ALL INDIA INSTITUTE OF MEDICAL SCIENCES,JODHPUR

COLLEGE OF NURSING

CLASSROOM PRESENTATION

 SUBJECT: Advanced nursing practice

 UNIT: 05

 TOPIC:Standard safety measures

Submitted by: Submitted to:

SUJATA JHA VIKAS CHOUDHARY

M.sc. Nursing 1st Year. NURSING TUTOR

AIIMS JODHPUR AIIMS JODHPUR

COLLEGE OF NURSING COLLEGE OF NURSING

Date of submission:

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 TABLE OF CONTENT

S.NO CONTENT PAGE NO.

1. INTRODUCTION OF SAFETY MEASURES

2. DEFINITION OF SAFETY MEASURE

3. COMPONENTS OF SAFETY MEASURES

4. HAND HYGIENE

5. PERSONAL PROTECTIVE EQUIPMENT

6. RESPIRATORY HYGIENE

7. SAFE INJECTION PRACTICE

8. CLEANING AND DISINFECTION

9. SAFE HANDLING SHARP

10. WASTE MANAGEMENT

11. LINEN OR LAUNDRY MANAGEMENT

12. SPILL MANAGEMENT

13. PRE AND POST PROPHYLAXIS

14. IMMUNISATION

15. RESEARCH FINDINGS

16. SUMMARY

17. CONCLUSION

18. REFERENCES

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INTRODUCTION :-

Standard safety measures are a set of infection control practices used to prevent
transmission of diseases that can be acquired by contact with blood, body fluids, non-
intact skin (including rashes), and mucous membranes.

 it help to control the communicable disease in hospital.

 It prevent the harmful infection in hospital or other health care centre.
 its prevents the transmission of infection or disease.
 to prevent the undesirable microorganism.
 To prevent the cross infection in hospitals

DEFINITION :-

Standard Safety measures are the minimum infection prevention practices that should be
used in the care of all patients all of the time. These practices are designed to both protect
the healthcare worker and to prevent the healthcare worker from spreading infections
among patients.

COMPONENTS OF SAFETY MEASURES :-

These measures are to be used when providing care to all individuals, whether or not they
appear infectious or symptomatic.

 Hand Hygiene.
 Personal Protective Equipment.
 Respiratory Hygiene.
 Safe Injection Practice.
 Cleaning and Disinfections.
 Safe Handling Sharp.
 Waste Management.
 Linen or Laundry Management.
 Spill Management.
 Pre and Post Prophylaxis
 Immunisation

 Hand Hygiene

 Practicing hand hygiene is a simple yet effective way to prevent infections.

 Cleaning your hands can prevent the spread of germs, including those that are
resistant to antibiotics and are becoming difficult, if not impossible, to treat.

 On average, healthcare providers clean their hands less than half of the times they
should.

 All the steps of hand washing should be followed properly.

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  Always use liquid soap instead of solid soap for hand washing.

 Increasing hand-washing compliance by 1.5 – 2 folds would result in a 25-50-%

decrease in the incidence of healthcare associated infections.

 Five moments of hand washing :

i. Before patient contact.

ii. Before doing any aseptic technique.

iii. After body fluid exposure risk.

iv. After patient contact.

v. After contact with patient’s surroundings.

 Types of hand hygiene :

Methods Agents Purpose Area Time Duration

Routine Water and Remove soil & All surfaces 5 Moments for 40- 60 sec
Hand wash plain soap transient of hands & Hand Hygiene.
microorganisms fingers

Anti septic Water and Remove or All surfaces Before all 1 min
hand wash antimicrobial destroy of hands & aseptic
soap (e.g transient fingers procedures on
chlorohexidine microorganisms the ward.
) and reduce
resident flora

Antiseptic Alcohol based Remove or All surfaces As an alternative Until hands

hand rub hand rub destroy of hands & to antiseptic are dry
transient fingers hand wash on
microorganisms visibly clean
and reduce hands.
resident flora

Surgical Water and Remove or Hands and Before all 3- 5 mins

Hand wash antimicrobial destroy forearms surgical/invasive
soap (e.g. transient procedures.
clorhexidine) microorganisms
and reduce
resident flora

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  Steps of hand washing :

 Step 1 - Wet your hands and apply enough soap (coin size).

 Step 2 - Rub your palms together.

 Step 3 - Rub the back of each hand

 Step 4 - Rub both your hands while interlocking your fingers

 Step 5 - Rub the back of your fingers.

 Step 6 - Rub the tips of your fingers.

 Step 7 - Rub your thumbs and the ends of your wrists.

 Step 8 - Rinse both hands properly with water.

 Personal protective equipment :

Personal protective equipment is special equipment that the person wear to create
a barrier between individual and germs. This barrier reduces the chance of
touching, being exposed to, and spreading germs.

Personal protective equipment (PPE) helps prevent the spread of germs in the
hospital. This can protect people and health care workers from infections.

All hospital staff, patients, and visitors should use PPE when there will be contact
with blood or other bodily fluids.

 Face mask / eye protection: protect mucous membranes of the eyes, nose and
mouth during procedures

 Gloves: Touching mucous membrane and non- intact skin and performing sterile
procedures.

 Gown: Prevent soiling of clothing and skin during procedures that are likely to
generate splashes of blood, body fluids, secretions or excretions

 Cap: During sterile technique to prevent infection

 Footwear: If contact with blood or body fluids may occur

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  Sequence of putting on PPE( Donning)

1. GOWN:-
 Fully cover torso from neck to knees, arms to end of wrists and
wrap around the back.
 Fasten in back of neck and waist.

2. MASK OR RESPIRATOR:-
 Secure ties or elastic bands at middle of head and neck.
 Fit flexible band to nose bridge.
 Fit snug to face and below chin.
 Fit check respirator.

3. GOGGLES OR FACE SHIELD:-

 Place over face and eyes and adjust to fit.

4. GLOVES:-
 Extend to cover wrist of isolation gown.

 Sequence of taking off PPE( “Doffing”)

1. GLOVES:-
 Outside of gloves is contaminated.
 Grasp outside of glove with opposite gloved hand; peel off.
 Hold removed gloves in gloved hand.
 Slide fingers of ungloved hand under remaining glove of wrist.
 Peel glove off over first gloves.
 Discard gloves in waste container.

2. GOGGLES OR FACE SHIELD:-

 Outside of goggles or face shield is contaminated.
 To remove, handle by head band or ear pieces.
 Place in designated receptacle or reprocessing or in waste
container.

3. GOWN:-
 Gown front and sleeves are contaminated.
 Unfasten ties.
 Pull away from neck and shoulders, touching inside of gown
only.
 Turn gown inside out
 Fold or roll into a bundle and discard

4. MASK OR RESPIRATOR:-
 Front of mask/ respirator is contaminated- DO NOT TOUCH
 Grasp bottom, then top ties or elastic sand remove
 Discard in waste container.

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  Respiratory hygiene :-

Respiratory hygiene is a relatively new concept introduced after the SARS

outbreak in 2003, comprising vigilance and prompt implementation of infection
control measures at the first point of encounter within a healthcare setting. It is
directed to patients and family members with signs of respiratory illness such as
cough, congestion, or increased respiratory secretion.

 Education regarding how respiratory illnesses spread and prevention

practices including “cover your cough”

 Availability and use of tissues and hand hygiene products.

 Use of mask for person who is coughing.

 Spatial separation of the person with a respiratory illness.


 At least 1 metre (3 feet) away from others in common waiting areas
(WHO, 2007)

 Safe injection practice :-

Safe injection practices are intended to prevent transmission of infectious diseases

between individuals and to prevent injuries such as needle sticks.
In developing countries 16 thousand million injections used each year. 90%, for
therapeutic purposes while 5 to 10% are given for preventive services, including
immunisation and family planning (WHO, 2014).

According to a study conducted in Western region of Nepal (DoHS, 2013), 70%

of clinical staff and 63% of non-clinical staff reported a needle stick injury (NSI)
or other sharps injury at some time.
Around 385,000 needle-sticks and other sharps related injuries are sustained by
hospital HCWs annually (CDC, 2013).
Nearly 15% of needle stick injuries occur during or after disposal (CDC, 2014).

 Safe injection practice includes :-

 Aseptic technique.

 Using a single syringe and fluid infusion sets only once.

 Using single-dose vials when possible.

 If multi-dose vials must be used, then use & store them according to
manufacturer's recommendation.

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  Safe Injection Practices: Finger stick Devices

 Single-use devices :-
 Disposable .
 Prevent reuse through an auto- disabling feature.
 Appropriate for settings where assisted monitoring of blood
glucose is performed Single.

 Reusable devices:-
 Often resemble a pen (“penlet”) not appropriate due to
 Failure to clean and disinfect properly .
 Links to multiple outbreaks of hepatitis B.
 Risk for occupational needle stick.
 Only appropriate for people who do not require assistance with
blood glucose monitoring (BGM).

 Needle Stick Injury Prevention :-

 Over 80% of needle stick injuries can be prevented with the use of safer
needle devices.
 Worker education and work practice controls can reduce injuries by 90%
( WHO, 2014).

 Cleaning and disinfection :-

Antiseptic Inhibits the growth of pathogenic and disease causing bacteria.

Antiseptic are used in living beings for humans and living cells.

Antibacterial – (antimicrobial)
 Bactericidal - kill bacteria.
 Bacteriostatic - suppresses their growth

Examples

 Clean:-

Activities that remove, or reduce, the amount of dirt and/or microbes. Thorough
cleaning will remove more than 90% of visible dirt. Cleaning process depends
essentially on mechanical action. There must be policies specifying the frequency
of cleaning and cleaning agents used for walls, floors, windows, beds, curtains,
screens, fixtures, furniture, baths and toilets, and all reused medical devices
(WHO, 2002).

 Disinfection :-

Destroys all pathogenic organism except spores. The use of a chemical procedure
that eliminates virtually all recognised pathogenic microorganisms but not

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 necessarily all microbial forms, such as bacterial endospores, on inanimate objects
and equipments (WHO, 2002).

Disinfection with hot water Articles Temperature

Article Temperature Time

Sanitary Equipment 80C 45-60 sec

Cooking Utensil 80C 1min

Linen 70C 25 min

95C 10 min

 Sterilisation

The process by which all microorganisms including spores are destroyed. The use
of a physical, radiation or chemical process to destroy all microbial life, including
highly resistant bacterial spores. It is never absolute; by definition, it reduces the
number of microorganisms by a factor of more than 106 (i.e. more than 99.9999%
of microorganisms are killed) (CDC, 2014)

 Principal Sterilisation Methods

Thermal sterilisation

Wet sterilisation: exposure to steam saturated with water at 121 °C for 30

minutes, or 134 °C for 13 minutes in an autoclave; (134 °C for 18 minutes for
prions).

Dry sterilisation: exposure to 160 °C for 120 minutes, or 170 °C for 60 minutes;
this sterilisation process is often considered less reliable.

Chemical Sterilisation
Ethylene oxide and formaldehyde for sterilisation

 Aseptic technique

Aseptic technique is a set of specific practices and procedures performed under

carefully controlled conditions with the goal of minimising contamination by
pathogens. Aseptic technique means without sepsis.

 Medical Asepsis :- clean technique-reduces the number of pathogens.

Clean technique; procedures used to reduce & prevent spread of
microorganisms.

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 Practices used to “confine a specific microorganism to a specific area,
limiting the number, growth and transmission of microorganisms”

 Surgical Asepsis: – Sterile technique practices used to render and keep

objects and areas free from organisms. Sterile technique; procedures used
to eliminate microorganisms.

Sterilisation Practices destroy all forms microorganisms

 Principle of maintaining asepsis

 Creation of sterile field using sterile equipment.

 All items in a sterile field must be sterile.

 Sterile packages or fields are opened or created as close as possible to

time of actual use.

 Moist areas are not considered sterile.

 Only areas that can be seen by the clinician are considered sterile (i.e., the
back of the clinician is not sterile).

 Gowns are considered sterile only in the front, from chest to waist and
from the hands to slightly above the elbow.

 Tables are considered sterile only at or above the level of the table. • Non
sterile items should not cross above a sterile field.

 There should be no talking, laughing, coughing, or sneezing across a

sterile field.

 Personnel with colds should avoid working while ill or apply a double
mask.

 Edges of sterile areas or fields (generally the outer inch) are not considered
sterile.

 When in doubt about sterility, discard the potentially contaminated item

and begin again.

 A safe space or margin of safety is maintained between sterile and non

sterile objects and areas.

 Tears in sterile packs and expired sterilisation dates are considered breaks
in sterility.

 When Should Apply the Aseptic Technique

 Wound care.

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  Drain removal and drain care.

 Intravascular procedures.

 Vaginal exams during labor.

 Insertion of urinary catheters.

 Respiratory suction.

 Injection technique.

 Collection of blood specimens

 Safe Handling of sharp :-

A hypodermic needle, suture needle, blade, scissors, forceps can be a potentially

lethal instrument. Vein puncture for example, is one of the most dangerous
procedures a health care worker can perform if it results in a needle prick injury.

 Preventing Sharps Injuries

 Preparation:-
 Assemble all equipment required for the procedure.

 Minimise distractions.

 Equipment:-
 Equipment should be used strictly according to protocols and only
for the purpose for which it was designed.

 Choose the safest equipment.

 Technique:-
 Perform the procedure slowly and carefully.

 Minimise the handling of sharp instruments. The less they are

handled the less chances of needle prick injuries occurring.

 The needle must be properly recapped; the sheath must not be held
in the fingers; either a single-handed technique, forceps or a
suitable protective guard designed for the purpose, must be used if
needed.

 Each health care worker who uses sharp instruments is responsible

for their management and disposal.

 Dispose of all the sharp instruments used during the procedure

immediately, carefully and appropriately.

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  The sharps container never be overfilled and dispose after ¾ filled
up the container.

 The sharp container must be securely sealed with a lid before

disposal. Use utility glove during disposing the sharps.

 Waste Management

Hospital waste is “Any waste which is generated in the diagnosis, treatment or

immunisation of human beings or animals or in research” in a hospital. Hospital
waste is a potential reservoir of pathogenic micro organisms and requires
appropriate safe and reliable handling. The main risk associated with infection is
sharps contaminated with blood.

 Principles Of Waste Management Steps in the management of

hospital waste :

 Generation.

 Segregation/separation.

 Collection.

 Transportation.

 Storage.

 Treatment.

 Final disposal.

 Linen and Laundry Management

Although soiled linen may harbour large numbers of pathogenic microorganisms,

the risk of actual disease transmission from soiled linen is negligible.

Dirty linen often contains a significant number of microbes (10–108 bacteria per
100 cm2 of soiled bed sheets), mostly Gram-negative rods and bacilli.

 Soiled Linen and Laundry

 All soiled linen should be bagged or placed in containers at the location

where it was used and should not be sorted or rinsed in the location of use.

 Linen heavily contaminated with blood or other body fluids should be

bagged and transported in a manner that will prevent leakage.

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  Soiled linen is generally sorted in the laundry before washing.

 Gloves and other appropriate protective apparel should be worn by laundry

personnel while sorting soiled linen.

 Management of the Clean Linen Storing Clean Linen

 Keep clean linen in clean, closed storage areas.

 Use physical barriers to separate folding and storage rooms from soiled
areas.

 Keep shelves clean.

 Handle stored linen as little as possible.

 Transportation of Clean Linen:-

 Clean and soiled linen should be transported separately.

 Containers or carts used to transport soiled linen should be thoroughly

cleaned before used to transport clean linen.

 Clean linen must be wrapped or covered during transport to avoid

contamination.

 Distribution of Clean Linen:-

 Protect clean linen until it is distributed for use.

 Do not leave extra linen in patients’ rooms.

 Handle clean linen as little as possible.

 Avoid shaking clean linen, it releases dust and lint into the room.

 Clean soiled mattresses before putting clean linen on them

 Spill Management :-
Cover the spill with a newspaper, blotting paper / paper towel or dry mud. Wipe
the spill with a newspaper moistened with hypochlorite solution (1% dilution
containing minimum 500ppm chlorine).
Wipe the area with a cloth mop moistened with 1% hypochlorite solution and
allow drying naturally.

 Equipment :-

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 Equipment (mop, bucket and cleaning agents) is to be readily available in
a location known to all.

A portable ‘spills kit’ can be made up to manage likely spills for the
area/activity.

 Basic Principles:-
 Assume all blood and body substances are potentially infectious
and cover cuts, maintain hand hygiene and use appropriate PPE.

 Cover the spill, to prevent the generation of splashes and aerosols

from the spilled substance.e.g. granular formulation such as vomit
control.

 Clean the area thoroughly, rinse and dry.

 Clean non-disposable cleaning equipment thoroughly after use,

rinse and store dry.

 Post Exposure Prophylaxis:-

Post exposure prophylaxis is intended to protect the health care workers from
different infection which could be acquired while performing medical procedures
(e.g. needle stick injury, blood splash on mucosa, blood and body fluid).
Expose with HIV cases -PEP should be started as soon as possible within72 hours
the course will be for 28 days.

 Pre Exposure Prophylaxis:-

Pre-exposure vaccination (immunisation) for HBV In healthcare settings,

immunisation against HBV must be provided to health workers who perform tasks
involving contact with potentially infectious blood or other bodily fluids. The risk
of acquiring HBV is far greater than that of HIV or Hepatitis C.

 Outcome

 Post-exposure prophylaxis can reduce the risk of HIV transmission by

80%.

 Risk of developing disease 30% in hepatitis B, 3- 10% in hepatitis C if not

vaccinated (WHO & ILO, 2007)

 Immunisation

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  Health care workers may be exposed to certain infections in the course of
their work.

 Vaccines are available to provide some protection to workers in a

healthcare setting.

 Before exposure, first responders (health personnel) may receive

vaccinations for different diseases, e.g. hepatitis B, influenza, measles,
mumps, rubella, tetanus, diphtheria and pertussis etc.

 Immunisations for Healthcare Workers

Since 1981 the CDC has recommended healthcare workers receive influenza
vaccination, and the coverage among healthcare workers during the 2013–14 flu
season was 75.2%. Coverage was highest (97.8%) among healthcare personnel
working in settings in which flu vaccination was a requirement for employment
(CDC, 2014e).

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ADVISORY COMMITTEE FOR IMMUNISATION PRACTICE(ACIP)

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  RESEARCH FINDINGS:-

1. Knowledge and practices regarding standard precautions among

health functionaries of peripheral health institutions of Haryana
Suraj Chawla, Ramesh Verma, Pardeep Khanna

Abstract

Background: Healthcare workers (HCWs) are at risk of infections due to blood-borne

pathogens as they are potentially exposed to blood and body fluids in the course of
their work. Standard precautions aim to both protect health care workers (HCWs) and
prevent them from transmitting the infections to their patients.

Methods: The study was conducted among health functionaries of all health centres
whether govt. or private of community development block Beri, District Jhajjar,
Haryana. A pre-tested semi-structured questionnaire was administered to the study
subjects and the responses were recorded by the investigator himself. The
questionnaire included information pertaining to knowledge and compliance with
standard precautions among HCWs.

Results: Knowledge among staff nurses and laboratory technicians was having wide
variations as 53% to 93% of them gave correct replies for different components of
standard precautions. Similarly, when knowledge of multipurpose health workers was
assessed only half or less than half of them were having correct knowledge for most
of the components.

Conclusions: To conclude, the HCWs in peripheral health institutes had inadequate

knowledge of and poor compliance with SPs. Enhancement of the existing training
and system for monitoring the appropriate use of personal protective equipment is
need of the hour.

2. Infection control and practice of standard precautions among

healthcare workers in northern Nigeria

Background: Healthcare-associated infections (HAIs) have been reported to be a

serious problem in the healthcare services as they are common causes of illness and
mortality among hospitalised patients including healthcare workers (HCWs).
Compliance with these standard precautions has been shown to reduce the risk of
exposure to blood and body fluids. Aims: This study therefore assesses the level of
knowledge and compliance with standard precautions by the various cadre of HCWs
and the factors influencing compliance in hospital environment in Nasarawa State,
Northern Nigeria.

Settings and Design: Nasarawa State has a current human immunodeficiency

virus/acquired immunodeficiency syndrome (HIV/AIDS) prevalence rate of 10.0%,
which was higher than most states in Nigeria with a high level of illiteracy and
ignorance. Majority of the people reside in the rural areas while a few are found in the
towns, informal settlements with no direct access to healthcare facilities are common.

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 Materials and Methods: This study is an analytical, cross-sectional study.
Proportional sampling technique was used to obtain a representative sample and a
structured self-administered questionnaire was used to collect relevant information
from the healthcare providers working in Nasarawa State from January to February
2009. Statistical analysis used: To describe patient characteristics, we calculated
proportions and medians. For categorical variables, we compared proportions using
chi-square tests. A logistic regression model was produced with infection control as
outcome variable to identify associated factors.

Results: A total of 421 HCWs were interviewed, Majority (77.9%) correctly describe
universal precaution and infection control with 19.2, 19.2, and 28.0%, respectively
unable to recognise vaccination, post exposure prophylaxis, and surveillance for
emerging diseases as standard precaution for infection control. About 70.1% usually
wear gloves before handling patients or patients' care products, 12.6% reported wash
their hand before wearing the gloves, 10.7% washed hands after removal of gloves,
and 72.4% changed gloves after each patient. Only 3.3% had a sharp disposal system
in their various workplaces. Majority (98.6%) of the respondents reported that the
major reason for noncompliance to universal precautions is the nonavailability of the
equipments. There was a statistically significant difference in the practice of standard
precaution among those that were exposed to blood products and body fluid compared
to those that had not been exposed in the last 6 months (c2 = 3.96, P = 0.03), public
healthcare providers when compared to private health workers (c2 = 22.32, P =
0.001), among those working in secondary and tertiary facilities compared to primary
healthcare centres (c2 = 14.64, P = 0.001) and urban areas when compared to rural
areas (c2 = 4.06, P = 0.02). The only predictor of practice of standard precaution was
exposure to blood and body fluid in the last 6 months odds ratio (OR) = 4.56
(confidence interval (CI) = 1.00-21.28).

Conclusions: This study implies that inadequate workers' knowledge and

environment related problems, including the lack of protective materials and other
equipments and utilities required to ensure safety of HCWs is a crucial issue that need
urgent attention. Institution of a surveillance system for hospital acquired infection to
improve consistent use of standard precautions among health workers is
recommended in Nigeria and other low income countries in Africa.

 SUMMARY :-
As we discussed standard measures it is a set of infection control measures used to
prevent transmission of infection. We also discussed about its components which
includes hand hygiene, personal protective equipment, respiratory hygiene, safe
injection practice, cleaning and disinfection, sharp handling, waste management, pre
and post prophylaxis and immunisation. After we came to research findings in the
field of standard safety measures.

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  CONCLUSION :-
As I concluded my topic Standard Safety measures are the minimum infection prevention
practices that should be used in the care of all patients all of the time. These practices are
designed to both protect the healthcare worker and to prevent the healthcare worker from
spreading infections among patients.
And these are very basic and essential to protect others as well as ourselves from any kind of
infection.
The condition of being safe from undergoing or causing hurt, injury, or loss. ‘The avoidance,
prevention and amelioration of adverse outcomes or injuries stemming from the process of
healthcare.’
 S - Sense the error.

 A - Act to prevent it.

 F - Follow the safety guideline.

 E - Enquire into accidents and death.

 T - Take appropriate remedial measures.

 Y - Your responsibility

 REFERENCES:-
 CP Baweja, Textbook of microbiology, Third edition, Aarya publication, page
no.622- 624
 Textbook of advanced nursing practice, page no. 326-330.
 http://www.jgid.org/article.asp?issn=0974-
777X;year=2013;volume=5;issue=4;spage=156;epage=163;aulast=Amoran
 https://www.ijcmph.com/index.php/ijcmph/article/view/1289

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