Standard Precautions, Hand Hygiene and PPE

Foundations of Standard Precautions and Hand Hygiene Practices

Standard precautions represent the baseline level of infection control used across healthcare. They apply to the care of all patients, regardless of their presumed or known infection status. Healthcare workers must treat blood, all body fluids, secretions, excretions (with the sole exception of sweat), non-intact skin, and mucous membranes as potentially infectious. By maintaining this consistent barrier approach for every patient interaction, providers prevent the unseen transmission of pathogens throughout healthcare facilities.

Effective hand hygiene is the cornerstone of preventing hospital-acquired infections. Alcohol-based hand rub is the preferred method for everyday hand hygiene when hands are not visibly soiled. To use an alcohol-based hand rub correctly, apply the product and rub it over all surfaces of the hands until they are completely dry. However, hand rub is not appropriate in every circumstance. Handwashing with soap and water is strictly mandatory whenever hands are visibly soiled with blood or body fluids. After caring for patients with C. difficile, soap and water is preferred during outbreaks or in hyperendemic settings; after caring for patients with suspected or confirmed norovirus, use soap and water during outbreaks. When washing with soap and water, rub all surfaces of the hands with soap for at least 20 seconds before rinsing under water.

Specific clinical milestones dictate exactly when hand hygiene must occur during daily workflow. Providers must perform hand hygiene immediately before having direct contact with a patient, and before performing an aseptic procedure or handling an invasive medical device. Perform hand hygiene after touching a patient, including intact skin, and after contact with body fluids, excretions, mucous membranes, or non-intact skin. Furthermore, hand hygiene must be performed immediately after removing gloves, as well as after touching inanimate objects or surfaces in the patient's immediate environment. Natural fingernails must be kept clean and trimmed short, generally less than one-quarter of an inch long, to minimize harbored debris. Healthcare personnel providing direct patient care should avoid wearing artificial fingernails or nail extenders entirely.

Understanding which hand hygiene method to select is vital for safe practice. The choice of hand hygiene method also depends on the activity; for example, healthcare personnel should wash with soap and water before eating and after using the restroom.