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STANDARD PRECAUTIONS AND PERSONAL PROTECTIVE EQUIPMENT
STANDARD SAFETY PRECAUTIONS: the industry-wide precautions implemented by most professionals in a specified field of employment. The healthcare industry is no exception.
A physical health assessment to determine one's baseline health status should be sought out by anyone wishing to work in the healthcare field.
A baseline assessment is invaluable when assessing for a work-related injury or acquired illnesses.
A wellness program for you will enable you to function at peak performance.
Awareness of shift-related fatigue should be implemented to prevent sleep deprivation.
Current immunizations that are recommended to be in place and are often mandated by healthcare employers include
- hepatitis B,
- measles/mumps/rubella (German measles),
- chickenpox (varicella), and
Screening for tuberculosis is mandated by many employers, as well.
Mandatory immunizations can sometimes by refused by healthcare employees, at the employee’s own risk.
Other standard safety precautions in the healthcare field include
- correct hand washing (which is still the leading way to prevent disease),
- adherence to standard precautions and OSHA regulations,
- safe operation of EMS/patient care equipment,
- environmental control, and
- occupational health and bloodborne pathogen considerations (preventing injuries from contaminated sharps, and keeping immunizations current).
Personal Protective Equipment
Exposure to disease spread through blood, body fluids, or respiratory droplets are best prevented through the use of standard precautions. Standard precautions include:
- correct hand washing techniques,
- proper glove usage,
- eye and face protection,
- gowns, and
- proper sharp handling.
HANDWASHING: Correct hand washing technique is the most important measure to limit the spread of infectious disease.
Hands should always be washed after removal of gloves, after using the restroom, after cleaning up from a medical emergency, before rubbing the eyes, and before eating.
Hand cleansing consists of washing with soap and warm water for approximately thirty seconds, to include between fingers and both thumbs and then drying thoroughly afterward; additionally, using at least a quarter-sized amount of an alcohol-based hand rub and rubbing vigorously over all surfaces until dry. (Obviously, washing with soap and water is the most effective method of cleaning hands soiled by blood or other bodily fluids.)
GLOVE USAGE: Proper glove use prevents direct skin-to-skin contact with potentially contaminated body fluids or blood. If the healthcare provider or patient has a latex allergy, an alternative type of glove should be used ("latex-free," commonly available).
EYE/FACE PROTECTION: Eye protection (goggles) or full face shields should be used if there is a risk of splash or spray of body fluids such as are possible during profuse bleeding or delivering a baby, and greatly reduces the risk of contamination to eyes, nose, or mouth of the healthcare professional.
MASKS: Masks used in the healthcare system include the high-efficiency particulate air (HEPA) or N95 mask used by healthcare providers when there is a need to prevent inhalation of potential airborne infectious disease (such as tuberculosis). Additionally, surgical masks can be used on patients to reduce expulsion of any airborne infectious diseases.
GOWNS: Disposable gowns should be utilized in situations where large amounts of blood or other body fluids are encountered, as well as during contact with the potential airborne infectious disease that may contaminate clothing.
Exposure Control Plans
Employers must develop written exposure control plans to limit the risk of exposure to their employees. The plan should include:
- the exposure determination which identifies job classifications of occupational exposure, and the tasks and procedures performed by employees when there is occupational exposure in the respective job classifications where there is such occupational exposure;
- the procedures for evaluating the circumstances surrounding exposure incidents;
- a schedule of how other provisions of the standard are implemented, including methods of compliance,
- HIV and HBV research laboratories and production facilities requirements,
- hepatitis B vaccination and post-exposure evaluation and follow-up,
- communication of hazards to employees, and
METHODS OF COMPLIANCE
Methods of compliance include:
- Universal Precautions.
- Engineering and work practice controls, e.g., safer medical devices, sharps disposal containers, hand hygiene.
- Personal protective equipment (PPE).
- Housekeeping, including decontamination procedures and removal of regulated waste.
If clothing becomes contaminated, it should be removed as soon as possible and the provider should shower as soon as possible.
Contaminated clothing should be bagged or containerized at the location--where it was used--for proper cleaning or disposal. Receiving facilities have decontamination areas where EMS professionals should remove contaminated clothing.
SHARPS: Sharps (i.e., hypodermic needles, IV catheters, lancets, ampules, etc.) should be handled with extreme care and disposed of immediately in "sharps" containers.
► Never attempt to recap an open needle, and remain aware of anywhere a needle is in use.
Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.
Exposure to infectious diseases occurs through different means.
- Infectious disease can be spread through the air by coughing,
- through direct contact with infected blood or body fluids,
- through needle sticks,
- through contaminated food, and
- can also be sexually transmitted.
Contact with infectious disease is not the same as the contraction of or possible contraction of the infectious disease.
An exposure or contact that has a high likelihood of resulting in contraction of infectious disease occurs when contact with blood or body fluids of an infectious disease crosses body barriers such as when a patient’s blood gets into a cut on the provider's hand, when a provider is stuck with a needle that has been used on a patient, or when a patient’s bloody saliva splashes into the provider’s eyes or mouth.
An exposure or contact that is likely to result in infection of the provider also occurs during close contact with a person who is infected with an airborne disease (i.e., influenza, tuberculosis, etc.).
If An Exposure Occurs
Although complete decontamination is difficult if not impossible, the standard actions apply:
- wash needle sticks and cuts with soap and water,
- flush splashes to the nose, mouth, or skin with water,
- irrigate eyes with clean water, saline, or sterile irrigants,
- report the incident to your supervisor,
- immediately seek medical treatment.
Always report the exposure to the EMS providers or healthcare personnel who take over care of the patient and report exposure to the appropriate person identified in your department infection control plan.
Immediate follow-up care should be sought as identified in your department infection control plan, as well.
- Always document the time and date of the exposure,
- circumstances pertinent to the exposure (during medication administration, during needle disposal, etc),
- actions taken after the exposure, and
- other information required by your department.
After every patient contact, adequate time should be allotted to inspect all equipment and vehicles used during the encounter for signs of contamination or soiling.
Non-disposable equipment should be cleaned and disinfected to manufacturer, OSHA, and department specifications.
Disposable equipment should be disposed of by the proper means.