Standard Precautions in Healthcare Settings
According to Occupational Exposure to Bloodborne Pathogens (Chapter 296-823 WAC), all human blood and body fluids that could potentially transmit bloodborne pathogen must treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens. Standard precautions expands on this principle.
Standard Precautions are used for all patient care encounters and are based on risk assessment, use of common sense practices, and proper use of personal protective equipment (PPE) to protect health care personnel (HCP) from exposure to infectious disease and prevent transmission between patients. Standard Precautions are used whether or not an infectious disease has been identified and are the minimum level of precautions used when providing care.
Components of Standard Precautions
- Hand Hygiene
- Use of PPE whenever there is expectation of possible exposure
- Respiratory hygiene and cough etiquette
- Proper cleaning and disinfection and careful handling of textiles and laundry
- Safe injection practices and handling of sharps
L&I standards and CDC guidance related to Standard Precautions:
- Core Rules (Chapter 296-800 WAC)
- Employer Responsibilities (WAC 296-800-110)
- Accident Prevention Program (APP) (WAC 296-800-140)
- Personal Protective Equipment (PPE) (WAC 296-800-160)
- Housekeeping, drainage, and storage (WAC 296-800-220)
- Sanitation: Drinking water, bathrooms, washing facilities and waste disposal (WAC 296-800-230)
- Respirators (Chapter 296-842 WAC)
- Occupational Exposure to Bloodborne Pathogens (Chapter 296-823 WAC)
- Hand Hygiene in Healthcare Settings
- Guideline for Isolation Precautions
- Respiratory Hygiene and Cough Etiquette
- Guidelines for Environmental Infection Control
- Guideline for Disinfection and Sterilization
- Injection Safety
- Guideline for infection control in health care personnel
- Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings
Types of PPE in Healthcare
Gloves protect hands and allow for efficient removal of organisms from hands when followed by hand hygiene. Wear gloves when anticipating contact with blood, body fluids, secretions or excretions with HCP’s hands. This could include when changing dressings, direct contact with patient’s broken skin or mucous membranes, or for blood draws.
Gowns protect skin and clothing. Wear a fluid resistant gown during procedures or activities when anticipating contact with blood, body fluids, secretions or excretions with HCP’s body. This could include when providing care for a patient who has a wound with uncontrolled drainage.
Masks protect mucous membranes of mouth and nose from splash and spray. Wear a mask when there is anticipated splash or spray of blood, body fluids, secretions or excretions to a HCP’s mouth or nose. This could include when placing a catheter, or when caring for a coughing patient.
Masks as source control protect others from the wearer’s respiratory secretions. Wear a mask as source control when performing certain procedures to limit contamination and as part of respiratory hygiene/cough etiquette.
Respirators prevent inhalation of infectious material. Respirators must be worn according to a facility’s Respiratory Protection Program. Also wear a respirator when anticipating exposure to aerosolized particles, especially when the risk of aerosol transmitted infection is high (for example, when there is high community transmission of aerosol transmissible diseases, such as flu, colds, or COVID-19.)
Eye protection protect mucous membranes of eyes; face shields also provide some protection of the mucous membranes of the mouth and nose. Personal eye glasses and contact lenses are not considered eye protection. Wear eye protection when there is anticipated splash or spray of blood, body fluids, secretions or excretions to a HCP’s eyes. Eye protection is often worn with masks.
Selection of PPE
Risk assessment is critical to anticipate level of blood and body fluid exposure for a particular care activity. In order to select appropriate PPE, it is necessary for all levels of HCP to be familiar with the risk assessment process. Some risk assessment is done at the facility level. For example, healthcare facilities have policies and procedures that require specific PPE based on anticipated level of blood and body fluid exposure for specific patient care activities. Patient level factors must also be considered when assessing risk of blood and body fluid exposure. For example, general patient care of a patient who has a wound with uncontrolled drainage would likely require HCP to wear a gown and gloves to protect from blood and body fluid exposure or a coughing patient would likely require HCP to wear a mask as PPE and the patient to wear a mask (if tolerated) as part of cough etiquette. Proper use of PPE, including careful donning and doffing and hand hygiene after PPE removal is essential to maintain HCP protections.
Uniforms are not PPE
Many healthcare facilities adopt a dress code or uniform policy and some staff may choose to wear garments such as lab coats to identify them as medical professionals. These garments are often worn as “street clothes,” worn outside the healthcare facility and laundered by the worker. Such garments are not PPE and must be protected from exposures to blood and bodily fluid when exposure is anticipated. Gloves, gowns, shoe covers and other PPE must be worn over clothing that is not intended to be removed and either disposed of or cleaned by the facility following an exposure to the clothing. Some discretion is allowed for rare events, but the facility should have a process in place for collecting and replacing or laundering clothing that becomes contaminated with potentially infectious material. Employees must not be required to take contaminated garments home for laundering.