Concerns on the Infection Prevention Limitations of Standard Precautions

Concerns on the Infection Prevention Limitations of Standard Precautions – 14th September, 2016

The Standard Precautions concept in healthcare dictates that healthcare workers assess risk in advance of a patient interaction and use appropriate interventions such as barriers, hand hygiene, and/or surface disinfection, to address the risk and prevent becoming contaminated by the patient or the patient’s environment. This approach has generally been credited with helping hospital employees protect themselves from acquiring infectious agents on a daily basis. However, a growing body of research has called into question whether this approach is in fact adequate.

Recent Research
Creamer (2010) looked at hand contamination rates with methicillin-resistant Staphylococcus aureus (MRSA) for healthcare workers. In the study, hands sampled after glove use did not test positive for MRSA, regardless of whether hand hygiene was performed or not. For hands tested when no gloves were worn, 1 of 59 were positive for MRSA after using alcohol hand gel, 7 of 210 were positive after hand washing and 2 of 35 were positive when using a chlorhexidine product. In total, 10 of 304 samples, or 3 percent, were positive.

Roughmann (2015) looked at long-term care and glove/gown contamination in an environment where 28 percent of residents were colonized with MRSA. While gowns (14 percent) and gloves (24 percent) were predictably contaminated after interactions with the residents (which averaged 7 interactions per monitored event), 5 percent of gowns/gloves were contaminated with MRSA from non-colonized residents. This implies either that these residents were colonized, but it was either not detected through nasal and perianal swabbing, the colonization occurred after initial testing, or that the colonized residents have spread MRSA into reservoirs around non-colonized residents, allowing them to be transiently colonized.

Bonifat (2015) tested the air during a norovirus outbreak to see if viable virus could be detected. The air contamination rate was 2000 genomes per cubic meter of air. Since the average person breathes 6 liters of air per minute, a healthcare worker could inhale 60 genomes in a five minute interaction even with no patient contact.

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