliva, nasal secretions, vomit, urine, semen, vaginal fluid etc)
  • Non-intact skin
  • Mucous membranes (lining of mouth, nose, eyes, vagina and urethra)

 

These routine procedures are called Standard Principles of Infection Control (or Standard Precautions).
These precautions apply to all clients regardless of their diagnosed or presumed infection status.
The principles of Standard Precautions include:

  • Hand Hygiene and Skin Care
  • Protective Clothing
  • Safe Handling of Sharps (including Sharps Injury Management)
  • Spillage Management
  • Management of Waste

All blood and body fluids are potentially infectious and precautions are necessary to prevent exposure to them. A disposable apron and latex or vinyl gloves should always be worn when dealing with excretions, secretions, blood and body fluids.
Everyone involved in providing tattooing, body piercing, and other forms of body modifications should know and apply the standard principles of hand decontamination, the use of protective clothing and the safe disposal of sharps. Each member of staff is accountable for his/her actions and must follow safe practices.

 

Hand Hygiene and Skin Care

There are two methods of hand decontamination which are handwashing and the use of handrubs, both alcohol and non-alcohol based. Hand decontamination is recognised as the single most effective method of controlling infection.
Hands must be decontaminated:

  • Before and after each treatment session.
  • Before and after physical contact with each client
  • Before putting on, and after removing, protective clothing, including gloves
  • After using the toilet, blowing your nose or covering a sneeze
  • Whenever hands become visibly soiled
  • After contact with body fluids
  • Before eating, drinking or handling food, and before and after smoking.
  • Between procedures on different sites on the body
  • Before leaving the place of work

Note that alcoholic handrubs are only effective for visibly clean hands.

How to Wash Your Hands
Hands that are visibly soiled, or potentially grossly contaminated with dirt or organic material, must be washed with liquid soap and water.
An effective handwashing technique involves three stages:

  • 1. Preparation
  • Before washing hands, all wrist and hand jewellery should be removed
  • Cuts and abrasions must be covered with waterproof dressings
  • Fingernails should be kept short, clean and free from nail polish
  • Hands should be wet under warm running water before applying liquid soap or an antimicrobial preparation.

  • 2. Washing and Rinsing
  • The handwash solution must come into contact with all of the surfaces of the hand
  • Hands must be rubbed together vigorously for a minimum of 15-30 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers (see figure 1)
  • Hands should be rinsed thoroughly.

Hygienic Hand Disinfection for Tattooing, Body Piercing and other Body Modifications
This can either be achieved by using antiseptic liquid soap, or by routine handwashing as demonstrated below, followed by application of an alcohol handrub as recommended by the manufacturer.

Hand Washing

3. Drying

• Dry hands thoroughly using good quality paper towels
• Disposable paper towels are the method of choice because communal towels can be a source of cross-contamination
• Store paper towels in a wall-mounted dispenser next to the washbasin, and throw them away in a pedal-operated domestic waste bin

Hot air dryers are not recommended. However if they are used, they must be regularly serviced and users must dry hands completely before moving away.

Alcohol Handrubs/Gels

Hands should be free from dirt and organic material. The handrub solution must come into contact with all surfaces of the hands. They should be rubbed together vigorously, paying particular attention to the tips of the fingers, the thumbs and finger webs until the solution has evaporated and the hands are dry, as described in Figure 2.

Hand washing
This may be used for general decontamination of hands with alcohol gel or liquid.

 

Hand Creams

An emollient hand cream should be applied regularly to protect skin from the drying effects of regular hand decontamination.
If a particular soap, antimicrobial hand wash or alcohol product causes skin irritation, the General Practitioner (GP) should be consulted.


Hand Decontamination Facilities

Hand Washing
Facilities should be adequate and conveniently located. Ideally, handwashing facilities must be available in the room where client consultations and procedures take place. Alternatively, facilities to do so should be a short distance away. They should have elbow or foot-operated mixer taps. A separate sink should be available for other cleaning purposes - such as cleaning instruments:

  •  Use wall-mounted liquid soap dispensers with disposable soap cartridges - keep them clean and replenished
  •  Dispensers should be dismantled and washed regularly with particular attention to the nozzle
  •  Place disposable paper towel dispensers next to the basins - soft towels will help to avoid skin abrasions
  •  Position foot-operated pedal bins near the hand washbasin - ensure they are the right size for the amount of waste generated (note: Health & Safety regulations recommend a metal, fireproof bin).

Location of Alcohol Handrubs/Gels
• Dispensers should be wall-mounted outside all treatment rooms
• Wall-mounted or free-standing in all examination areas
• Wall-mounted at the entry and exits to clinical areas

Note that there are instances where a risk assessment is required for placement of alcoholic rub dispenser, particularly where monitoring of its use is difficult.

 

Protective Clothing

Assessment of Risk
Another element of standard principles of infection control is the wearing of protective clothing. The aim is to protect customers from micro-organisms that may be present on the operator’s hands, and also to shield the operator from the customer’s blood or skin micro-organisms.
Selection of protective equipment must be based on an assessment of the risk of transmission of infection between the client and practitioner.

WHAT TO WEAR WHEN

No exposure to blood/body fluids anticipated

Exposure to blood/body fluids anticipated, but low risk of splashing

Exposure to blood/body fluids anticipated – high risk of splashing to face

No protective clothing

Wear gloves and a plastic apron

Wear gloves, plastic apron and eye/mouth/nose protection

Types of Protective Clothing

Disposable Gloves

Gloves must be worn for invasive procedures and all activities that have been assessed as carrying a risk of exposure to blood, body fluids, secretions and excretions, or to sharp or contaminated instruments.
Gloves that conform to European Community (CE) standards must be available.
DO NOT USE powdered gloves or polythene gloves.
Gloves must be worn as single-use items. They must be put on immediately before an episode of client contact and removed as soon as the activity is completed.
Gloves must be changed between treatments for different clients and disposed of as clinical waste.
Hands should be washed after gloves have been removed. Note that gloves are not a substitute for handwashing.
Sensitivity to natural rubber latex in clients and staff must be documented. Alternatives to natural rubber latex gloves must be available, such as nitrile gloves.
Gloves should not be washed between clients as the gloves may be damaged by the soap solution and, if punctured unknowingly, may cause body fluid to remain in direct contact with skin for prolonged periods.
1. Non Sterile Gloves
Should be used when hands may come into contact with blood/body fluids, the oral cavity and when cleaning up items contaminated with body fluids such as equipment.

 

2. General-purpose Utility Gloves
General-purpose utility gloves, e.g. rubber household gloves, can be used for cleaning instruments prior to sterilisation, or when coming into contact with surfaces or items possibly contaminated with blood or body fluids. Ideally, colour coding of such gloves should be used e.g. blue for the kitchen, yellow for general environmental cleaning and pink/red for ‘dirty’ duties. This will help prevent cross-infection from one area of work to another. The gloves should be washed with general-purpose detergent (GPD) and hot water, and dried between uses. They should be discarded weekly, or more frequently if the gloves become damaged.
3. Polyurethane/polythene Gloves (Non Sterile and Sterile)
Polyurethane/polythene gloves do not act as a barrier to infection and SHOULD NOT BE USED.

Hands must be decontaminated prior to, and after use of gloves when performing any body modification procedure.

Disposable Plastic Aprons

Apart from gloves, the operator should wear clean and washable clothing. A disposable plastic apron is useful for keeping work clothes clean and should be worn when there is a risk that clothing may be exposed to blood, body fluids, secretions or excretions.
Plastic aprons should be worn as single-use items, for one procedure or episode of client care. These should then be discarded and disposed of as clinical waste.
Face Masks and Eye Protection
These must be worn where there is a risk of blood, body fluids, secretions or excretions splashing into the face and eyes. Their use will be very dependent on a risk assessment of the type of procedure being envisaged, such as manual decontamination of equipment where aerosols can be generated.

 

Safe Handling of Sharps

All staff should be fully immunised. In addition, all those handling sharps should have had a course of Hepatitis B vaccine. A record of Hepatitis B antibody response should be kept for all staff who have regular exposure to blood/blood-stained body fluids.
Care should be taken to avoid accidental needlestick injury, as exposure to contaminated blood may be associated with transmission of blood-borne viruses (BBVs).
Sharps include needles, scalpels, sharp instruments and razors and glass. Sharps must be handled and disposed of safely to reduce the risk of exposure to blood-borne viruses. Always take extreme care when using and disposing of sharps. Avoid using sharps whenever possible.

  •  Sharps should be single-use only, or if re-useable be capable of sterilisation
  •  Do not re-sheath a used needle - if this is necessary, a safe method, i.e. a re-sheathing device, must be used
  •  Discard sharps directly into a sharps container immediately after use and at the point of use
  •  Sharps containers should be available at each location where sharps are used
  •  Sharps containers must comply with UN 3921 and BS7320 standards
  •  Close the aperture to the sharps container when carrying or if left unsupervised to prevent spillage or tampering
  •  Place sharps containers on a level stable surface
  •  Do not place sharps containers on the floor, window sills or above shoulder height - use wall or trolley brackets
  •  Assemble sharps containers by following the manufacturer’s instructions
  •  Carry sharps containers by the handle - do not hold them close to the body
  •  Never leave sharps lying around
  •  Do not try to retrieve items from a sharps container
  •  Do not try to press sharps down to make more room
  •  Lock the container when it is three-quarter full using the closure mechanism
  •  Label sharps containers with the source details prior to disposal
  •  Place damaged sharps containers inside a larger container - lock and label prior to disposal. Do not place inside yellow clinical waste bag.

For Management of Sharps Injuries, see this section

Spillage Management

Deal with blood and body fluid spills quickly and effectively.  Ready-made spillage kits are available from manufacturers.
For spillage of high-risk body fluids such as blood, method 1 below is recommended. For spillage of low-risk body fluids (non-blood containing fluids) such as excreta, vomit etc., use method 2.

  • 1. Hypochlorite Method
  • Prevent access to the area until spillage has been safely dealt with
  • Wear protective clothing
  • Cover area with towels soaked in 10,000 parts per million of available chlorine (1% hypochlorite solution = 1 part household bleach to 10 parts water) e.g. household bleach, Milton, and leave for at least two minutes
  • Remove organic matter using the towels and discard as clinical waste
  • Clean area with detergent and hot water
  • Rinse area with water and dry thoroughly
  • Clean the bucket/bowl in fresh soapy water and dry
  • Discard protective clothing as clinical waste
  • Wash and dry hands.
  • 2. Detergent and Water Method
      •  Wear protective clothing
      •  Mop up organic matter with paper towels and/or absorbent crystals
      •  Clean surface thoroughly using a solution of detergent and hot water and paper towels or disposable cloths
      •  Rinse the surface and dry thoroughly
      •  Dispose of materials as clinical waste
      •  Clean the bucket/bowl in fresh hot, soapy water and dry
      •  Discard protective clothing as clinical waste
      • Wash and dry hands.

Blood Spillage on Clothing: change clothing as soon as possible and put in a plastic bag. Wash items as soon as possible in the hottest wash cycle the garments will stand. Use gloves to remove them from the bag and place directly into the machine. Do not soak or manually wash the garments.

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