Chapter 5: Direct Patient Care
Karen Piette and Kristen Hosey
Due to the nature of the profession, healthcare workers can be exposed to blood through needlestick and other sharps injuries, mucous membrane, and skin exposures (NIOSH, 2023). They are at increased risk of bloodborne pathogen exposure due to working closely with patients. Standard precautions are important concepts that should be utilized for all patient care, at all times. According to the Centers for Disease Control (CDC), standard precautions involve hand washing and the use of personal protective equipment (PPE) to protect healthcare providers from infection and to prevent the spread of infection from patient to patient. The proper use of standard precautions prevents the spread of bloodborne pathogens. Bloodborne pathogens are microorganisms such as viruses and bacteria that are carried in blood and cause disease such as Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV).
hand hygiene is an important aspect of standard precautions and involves both the proper use of hand sanitizer and adequate hand washing at appropriate times during patient care. It is the most widely known form of standard precautions, yet on average healthcare providers clean their hands less than half of the times they should (CDC, 2023). The CDC has many materials to help support healthcare providers understand hand hygiene in healthcare settings. Remember, in the healthcare setting workers will encounter more sick people than in any other work settings. Therefore, understanding good hand hygiene will be important for safety, as well as for the safety of the patients being served.
In the healthcare field, it is vital to utilize Personal Protective Equipment (PPE) in order to minimize exposure to bloodborne pathogens and injury. PPE act as a barrier to infectious materials by blocking the transmission of contaminants from bodily fluids, blood and respiratory secretions (FDA, 2023). Healthcare workers are exposed to bodily fluids, medical equipment and sharp instruments. PPE consists of equipment worn by workers to minimize exposure to hazards that cause workplace injuries or illnesses. PPE that can be worn in the healthcare setting include gowns, masks or respirators, goggles, face shields and gloves. PPE should also be donned (put on) and doffed (taken off) in a specific order to prevent contamination.
Respiratory hygiene and cough etiquette are also important standard precautions to prevent respiratory infections. Covering your mouth and nose when coughing or sneezing with a tissue followed by appropriate hand hygiene may stop the spread of infection through respiratory droplets. Healthcare facilities should ensure availability of materials to support respiratory hygiene/cough etiquette
Sharps safety and needlestick prevention is also an important standard precaution in healthcare settings. Sharps are any sort of device, such as a needle, that can penetrate the skin and cause injury and spread bloodborne pathogens. Needlestick exposures to bloodborne pathogens are a serious problem, resulting in approximately 385,000 cases a year (CDC, 2015). Sharps should be immediately disposed of in a sharps container after use. Sharps injuries are primarily associated with disease transmission such as hepatitis B and C, HIV, and as well as 20 other pathogens (CDC, 2015).
It is a requirement through the Occupational safety and Health Administration (OSHA) that employers in the healthcare field have an exposure control plan to eliminate the hazards of occupational exposure to bloodborne pathogens. This is required through OSHA’s bloodborne pathogens standard. Individuals go through bloodborne pathogen training when working in the healthcare setting. These trainings provide a good overview of what sort of exposure risks would involve different PPE.
Attributions
- Figure 5.3: Medical personnel don PPE before entering a COVID-19-positive, non-critical patient’s room. (50199060167).jpg by Petty Officer 3rd Class Jacob L Greenberg/U.S. Navy in the Public Domain
Microorganisms that are carried in blood and cause disease in people.
Minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient in any and all healthcare settings.
Equipment worn to minimize exposure to hazards that cause workplace injuries or illnesses.
Cleaning hands either by hand washing or antiseptic handwash.
Small droplets produced by exhalation such as coughing or sneezing consisting of saliva and mucous derived from the respiratory tract.