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Healthcare-Associated Infections: Precautions

Many precautions must be taken when caring for others in order to prevent the spread of disease. Below, you can find information on standard precautions and transmission-based precautions.

Standard Precautions

Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures should be used when providing care to all individuals, whether or not they appear infectious or symptomatic.

Hand hygiene refers to both washing with plain or antibacterial soap and water, and to the use of alcohol gel to decontaminate hands.

When hands are not visibly soiled, alcohol gel is the preferred method of hand hygiene when providing health care to clients.

Hand hygiene should be performed:

  • Before and after contact with a client.
  • Immediately after touching blood, body fluids, non-intact skin, mucous membranes, or contaminated items (even when gloves are worn during contact).
  • Immediately after removing gloves.
  • When moving from contaminated body sites to clean body sites during client care.
  • After touching objects and medical equipment in the immediate client-care vicinity.
  • Before eating.
  • After using the restroom.
  • After coughing or sneezing into a tissue as part of respiratory hygiene.

Visit the Centers for Disease Control and Prevention (CDC) Hand Hygiene in Healthcare Settings page to learn more.

Safe handling of needles and other sharp devices are components of standard precautions that are implemented to prevent health care worker exposure to bloodborne pathogens. The Needlestick Safety and Prevention Act mandates the use of sharps with engineered safety devices when suitable devices exist.

  • The safety devices on needles and other sharps should be activated immediately after use.
  • Used needles should be discarded immediately after use and not recapped, bent, cut, removed from the syringe or tube holder, or otherwise manipulated.
  • Any used needles, lancets, or other contaminated sharps should be placed in a leak-proof, puncture-resistant sharps container that is either red in color or labeled with a biohazard label.
  • Do not overfill sharps containers. Discard when two-thirds full or when contents are at the "full" line indicated on the containers.
  • Used sharps containers may be taken to a collection facility, such as an area pharmacy, hospital, or clinic that provides this service.

The following areas should be cleaned routinely:

  • Client care areas
  • Common waiting areas
  • Other areas where clients may have potentially contaminated surfaces or objects that are frequently touched by staff and clients, such as:
    • Doorknobs
    • Sinks
    • Toilets
    • Other surfaces and items in close proximity to clients

These areas should be cleaned with EPA-registered disinfectants, following the manufacturer's instructions for amount, dilution, and contact time.

Housekeeping surfaces, such as floors and walls do not need to be disinfected unless visibly soiled with blood or body fluids. They may be routinely cleaned with detergent only or a detergent and disinfectant product.

Most disinfectants are not effective in the presence of dirt and organic matter, therefore cleaning must occur before disinfection. Wet a cloth with the disinfectant, wipe away dirt and organic material, then apply the disinfectant to the item using a clean cloth, and allow to air dry for the time specified by the product manufacturer. Some patient care items may be damaged or destroyed by certain disinfectants. Consult with the manufacturer of the items before applying disinfectants.

Some pathogens, such as norovirus and Clostridium difficile are not inactivated by commercial disinfectants routinely used in health care settings. In situations where contamination with these pathogens is suspected, a bleach solution (1:10) is recommended for disinfecting contaminated surfaces and items. Appropriate PPE must be worn if preparing a fresh bleach solution. Please note that a homemade bleach solution should be discarded after 24 hours.

Clients in waiting rooms or other common areas can spread infections to others in the same area or to health care staff. Measures to avoid spread of respiratory secretions should be promoted to help prevent respiratory disease transmission.

Elements of respiratory hygiene and cough etiquette include:

  • Covering the nose and mouth with a tissue when coughing or sneezing or using the crook of the elbow to contain respiratory droplets. Using tissues to contain respiratory secretions and discarding in the nearest waste receptacle after use.
  • Performing hand hygiene (handwashing with non-antimicrobial soap and water, alcohol-based hand sanitizer, or antiseptic hand wash) immediately after contact with respiratory secretions and contaminated objects or materials.
  • Asking clients with signs and symptoms of respiratory illness to wear a surgical mask while waiting in common areas or placing these clients immediately in examination rooms or areas away from others. Provide tissues and no-touch receptacles for used tissue disposal.
  • Spacing seating in waiting areas at least three feet apart to minimize close contact among persons in those areas.
  • Providing supplies, such as tissues, waste baskets, alcohol gel, and surgical masks in waiting and other common areas. Place cough etiquette signs where the general public can see them.

The Wisconsin Department of Natural Resources (DNR) regulates the management of medical waste under Wis. Admin. Code ch. NR 526. Anyone handling, storing, or disposing of medical waste is covered under this chapter. Home generators of medical waste are exempt, except for rules related to the safe disposal of sharps.

Sharp Items

Sharp items should be disposed of in containers that are:

  • Puncture resistant.
  • Leak proof.
  • Closable.
  • Labeled with the biohazard symbol OR are red in color.

Sharps containers should be replaced when filled up to the indicated “full” line. Items that should be discarded into sharps containers include:

  • Contaminated items that may easily cause cuts or punctures in the skin, such as:
    • Used needles.
    • Lancets.
    • Broken glass.
    • Rigid plastic vials.
  • Unused needles and lancets that are being discarded.
  • Syringes or blood collection tube holders attached to needles (these must be discarded still attached to the needles).
Non-Sharp Items

Non-sharp disposable items saturated with blood or body fluids (i.e., fluid can be poured or squeezed from the item or fluid is flaking or dripping from the item) should be discarded into biohazard bags that are:

  • Puncture-resistant.
  • Leak-proof.
  • Labeled with a biohazard symbol OR red in color.

Such items may include used PPE and disposable rags or cloths.

Health care settings that generate infectious waste can transport infectious waste themselves or contract with a waste hauler to collect and transport the waste. Organizations that generate less than 50 pounds of infectious waste per month do not need a license from the DNR to haul infectious waste from their facility to a waste disposal site.

A health care setting that generates infectious waste is required to maintain a log of waste that is transported from the facility, regardless of the amount or how it is transported. The log must contain the following information:

  • Date of disposal.
  • Location to which waste is transported.
  • Name of person transporting the waste.
  • Amount and type of waste transported (e.g., three sharps containers, or five biohazard bags).

Care must be taken to contain the waste during transport, keep waste separate from clean items in the transport vehicle, and to clean and disinfect areas of the vehicle containing infectious waste before hauling clean items and materials.

Outbreaks of hepatitis B and C infections, as well as other microorganisms in U.S. ambulatory care facilities, have prompted the need to re-emphasize safe injection practices. All health care personnel who give injections should strictly adhere to the CDC recommendations on Injection Safety, which include:

  • Use of a new needle and syringe every time a medication vial or IV bag is accessed.
  • Use of a new needle and syringe with each injection of a client.
  • Use of medication vials for one client only, whenever possible.

Safe injection practices packet:

Also see the CDC guideline for isolation precautions.

Transmission-Based Precautions

Transmission-based precautions are used in addition to standard precautions when the use of standard precautions alone does not fully prevent communicable disease transmission. There are three types of transmission-based precautions. The type of precaution used depends on the mode of transmission of a specific disease. Some diseases require more than one type of transmission-based precaution.

  • Use contact precautions in addition to standard precautions when in contact with individuals known or suspected of having diseases spread by direct or indirect contact (examples include norovirus, rotavirus, draining abscesses, and head lice).
  • Wear gloves and a gown when in contact with the individual, surfaces, or objects within their environment.
  • Clean and disinfect all reusable items taken into an exam room or home before removal. Disposable items should be discarded at point of use.

In addition to standard precautions, wear a surgical mask when within 3 feet (6 feet for smallpox) of people known or suspected of having diseases spread by droplets.

Examples include:

  • Influenza.
  • Pertussis.
  • Meningococcal disease.
  • Mumps.
  • Rubella.

Use the following measures in addition to standard precautions when in contact with individuals known or suspected of having diseases spread by fine particles dispersed by air currents (examples include tuberculosis, measles, and SARS):

  • Put on a NIOSH-certified, fit-tested N95 respirator just before entry to an area of shared air space and wear at all times while in the area of shared air space. Remove and discard respirator just after exiting area. The respirator may be discarded into the regular trash unless contact precautions must also be followed. In this case, place the respirator in a plastic zip-lock bag, seal and then discard into the trash. A powered air-purifying respirator may also be used.
  • If available, portable, high-efficiency particulate air (HEPA) filtration units may be operated in the area where the infected individual is located to filter out infectious particles. Use of such a unit does NOT eliminate the need for employees to wear respiratory protection.

Visit the Wisconsin DHS Tuberculosis Program webpage for resources and information on tuberculosis infection control plans, and a respiratory protection plan model.

Questions about HAIs? Contact us!
Phone: 608-267-7711 | Fax: 608-266-0049

Last revised June 15, 2022