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Infection Prevention: The Importance of Standard Precautions
As the minimum infection prevention practices used in patient care, standard precautions are one of the most significant elements of an ambulatory surgery center’s (ASC) infection control program. A lack of compliance with standard precautions has been a recurring theme and is a concept that can be easily forgotten — especially in ophthalmology. Considering that ophthalmic ASCs do not see a great deal of blood or bodily fluids, it is sometimes assumed that protection is not as necessary. The reality is quite the opposite.
Standard precautions were introduced in Guideline for Isolation Precautions in Hospitals that combined features of universal precautions, which were developed in response to the HIV/AIDS epidemic and body substance isolation (CDC, 2016). These documents/guidelines have evolved over the years into today’s standard precautions, which are designed to reduce the risk of transmission from both recognized and unrecognized sources of infection among patients and health care workers. These precautions should be applied to all patients in a facility, regardless of their diagnosis or suspected infection status, and extend to:
- All bodily fluids, secretions, and excretions except sweat (whether or not they contain visible blood);
- Non-intact skin, including rashes; and
- Mucous membranes.
The concept of standard precautions is one that all medical and facility staff members should thoroughly understand and keep at the forefront of their minds. All patients should be thought of as "infected.” Standard precautions include:
- Hand hygiene;
- Use of personal protective equipment (PPE) such as gloves, masks, and eyewear;
- Safe injection practices;
- Respiratory hygiene/cough etiquette;
- Sterile instruments and devices; and
- Care of environment — clean and disinfected environmental surfaces (CDC, 2018).
It is highly recommended that you do a basic review/in-service of standard precautions with your staff, followed by annual updates. During quarterly rounds for infection control compliance, add standard precautions to the checklist and do a self-audit within the facility to assess compliance with standard precautions. Below are some examples of noncompliance recently noted.
- Setting down a medical record chart on a patient.
- Recording medical record documentation while wearing the gloves used for patient care.
- Opening doors while wearing gloves.
- Taking a pump of alcohol-based hand rub before touching a door handle and then performing hand hygiene.
- Failing to ensure hand hygiene is always performed in between patients.
- Setting down a medicine cup of eye drop bottles on a patient’s chest.
- Failing to wear gloves during eye drop administration.
- Placing a Kleenex box on patient’s lap in pre-op.
- Wiping down the operating room before the previous patient is transported out.
- Storing uncovered general supplies on wire racks in the operating room while other patients are in the room.
- Failing to wipe down vital sign cables between patients.
The Foundation for Infection Preventation
While it is admittedly easier to focus on larger elements of the ASC infection control program, it is extremely important that basic concepts aren’t neglected, as they are the foundation of the program. Standard precautions can mean the difference among a positive outcome, a post-op infection, or staff illness. The overall elements of standard precautions — hand hygiene, PPE, safe injection practices, etc. — are key principles in preventing infection in the ASC environment!
YOUR TURN: What practices do you follow to prevent infection? We’d love to know. Share with us in the comment section below.