Specific Learning Objectives:

i) Explain the following (C2)

a. Hand hygiene
b. Personal protective equipment (PPE)
c. Respiratory hygiene
d. Sharp safety
e. Sterile instruments and devices.
f. Clean and disinfected environmental surfaces

STANDARD PRECAUTIONS IN INFECTION CONTROL

Standard precautions are meant to reduce the risk of transmission of blood borne and other
pathogens from both recognized and unrecognized sources. They are the basic level of infection
control precautions which are to be used, as a minimum, in the care of all patients.

The five Standard Precautions for Infection Control include:

a. Hand hygiene.
b. Use of personal protective equipment (e.g., gloves, masks, eyewear).
c. Respiratory hygiene / cough etiquette.
d. Sharps safety (engineering and work practice controls).
e. Safe injection practices (i.e., aseptic technique for parenteral medications).
f. Sterile instruments and devices.

I. Hand Hygiene:

Hand hygiene is a major component of standard precautions and one of the most effective
methods to prevent transmission of pathogens associated with health care.

Hand hygiene is a method of cleaning the hands so as to reduce potential pathogens on the hands.
It is the basic measure to reduce transmission of infections among patients and healthcare
personnel.

Food and Drug Administration (FDA) has divided products into three categories and defined
them as follows:

• Patient preoperative skin preparation. A fast-acting, broad-spectrum, and persistent

antiseptic-containing preparation that substantially reduces the number of microorganisms on
intact skin.
 • Antiseptic hand wash or HCW hand wash. An antiseptic containing preparation designed
for frequent use; it reduces the number of microorganisms on intact skin to an initial baseline
level after adequate washing, rinsing, and drying; it is broad-spectrum, fast-acting, and if
possible, persistent.

• Surgical hand scrub. An antiseptic-containing preparation that substantially reduces the

number of microorganisms on intact skin; it is broad-spectrum, fast-acting, and persistent.

 5 Moments for Hand Hygiene

 before touching a patient,

 before clean/aseptic procedures,
 after body fluid exposure/risk,
 after touching a patient, and.
 after touching patient surroundings.

7 Steps of Hand Washing

1. Step 1: Wet Hands. Wet your hands and apply enough liquid soap to create a good lather.
...
2. Step 2: Rub Palms Together.
3. Step 3: Rub the Back of Hands.
4. Step 4: Interlink Your Fingers.
5. Step 5: Cup Your Fingers.
6. Step 6: Clean the Thumbs.
7. Step 7: Rub Palms with Your Fingers.

Joseph Lister promoted the application of carbolic acid to the hands of surgeons before
procedures. Preoperative cleansing of hands and forearms with an antiseptic agent has been an
accepted practice

II. Personal Protective Equipment:

Personal protective equipment, or PPE, as defined by the Occupational Safety and Health
Administration, or OSHA, is “specialized clothing or equipment, worn by an employee for
protection against infectious materials.”
It is important to assess the risk of exposure to body substances or contaminated surfaces before
any health-care activity and the appropriate PPE should be selected based on the assessment of
risk:
Types of PPE used in Healthcare Settings:
 Gloves – protect hands
 Gowns/aprons – protect skin and/or clothing
 Masks and respirators– protect mouth/nose – Respirators – protect respiratory tract from
airborne infectious agents
 Goggles – protect eyes
 Face shields – protect face, mouth, nose, and eyes
 Respirator, has been designed to also protect the respiratory tract from airborne
transmission of infectious agents. The most commonly used respirators in healthcare
settings are the N95, N99, or N100 particulate respirators. Respirators are approved by
the CDC’s National Institute for Occupational Safety and Health. Like other PPE, the
selection of a respirator type must consider the nature of the exposure and risk involved.
For example, N95 particulate respirators might be worn by personnel entering the room
of a patient with infectious tuberculosis or COVID. However, if a bronchoscopy is
performed on the patient, the healthcare provider might wear a higher level of respiratory
protection, such as a powered air-purifying respirator or PAPR.

How to Put On (Don) PPE Gear

1. The gown should be donned first.
2. The mask or respirator should be put on next and properly adjusted to fit; remember to fit
check the respirator.
3. The goggles or face shield should be donned next and the gloves are donned last. Keep in
mind, the combination of PPE used, and therefore the sequence for donning, will be
determined by the precautions that need to be taken
4. Put on NIOSH-approved N95 filtering face piece respirator or higher (use a
facemask if a respirator is not available). If the respirator has a nosepiece, it should be
fitted to the nose with both hands, not bent or tented. Do not pinch the nosepiece with one
hand. Respirator/facemask should be extended under chin. Both your mouth and nose
should be protected. Do not wear respirator/facemask under your chin or store in scrubs
pocket between patients.
o Respirator: Respirator straps should be placed on crown of head (top strap) and
base of neck (bottom strap). Perform a user seal check each time you put on the
respirator.
 o Facemask: Mask ties should be secured on crown of head (top tie) and base of
neck (bottom tie). If mask has loops, hook them appropriately around your ears.
5. Put on face shield or goggles. When wearing an N95 respirator or half facepiece
elastomeric respirator, select the proper eye protection to ensure that the respirator does
not interfere with the correct positioning of the eye protection, and the eye protection
does not affect the fit or seal of the respirator. Face shields provide full face coverage.
Goggles also provide excellent protection for eyes, but fogging is common.
6. Put on gloves. Gloves should cover the cuff (wrist) of gown.
7. Healthcare personnel may now enter patient room.

Sequence for Removing PPE (doffing)

• Gloves

• Face shield or goggles

• Gown

• Mask or respirator

The sequence for removing PPE is intended to limit opportunities for self contamination. The
gloves are considered the most contaminated pieces of PPE and are therefore removed first. The
face shield or goggles are next because they are more cumbersome and would interfere with
removal of other PPE. The gown is third in the sequence, followed by the mask or respirator

III. Respiratory Hygiene/Cough Etiquette

These are infection prevention measures designed to limit the transmission of respiratory

pathogens spread by droplet or airborne routes. The strategies target primarily patients and

individuals accompanying patients to the dental setting who may have undiagnosed respiratory

infections but also apply to anyone (including dental health care personnel (DHCP)) with signs

and symptoms of illness. They were added to Standard Precautions in 2007 and emphasize two

key elements:
 1. Implement measures to prevent the spread of respiratory infections from anyone in a

health care setting with signs or symptoms.

2. Educate DHCP on the importance of prevention measures when examining and caring for

patients with signs and symptoms of a respiratory infection.

1. Implement measures to prevent the spread of respiratory infections from anyone in a

health care setting with signs or symptoms.

 Post signs at entrances asking patients with symptoms of respiratory infection to:
o Cover your mouth and nose when coughing or sneezing.
o Use tissues and throw them away.
o Wash your hands or use a hand sanitizer every time you touch your mouth or
nose.
 Provide tissues and no-touch receptacles for their disposal.
 Provide resources for performing hand hygiene in or near waiting areas.
 Offer masks to symptomatic patients when they enter the dental setting.
 Provide space and encourage symptomatic patients to sit as far away from others as
possible. Facilities may wish to place these patients in a separate area, if available, while
waiting for care.

IV. Sharp safety:

Sharps are devices, such as needles, scalpels, and lancets, which are used to cut or pierce skin,
blood vessels or tissue. 

Occupational exposure to blood borne pathogens from needle sticks and other sharps injuries is a
serious problem, Sharps injuries are primarily associated with occupational transmission of
hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV),
but they have been implicated in the transmission of more than 20 other pathogens.

Individuals working with sharps should take necessary precautions to prevent injury and
exposure to biological, chemical and other potentially hazardous agents. The following
precautions are recommended while preparing to work with sharps:
 1. Eliminate sharps from procedures or substitute for safer sharps devices as appropriate.
2. Develop written procedures to handle sharps safely.
3. Train all staff working with sharps.
4. Dispose of sharps properly.
5. Prepare for exposure and spill response.

Before the procedure

1. Eliminate or substitute sharps:

The best way to avoid needle stick and other sharps injuries is to avoid using a sharps device
when it is not necessary, or use tools to minimize the hazard, such as a safety-engineered device
or a needle-syringe holder. It is important to identify all sharps in the procedure and do the
following:

a) Think of ways to perform the task without a sharps device. Examples:

 Eliminate glass by choosing plastic when possible.

 Use a blunt needle instead of a sharp needle.

b) Select a safer device that will accomplish the same result while also lowering your risk of
injury.

 Example: Use sharp tissue scissors to cut tissue rather than a razor blade for more control.

c) Prepare written procedures

Prior to beginning a new procedure, develop a standard operating procedure (SOP) that

describes:

 Steps to perform the procedure safely

 Tools and instruments that are needed to perform the procedure safely
 Personal protective equipment
 Steps for responding to an accident, exposure or injury
During the procedure

1. During all procedures involving sharps, awareness of your surroundings and careful action is
required to avoid accidents and injuries. Best practice is to announce that sharps are in use when
others are present. Always wear the appropriate personal protective equipment (PPE) and follow
all written procedures.

In addition, keep in mind the following safety tips:

Safe handling of needles:

 Avoid recapping needles. Use a needle holder or recapper, if necessary.

 Dispose of uncapped needles immediately after use. Never leave an uncapped needle
laying on a workbench.
 Use a tool to remove a needle from a syringe, if removal is necessary.
 Point the needle away from yourself.
 Keep visual contact with the needle at all times while uncapped.
 Use disposable safety scalpels with a fixed blade and a retractable sheath when possible.
 Don’t use excessive force or a sawing motion when using a scalpel.
 Don’t use your fingers to hold a razor blade. Use blade with a handle, or use pliers to
place the razor blade in a holder.
 Don’t cut or trim an object you are holding with your other hand. Use forceps or another
tool to hold an object while cutting.
 Sharp tissue scissors provide more control than a razor blade for cutting tissue.
 Purchase safety cutters to open boxes.
 Don’t use a razor blade to cut smaller strips of tape from a larger roll. Order the
appropriate sized tape.
 Don’t get distracted and rush though the task.            
 Place reusable sharps in a reusable sharps container immediately after use.

After the procedure

 Keep a sharps container near your work station and immediately dispose of sharps after
the procedure.
  Needles should never be laid uncapped on a workbench.
 Sharps that retract after use should be disposed of like all other sharps.
Never fill a sharps container more than two-thirds full. Overfilling a sharps container
presents hazards to those using it, and to those collecting the containers for disposal.

 Exposure and spill response

Be prepared for a sharps injury or exposure by placing the Exposure Response Poster in a

visible location.

Clean and Disinfected Environmental Surfaces

Cleaning is the necessary first step of any disinfection process. Cleaning removes organic matter,
salts, and visible soils, all of which interfere with microbial inactivation. The physical action of
scrubbing with detergents and surfactants and rinsing with water removes substantial numbers of
microorganisms. If a surface is not cleaned first, the success of the disinfection process can be
compromised. Removal of all visible blood and inorganic and organic matter can be as critical as
the germicidal activity of the disinfecting agent. When a surface cannot be cleaned adequately, it
should be protected with barriers.

Environmental surfaces can be divided into clinical contact surfaces and housekeeping
surfaces. Clinical contact surfaces can be directly contaminated from patient materials either by
direct spray or spatter generated during procedures or by contact with gloved hands of health
care personnel. These surfaces can subsequently contaminate other instruments, devices, hands,
or gloves. Housekeeping surfaces (e.g., walls, floors, sinks) are not directly touched during
treatment and carry the lowest risk of disease transmission.

Recommendations for Cleaning and Disinfecting Environmental Surfaces

 * High-level disinfectants should never be used on environmental surfaces.

There are three levels of disinfection: high, intermediate, and low. High-level disinfectants, such
as glutaraldehyde, are used as chemical sterilants and should never be used on environmental
surfaces. Intermediate-level disinfectants are registered with the Environmental Protection
Agency (EPA) and have a tuberculocidal claim, and low-level disinfectant are EPA-registered
without a tuberculocidal claim (i.e., hepatitis B virus and HIV label claims).

(References: CDC document)