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Specific Recommendations for Hand Hygiene
Hand washing is recommended—
• Before performing invasive procedures
• Before taking care of susceptible patients (e.g., immunocompromised patients, newborns)
• Before and after touching wounds
• After situations during which microbial contamination may occur (e.g., contact with blood, mucus, feces, urine, sputum)
• After touching inanimate sources that may have contaminants
• Before and after contact with patients
Generally, superficial contact with sources not known to contain pathogens does not necessitate any hand hygiene.
Hand Hygiene Technique
Vigorous rubbing together of all surfaces of lathered hands for at least 20 seconds, followed by a thorough rinse using clean, uncontaminated water. Antiseptic-containing products should be used before caring for high-risk patients (such as newborns or immunocompromised patients) and before surgical procedures.
Specific Recommendations for the Use of Gloves
Use of gloves is encouraged for all surgical procedures and for patient examinations where contamination may be a risk. There are two important reasons for using gloves—
• To provide a protective barrier to prevent gross contamination from blood, body fluids, secretions, and wounds
• To prevent the transmission of pathogens from hands to patients
Wearing gloves does not eliminate the need for hand hygiene, because the gloves may have small defects or become torn during use. Failure to change gloves between patient contacts is an IC hazard. Policies and procedures describing proper hand hygiene and the use of gloves should be established and made available to hospital staff. A system to monitor compliance with these policies is necessary. Observation checklists are useful to determine if hospital staff are applying appropriate hand hygiene practices.
Isolation and Standard Precautions
Patient overcrowding in hospital wards commonly leads to the spread of infectious diseases between patients and to hospital staff. This spread can be remedied by following procedures to isolate and protect individuals with communicable diseases. Isolation and the use of standard precautions are necessary when patients present with communicable diseases such as acute respiratory infection, diarrhea, active tuberculosis, measles, chicken pox, and other common communicable diseases. Ideally, each of these patients should be placed in a single room, with appropriate isolation procedures. If a private room is not available, placement with other patients with the same infectious disease is necessary, along with appropriate barrier protection.
Standard precautions and isolation techniques include—
• Comprehensive written policies and procedures
• Patient placement and transport—private rooms when possible to limit the transmission of microorganisms to staff, visitors and other patients; use cohort rooming when patients are infected with the same pathogen.
• Visitation policy
• Hand hygiene and use of gloves as discussed above
• Masks, eye protection, face shields—for patient care activities that may generate splashes or sprays of blood or body fluids and for use of aerosolized contaminants