Title
Procedure
Reference
Date Revised
Standard Precautions
X
Hospice
X
HONF
X
05/16/2008
PURPOSE
To reduce the risk of exposure to and transmission of infections when caring for patients.
PROCEDURE
Under Standard Precautions, blood and certain body fluids of all patients are considered
potentially infectious for blood borne pathogens such as human immunodeficiency virus (HIV),
and hepatitis B virus (HBV). Standard Precautions apply to blood and other body fluids
potentially containing blood or blood borne pathogens. These body fluids include: emesis,
sputum, feces, urine, semen, vaginal secretions, cerebrospinal fluid (CSF), synovial fluid, pleural
fluid, pericardial fluid and amniotic fluid. Standard Precautions should be used with other
fluids, such as nasal secretions, saliva, and tears when they contain visible blood or other
potentially infectious materials.
Hospice personnel will adhere to the following precautions and will instruct patients and
families/caregivers in infection control precautions as appropriate to the patient's care needs.
[Note: Patients may be given a copy of this procedure if needed as a teaching tool.]
PERSONAL PROTECTIVE EQUIPMENT
1.
On Hospice assignments where personnel have a risk of occupational exposure, the
organization will furnish, repair, clean, and launder, at no cost to personnel, appropriate
personal protective equipment so that barrier precautions can be observed and
compliance with this policy can be maintained. Personal protective equipment includes,
but is not limited to, gloves, gowns, laboratory coats, face shields or masks, eye
protection, mouthpieces, resuscitation bags, pocket masks, or other ventilation devices.
Personal protective equipment will be considered appropriate only if it does not permit
blood or other potentially infectious materials to pass through to or reach Hospice
personnel's work clothes, street clothes, undergarments, skin, eyes, mouth, or other
mucous membranes under normal conditions of use and for the duration of time which
the protective equipment will be used.
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2.
All personnel must use appropriate personal protective equipment when exposed to
blood or other potentially infectious materials. This equipment will be readily accessible
at the work-site or will be issued by personnel prior to arriving on Hospice assignments
where personal protective equipment is needed. If in rare and under extraordinary
circumstances, Hospice personnel decline to use personal protective equipment for
brief and temporary periods, they must do so only when in their professional judgment,
in that specific
instance, its use would have prevented the delivery of health care or public safety
services or would have posed an increased hazard to the safety of themselves or a coworker. When this occurs, Woodland Hospice will investigate the circumstances
involved in order to determine whether changes can be instituted to prevent such
occurrences.
3.
Garments penetrated by blood or other potentially infectious materials, will be removed
immediately or as soon as feasible.
4.
All personal protective equipment will be removed prior to leaving the work area.
When removed, it will be placed in an appropriately designated container or area for
storage, washing, decontamination or disposal.
5.
Mouth pipetting or suction of blood or infectious material is prohibited.
6.
See Procedure 8.2.3 – Procedure Classification and Tables A through C.
PROCEDURE
GENERAL PRECAUTIONS
1.
Hand washing: Hand washing will be performed to prevent cross-contamination
between patients and personnel.
A.
Hands and other skin surfaces should be washed with soap and warm water
when hands are visibly soiled.
B.
Use soap, warm water and friction for hand washing. Lather and scrub for 15 to
20 seconds. Rinse well, beginning at fingertips, so dirty water runs off at wrists.
Dry hands on paper towels. Use dry paper towels to turn off faucets.
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2
3.
C.
If hands are not visibly soiled or after washing hands with soap and water, the
preferred method of decontamination is with an alcohol based hand rub. A
minimum of 62% alcohol must be used to properly decontaminate hands.
D.
Alternating soap and water hand washing with alcohol based decontamination
prevents dermatitis.
Gloves: The use of gloves (intact Nitryl or vinyl of appropriate size and quality) is
important where the worker has cuts, abraded skin, chapped hands, dermatitis, etc.;
during instrument examination of oropharynx, gastrointestinal tract and genitourinary
tract; when examining abraded or non-intact skin or patients with active bleeding;
during invasive procedures; during all cleaning of body fluids and decontamination
procedures.
A.
Gloves are to be worn by the family/caregiver when direct contact with any body
substance is anticipated (blood, urine, pus, feces, saliva, drainage of any kind.)
B.
Gloves are to be worn when contact with non-intact skin is anticipated.
C.
Gloves are to be worn when handling soiled linen.
D.
Sterile gloves are to be worn for sterile procedures.
E.
Gloves are to be changed between patient contacts.
F.
Gloves should not be washed or disinfected for reuse.
G.
Use general purpose utility gloves (e.g., rubber household gloves) for
housekeeping chores involving potential blood contact and for instrument
cleaning and decontamination procedures.
H.
Gloves are not necessarily needed for general care or during casual contact such
as bathing of intact skin or assisting with ambulation.
Gowns: The use of gowns is required when splashes to the skin and/or clothing is likely.
The gowns will be made of or lined with fluid-proof or fluid-resistant material and will
protect all areas of exposed skin.
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4.
Mask/Protective Eyewear: Masks, protective eye wear, or face shields are required
when contamination of mucosal membranes, eyes, mouth or nose is possible, such as
splashes or aerosolization of material. They are not required for routine care.
5.
Resuscitation Equipment: CPR microshield, resuscitation bags, or other ventilation
devices will be provided to personnel where the need for emergency mouth-to-mouth
resuscitation would be required. This equipment will all be disposable.
6.
Needles, Syringes and Sharps: After use, needles and other sharps will be placed
directly into a puncture-proof container located at the patient's bedside. Needles must
not be re-capped, bent, broken or clipped. Woodland Hospice will use safe injection
practices at all times.
7.
Laboratory Specimens: Laboratory specimens should be transported in a biohazard
ziplock bag or other leak-proof container. The leak-proof container should be
transported to the office or alternate lab site in a temperature controlled, opaque and
puncture resistant container. Specimens transported to the office are placed in the
stationary storage container located in the soiled utility room.
8.
Labels: Biohazard labels will be used to prevent accidental injury or illness to personnel
exposed to hazardous or potentially hazardous conditions which are out of the ordinary,
unexpected, or not readily apparent.
A.
Labels will contain a signed work and major message -- BIOHAZARD -- or the
hazard symbol, readable at the minimum distance of five feet.
B.
Personnel will be informed as to the meaning of the labels.
C.
Labels will be affixed as close as possible to respective hazards.
D.
Labels will be used to identify equipment, containers, and rooms, contained with
hazardous agents.
E.
If labels are not used, other effective means will be used, such as RED bagging.
HOUSEKEEPING AND HYGIENE
1.
Housekeeping
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2.
A.
Good, common sense practices provide an environment that is safe for
everybody.
B.
A good disinfectant (e.g., household bleach 5.25% mixed 1:10 with water) should
be used to clean floors, toilet bowl, tub, shower, sink, countertops and soiled
furniture. The Hospice House will use industrially prepared sanitizing and
disinfectant solutions for the cleaning solutions.
C.
Sponge and mops used to clean up body fluid spills should not be rinsed out in
the kitchen sink or used where food is prepared. Mop heads are changed after a
clean up of hazardous waste.
D.
Dirty mop water should be poured down the toilet, rather than the sink.
E.
Rooms will be kept well aired to decrease the risk of colds, flu and other airborne
communicable disease.
F.
Infectious organisms may be found in animal wastes, bird cages, cat litter boxes,
and fish tanks. They should be maintained by someone other than a person with
HIV disease or other causes of immunosuppression.
G.
Humidifiers and air conditioners can harbor infectious organisms, these should
be cleaned and serviced regularly.
Blood/Body Fluid Spills
A.
First, contain the spill with a soaking material like cat litter or Red Z, a chemical
that would be provided by hospice. Once the fluid has solidified with the
absorbent material, scoop up the material and discard of in a leak proof bag or
container. Next, blood/body fluid spills should be mopped or wiped up with hot
soapy water and then disinfected with bleach as described above. If the cleanup is done by hand, disposable gloves to be worn.
B.
Soiled sponges and mops can be disinfected by soaking in a 1:10 dilution of
bleach for 5 minutes. Hospice House mops are placed in the biodegradable
biohazard laundry bags and sent to Cintas for processing.
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3.
Hygiene
A.
Personal items such as toothbrushes, razors and enema equipment should not
be shared.
B.
Maintaining a state of personal cleanliness is the key to reducing infection
transmission from person to person. This includes bathing regularly and washing
hands after use of bathroom facilities or contact with one's own body fluids and
before preparing food.
WASTE DISPOSAL
1.
Flushable Waste: Body wastes will be flushed down the toilet.
2.
Non-Flushable Disposables: Non-flushable items contaminated with blood or body
substances should be placed in a leakproof plastic bag which is tied securely at the neck.
This bag should then be placed in a second sealed, plastic bag to afford extra strength
and protection against breakage and spillage. The bag will then be disposed of in the
home trash receptacle. Large amounts of blood will be disposed of in a biohazard bag
and placed in a biohazard waste container at the site. This container will be returned to
hospice facility and processed by our contracted biohazard waste company.
3.
Syringe/Sharps Disposal: In the home setting, a sharps disposal container will be
available for use by the clinical or patient/caregiver. The uncapped needle will be
placed directly into the disposal container. When 3/4 full, the disposal container will be
sealed and transported to the dirty supply area located in the office or will be picked up
by the pharmacy. A new container will be provided for any future use.
LAUNDRY
1.
Handling and Changing of Linens – Home Setting
A.
Towels and wash cloths should not be shared by different users.
B.
Gloves are to be worn when handling soiled linen.
C.
Soiled clothing and linens should be washed as promptly as possible. Ideally,
they should be machine washed in hot (160 F) soapy water for twenty-five
minutes. If appropriate, (e.g., colorfast material), a cup of bleach may be added
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to the water. If low temperature (less than 150 F) laundry cycles are used,
chemicals suitable for low temperature washing at proper use concentration
should be used.
D.
If a washing machine is not available, soiled linens should be soaked in cold
water (to lift stains) containing bleach (1:10 dilution) for 15-20 minutes. Wearing
gloves, work out any stains. Rewash with hot soapy water.
E.
Commercial or home clothes dryers are the preferred method of drying linens. If
not available, air dry linens, preferably in the sun.
EQUIPMENT/NON-DISPOSABLE INSTRUMENTS
1.
2.
Bedpans/Urinals/Commodes
A.
Bedpans and urinals should be used by only one patient and should be cleaned
on a regular basis with household detergent.
B.
Shared commodes do not require special precautions unless blood,
contaminated body substance, or fluid is present. If soiled, the commode should
be cleaned with a 1:10 dilution of bleach.
Thermometers
A.
Electronic thermometers with disposable sheaths need no special precautions
unless they become visibly soiled. When thermometers are soiled, they should
be wiped with a disinfectant solution. Electronic thermometers are not supplied
by Woodland Hospice but may be owned by patients.
B.
3.
Glass thermometers used in the home should be rinsed with soap and water
before and after use. If the thermometer will be used by more than one
family/caregiver member, it should be soaked in 70-90% ethyl alcohol for 30
minutes followed by a rinse under a stream of water in between users.
Medical Equipment/Supplies
A.
Any non-disposable equipment returned to Hospice stock will be placed in the
dirty utility area and then thoroughly wiped down with an Hospice-approved
disinfectant by the staff member who returned the equipment. After proper
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cleaning, the equipment will be covered with plastic and stored in the garage or
basement until needed for client care.
B.
In the event a non-disposable piece of equipment (e.g., stethoscope, blood
pressure apparatus, bandage scissors) comes in contact with blood or body
fluids, a 1:10 dilution of bleach or other Hospice-approved disinfectant is used to
clean it. Soiled blood pressure cuffs will be wiped with disinfectant wipes
approved by Woodland Hospice.
C.
Dressing supplies contaminated with the patient's blood or body fluids in the
home environment should be double bagged in plastic bags, tied securely, and
labeled "contaminated" then placed with household trash for garbage pick-up.
KITCHEN/FOOD PREPARATION – Home Care Setting
1
Hand washing: Proper hand washing techniques should be observed prior to touching
food.
2.
General Hygiene: "Tasting" of food during cooking should be done with a new, clean
spoon each time. Wash the spoon with soap and water immediately after "tasting".
3.
Cleaning of Kitchen: Counters, sinks, and floors in the kitchen should be free from food
particles and cleaned with a sanitizer regularly.
4.
Refrigerator: The interior of the refrigerator should be cleaned with soap and warm
water regularly to control molds.
5.
Food Freshness: Observe expiration dates and general freshness of food. Do not use
cracked eggs due to the likelihood of salmonella contamination.
6.
Food Storage: Store open packages of food (e.g., sugar) in covered containers to
discourage infestation.
7.
Food Preparation: Pork, poultry and eggs should be thoroughly cooked before eating.
Porous (e.g., wood) cutting boards used for poultry should not also be used for fruits
and vegetables.
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8.
Dishes/Utensils: Wash dishes and utensils in hot soapy water. The water should be hot
enough to require the use of lined gloves. Allow dishes to air dry. Known infected
persons do not need separate dishes or utensils provided they are washed as described.
9.
Sponges: Sponges used to clean in the kitchen should not be the same sponges used to
clean bathrooms and body fluid spills. Sponges used to clean bathrooms and body fluid
spills should be disinfected with bleach and changed periodically.
SPECIAL CONSIDERATIONS FOR A PERSON WITH HIV DISEASE
1.
Unpasteurized milk, raw eggs, products containing raw eggs or cracked or non-intact
eggs should be avoided. They have been associated with Salmonella infections and may
be problematic for the person with HIV disease.
2.
All fresh produce will be washed thoroughly.
OTHER CONSIDERATIONS
1.
Eating, drinking, smoking, applying make-up or lip-balm or handling contact lenses
should be avoided in work areas where there is a reasonable chance of exposure.
2.
Sterile technique will be employed for sterile dressing changes, IV insertion, IV site care,
phlebotomy, tracheal suctioning, insertion of a urinary catheter, and whenever
appropriate to prevent infection.
3.
Disinfectants
HIV is inactivated rapidly after being exposed to chemical germicides. HIV can be
inactivated after exposure for ten minutes to any of the following:
A.
Chlorine bleach (1:10 dilution)
B.
Alcohol (70-95%)
C.
Quaternary Ammonium (TRI-GUAT)
D.
Phenolic (Vesphene II)
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NOTE:
Woodland Hospice has the right to limit the practice of the worker if patient
safety is in question.
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Universal / Standard Precautions Outline
Universal Precautions vs. Standard Precautions
 Thought to be interchangeable but are different and we practice Standard
Precautions
 Universal Precautions: defined by the CDC, are a set of precautions designed
to prevent transmission of HIV, Hepatitis B & C, and other blood Bourne
pathogens when providing first aid with these various blood Bourne
pathogens. Precautions consist of wearing barriers (gloves) when handling
fluids; gowns if may be splashed; proper handling and disposing of needles;
and use of ventilation devises for mouth to mouth resuscitation, etc.
 Standard Precautions: Combine major features of Universal Precautions and
Body substance Isolation and are based on the principle that all blood and
body fluids, secretions and excretions except sweat, non-intact skin, and
mucous membranes may contain transmissible infectious material.
4 Components of Standard Precautions
 PPE- Personnel Protective Gear
 Hand washing
 Decontamination
 Waste Disposal
Protective Gear
1. Biohazard Bag in client’s homes
2. Soiled Utility Room in Hospice House / Client’s rooms
3. Procedure Classification
 Category I-Procedures that involve exposure to blood, body fluids, and
/or tissue. Examples: catheter care; catheterization; oral hygiene;
disposal of contaminated items; laundry / lined including sorting and
pre-soaking, cleaning rooms, and post mortem care
 Category II – Procedures that involve no exposure to blood, body fluids,
or tissue however, necessary. Examples – dressing / undressing client;
cleaning of equipment; washing windows; placing O2; client transfer;
bed making; hair Care; meal Service and tray set up; turning and
repositioning client
 Category III – Use of public / shared bathrooms; telephones;
handshaking; cleaning office areas
Hand washing
1. Review Process
 Wash with soap and warm water for 30 seconds
 Wash all surfaces to include uder the nails and between the fingers
 Rinse well, moving from the wrist down
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 Dry with a paper towel then turn off water
 Discard towel
2. Ask home clients to have liquid soap and paper towels available for you to
wash your hands in the home. Do not use the kitchen sink.
3. When to wash your hands
 Before and after touching food
 Before you touch your mouth
 Before you do any type of procedure
 After going to the bathroom
 After you blow your nose, cough, or sneeze
 Wash after you touch an animal, even your own pet
Decontaminating
1. Surface areas-wash with a 1:10 bleach solution or a disinfectant solution that
is approved for HIV, Hep B & C, and TB. They should take care of just about
any pathogen.
2. Carpets – Regular Standard Carpet cleaning chemicals will work
3. Laundry
 If employees clothing Hospice is responsible for cleaning. Remove
immediately, double bag, and bring to the Hospice House for processing
 Laundry treated at hospice must either be washed in 165 degree water
for 25 minutes or if water is not hot enough add bleach to the load or
an approved disinfectant laundry chemical
 Employees need to remember to wear PPE when bagging, sorting, and
pre soaking contaminated laundry
4. Sharps
 Dispose in a container that is closeable, puncture resistant, leak proof
and biohazard labeled or color-coded red. All needles, broken glass,
etc. should be discarded in this type of container
 Needles or other contaminated sharps will not be bent, recapped,
removed or purposely broken
 Located in areas away from children
Waste Disposal
1. Regulated (bio-hazardous) waste is defined as:
 Liquid or semi-liquid blood or other potentially infectious material
 Contaminated items that would release blood or other potentially
infectious materials if compressed
 Items caked with dried blood or other potentially infectious materials if
compressed
 Contaminated sharps
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2. 2 Types of waste:
 Contaminated waste includes: diapers, sanitary napkins, used band-aid (not
saturated with blood), discarded gloves or other PPE (not saturated with
blood), vomit etc.
Contaminated
waste should be double-bagged in plastic and disposed of in covered trash
containers that are not accessible to children
 Regulated (bio-hazardous waste includes items that saturated with fluids
containing blood, or items caked with dried blood. This waste must be
placed in special containers, and handled by a hazardous waste company
What is an Exposure Incident?
 Means a specific eye, mouth, or other mucous membrane, on-intact skin or
parental (needle or sharp object) with blood or other potentially infectious
material that result from the performance of an employee’s duties
What happens after an Exposure?
Responsibilities and procedures after an exposure incident with potentially
infectious materials include:
 Wash the affected area and remove contaminated clothing
 Protect others from the exposure
 Report the event to appropriate supervisor
 Seek medical attention within 2 hours if the exposure warrants
 Physician / Clinician will determine significance of exposure as well as
dictated follow-up
 If consent for testing is obtained from source of exposure on physician and
exposed worker are entitled to those results
 Confidentiality of source and exposed worker must be confidential
 Document exposure before end of day
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