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Graded protection standards, a must for medical workers!
Time: Feb 09, 2022

In the process of medical practice, medical personnel need to protect themselves according to different diseases and different transmission methods, and at the same time, they need to ensure the safety of patients to avoid two-way transmission.

Standard Prevention Knowledge Points
Standard precautions refer to the belief that the patient's blood, body fluids, secretions, and excretions are infectious and need to be isolated, regardless of whether there is obvious bloodstains, pollution, or contact with incomplete skin and mucous membranes. Precaution.

1. Standard precautionary principles

It is the basis for the protection of medical personnel and is suitable for all medical personnel in different work areas and positions.

2. Standard Precautions Core

It refers to a set of prevention and control measures to reduce the risk of nosocomial infection based on the principle that patients' blood, body fluids, secretions (excluding sweat), excrement, incomplete skin and mucous membranes may contain infectious agents. This includes hand hygiene, use of personal protective equipment, cough etiquette, etc.

3. Standard precautions include the following

(1) All patients' blood, body fluids, secretions, and excretions are considered infectious and must be isolated, contacting substances with obvious blood, body fluids, secretions, and excretions, or contact with incomplete skin and mucous membranes , protective measures must be taken.

(2) To prevent the spread of blood-borne diseases, but also to prevent the spread of non-menstrual blood-borne diseases.

(3) Emphasize two-way protection. It is necessary to prevent the transmission of diseases from patients to medical staff, and to prevent the transmission of diseases from medical staff to patients.

4. Specific measures for standard precautions include

(1) The cleaning and disinfection of hands is an important measure to cut off contact transmission. The cleaning and disinfection of hands should meet the requirements of the "Hand Hygiene Standards for Medical Staff".

(2) Gloves should be worn when touching blood, body fluids, secretions, excrement and other substances and articles contaminated by them.

(3) Wash hands immediately after removing gloves.

(4) Medical staff should wear surgical masks, protective glasses or face shields, isolation gowns or waterproof aprons when their work clothes, face and eyes may be splashed and contaminated by blood, body fluids, secretions and other substances.

(5) Special care should be taken when handling all sharps to avoid being stabbed.

(6) Correct disinfection and sterilization measures should be taken for the medical devices and instruments used by patients.

Exposure risk grading for healthcare workers
1. Exposure Risk Grading Criteria

Take droplet isolation, contact isolation and air isolation protection measures, and take appropriate personal protection according to different exposure risks:

(1) Low risk: indirect contact with patients, such as consultation, consultation, general outpatient clinic and ward rounds, etc.

(2) Medium risk: direct contact with patients, such as physical examination, puncture, injection, etc.; (recommended for physical examination with mucosal or body cavity contact, invasive operations without risk of body fluid splashing, such as ultrasound-guided breast puncture, deep vein puncture Wait).

(3) High risk: operations or surgeries that splash blood, body fluids, secretions, etc. or may generate aerosols, such as throat swab collection, sputum suction, oral care, tracheal intubation, non-invasive ventilation, tracheotomy, Cardiopulmonary resuscitation, manual ventilation before intubation, and endoscopy.

2. Protection selection based on risk level

(1) Low-risk operations: work clothes or isolation gowns, medical surgical masks, work caps, and hand hygiene.

(2) Medium-risk operations: work clothes and isolation gowns, medical surgical masks/medical protective masks, work caps, protective face shields/goggles, gloves, and hand hygiene.

(3) High-risk operations: medical protective clothing (disposable), isolation gowns, medical protective masks, work caps, protective face shields/goggles, double gloves, and hand hygiene. Procedures should be performed in a well-ventilated room limited to the minimum number of patients required for the care and support.

Medical staff protection classification
The protection of medical personnel should take different protective measures according to the different patients they receive, and meet the following requirements:

1. General protection

It is suitable for medical staff in general outpatient (emergency) clinics and general wards.

(1) Strictly abide by the principles of Standard Precautions.

(2) Wear work clothes and surgical masks when working.

(3) Conscientiously implement hand hygiene.

2. Primary protection

It is suitable for medical staff in fever (emergency) clinics.

(1) Strictly abide by the principles of Standard Precautions.

(2) Strictly abide by the rules and regulations of disinfection and isolation.

(3) Wear work clothes, isolation gowns, work caps, surgical masks, and disposable latex gloves when necessary.

(4) Strictly implement hand hygiene.

(5) Perform personal hygiene when off work, and pay attention to the protection of the respiratory tract and mucous membranes.

3. Secondary protection

It is suitable for medical staff entering respiratory isolation wards and isolation wards; staff who contact specimens collected from patients, handle their secretions, excretions, used items and dead patients' bodies, and medical staff and drivers who transport patients.

(1) Strictly abide by the principles of Standard Precautions.

(2) Droplet isolation and contact isolation are adopted according to the transmission route.

(3) Strictly abide by the rules and regulations of disinfection and isolation.

(4) Medical staff entering isolation wards and isolation wards must wear medical protective masks, work clothes, isolation gowns or protective clothing, shoe covers, gloves and work caps. Strictly follow the division of clean area, potential pollution area and pollution area, correctly wear and take off protective equipment, and pay attention to the hygiene and protection of respiratory tract, oral cavity, nasal mucosa and eyes.

4. Three-level protection

It is suitable for medical personnel performing aerosol-inducing procedures.

Procedures that can trigger aerosols include endotracheal intubation, nebulization therapy, examination of induced sputum, bronchoscopy, aspiration of respiratory sputum, tracheal incision care, thoracic physiotherapy, nasopharyngeal aspiration, and positive pressure mask ventilation (such as BiPAP and CPAP), high-frequency shock ventilation, resuscitation, postmortem lung biopsy, etc.

In addition to secondary protection, face shields or full-scale respiratory protection should be worn.

Procedures for wearing protective equipment when entering the quarantine area
1. Medical personnel enter the clean area through the special channel for employees. After carefully washing their hands, they should wear medical protective masks, disposable hats or cloth caps, and change work shoes and socks.

2. Wear work clothes before entering the potentially contaminated area, and those with damaged or suspected damage on the hands should wear gloves to enter the potentially contaminated area.

3. Before entering the polluted area, take off your work clothes and put on protective clothing or isolation clothing, plus a disposable hat and disposable medical surgical mask (two layers of hats and masks in total), protective glasses, gloves, and shoe covers.

Procedures for removing protective equipment from the quarantine area
1. Before leaving the contaminated area, medical staff should disinfect their hands, take off protective glasses, outer disposable medical surgical masks, outer disposable caps, protective clothing or isolation gowns, shoe covers, gloves and other items in sequence, and put them in separate places. In a special container, disinfect your hands again, enter the potentially contaminated area, and change into work clothes.

2. Before leaving the potentially contaminated area and entering the clean area, wash and sanitize hands, take off work clothes, wash hands and sanitize hands.

3. Before leaving the cleaning area, wash and sanitize hands, remove the inner disposable hat or cloth cap, the inner medical protective mask, take a shower and change clothes, and clean the oral cavity, nasal cavity and external auditory canal.

4. Wash and disinfect hands immediately after each patient contact.

5. Disposable medical surgical masks, medical protective masks, protective clothing or isolation gowns and other protective equipment should be replaced immediately when they are contaminated by the patient's blood, body fluids, secretions, etc.

6. Personal hygiene should be carried out before get off work, and attention should be paid to the protection of the respiratory tract and mucous membranes.

Precautions for putting on and taking off protective equipment
Medical protective masks can be used continuously for 6-8 hours, and should be replaced in time in case of pollution or moisture.
2. Disinfect the glasses you wear before leaving the quarantine area.

3. When medical staff are in contact with multiple patients with the same infectious disease, isolation gowns or protective clothing can be applied continuously.

4. In contact with suspected patients, the gown or protective clothing should be changed between each patient contact.

5. When the isolation gown or protective clothing is contaminated by the patient's blood, body fluids and dirt, it should be replaced in time.

6. Wear a medical protective mask or a full-scale respirator to perform a facial tightness test.

7. Medical staff working in the isolation area should monitor their body temperature twice a day, and seek medical treatment in time if the body temperature exceeds 37.5°C.

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