Standard Precautions, Hand Hygiene and Personal Protective Equipment
Standard Precautions
One standard for every patient
Standard precautions are the baseline: all blood, all body fluids, secretions and excretions (except sweat), nonintact skin, and mucous membranes are treated as potentially infectious regardless of a patient's diagnosis, history, or appearance. Saliva in dental settings is an other potentially infectious material (OPIM). The bundle includes hand hygiene, PPE selected by anticipated exposure, safe injection practices, respiratory hygiene and cough etiquette, sharps safety, and correct handling of contaminated equipment and surfaces.
Traps
- Equating standard precautions with universal precautions. Universal precautions covered blood and certain body fluids only; standard precautions add OPIM, hand hygiene, and PPE for anticipated splashes.
- Relaxing precautions for a low-risk patient or one with a known negative test result. A test result never changes the precautions applied.
- Believing gloves replace hand hygiene. They do not; they are an adjunct.
- Safe injection errors: reusing a syringe or needle, drawing from a single-dose vial for multiple patients, or leaving a needle on a syringe for later use.
Rule of thumb
You cannot tell by looking. Because infectious status is unknowable in the moment and test results lag behind exposure, the correct answer to which precautions for this patient? is almost always standard precautions, the same as for every other patient. Transmission-based precautions (airborne, droplet, contact) are layered on top when a specific condition is suspected; they never replace the baseline.
Hand Hygiene and Personal Protective Equipment
Hand hygiene
Indications: before and after every patient contact; before donning and immediately after removing gloves; after touching contaminated instruments, surfaces, or waste; before leaving the operatory. Soap and water (15–20 seconds of lathering) is required when hands are visibly soiled, after restroom use, before eating, and when spore-forming organisms such as C. difficile are a concern. Otherwise an alcohol-based hand rub (60–95% alcohol, 20–30 seconds, rubbed until dry) is preferred for speed and skin tolerance. Nails short; artificial nails and extenders avoided for staff with direct patient contact; rings and jewelry that trap debris removed.
PPE
Gloves (nonsterile examination gloves for routine care, sterile for surgical), a surgical mask, protective eyewear with side shields or a face shield, and a gown when splash is anticipated. Donning order: gown, then mask or respirator, then eye protection, then gloves. Doffing order: gloves first, then eye protection, then gown, then mask - with hand hygiene immediately after glove removal.
Traps
- Washing or reusing gloves, or wearing gloves to answer phones and touch records.
- Removing the mask first, or letting it dangle below the chin.
- Choosing hand rub on visibly soiled hands.
- Assuming a surgical mask is respiratory protection.
Rule of thumb
Gloves off, hands cleaned, then touch the next thing. The instant gloves come off, the hands are contaminated until cleaned.