HHC Health & Home Care

Surveillance, Prevention & Control of Infections STANDARD PRECAUTIONS

Policy No: 9-005.1

PURPOSE
To reduce the risk of exposure to and transmission of infections when caring for patients.

POLICY
Agency personnel will adhere to the following precautions and will instruct patients and families/caregivers in infection control precautions as appropriate to the patients care needs. HHC Health & Home Care will use blood drawing devices with integrated safety features designed to prevent percutaneous injuries. Such devices include; shielded or selfblunting needles for vaccum tube phlebotomy, shielded, retracting or self blunting butterfly-type needles and syringes with a cylindrical sheath that shields needles when injecting blood into tubes. Additionally, needleless or blunt cannula devices are used during infusion therapy. Staff with increased chance of exposure to blood borne pathogens are included in all decision making related to type of product selected as well as practical application. Staff are instructed not to manually recap or remove needles from blood drawing devices. Note: Patients may be given a copy of this procedure if needed as a teaching tool. Definition Under Standard Precautions, blood and certain body fluids of all patients are considered potentially infectious for bloodborne 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 bloodborne 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, sweat, and tears when they contain visible blood or other potentially infectious materials and it is impossible to differentiate between body fluids.

PROCEDURE
General Precautions 1. Handwashing: Handwashing will be performed to prevent cross-contamination between patients and personnel. (See also "Handwashing," Policy No: 9-007.) A. Hands and other skin surfaces should be washed thoroughly with soap and warm water immediately before and after patient contact. If contaminated with body substances, hands and other skin surfaces should be washed thoroughly before and after gloves are worn, and before preparing or eating food.

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Surveillance, Prevention & Control of Infections

B. Use soap, warm water and friction for hand washing. Lather and scrub for 1015 seconds. Rinse and dry hands from the fingers toward the forearm. Use dry paper towels to turn off the faucets. C. Use a waterless handwashing product for immediate use if handwashing facilities are not available in the patients home. Handwashing facilities should be located as soon as possible after leaving the home. Personal Protective Equipment (See Policy No: 9-006) Universal precautions should be followed in all procedures, particularly when risk of exposure to body fluids is known. 1. Gloves: The use of gloves (intact latex 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. Gloves are not necessarily needed for general care or during casual contact such as bathing of intact skin or assisting with ambulation. 2. Gowns/Aprons: The use of gowns/aprons is required when splashes to the skin and/or clothing is likely. The gowns/aprons will be made of or lined with fluid-proof or fluid-resistant material and will protect all areas of exposed skin. The type and characteristics will depend on the task and degree of exposure anticipated. 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. Resuscitation Equipment: CPR microshield, resuscitation bags, or other ventilation devices will be provided to personnel where the need for emergency mouth-tomouth resuscitation would be required.

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Surveillance, Prevention & Control of Infections

Sharps 1. Needles, Syringes and Sharps: After use, needles and other sharps will be placed directly into a puncture-proof container located in the patients home. Needles must not be recapped, bent, broken or clipped.

HHC Health & Home Care

Surveillance, Prevention & Control of Infections

Policy No: 9-005.4

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, and should be cleaned and serviced regularly. H. All bins, pails, cans (e.g. wastecans) intended for reuse which have a reasonable likelihood for becoming contaminated with blood and other potentially infectious materials will be inspected and decontaminated weekly. They will also be cleaned and decontaminated immediately, or as soon as feasible upon visible contamination. 2. Blood/Body Fluid Spills in patient homes A. Blood/body fluid spills should be mopped or wiped up with hot soapy water and then disinfected with bleach as described in 1B. If the clean-up is done by hand, disposable gloves must be worn. B. Soiled sponges and mops can be disinfected by soaking in a 1:10 dilution of bleach for 5 minutes. Waste Disposal (See also, Hazardous Waste Handling, Policy No: 8-012, and Contaminated Waste Disposal, Policy No: 9-011.) 1. 2. Flushable Waste: Body wastes will be flushed down the toilet. 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.

HHC Health & Home Care

Surveillance, Prevention & Control of Infections

Policy No: 9-005.5

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Syringe/Sharps Disposal A. In the home setting, a sharps disposal container will be available for use by the clinician or patient/family/caregiver. A puncture resistant container with a cap that has been approved for use by the visiting nurse staff. The uncapped needle will be placed directly into the disposal container. When 3/4 full, the disposal container will be sealed and placed in the patients garbage. The container will be labeled as sharps. There should be a solution of 1:10 of bleach added. B. If the patient is self administering medications and generating one or more syringes per day, the patient should place uncapped needles and syringes in the puncture resistant container provided by the visiting nurse staff or approved for use by the staff.

Laundry 1. Handling and Changing of Linens: Contaminated laundry should be handled as little as possible with minimal agitation. A. Towels and wash cloths should not be shared by different users. B. Gloves and other appropriate personal protective equipment are to be worn when handling soiled linen. C. Soiled clothing and linens should be soaked as promptly as possible. Ideally, they should be machine washed in hot (160 F) soapy water. If appropriate, (e.g., colorfast material), a cup of bleach may be added 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. When contaminated laundry is wet and likely to soak through or leak from the bag to the container, the laundry should be transported in containers or bags which prevent leakage to the exterior. E. Laundry and linens should be carried away from the body. Linens should never be placed on the floor. Equipment/Non-Disposable Instruments 1. 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.

HHC Health & Home Care

Surveillance, Prevention & Control of Infections

Policy No: 9-005.6

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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. Thermometers are not supplied by HHC Health & Home Care but may be owned by patients.

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Medical Equipment/Supplies A. 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 agency-approved disinfectant is used to clean it. Soiled blood pressure cuffs will be wiped with Alcohol.

B. Dressing supplies contaminated with the patients blood or body fluids should be double bagged in plastic bags, tied securely, and labeled "contaminated" then placed with household trash for garbage pick-up. Kitchen/Food Preparation 1. Handwashing: Proper handwashing techniques should be observed prior to touching food. 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". Cleaning of Kitchen: Counters, sinks, and floors in the kitchen should be free from food particles and cleaned with a disinfectant regularly. Refrigerator: The interior of the refrigerator should be cleaned with soap and warm water regularly to control molds. Food Freshness: Observe expiration dates and general freshness of food. Do not use cracked eggs due to the likelihood of Salmonella contamination. Food Storage: Store open packages of food (e.g., sugar) in covered containers to discourage infestation.

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Surveillance, Prevention & Control of Infections

Policy No: 9-005.7

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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. 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. 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.

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Special Considerations for a Person with Immune Compromised Diseases 1. Unpasteurized milk, raw eggs, products containing raw eggs or cracked or nonintact eggs should be avoided. They have been associated with Salmonella infections and may be problematic especially for the person with HIV disease, or other immune-suppressed diseases. All fresh produce should be washed thoroughly.

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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. 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. Disinfectants HIV is inactivated rapidly after being exposed to chemical germicides. Be sure to clean surfaces well with soap and H2o and dry before applying the germicide on the surface. 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) NOTE: HHC Health & Home Care has the right to limit the practice of agency personnel if patient safety is in question.

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