Standard precautions should be exercised when caring for all patients and include hand washing, gloves, mask and eye protection or face shield, gowns, handling of patient care equipment and linens, environmental controls, workplace controls, and patient placement.
Hand washing is to be performed after touching blood, body fluids, secretions, excretions, and contaminated items whether or not gloves are worn. Hands should be washed immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid the transfer of organisms to other patients or environments. It may be necessary to wash hands between procedures on the same patient to prevent cross-contamination of various body sites. Plain soap and water are recommended for routine use. Washing with an antimicrobial agent or waterless antiseptic may be utilized for control of outbreaks or hyperendemic infections.
Clean, nonsterile gloves are to be used when touching blood, body fluids, secretions, excretions, and contaminated items. Clean gloves should be used before touching nonintact skin and mucous membranes. Gloves should be changed between tasks and procedures following contact with material that may contain a high concentration of microorganisms. Gloves should be removed and hands washed before touching noncontaminated items, environmental surfaces, or other patients.
Face masks, eye protection, and face shields should be fluid resistant and are worn to protect mucous membranes of the eyes, nose, and mouth during patient care activities and the performance of procedures likely to generate splashes or sprays of blood, body fluids, secretions, excretions, and infectious materials. Masks that become significantly soiled, moistened by the user's exhaled vapor, or contaminated by fluids should be immediately replaced, since loss of protective function occurs if the barrier device is completely saturated.
Clean, nonsterile gowns should be fluid resistant and used to protect the worker's skin and clothing during patient care activities and the performance of activities likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. The gown selected should be appropriate for the type and volume of fluid likely to be encountered. Soiled gowns should be replaced as soon as possible, since barrier protection is lost if the garment is saturated with contamination. Sleeve protectors, booties, and leggings should be used if a large volume of contamination or infectious material difficult to contain is anticipated.
Patient care equipment and linens soiled with blood, body fluids, secretions, and excretions should be handled to prevent skin and mucous membrane exposure, contamination of clothing, and transfer of microorganisms to other patients and environments. Reusable items should be cleaned and reprocessed to eliminate infectivity. Single-use items should be discarded properly.
Environmental controls relate to hospital procedures for the decontamination of objects in patient care areas. Environmental surfaces, beds, bed rails, bedside equipment, and frequently touched surfaces should be cleaned and disinfected between patient use.
Workplace controls (work practice controls) include proper disposal techniques for needles, scalpels, and other sharp instruments. Proper handling of these devices should stress the avoidance of recapping, excessive handling, and manipulation. Proper disposal should emphasize the use of self-sheathing devices, use of puncture-resistant containers, and routine replacement of sharps containers prior to overflowing. Patients who contaminate the environment or those who cannot assist in their own hygiene should be placed in a private room if available.
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