NCPT

Standard Precautions are the foundation of infection control and apply to every patient, regardless of diagnosis or presumed infection status. They treat all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes as potentially infectious. Standard Precautions combine and expand the older Universal Precautions, which applied only to blood and certain body fluids.

Element	WhatItRequires
Handhygiene	Beforeandaftereverypatientcontact beforeanaseptictask afterbodyfluidexposure after , , ,
	touchingpatientsurroundings andafterremovinggloves ,
PPE	Selectedfortheanticipatedexposure:glovesforeveryvenipuncture;gown mask andeye , ,
	protectionwhensplashesorspraysarelikely
Respiratoryhygieneandcough	Covercoughsandsneezes discardtissuespromptly performhandhygiene andoffermasksto , , ,
etiquette	coughingpatientsandvisitors
Safeinjectionandsharps	Single-use needles syringes and lancets are used once; safety features are activated , ,
practices	immediately; no two-handed recapping
Environmentalcleaning	Disinfect patient-care equipment and surfaces between patients and after contamination

Hand Hygiene

Hand hygiene is the single most important measure for preventing the spread of infection. An alcohol-based hand rub is preferred for routine hand hygiene when hands are not visibly soiled: apply enough product to cover all surfaces and rub for at least 20 seconds, until hands are dry. Soap and water are required when hands are visibly soiled, after the restroom, and after caring for patients with spore-forming Clostridioides difficile or with norovirus, because alcohol does not reliably kill spores or norovirus.

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Warm running water;

Lather all surfaces

Palms, backs, between

Fingertips pointing down

Clean paper towel; use it

keep hands lower than

fingers, nails, wrists

to turn off the faucet

elbows

Transmission-Based Precautions

Transmission-Based Precautions are used in addition to Standard Precautions for patients with known or suspected infections spread by a specific route. A sign on the door identifies the category and the required PPE. Take only the supplies needed into an isolation room, leave the tray outside, and use a disposable tourniquet that stays in the room or is discarded there.

Category	ExampleOrganisms	RequiredPPE	RoomandOtherMeasures
Contact	MRSA VRE otherMDROs C difficile , , , . ,	Gownandglovesonentry	Privateroomorcohorting;
	scabies somewoundandGI ,		dedicatedequipment;soapand
	infections		waterhandhygieneforC difficile .
Droplet	Influenza pertussis Neisseria , ,	Surgicalmaskwhenwithinabout6	Privateroomorcohorting;patient
	meningitidis(bacterialmeningitis) ,	feetofthepatient	wearsamaskduringtransport
	mumps
Airborne	Tuberculosis measles(rubeola) , ,	Fit-tested N95 or higher respirator	Airborneinfectionisolationroom
	varicella(chickenpox) disseminated ,		(AIIR)withnegativepressure;
	zoster		doorkeptclosed
Protective	Protectsthepatient:neutropenic ,	Cleangown mask andglovesas , ,	Positive-pressure room; nothing
(reverse)	chemotherapy transplant andsevere , ,	posted	entersthatcouldcarryorganisms
	burnpatients		tothepatient

A surgical mask is not enough for tuberculosis, measles, or chickenpox; these require a fit-tested N95 respirator and a negative-pressure room. Droplet organisms such as influenza and pertussis need only a surgical mask.

Bloodborne Pathogens and Hepatitis

Bloodborne pathogens are microorganisms in human blood that can cause disease. The three of greatest occupational concern are hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV); syphilis and malaria can also be transmitted by blood. Exposure occurs through a percutaneous injury (needlestick or cut) or through contact of blood with mucous membranes or nonintact skin. Other potentially infectious materials (OPIM) include semen, vaginal secretions, cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids, saliva in dental procedures, any fluid visibly contaminated with blood, and unfixed human tissue.

Hbv

Hcv

Hiv

The most infectious of the three after a

The most common chronic bloodborne

Attacks CD4 (helper T) lymphocytes

needlestick in an unvaccinated worker;

infection in the United States; no

and can progress to AIDS; transmission

can survive in dried blood on surfaces

vaccine; most infections are curable

risk after a needlestick is about 0.3%;

for at least 7 days; preventable by

with antiviral medication.

no vaccine, but post-exposure

vaccination.

prophylaxis is effective when started quickly.

Viral Hepatitis A–E

Hepatitis is inflammation of the liver. Viral hepatitis often causes fatigue, nausea, abdominal pain, dark urine, and jaundice (yellowing of the skin and sclera from bilirubin), though many infections are asymptomatic. Chronic infection can progress to cirrhosis (scarring) and hepatocellular carcinoma. For exam purposes, sort the five viruses by route: A and E are fecal-oral; B, C, and D are bloodborne.

Virus	Transmission	ChronicInfection	Vaccine	KeyFacts
HAV	Fecal -oral; contaminated	No	Yes	Symptomsappearabout2–6weeksafter
	foodandwater;close			exposure;childrenareoften
	contact			asymptomatic;recoveryusually
				complete
HBV	Blood sexualcontact , ,	About5%ofadults;	Yes (2 - or 3 -dose	Highlyinfectious;greatestoccupational
	mothertonewbornatbirth	about90%ofinfants	series)	risktounvaccinatedphlebotomists
		infectedatbirth
HCV	Blood;injectiondruguseis	Morethanhalfof	No	Oftensilentforyearswhileliverdamage
	themostcommonroute;	infectedpeople		progresses; direct-acting antivirals taken
	sexualspreadisinefficient			for8–12weekscuremorethan95%
HDV	Blood;occursonlywith	Yes withchronicHBV ,	HBVvaccine	NeedsHBVtoreplicate;combined
	HBV(coinfectionor		preventsit	infectionspeedsliverdamage
	superinfection)
HEV	Fecal -oral; contaminated	Rare	Notavailableinthe	Usually self -limited; can be severe in
	water;undercookedpork	(immunocompromised)	US . .	pregnancy

Hepatitis B Vaccination and Serology

The hepatitis B vaccine is given as a two- or three-dose series, depending on the product, and produces protective antibody in more than 90% of healthy adults. Healthcare workers should have their antibody level checked 1–2 months after completing the series; nonresponders may receive a second series. HBV infection and immunity are tracked with serologic markers.

Marker	WhataPositiveResultMeans
HBsAg(surfaceantigen)	Currentinfection acuteorchronic;thepersoncantransmitHBV ,
Anti -HBs (surface antibody)	Immunity fromvaccinationorfromrecoveryfrompastinfection ,
Anti -HBc (core antibody)	Pastorcurrentinfection;neverproducedbyvaccinationalone

A vaccinated phlebotomist who never had hepatitis B has anti-HBs only. A positive anti-HBc means the person was actually infected at some point, because the vaccine contains only surface antigen.