Standard Precautions

1. Standard Precautions Jan Bright RN, BSN Healthy Start in Child Care Lexington-Fayette County Health Department

2. Germs: How are they spread? • Airborne (Respiratory) • TB, common cold

3. Germs: How are they spread • Direct contact • Poison Ivy; Chicken Pox, Pink Eye, MRSA

4. Germs: How are they spread? • Fecal-Oral • Stomach bug, Hepatitis A • Blood Contact • HIV/AIDS; Hepatitis B, Hepatitis C

5. Universal Precautions vs. Standard PrecautionsWhat is the difference?

6. Definition Universal precautions: • Term used for CDC guidelines begun in the 1980’s to reduce the spread of infection to health care workers & patients.

7. Universal Precautions Are good hygiene habits • hand washing • use of gloves and other barriers • correct sharps handling • aseptic techniques.

8. Universal Precautions • Apply to blood, semen, and vaginal secretions • Avoiding injuries from sharp instruments and the use of protective barriers • Includes gowns, eye protection, and face masks

9. definition Standard Precautions: • combination of Universal Precautions (UP) and Body Substance Isolation (BSI) • Assumes that all body fluids except sweat, non-intact skin and mucous membranes may have transmissible infectious disease

10. Standard Precautions • Appropriate barrier protection • Involve cleaning and sanitizing contaminated surfaces.

11. Bloodborne Pathogens • Disease causing germs found in blood or other body fluids such as semen or vaginal secretions • HIV • Hepatitis B Virus • Hepatitis C Virus

12. HIV • Human Immunodeficiency Virus • Virus that destroys immune system and causes AIDS • 12/05: KY statistics: • 1,038 cases of HIV • 4,453 cases of AIDS

13. HIV Transmission • Sexual contact w/ infected person • Sharing needles/syringes • Transfusions (rare in countries where blood is tested) • To babies during birth or after birth via breastfeeding

14. HIV Facts • Does not survive well in environment • Transmission in households rare • Foodservice workers should be allowed to work • No known cases of HIV being transmitted thru tattooing or body piercing

15. HIV Facts cont. • Biting is not a common way to transmit virus • No virus in sweat • Low quantities of virus in saliva and tears in AIDS patients—does not mean it’s transmitted by that body fluid

16. HIV Facts cont. • Closed-mouth kissing not a risk • Effectiveness of condoms • Insects do not transmit HIV

17. Rapid wt loss Dry cough Recurring fever and night sweats Extreme fatigue Swollen glands Memory loss Depression Diarrhea for over a week White spots or blemishes in throat or mouth; red, brown, pink, or purplish blotches on or under skin or in mouth, nose, eyelids Pneumonia HIV Symptoms

18. Hepatitis B • HBV • Caused by a virus that attacks the liver • Can cause lifelong infection, cirrhosis, liver cancer, liver failure, and death HBV is the cause of 80% of liver cancer

19. Hepatitis B Transmission • Blood or body fluids • Sexual intercourse • Sharing drugs or needles (sharps exposure) • Infected mother to baby during birth

20. Hepatitis B Facts • Survives longer than HIV • HBV vaccine • Not spread through water or casual contact • How many infected with HBV in the US? • How many die each year from HBV? 1 in 20 5,000 Highest rate of disease is in people 20-49 yrs. of age.

21. Hepatitis B Facts cont. • Symptoms include • Yellow eyes or skin • Loss of appetite • Nausea, vomiting, fever, stomach, or joint pain • Extremely tired • No cure but meds can treat

22. Who needs to be vaccinated? • All babies, at birth • All children 0-18 years of age that have not been vaccinated • People of any age whose behavior puts them at risk • People who work where they can be exposed to blood

23. Hepatitis C • HCV • Liver disease caused by HCV • 3.9 million people in the US are infected. • 36,000 new infections each year. • 8-10,000 deaths each year.

24. Hepatitis C Transmission • Blood or body fluids from an infected person enters the body of someone who is not infected • Sharing needles • Needlesticks or sharps exposures • Infected mother to her baby during birth

25. Hepatitis C Facts • Recommended HCV testing if someone is the recipient of a clotting factor made before 1987 or a recipient of blood and/or solid organs before 1992 • Can survive outside of the body at room temp. for at least 16 hours but not more than 4 days

26. Hepatitis C Facts cont. • Spread in a household setting—does not occur very often; if there is an incident, it’s most likely due to an exposure to blood of the infected person • No evidence that breastfeeding spreads HCV

27. Hepatitis C Facts cont. • No vaccine to prevent HCV • Do not share personal care items that may have blood on them (ie. razors or toothbrushes) • Infected people should be allowed to go to work, attend school or childcare, and play • Leading indication for liver transplants

28. Hepatitis C Facts cont. • Not spread by • Sneezing • Hugging • Coughing • Food or water • Sharing eating utensils or drinking glasses • Casual contact

29. HCV Symptoms • Yellowing of eyes/skin • Fatigue • Dark Urine • Abdominal pain • Loss of appetite • Nausea *80% of persons have no signs or symptoms www.cdc.gov

30. Staphylococcus • Commonly called staph • 30-50% of healthy adults & children are carriers

31. STAPH MRSA bacteria is most likely to cause infection when a person has a break in their skin or another opening where bacteria can get inside the body.

32. What do MRSA infections look like? • Infected cuts • Boils • Infected hair follicles • Fluid filled blisters (impetigo) • Skin sores that look like infected insect bites

33. What MRSA looks like -

34. What MRSA looks like - Often mistaken for a spider bite...

35. Most common settings for MRSA infections… • These factors, referred to as the 5 C’s: • Crowding • Frequent skin-to-skin Contact • Compromised skin (cuts/abrasions) • Contaminated items and surfaces • Lack of Cleanliness

36. Most common settings for MRSA infections… • Locations where the 5 C’s are common include: • Schools • Dormitories • Military barracks • Households • Correctional facilities • Daycare centers

37. Should we exclude MRSA infected kids? Exclude kids only when directed by a physician or if they have a wound that has drainage (pus) that cannot be covered and contained with a clean, dry bandage and for those who cannot maintain good personal hygiene.

38. Communicable Disease Concerns for Pregnant Women • Cytomegalovirus (CMV) • Hepatitis B • HIV/AIDS • Fifth Disease • Rubella • Varicella or Shingles

39. Protecting Yourself • Barriers (Handwashing, Gloves) • Immunization • Adults and children with open sores

40. Barriers

41. Handwashing

42. Gloves • Should be available to everyone • Worn when risk of touching blood, bloody fluids • Optional for other fluids

43. Wear Disposable Gloves when: • Handling blood • You have open cuts, sores, or cracked skin • Cleaning bathrooms, diapering area, or any areas contaminated with stool, vomit, or urine

44. Pocket Mask For CPR

45. Needles and Sharps • Needles, syringes, or lancets go into sharps container • Notify employer immediately if any sticks occur

46. Biting • Transmission of bloodborne infection unlikely • Biting may bruise; doesn’t usually break the skin

47. What Should I Do? • Wound cleaned with water • Pressure applied to stop bleeding • Have biting child rinse mouth • Note incident in injury log • Notify both parents • DPT and Hep B vaccines

48. Open Skin Sores • Draining or bleeding • Keep covered • Wash hands frequently

49. OSHA Regulations • Hepatitis B vaccine • Training within 10 working days • If employee declines then later decides to receive vaccine, must make vaccine available at no cost to the employee.

50. Cleaning of Body Fluid Spills • Gather all needed equipment • Put on disposable gloves • Wipe up blood or body fluids • Scrub area with cleaning solution • Apply bleach solution for two minutes