SP21-2 Controversies in standard precaution

Abstract

The Centers for Diseases Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) updated in 2007 a previous guideline and developed a two-level system for isolation precautions: standard precautions (SP), which apply to all patients, and transmission-based precautions (contact, droplet and airborne), put in place for patients with suspected or proven colonization or infection with certain microorganisms at risk of spreading. SP combine the major features of Universal Precautions (designed in 1987 to initially prevent HIV transmission and one year after, hepatitis B virus and other blood-bornepathogens transmission, to the healthcare workers [HCWs]) and Body Substance Isolation (designed in 1987 to prevent pathogen transmission frommoist body surfaces to the HCWs). SP apply to all patients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered: they include the performance of hand hygiene according to pre-specified guidelines, use of personal protective equipment, respiratory hygiene/cough etiquette, safe injection practices, use of masks for catheter insertion and lumbar puncture procedures, safe handling of contaminated equipment, textiles and laundry, and routine cleaning and disinfection of environmental surfaces. Avoiding the exposure to potentially infectious sources such as blood, wounds, mucous membranes and excretions is the primary goal of SP. Current controversies surrounding SP will be discussed during the presentation. For instance, the impact of environmental contamination on healthcare-associated infection rates and the costeffectiveness of surface disinfection as opposed to detergent-based cleaning remains a scientifically unresolved issue, despite a growing body of literature. Furthermore, education of HCW about SP is an essential component of hospital infection control programmes. HCW education programmes are recommended by the Society for Healthcare Epidemiology of America as a means of reducing nosocomial infections. HCW education has been shown to increase compliance with hand hygiene and reduce rates of nosocomial acquisition ofmethicillin resistant Staphylococcus aureus . Despite this, the effectiveness of different education interventions to improve SP is seldom formally assessed.