STANDARD

PRECAUTION
 Standard precaution

Patient Care Patient

Hand hygiene PPE LINEN
Equipment Placement

Occupational
Environmental Medical Waste Respiratory Safe Injection
Health and Blood
Hygiene Management Hygiene Practices
Borne Pathogen
 Hand hygiene

The 5 Moments.
 Moment 1 - before touching a patient.
 Moment 2 - before a procedure.
 Moment 3 - after a procedure or body fluid exposure risk.
 Moment 4 - after touching a patient.
 Moment 5 - after touching a patient's surroundings.
 Hand hygiene
 Hand must be washed with soap and water promptly for 40-
60seconds if hands are visibly dirty.
 Non-visibly dirty hands or after hand washing, clean the hand
with an alcohol based hand rub 20–30 seconds. No artificial nails
or nail polish allowed on contacting and doing procedures for
the patients
 Surgical Hand Scrub: Before starting operation procedure by
anti-microbial soaps such as chlorhexidine, hexachlorophene,
iodophores with sponges (and brush to the nails) to achieve
friction for at least 3-5 minutes.
 Personal Protective Equipment
The type of PPE used must provide adequate protection to staff against the risks
associated with the procedure or task being undertaken .
4.2.1 All PPE should be:
1. Located close to the point of use;
2. Stored to prevent contamination in a clean/dry area until required for use.
3. Single-use only items unless specified by the manufacturer disposed of
after use into the correct waste stream i.e. healthcare waste or domestic
waste.
4. Reusable PPE items, e.g. non-disposable goggles face shields/visors must
have a decontamination schedule with responsibility assigned.
 Personal Protective Equipment
4.2.2 Gloves must be:
4.2.2.1 Worn when exposure to blood and/or other body fluids is anticipated/likely.
4.2.2.2 Changed immediately after each patient and/or following completion of a
clinical procedure or task;
4.2.2.3 Orthopedic and gynecological operations, attending major trauma/road traffic
collision.
4.2.3 Aprons must be:
4.2.3.1 Worn to protect uniform or clothes when contamination is anticipated/likely
e.g. when in direct care contact with a patient; and Changed between
patients and/or following completion of a procedure or task.
 Personal Protective Equipment
4.2.4 Full body gowns/Fluid repellent coveralls must be:
4.2.4.1 Worn when there is a risk of extensive splashing of
blood
and/or other body fluids.
e.g. in the operating theatre; and Changed between
patients and immediately after completion of a
procedure.
 Personal Protective Equipment
4.2.5 Eye/face protection (including full face visors) must be:
4.2.5.1 Worn if blood and/or body fluid contamination to the eyes/face is
anticipated/likely by members of the surgical theatre team and
always
during Aerosol Generating Procedures (AGPs). Regular corrective
spectacles are not adequate eye protection.
4.2.6 Surgical face masks must be:
4.2.6.1 Worn if splashing or spraying of blood, body fluids, secretions or
excretions
onto the respiratory mucosa is anticipated/likely; well-fitting and
fit for
purpose (fully covering the mouth and nose); manufacturers'
instructions
 Personal Protective Equipment

4.2.6.2 Removed or changed; at the end of a procedure/task; if the

integrity of the mask is breached,
e.g. from moisture build-up after extended use or from
gross
contamination with blood or body fluids; and In accordance
with
manufacturers' instructions.
 Personal Protective Equipment
4.2.7 Footwear must be:
4.2.7.1 Non-slip, clean and well maintained, and support and cover the entire foot to
avoid contamination with blood or other body fluids or potential injury from
sharps.
4.2.7.2 Removed before leaving a dedicated footwear area e.g. theatre
4.2.8 Headwear must be:
4.2.8.3 Worn in theatre settings/clean rooms e.g. Central Decontamination Unit (CDU).
Well-fitting and completely cover the hair. Changed/disposed of between sessions
or
if contaminated with blood or body fluids.
 Patient Care Equipment
4.3 Patient Care Equipment
1. Handle used patient-care 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
microorganisms to other patients and environments.
2. Ensure that reusable equipment is NOT used for the care of another patient
until it has been appropriately cleaned and reprocessed.
3. Ensure that single use items are properly discarded. When disposing of
used needles.
 LINEN
4.4 Linen
1. Handle, transport and process linen soiled with blood, body fluids, secretions
and excretions in a manner that prevents skin and mucous membrane
exposures, contamination of clothing and avoids transfer of microorganisms
to other patients and environments.
2. Soiled linen must be placed in the black plastic bag. Contaminated linen or
linen from isolation areas must be placed in bags labeled as "contaminated”
or “infectious” or yellow color-coded bags.
3. Close and tie bags when it is a full before placing them to laundry trolley in
utility room.
4. Never place soiled linen on the floor or any clean surfaces.
5. All laundry items being stripped should be placed immediately inside the bag
inside patient area not carried outside the room..
 Patient Placement
4.5 Patient Placement.
1. Appropriate or selective placement of patients is important in
preventing the transmission of infections in the hospital
setting on contaminated secretions, excretions or wound
drainage and infants with viral respiratory or gastro intestinal
infections.
2. Spacing between beds: In the wards, there should be
adequate spacing between each bed to reduce the risk of
cross contamination/ infection. Occurring from direct or
indirect contact or droplet transmission. Optimum spacing
between beds should be 1-2 meters.
 Patient Placement

3. Single rooms: Single room should have the hand washing,

toilet and bathroom facilities.
4. Anterooms: Single rooms used for isolation purpose should
include an anteroom to support the use of personnel protective
equipment.
5. Cohorting: If single rooms are not available or if there is a
shortage of single room, patient infected or colonized by the
same organisms can be cohorted (sharing of room).
 Occupational Health and Blood borne
Pathogens
4.6 Occupational Health and Blood borne Pathogens
1. Take care to prevent injuries:
2. When using needles, scalpels and other sharp
instruments or devices.
3. When handling sharp instruments after procedures
4. When cleaning used instruments
5. When disposing of used needles
Occupational Health and Blood borne
Pathogens
6. DO NOT:
7. Recap used needles.
8. Manipulate them using both hands or any technique that
involves directing the point of a needle toward any part of
the body
9. Removed used needles from disposable syringes by hand.
10. Bend, break or otherwise manipulate used needles by hand
11. IF needles must be recapped, then use a one-handed
‘scoop” technique.
Occupational Health and Blood borne
Pathogens
11. Place used disposable syringes and needles, scalpel blades and other
sharp items in appropriate puncture-resistant containers located as
close as practical to the area in which the items were used.
12. Do not overfill the sharp containers. It must be replaced when it is 4
full. If a health care worker is stuck with a needle/sharp or splashed in,
eyes, mouth or other mucus membrane with blood or other potentially
infectious material, this exposure incident must be reported to
Infection Control Department for proper evaluation and management.
13. Use mouthpieces, resuscitation bags or other ventilation devices as an
alternative to mouth-to-mouth resuscitation methods in areas where
the need for resuscitation is predictable. These devices are stored in a
Plexiglas container mounted to the wall in each patient room.
 Environmental Hygiene
4.7 Environmental Hygiene
1. A clean environment plays an important role in the prevention of hospital --associated
infections. Cleaning is, necessary to prevent the spread of infection and preserve the life of
building, fabrics and furnishing.
2. Clean and disinfect surfaces that are likely to be contaminated with pathogens, including
those that are in close proximity to the patient (e.g.: bedrails, over bed tables) and frequently
-touch surfaces in the patient care environment (e.g.: door knobs, surfaces in and surrounding
toilets in patients room) on a more frequent schedule compared to that for other surfaces.
3. Cleaning and disinfection of multi-use electronic equipment should be done also especially
those items that are used by patients e.g.: glucometer, those used during delivery of patient
care and mobile devices that are moved in and out of patient room frequently.
 Medical waste management
4.8 Medical waste management
1. Any waste which is generated at a medical facility or
research laboratory can be infectious, cytotoxic, and
radio-active and can be an actual or potential hazard to
human health or environment.
2. It is important that all personnel should know how to
handle, manage or dispose of properly waste in their
work areas.
3. All medical waste should be segregated at the point of
generation.
Respiratory Hygiene / Cough Etiquette

1. Respiratory hygiene and cough etiquette is designed to contain

respiratory secretions to prevent transmission of respiratory
infections this includes:
2. Covering the nose and mouth with a disposable tissue when
sneezing, coughing, wiping and blowing the nose;
3. Disposing of all used tissues promptly into a waste bin;
4. Washing hands with non-antimicrobial liquid soap and warm
water after coughing, sneezing, using tissues, or after contact
with respiratory secretions or objects contaminated by these
secretions.
Respiratory Hygiene / Cough Etiquette
5. Antimicrobial hand wipes should not be used in the hospital
setting. Out with the hospital setting, if running water is not
available, then staff should use antimicrobial” hand wipes
followed by ABHR and wash their hands at the first available
opportunity;
6. Keeping contaminated hands away from the mucous
membranes of the eyes and nose.
7. Staff should promote respiratory hygiene and cough etiquette
to all individuals and help those (e.g. elderly, children) who
need assistance with containment of respiration.
 Safe Injection Practices
4.10 Safe Injection Practices The following recommendations are
applied to the use of needles, cannulas and where applicable
intravenous delivery system.
1. Aseptic technique should be used to avoid
contamination of sterile injection equipment.
2. Do not administer medication from a syringe to multiple
patients, even if the needle or cannula on the syringe is
changed.
 Safe Injection Practices
3. Needles, cannula and syringes should be sterile, single-use items, and
they should not be reused for another patient or to access a
medication or solution that might be used for a subsequent patient.
4. Use fluid infusion and administration sets (i.e.: intravenous bags,
tubing and connectors) for one patient only and dispose appropriately
after use.
5. Consider a syringe or needle/cannula contaminated once it has been
used to enter or connect to a patient's intravenous bag or
administration set.
6. Use single-dose vial for parenteral medication, whenever possible.
7. Do not administer medication from s single-dose vial s or ampoule to
multiple patients or combine leftover contents for later use.
 Safe Injection Practices

8. If multi-dose vials are used, both the needle or cannula and syringe used to
access the multi-dose vials must be sterile.
9. Do not keep the multi-dose vials in the immediate patient treatment area and
store in accordance with the manufacturer's recommendations. Discard if
sterility is compromised or questionable.
10. Do not use bags or bottles of intravenous solution as a common source of
supply for multiple patients.
11. Date should be written when opening intravenous fluids like Normal Saline and
multi dose medications vials like Insulin injection.
12. Do not touch or palpate site of injection after disinfecting except if you are
wearing sterile gloves