Standard and Transmission Based Precautions (TBP)

Page 1 of 35 FHS EC-06-001 FLOYD Health System ~ ENVIRONMENT OF CARE SUBJECT: STANDARD AND TRANSMISSION BASED PRECAUTIONS NUMBER: FHS EC-06-001 EFFECTIVE DATE: 3/21 Standard and Transmission Based Precautions (TBP) PURPOSE 1. To prevent the transmission of infectious agents. 2. To describe the standard of practice for the use of protective apparel for all contact with blood and body substances and the use of Airborne, Droplet and Contact Precautions. POLICY The FLOYD Health System uses a coordinated process of standard and transmission based precautions to prevent the spread of health-care acquired infections in patients and employees. Responsibilities A. This policy applies to all employees of FLOYD Health System and its affiliated facilities including Floyd Medical Center, Floyd Behavioral Health, Floyd Primary Care/Urgent Care, Heyman Hospice Care, as well as Polk Medical Center and Floyd Cherokee Medical Center and to all medical staff, volunteers, contract workers and students. B. Supervisors, managers, and directors are required to enforce the provisions of this policy in their areas. Employees who do not follow the contents of this plan may be subject to disciplinary action. C. The Infection Prevention Department is available to provide consultation regarding standard and transmission based precautions. D. Any patient known or suspected to have a disease or condition that warrants transmission based precautions will be placed in the appropriate transmission precautions upon admission. Physicians and/or nurses will promptly order the precautions category for newly diagnosed or suspected cases. 1. The nurse is responsible for ensuring that the precautions are initiated and maintained according to the specified protocol. 2. The infection prevention staff, or the patient’s nurse may initiate transmission based precautions without the physician’s order based upon a lab report or patient’s changing status (e.g., diarrhea) or based on a prior known admission infectious status. In those instances, the EMR banner bar stating the TBP will be notification to the physician. At Cherokee, the nurse will notify the physician. Page 2 of 35 FHS EC-06-001 STANDARD Precautions apply to all patients regardless of their diagnosis or presumed infection status. A. Standard Precautions apply to: Blood All body fluids, secretions/excretions, except sweat Non-intact skin (skin that is cut, chapped, abraded, cracked, afflicted with weeping or exudative lesions, or is otherwise broken.) Mucous membranes B. Standard Precautions requires the use of personal protective equipment (PPE) for all contact with blood and body substances. Employees will use judgment in order to anticipate the type of exposure that may occur and utilize barrier precautions suitable to the task. 1. Gloves will be worn for contact with anybbody substance, secretion or excretion (except sweat), contact with mucous membranes or non-intact skin, or when handling contaminated equipment. The use of gloves is intended to supplement, not replace, hand washing or other existing control measures. When transporting a patient, that requires PPE, staff will be mindful of their potentially contaminated gloves and touching surfaces, i.e., elevator buttons, door handles so as to not contaminate these surfaces, i.e., pushing elevator button with elbow, changing gloves before opening a door, etc. 2. Gloves (intact- no fingers on gloves will be removed) will be worn when performing vascular access procedures such as starting an IV or drawing blood. 3. Gloves will be worn in providing care to a patient or in managing equipment when the health care worker has cuts, scratches, or other breaks in the skin on his/her hands. 4. Protective gowns will be worn while performing patient care tasks that might result in clothing becoming soiled with blood and body substances. 5. Protective eyewear is worn to prevent blood and body substances from contaminating the mucous membranes of the eyes. Protective eyewear will be worn where blood and body substances may be expected to splash or splatter. 6. Face Shields and/or standard surgical or procedural masks will be worn to prevent blood and body substances from contaminating the mucous membranes of the eyes, nose, and mouth during procedures which may cause splashing or splattering. When irrigating a Foley catheter or a PEG tube a face shield must be worn. If blood and body substances are expected to become aerosolized during a procedure, an N-95 will also be worn. 7. Surgical masks do NOT provide adequate protections for those diseases spread by the airborne route (i.e. Mycobacterium tuberculosis, COVID-19). 8. PPE will be located in each department. 9. PPE should be worn according to the type of transmission-based precautions that are applicable to the patient and to the specific task being performed. PPE should not be worn in the hallways, when there is no risk of a Blood/Body Fluid exposure. Page 3 of 35 FHS EC-06-001 Equipment Any equipment that is taken into a patient’s room (regardless of transmission based precautions) will be cleaned after each use with an antiseptic wipe approved by the Infection Prevention Department. This includes, Dinamapps, blood glucose monitors, pulse oximeters, EKG machine leads, and diagnostic portable machines such as otoscopes, ophthalmoscopes, ultrasound, radiology equipment, and physical therapy/occupational equipment. A disposable thermometer and bleach wipes will be ordered by the unit from Central Service to clean equipment if patient has been diagnosed with Clostridioides difficile. Ice pitchers will not be taken from any patient room to the ice machine, but a disposable cup or plastic bag will be utilized to fill ice pitchers. Hand Hygiene Hand hygiene is the single most effective means of preventing the spread of hospital associated infections among hospital patients and personnel. Hand hygiene not only incorporates the traditional method of hand washing (i.e. the removal of microorganisms with soap and water), but also hand antisepsis which is the removal of or destruction of microorganisms using soap or an alcohol-based hand rub. Trash Trash from routine patient care activities will be placed in a regular waste container. However, if waste is grossly bloody or contains other potentially infectious materials (e.g., sterile space fluids, semen, and vaginal secretions), it must be discarded in a biohazard container. See FHS EC-05-007 Regulated Medical Waste. Lab specimens 1. Always wear gloves and other indicated barrier protection when collecting and handling laboratory specimens. 2. Place each laboratory specimen in an appropriate leak-proof primary non-glass container (e.g., vacutainer tube, specimen cup, etc.). Care will be taken when collecting and handling specimens to avoid contamination of the outside of the container. 3. Secure lids tightly to prevent leakage. 4. Place the specimen(s) into a plastic zip-lock type bag ensuring that the outside of the bag remains clean. Once this has been accomplished, gloves should be discarded, and appropriate hand hygiene performed. 5. Seal the bag before transporting to the laboratory by the pneumatic tube system or by hand. 6. Hand washing must be performed following any direct contact with blood or body substances in the handling or transporting of laboratory specimens. 7. Whole blood may be transported to the area of use in a clear plastic bag. 8. If a lab tray is brought into the patient’s room, the tray must be wiped with an antiseptic wipe approved by the Infection Prevention department after exiting the patient room. An alternative would be to place the tray on a clean barrier instead of on a contaminated environmental surface. Page 4 of 35 FHS EC-06-001 Linen Soiled textiles, including bedding, towels, and patient or resident clothing may be contaminated with pathogenic microorganisms. However, the risk of disease transmission is negligible if they are handled, transported, and laundered in a safe manner. Key principles for handling soiled laundry are 1. Not shaking the items or handling them in any way that may aerosolize infectious agents 2. Avoiding contact of one’s body and personal clothing with the soiled items being handled 3. Containing soiled items in a laundry bag or designated bin. When laundry chutes are used, they must be maintained to minimize dispersion of aerosols from contaminated items. 4. Place all linen in the designated leak-proof, blue laundry bags. It is not necessary to put any linen in a red bag. 5. Linen bags will be closed securely to prevent contact with contaminated linen and to prevent aerosolizing contents of the bag. 6. Caution must be exercised to help prevent laundry bags from being OVERFILLED. Do not drag the linen bag on the floor while transporting to soiled utility room. 7. Linen should not be stockpiled in rooms. 8. Double bagging will be utilized only when the original linen bag is torn, punctured, or visibly contaminated on the outside; or if the linen contains such a large amount of fluid that the original bag may leak. Medical Emergency Situations The Standard Precautions system requires hospital personnel to take the time to don PPE and to practice special precautions where contact with blood and body substances may occur. However, medical emergencies may arise when the patient’s condition demands immediate attention and a quick response. In these situations, staff members may feel that they have only a limited amount of time in which to take all necessary precautions. Even in emergency situations, health care workers have both the right and the duty to protect themselves from exposure to potentially infectious blood and body substances. ************************************************************************************************************** TRANSMISSION Based Precautions are designed for patients documented or suspected to be infected/ colonized with highly transmissible or epidemiologically important pathogens for which additional precautions beyond Standard Precautions are needed to interrupt transmission. The three categories of TBP include: Contact, Droplet, and Airborne.

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