1. What are standard precautions?

 Standard Precautions are a set of infection control practices that

healthcare personnel use to reduce the risk of transmission of
microorganisms from one patient to another in healthcare settings.
 These measures are applied to ALL patients visiting the hospital. All
patients should be considered infectious, regardless of their complaints.

STANDARD PRECAUTIONS INCLUDE:

 Hand hygiene (hand-washing with soap and water or use of an alcohol-

based hand sanitizer) before and after patient contact and after contact
with the immediate patient care environment.
 Personal protective equipment (PPE) when exposure to blood, body
fluids, excretions, secretions (except sweat), mucous membranes, or
non-intact skin is anticipated
 Proper disposal of sharps without recapping i.e. in puncture-proof
containers
 Proper handling of waste
 Proper handling of linen
 Proper environmental decontamination
 Respiratory Hygiene and cough etiquette

Special note for COVID-19:

Due to COVID-19 universal masking using a surgical mask may be mandated. Please check
current guidelines from DIPHE.

2. Personal Protective Equipment (PPE)

 These are required only when exposure to blood and body fluids (which
include all excretions and secretions except sweat) is anticipated. The
exposure may be to the skin or one of the mucous membranes.
 PPE and its indications include:
o Gloves: When hand contamination is anticipated.
o Masks and eye protection: When splashes may occur.

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 o Gowns: When soiling of clothes may occur

The type of PPE worn is based on the assessed risk of the clinical intervention
to be undertaken

Gloves:

 Wear gloves when contact with blood and body fluids, mucous
membranes, non-intact skin, or potentially contaminated intact skin
(e.g., that of a patient incontinent of stool or urine) is anticipated.
 The use of cellophane gloves is discouraged for use in patients.
 Remove gloves after contact with a patient and/or the surrounding
environment (including medical equipment) making sure to prevent
hand contamination. Do not wear the same pair of gloves for the care of
more than one patient
 Hand Hygiene must be performed after glove use
 Do not wash gloves for the purpose of reuse.
 Never leave the patient care area without removing gloves.

Gowns:

 Wear gowns, to protect skin and prevent soiling or contamination of

clothing during procedures and patient-care activities when contact with
blood and body fluids is anticipated.
 Remove gown and perform hand hygiene before leaving the patient’s
environment.
 If the gown is visibly soiled then it should be replaced

Mouth, nose, eye protection:

 Use surgical masks and/or eye shields to protect the eyes, nose, and
mouth during procedures that are likely to generate splashes or sprays
of blood and body fluids.
 Select masks, goggles, face shields, and combinations of each according
to the need anticipated by the task performed.
 Wear a surgical mask while assisting or performing a lumbar puncture.

Special note for COVID-19:

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Due to COVID-19 universal masking using a surgical mask may be mandated. Please check
current guidelines from DIPHE.

Caps and boots/shoe covers:

 Wear caps and boots/shoe covers where there is the likelihood the
patient’s blood and body fluids may splash, spill or leak onto the hair or
shoes.
 Do not reuse disposable caps/shoe covers
 Wear clean and disinfected reusable boots.

3. Sharp Disposal

 Place used disposable uncapped syringes and needles, scalpel blades

and other sharp items in the designated puncture-resistant containers.
 Take extra care when cleaning reusable sharp instruments or equipment.
 Never recap or bend needles.
 Replace the sharps disposal container when three-fourths full
 Use of needle cutters is prohibited.
 All blood and body fluids spillages should be dealt immediately.
o Treat all blood and body fluids exposures as potentially infectious.

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See the section on Blood and Body Fluids for more details

4. Disinfection
Disinfection:

 Clean and disinfect non-critical surfaces with 1000ppm of hypochlorite

solution inpatient-care areas especially frequently touched surfaces e.g.,
bedrails, bedside tables, commodes, doorknobs, sinks, horizontal
surfaces and equipment in close proximity to the patient.
 Cleaning to remove organic material must always precede high level
disinfection and sterilization of critical and semi-critical instruments and
devices.
 Patients’ folders, HCW pens, stethoscopes, computers, keyboards and
mouse should be cleaned and disinfected in the same manner as other
non-critical items.
 Wear appropriate gloves for cleaning the environment or medical
equipment.

Environmental cleaning:

 Proper environmental interventions are required such as daily cleaning

and disinfection of, doctors & staff changing areas, toilets, doctor’s
room and lounge areas

See section on Cleaning and Decontamination for more details

5. Linen
Handling of linen:

 Soiled linen should be handled as little as possible and with minimum

agitation.
 All soiled linen should be bagged where it was used and should not be
sorted or rinsed in the location of use.
 If linen is heavily soiled it must go in a red bag and then in a hamper
bag.

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6. Cough Etiquette
Respiratory Hygiene/Cough Etiquette:

 These are recommended for all individuals with signs and symptoms of
respiratory infection to prevent its spread.
 Nose/mouth should be covered with the inside of elbow when coughing
or sneezing;
 Use tissues to contain respiratory secretions and dispose them in the
nearest waste receptacle after use
o Perform hand hygiene after having contact with respiratory
secretions and contaminated objects/materials.
o Do not re-use tissue papers

What is infection control?

Infection control is doing everything possible to prevent the
spread of infection among patients, health care workers, and
visitors
Importance of infection control:
In a hospital, patients are cared for by many health care workers
often in close quarters. If care is not taken can lead to Health
Care Associated Infections (HCAI).
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Health Care Associated Infections (HCAI) can lead to:
 More serious illness
 Prolongation of stay in a health-care facility
 Long term disability
 Excess deaths
 High and additional financial burden
 High personal cost on patients and their families
In this course, you will learn the basics of protecting your
patients and yourself from getting infections.
To complete the course you must get all 11 questions in the
quiz correct. The reading material is for your reference.
Good Luck!

Standard prections
Key points to remember
 Consider every person (patient or staff) as potentially
infectious and susceptible to infection.
 Hands hygiene is the most important process for
preventing cross contamination.
 Wear gloves before touching anything wet (broken skin,
mucous membranes, blood or other body fluids, or soiled

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 instruments and contaminated waste materials) or before
performing invasive procedures.
 Use physical barriers (protective goggles, face masks and
aprons) if splashes and spills of any body fluids (secretions
and excretions) are likely.
 Use safe sharp practices such as not recapping or bending
needles, safely passing sharp instruments and suturing,
when appropriate, with blunt needles.
 Safely dispose of infectious waste materials to protect
those who handle them and prevent injury or spread of
infection to the community.
 Process instruments and other items after use by first
decontaminating and thoroughly cleaning them, then either
sterilizing or high-level disinfecting using the
recommended and approved procedures.
Hand Hygiene
1. What to perform Hand Hygiene with
Cleaning hands with alcohol hand rubs is preferred over soap and water.

Compared to soap and water, alcohol hand rubs are

 Faster
 More effective
 Better tolerated

Soap and water is prefered if

 Hands are visibly dirty or soiled with blood or other body fluids.
 There is a suspected or confirmed case of C.difficile

2. How to perform Hand Hygiene

In order to be effective,while performing hand hygiene all the areas of hand
must be cleaned. The 7 steps of hand hygiene makes sure of this.

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These posters (developed by WHO) demonstrate the steps to Hand
Rub and Hand Wash

Do not wear rings, watches while performing hand hygiene. Keep you wrists
bare

3. When to Preform Hand Hygiene

There are 5 moments of hand hygiene when hand hygiene must be
performed.

The first 2 are to protect the patient from getting an infection and the last 3
are to protect other patients and your self.

These are

1. Before touching the patient

2. Before any aseptic procedure
3. After blood or body fluid exposure
4. After touching the patient
5. After touching the patient's surroundings

This poster designed by WHO demonstrates these 5 moments

4. Hand Hygiene and Glove use

 The use of gloves does not replace the need for cleaning your hands.
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 Hand hygiene must be performed when appropriate regardless of the
indications for glove use.
 Remove gloves to perform hand hygiene, when an indication occurs
while wearing gloves.
 Discard gloves after each task and clean your hands – gloves may carry
germs.
 Wear gloves only when indicated according to Standard and Contact
otherwise they become a major risk for germ transmission.
 Wearing the same pair of gloves and washing gloved hands between
patients or between dirty to clean body site care is not a safe practice

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Cleaning, Disinfection and Sterilization

1. Cleaning vs disinfection vs sterilization

Cleaning
Cleaning is the physical removal of material from any equipment, usually using
a detergent or chemicals and water. This not only reduces the number of
organisms on the equipment but also makes the sterilization and disinfection
process effective. In fact, without cleaning an instrument first, sterilization and
disinfection is not possible.
All items are cleaned before sterilizing or disinfecting.

Disinfection
Disinfection is the process by which many or all pathogenic microorganisms
are removed from an object, with the exception of bacterial spores. This is
usually done using various chemicals

Sterilization
Sterilization is the destruction or elimination of all forms of microbial life from
an object. This is done through chemicals or heat (autoclaving)

2. Deciding between sterilizing and disinfection

Each piece of equipment used in or on a patient must be cleaned. However
not all need to be sterilized or disinfected.

Using the Spaulding Criteria, equipment is divided into types (based on their
use) and handled accordingly

Critical items
These are introduced into sterile body area, close contact with a break in skin
or mucous membrane.
Examples include surgical instruments and syringes
Critical items are sterilized

Semi critical items

These come in contact with mucous membrane or skin which is not intact
Examples are thermometer, endoscopes, respiratory therapy and anesthesia
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instruments.
Semi critical items can be (high level) disinfected or sterilized

Non-critical items
These come in contact with intact skin
Examples are blood pressure apparatus and furniture.
Non-critical items are only cleaned or (low level) disinfected

Disposable items
These may come sterilized or may be non-sterile and meant to be used once
only
Examples are bandages, tongue depressors, gloves
Disposable items are discarded

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Transmission Based Precautions

1. Airborne Precautions

Airborne precautions are used for patients who have an infection with
organisms that are able to travel long distances in the air.

There are 3 infections that need airborne isolation (remember MTV)

Measles

TB (only pulmonary/lung TB)

Varicella (i.e chickenpox)

Certain infections may need Airborne precautions if an aerosol-generating procedure is

performed. These include influenza and COVID-19

Patient placement:
Negative Pressure Room
If a negative pressure room is not available then place in a single room with
the door closed, air conditioner off, windows open with a fan facing outwards
till a negative pressure room is available, or place in a room with a UVGI light.

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Personal Protective equipment:
N-95 Mask.
You must be fit tested for which N95 mask will fit you best.
Perform a seal check every time the N95 mask is worn by blowing into the
mask and checking if air leaks from the sides.
Mask must be worn at all times with both straps on.
Do not wear another mask under or over the N-95.
The mask can be reused on different patients unless it is bent out of shape or
gets wet. Store masks in a paper bag

Special note for COVID-19:

Faceshield must be worn with the N95 mask when dealing with COVID-19
suspected or confirmed patients.

2. Droplet Precautions

Droplet precautions are required for patients with infections in which the
organism travels through the air for short distances only (about 1 meter). To
cause infection, the organism must enter the body through the nose, mouth,
or eyes

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Some organisms that needed droplet precautions include
Mumps
Rubella
Influenza
Meningococcal meningitis
Diphtheria
COVID-19

(See policy for the entire list)

Patient placement:
Single room isolation, but with no special air handling (that is negative
pressure is not required)

Personal Protective Equipment:

Surgical mask only during patient care.

Special note for COVID-19:

Faceshield must be worn with the mask when dealing with COVID-19 suspected or
confirmed patients.

3. Contact Precautions

Contact precautions are meant for patients with organisms that stick to
surfaces including the surroundings, your clothes, and any equipment used on
the patient

Some organisms needing contact precautions include

Resistant organisms like MRSA, VRE, CRE, MDR Acinetobacter, MDR

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Pseudomonas
C.difficile
Shingles
Chicken Pox
Scabies

(see policy for full list)

Patient Placement:
For CRE: Single room isolation with no special air handling (that is no negative
pressure room)
For other MDROs contact precaution: Isolation precautions in the ward

Personal Protective Equipment

Gowns and gloves for all any contact with the patient of the patient's
surroundings
Remove gowns and gloves before leaving the patient
Perform hand hygiene immediately after removing gloves and gowns
Gowns must be tied at the back and should not hang over the shoulders

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4. Donning and Doffing
The order in which the PPE is put and removed is extremely important to avoid
contamination and spread of microorganisms

Some tips to remember

Gloves are always put on last and removed first

When putting PPE on (donning), we wear the gowns first as it would be difficult pull the
gown over the head while wearing a face shield

o Then we wear the things on the face

o Gloves are always put on last

When removing (doffing) PPE, always go from the most contaminated to the least
contaminated

o So gloves are removed first

o Gowns are the second most contaminated
o Anything on the face is removed last

Order to put on PPE (Donning)

1. Perform Hand Hygiene

2. Wear gown
3. Wear mask (if not already wearing one)
4. Wear eye protection (if not already wearing)
5. Wear gloves

Order to remove PPE (Doffing)

1. Remove gloves
2. Remove gown
3. Perform hand hygiene and leave the room
4. Remove eye protection
5. Remove mask (unless performing universal masking)

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Blood and Body Fluid Exposures

Blood and body fluids (BBF) exposures include:

Percutaneous injury
Examples are a needle-stick or cut with a sharp object

Contact of mucous membrane or non-intact skin with blood, tissue, or other body fluids
that are potentially infectious.
Examples are splashes in the eyes or mouth or exposure skin that is scratched or suffering
with dermatitis

Blood and body fluids which are considered to be infectious are

 Blood, serum and plasma or

 Cerebrospinal fluid
 Synovial fluid
 Pleural fluid
 Peritoneal fluid
 Pericardial fluid
 Amniotic fluid
 Any visibly bloody fluid/secretion

Blood and body fluids which are considered to be not infectious (unless bloody) are

 Feces
 Nasal
 secretions
 Saliva
 Sputum
 Sweat
 Tears
 Urine

Next
1. What is a BBF exposure
Blood and body fluids (BBF) exposures include:

Percutaneous injury
Examples are a needle-stick or cut with a sharp object

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Contact of mucous membrane or non-intact skin with blood, tissue, or
other body fluids that are potentially infectious.
Examples are splashes in the eyes or mouth or exposure to skin that
is scratched or suffering from dermatitis

Blood and body fluids that are considered to be infectious for blood-borne
diseases like HIV Hepatitis B and Hepatitis C are

 Blood, serum, and plasma or

 Cerebrospinal fluid
 Synovial fluid
 Pleural fluid
 Peritoneal fluid
 Pericardial fluid
 Amniotic fluid
 Any visibly bloody fluid/secretion

Blood and body fluids that are considered to be not infectious for blood-
borne diseases like HIV Hepatitis B and Hepatitis (unless bloody) are

 Feces
 Nasal
 secretions
 Saliva
 Sputum
 Sweat
 Tears
 Urine

Blood and body fluids (BBF) exposures include:

Percutaneous injury
Examples are a needle-stick or cut with a sharp object

Contact of mucous membrane or non-intact skin with blood, tissue, or other body fluids
that are potentially infectious.
Examples are splashes in the eyes or mouth or exposure skin that is scratched or suffering
with dermatitis

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Blood and body fluids which are considered to be infectious are

 Blood, serum and plasma or

 Cerebrospinal fluid
 Synovial fluid
 Pleural fluid
 Peritoneal fluid
 Pericardial fluid
 Amniotic fluid
 Any visibly bloody fluid/secretion

Blood and body fluids which are considered to be not infectious (unless bloody) are

 Feces
 Nasal
 secretions
 Saliva
 Sputum
 Sweat
 Tears
 Urine

Previous
Next

2. What to do after an exposure

Why should you report an exposure?

By reporting an exposure, the hospital will take full financial responsibility for
providing post-exposure care (including medication and testing) as well as
treatment in case you develop an infection.

If you report the incident you will not be blamed for the exposure and this will
not reflect negatively on your personal file.

However, if you do develop an infection after an exposure that was not

reported, the hospital will not take responsibility for this.

What should you do if you are exposed?

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  In case of sharp injury/ needle-stick injury, allow the injured area to
bleed (don't press the blood out).In case of spill/splash over non-intact
skin or a mucus membrane, wash the area thoroughly.
o Wash the area with soap and water.
o Dry with tissue and cover it with a bandage.

 Immediately call/inform the following Fill out the online incident form
(to help us keep track of BBF exposures).
o Your supervisor
o Infection control nurse (weekdays from 0700 –1700 hours at Ext:
1228/1229/3867, or on weekend call IP on-call through BMO office.
 If the exposure is from a known patient, collect the blood sample in Gel
top if possible.

Blood and body fluids (BBF) exposures include:

Percutaneous injury
Examples are a needle-stick or cut with a sharp object

Contact of mucous membrane or non-intact skin with blood, tissue, or other body fluids
that are potentially infectious.
Examples are splashes in the eyes or mouth or exposure skin that is scratched or suffering
with dermatitis

Blood and body fluids which are considered to be infectious are

 Blood, serum and plasma or

 Cerebrospinal fluid
 Synovial fluid
 Pleural fluid
 Peritoneal fluid
 Pericardial fluid
 Amniotic fluid
 Any visibly bloody fluid/secretion

Blood and body fluids which are considered to be not infectious (unless bloody) are

 Feces
 Nasal
 secretions
 Saliva

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  Sputum
 Sweat
 Tears
 Urine

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3. How to clean a blood spill
The steps to clean a blood spill are:

1. Put on disposable latex gloves to prevent contamination of hands.

2. Cover the spill with paper towels or absorbent material.
3. Use a scoop to pick up sharps if it is present.
4. Gently pour bleach solution (or equivalent) onto all contaminated areas
of the surface. Let the bleach solution remain on the contaminated area
for 5 to 10 minutes.
5. Wipe up the remaining bleach solution.
6. All cleanup supplies may then be placed in a red bag for disposal.
7. Discard the used glove in the same bag.
8. Thoroughly wash hands with soap and water.

The following pictorial shows the following steps

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