universal precautions

2. Background …..
 In 1985, largely because of the emergence of
HIV/AIDS, guidelines for protecting healthcare
workers from becoming infected with HIV and other
Blood borne infections (e.g., HCV) were quickly
developed and became known as Universal
Precautions (UP).
 Universal precautions protect staff and patients from
hospital acquired infection.

3. Definition :
“ Universal Precautions is the term applied to
treating all blood , tissues and some body fluids as
potentially infectious .The appropriate level of
Precautions necessary is determined according to
the extent of possible exposure to blood & body
fluid and not because of the speculation of the
infectious status of the patient”

4. Body fluids to be treated with Universal Precautions
1.
 Cerebrospinal fluid
 Peritoneal fluid
 Pleural fluid
 Pericardial fluid
 Synovial fluid
 Amniotic fluid
 Urine
 Semen
 Vaginal secretions
2. Any other fluid containing visible blood including saliva
3. Tissues & organs

5. Universal precautions includes
1. Care of the skin
2. Hand washing
3. Protective Apparel
4. Procedure for safe handling of sharps
5. Procedure for safe disposal of sharps
6. Management of blood and body fluid spillages
7. Waste disposal

6. Care of the
skin….
• Bacteria and viruses cannot penetrate intact skin. It is therefore
vital to keep the skin in good condition and prevent cracking ,
chapping and drying of the skin.
 regularly check skin for cuts and cover with a waterproof
dressing to allow adequate hand washing.
 Following removal of gloves wash hands
 Ensure thorough drying of skin following hand wash.

7. Hand washing…..
 Hand washing is considered the simplest and most important
action to prevent infection transmission
 Microbes on human skin can be classified into two groups:
1. Resident flora
2. Transient/contaminated flora
Resident flora : Not easy to eliminate by scrubbing since they
are adapted to living on human hands.
Transient /contaminated flora :Easy to eliminate by scrubbing
with soap or detergent. This kind of microbe can be frequently
found on the skin of health care workers.

8. Hand washing Indications
BEFORE:
• Starting Work
• Examining a Patient
• Administering an Injection
• Handling Disinfected Instruments
• Putting on Gloves
• Going Home
AFTER:
• Examining a Patient
• Handling Instruments or Potentially
• Contaminated Items or Body
• Secretions/Excretions
• Removing gloves
• Using the toilet or latrine
• Sneezing or Coughing

11. USING PROTECTIVE BARRIERS……
# The wearing of protective appreal
provides the healthcare worker with
a barrier between themselves and
potential blood and bodyfluid.
# Common barriers are gloves,
aprons, masks, eye protectors, caps,
and sturdy footwear.

12. Rationale for Barrier Use
BARRIER PROTECTS PATIENTS PROTECTS HEALTH CARE WORKERS PRECAUTIONS
Gloves Prevent microorganisms on
the service provider’s hands
from coming in contact with
the client
Prevent the service provider’s hands
from coming in contact with the client’s
blood or other body fluids, mucous
membranes, and non-intact skin, as
well as instruments, other items, or
surfaces that have been contaminated
with blood or other body fluids
Mask Prevent droplets from the
service provider’s (and other
persons in the clinic) nose
and mouth which contain
microorganisms that are
expelled during talking,
coughing and breathing
from contact with the client
Prevent the mucous membranes of the
service provider’s nose and mouth from
being exposed to splashes of blood and
other body fluids; also protects from
droplets containing microorganisms.
Mask should
cover nose,
mouth, and
cheeks and
extend
below the
chin.

13. BARRIER PROTECTS PATIENTS PROTECTS HEALTH
CARE WORKERS
PRECAUTIONS
Eye protectors No protection
documented
Prevent the mucous
membranes of the
service provider’s
eyes from being
exposed to splashes
of blood or other
body fluid
Cap Prevent microorganisms
in service provider’s hair
or on skin shed from the
service provider’s head
from falling on the sterile
field
No protection
documented

14. BARRIER PROTECT PATIENTS PROTECT HEALTH CARE
WORKERS
PRECAUTIONS
Jacket, gown &
plastic apron
Prevent microorganisms on
the service provider’s arms,
torso & clothing from
coming in contact with the
client
Prevents the service
provider’s skin from being
exposed to splashes of
blood or other body fluids
A waterproof apron should
be worn under the jacket or
gown during all procedures
in which large amounts of
blood
& other body fluids are likely
(e.g., cesarean delivery)
Shoes Clean footwear minimises
the number of
microorganisms brought
from other areas of the
facility or the outside into
the surgical/procedure area
From stepping on
contaminated sharps or
from falling equipment
Sturdy shoes should be
worn in surgery. Health
care workers should never
walk barefoot in the
operating room. Clean
plastic or
leather boots that cover the
whole foot are
recommended. Sandals &
open shoes are not
recommended.

15. Selection of Protective Barriers
Type of Exposure Protective
Barrier Example
Low Risk:
Contact with intact skin; no
exposure to blood
Gloves not
essential Injection
Minor wound dressing
Medium risk:
Probable contact with blood,
but splashing unlikely
Gloves
Gown or apron may be
necessary
Pelvic exam
Handling of laboratory Specimens
IUD insertion
IUD removal
Large, open wound dressing
Intravenous Drawing of blood
catheter insertion
or removal
High risk:
Contact with blood likely;
splashing probable;
uncontrolled bleeding
Gloves
Apron
Eyewear
Mask
Major surgical procedures
Oral surgery
Vaginal delivery

16. Procedure for safe handling of
sharps
• Needles must never be re-sheathed or recapped
• Staff must obtain assistance when taking blood or giving
injections to uncooperative or confused patients
• Never carry sharps by the hand , if transporting always place
in an appropriate container
• Needles must never be broken or bent prior to disposal
• Needles must never be passed from hand to hand
• When performing phlebotomy , cannulation or giving
injections , all staff must wear appropriate disposable gloves
• Never reuse a sharp

17. Procedure for safe disposal of sharps
• Do not dispose of sharps with other clinical waste .
• Sharps bins to be kept in location that precludes injury to
patients , visitors and staff ensuring that sharps bins are
situated at a suitable height i.e. not placed on the floor or
above shoulder height.
• Always dispose of needles as a complete unit into a sharps
container never disassemble prior to disposal
• Sharps containers should be ¾ full prior to sealing and
disposal
• Never force a sharp into a sharps container

18. Management of spillage
Spillage Disinfectant Procedure
•Blood
•Body fluid
containing
blood
•1% hypocholrite
solution
•NaDCC
(Sodium
dichloroisocyanu
rate) granules
Wear protective clothing .Soak up excess fluid
using disposable paper towels. Cover area with
towels soaked in 1% hypocholrite and NaDCC.
Leave for at least 2 minutes. Dispose of as
infectious waste - yellow bag. Clean area with hot
water and detergent Dry area using disposable
paper towels Dispose of protective clothing as
above Wash hands.
•Urine and
vomitus
1% hypocholrite
solution
NaDCC (Sodium
dichloroisocyanu
rate) granules
The excess urine/vomit must be mopped up with
paper towels first. This is because if urine or vomit
comes into direct contact with the chlorine product
toxic fumes will be released. The room should be
well ventilated (i.e. window open) before this
procedure is carried out.

19. Spillage of body
fluids not containing
blood / For blood on
carpets or soft
furnishings
•1% hypocholrite
solution
•NaDCC (Sodium
dichloroisocyanurate)
granules
Wear protective clothing PPE. Soak
up fluid with paper towels. Wash area
with hot water and detergent. Rinse
with hot water. Dispose of paper
towels and protective clothing in
clinical waste (infectious waste-
yellow bag).Wash hands
Spillage from a
Sharps Container
•1% hypocholrite
solution
•NaDCC (Sodium
dichloroisocyanurate)
granules
Wear protective clothing
Gather up spilled sharps using the
equipment in the ‘Community Sharps
handling kit’ stored in every health
centre. Follow procedure as for blood
spillage on floor area where sharps
were spilled.

20. WASTE DISPOSAL

23. Precautions for Laboratories
To supplement the "universal precautions" listed above
the following precautions are recommended:
1. All specimens of blood and body fluids should be put
in a well-constructed container with a secure lid to
prevent leaking during transport.
2. All persons processing blood and body-fluid
specimens, e.g., removing tops from vacuum tubes,
should wear gloves. Masks and protective eyewear
should be worn if mucous membrane contact with
blood or body fluids is anticipated. Gloves should be
changed and hands washed after completion of
specimen processing.

24. 3. For routine procedures, such as histologic and pathologic
studies or microbiologic culturing, a biological safety
cabinet is not necessary. However, biological safety
cabinets should be used whenever procedures are
conducted that have a high potential for generating
droplets.
4. Mechanical pipetting devices should be used for
manipulating all liquids in the laboratory. Mouth pipetting
must not be done.
5. Use of needles and syringes should be limited to situations
in which there is no alternative, and the recommendations
for preventing injuries with needles outlined under
universal precautions should be followed.
6. Laboratory work surfaces should be decontaminated with
an appropriate chemical germicide after a spill of blood or
other body fluids and when work activities are completed.

25. 7. Contaminated materials used in the laboratory should be
decontaminated before reprocessing or be placed in bags
or other containers and disposed of according to the
Universal procedures.
8. Equipment that has been contaminated with blood or
other body fluids should be decontaminated and cleaned
before being repaired in the laboratory or transported to
the manufacturer.
9. All persons should wash their hands after completing
laboratory activities and should remove protective
clothing before leaving the laboratory.

26. • Almost from the moment universal precautions were
issued and hospitals and clinics began implementing
them, it was recognized that this new strategy, while
protecting hospital personnel (patient-to-personnel
transmission), sacrificed some measures of
preventing patient-to-patient and personnel-to-patient
transmission.

27. • Also, because many people with bloodborne
infections such as HIV/AIDS do not have
symptoms, nor can they be visibly recognized as
being infected, Universal Precautions had to be
modified to include all persons—patients and
clients— attending healthcare facilities
regardless of whether or not they are infected .

28. • Standard Precautions are designed for the care of
all persons— patients, clients and staff—
regardless of whether or not they are infected.

29. Standard Precautions are evidence based
clinical work practices published by the Centre of
Disease Control (CDC) in 1996 and updated in
2007 that prevent transmission of infectious
agents in healthcare settings.

30. Chain of Infection
Standard Precautions breaks the chain of
infection thus minimizing transmission of
infection within the Healthcare environment.

31. Standard
precaution
Breaking the chain of transmission
Hand washing
Use of personal
protective
equipment

32. Standard
precaution
Breaking the chain of transmission
sharps
Linen

33. Standard
precaution
Breaking the chain of transmission
Disposal of
biowaste
Environmental
cleaning
Routinely care,
clean and disinfect
equipment and
furnishings in
patient care areas

34. Standard precaution Breaking the chain of transmission
Patient care
equipment
1.Handle soiled
equipment in a manner
to prevent contact with
skin or mucous
membranes and to
prevent contamination
of clothing or the
environment
2. Clean reusable
equipment prior to
reuse

35. Standard precaution Breaking the chain of transmission
Patient resuscitation
Use mouthpieces,
resuscitation bags or other
ventilation devices to avoid
mouth-to- mouth
resuscitation
Patient placement
Place patients who
contaminate the
environment or cannot
maintain appropriate hygiene
in private rooms

36. Conclusion
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