Infection Prevention and Control is not a new concept. It has been an essential part of ‘healthcare’ since the Nightingale era, and Standard Precautions, whilst not formalised with that term, were being practised even back then.
The Centers for Disease and Control (CDC) introduced Universal Precautions in 1985, mostly in response to the human immunodeficiency virus (HIV) epidemic. Universal precautions are a standard set of guidelines that aim to prevent bloodborne pathogen transmission through exposure to blood and other potentially infectious materials.
In 1987, the CDC introduced another set of guidelines termed ‘Body Substance Isolation’. These advocated the avoidance of direct physical contact with “all moist and potentially infectious body substances”, even if blood was not visible. A limitation of this guideline was its emphasis on hand washing after glove removal only if hands were visibly soiled.
The formalisation of Standard Precautions
So, how did we get to Standard Precautions? In 1996, the CDC Guideline for Isolation Precautions in Hospitals, prepared by the Healthcare Infection Control Practices Advisory Committee (HICPAC), combined the major features for Universal Precaution and Body Substance Isolation into what is now referred to as Standard Precautions.
Florence Nightingale’s philosophy of cleanliness and sanitation in order to prevent infection in patients can be credited for shaping today’s healthcare. The ‘habit’ of hand washing is one of the most important infection prevention practices. It is not only effective, it is also easy to do and teach. In fact, hand hygiene is one of the most important components of Standard Precautions.
Hands are the most common vehicle for transmission of organismsMehta et al., 2014
Aged care facility residents are most vulnerable to infections due to co-morbidities and/or advanced age. Also, the communal living environment facilitates the spread of infection and illness. In a presentation given by A/Prof. Paul Griffin through the Immunisation Coalition in February 2019, he identified that in 2000, there were an estimated 1.6 to 3.8 infections in 1.5 million US patients across 17,000 nursing homes every year (Strausburgh et al. 2000). More recently, estimates range from 1.4 to 5.2 infections per 1000 resident care days. Recent Australian data from Bennett et al. (2018) shows that infection prevalence is 2.9%.
Standard Precautions in Aged Care
Now, with all that important background information about Standard Precautions out of the way, here is a quick reminder regarding Standard Precaution practices.
Application of Standard Precautions is essential at all times. This is because people may be in contact with, and may be placed at risk from, infectious people before signs and symptoms of a disease are recognised, detected or confirmed by pathology tests. People may be at risk from infectious agents present in the surrounding environment, including environmental surfaces or from equipment.
Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019 advise:
“Standard Precautions are a set of infection control practices which consist of:
- hand hygiene, as consistent with the present 5 Moments of Hand Hygiene.
- the use of appropriate personal protective equipment (PPE).
- the safe and disposal of sharps.
- routine environmental cleaning
- reprocessing of reusable medical equipment and instruments
- respiratory hygiene and cough etiquette
- aseptic technique
- waste management
- appropriate handling of linen
Standard Precautions should be used in the handling of blood (including dried blood); all other body substances, secretions and excretions (excluding sweat), regardless whether they contain visible blood non-intact skin; and mucous membrane.’’
It is the responsibility of caregivers to rigorously apply Standard Precautions in everyday practice, to protect both the resident and themselves, which will extend to a safer community.
If you have any questions about Standard Precautions, infection prevention and control, and any other issues in aged care, please feel free to contact us. By working together, we can stop infections in aged care.
- Bennett et al. (2018). Prevalence of infections and antimicrobial stewardship in Australian aged care facilities: Evaluation of modifiable and nonmodifiable determinants.
- Mehta et al. (2014). Guidelines for prevention of hospital acquired infections.
- Strausbaugh et al. (2000). The burden of infection in long-term care.