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Infection Control

Infection Control

Learning Objectives

You will be able to:

  • Identify that the agency has an infection control program
  • Understand the four disease transmission categories
  • Understand standard and additional precautions and when and how they should be used
  • Apply the knowledge you have learned

Infection Control and Prevention

Healthcare agencies must have an infection control program. The infection control program includes collecting data on all clients with an infection. The data is then analyzed to identify any possible patterns or trends related to infections. The local and/or state health department must be notified of any infections that are highly contagious or are required to be reported. It is the responsibility of all direct care workers to use the best infection control practices including standard or additional precautions.

Disease Transmission

Diseases are transmitted by four methods:

Airborne Transmission – Airborne germs can travel long distances through the air and then can be breathed in by people. Examples are TB, Chickenpox, Influenza, and some types of pneumonia.

Bloodborne Transmission – This occurs when the blood of an infected person comes into contact with another person’s bloodstream. Blood and bloodborne pathogens can be in other body fluids such as mucous, urine, saliva, and vomit. Examples of diseases caused by bloodborne microorganisms are HIV and Hepatitis.

Contact Transmission – This occurs by touching the microorganism that causes the disease. You do not have to touch the person for transmission to occur. You could touch an object that the infected person has handled, touched, or been in contact with. Examples include MRSA, pink eye, and scabies.

Droplet Transmission – Some microorganisms travel through the air but only for short distances, usually less than 6 feet. Actions that produce droplets are coughing, sneezing, and talking. Examples of droplet transmission diseases are COVID-19, SARS-CoV-2.

Standard Precautions

Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of the suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients. Standard Precautions include —

      1. Hand hygiene.
      2. Use of personal protective equipment (e.g., gloves, masks, eyewear).
      3. Respiratory hygiene/cough etiquette.
      4. Sharps safety (engineering and work practice controls).
      5. Safe injection practices (i.e., an aseptic technique for parenteral medications).
      6. Sterile instruments and devices.
      7. Clean and disinfect environmental surfaces.

Personal Protective Equipment (PPE)

Personal protective equipment (PPE) refers to wearable equipment that is designed to protect DHCP from exposure to or contact with infectious agents. PPE that is appropriate for various types of patient interactions and effectively covers personal clothing and skin likely to be soiled with blood, saliva, or other potentially infectious materials (OPIM) should be available. These include gloves, face masks, protective eyewear, face shields, and protective clothing (e.g., reusable, or disposable gown, jacket, laboratory coat). Examples of appropriate use of PPE for adherence to Standard Precautions include—

    • Use of gloves in situations involving possible contact with blood or body fluids, mucous membranes, non-intact skin (e.g., exposed skin that is chapped, abraded, or with dermatitis) or OPIM.
    • Use of protective clothing to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated.
    • Use of mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids.

The application of Standard Precautions and guidance on appropriate selection and an example of putting on and removal of personal protective equipment is described in detail in the 2007 Guideline for Isolation Precautions pdf icon[PDF – 1.4 MB].

Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions because they help DHCP make appropriate decisions and comply with recommended practices.

When Standard Precautions alone cannot prevent transmission, they are supplemented with Transmission-Based Precautions. This second tier of infection prevention is used when patients have diseases that can spread through contact, droplet, or airborne routes (e.g., skin contact, sneezing, coughing) and are always used in addition to Standard Precautions.

Hand Hygiene

Hand hygiene is the most important measure to prevent the spread of infections among patients and DHCP. Education and training programs should thoroughly address indications and techniques for hand hygiene practices before performing routine and oral surgical procedures.

Although alcohol-based hand rubs are effective for hand hygiene in health care settings, soap and water should be used when hands are visibly soiled (e.g., dirt, blood, body fluids). For all types of hand hygiene products, follow the product manufacturer’s label for instructions. Complete guidance on how and when hand hygiene should be performed, including recommendations regarding surgical hand antisepsis and artificial nails can be found in the Guideline for Hand Hygiene in Health-Care Settings pdf icon[PDF – 494 KB]. Refer to the agency policy on Hand Hygiene.

Respiratory Hygiene/Cough Etiquette

Respiratory hygiene/cough etiquette infection prevention measures are designed to limit the transmission of respiratory pathogens spread by droplet or airborne routes. The strategies target primarily patients and individuals accompanying patients to the dental setting who might have undiagnosed transmissible respiratory infections but also apply to anyone (including DHCP) with signs of illness including cough, congestion, runny nose, or increased production of respiratory secretions.

DHCP should be educated on preventing the spread of respiratory pathogens when in contact with symptomatic persons. Respiratory hygiene/cough etiquette measures were added to Standard Precautions in 2007.

Sharps Safety

Most percutaneous injuries (e.g., needlestick, cut with a sharp object) among direct care workers involve burs, needles, and other sharp instruments. Implementation of the OSHA Bloodborne Pathogens Standard has helped to protect direct care workers from blood exposure and sharps injuries. Engineering and work-practice controls are the primary methods to reduce exposure to blood and OPIM from sharp instruments and needles. Whenever possible, engineering controls should be used as the primary method to reduce exposure to bloodborne pathogens. When engineering controls are not available or appropriate, work-practice controls should be used. Work-practice controls are behavior-based and are intended to reduce the risk of blood exposure by changing the way direct care workers perform tasks, such as using a one-handed scoop technique for recapping needles between uses and before disposal. Other work-practice controls include not bending or breaking needles before disposal, and not passing a syringe with an unsheathed needle by hand.  All used disposable syringes and needles, scalpel blades, and other sharp items should be placed in appropriate puncture-resistant containers located close to the area where they are used. Sharps containers should be disposed of according to state and local regulated medical waste rules.

Environmental Infection Prevention and Control

Policies and procedures for routine cleaning and disinfection of environmental surfaces should be included as part of the infection prevention plan. Cleaning removes large numbers of microorganisms from surfaces and should always precede disinfection. Disinfection is generally a less lethal process of microbial inactivation (compared with sterilization) that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial spores). Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated with pathogens, including clinical contact surfaces (e.g., frequently touched surfaces such as doorknobs and light switches) in the patient-care area. When these surfaces are touched, microorganisms can be transferred to other surfaces, or the nose, mouth, or eyes of direct care workers or patients. Although hand hygiene is the key to minimizing the spread of microorganisms, clinical contact surfaces should be barrier-protected or cleaned and disinfected between patients. EPA-registered hospital disinfectants or detergents/disinfectants with label claims for use in healthcare settings should be used for disinfection. Disinfectant products should not be used as cleaners unless the label indicates the product is suitable for such use. Direct Care Workers should follow manufacturer recommendations for use of products selected for cleaning and disinfection (e.g., amount, dilution, contact time, safe use, and disposal).

Transmission-Based Precautions

Additional precautions are used in conjunction with standard precautions when a person you are caring for requires extra infection control measures. If the person you are caring for has an actual or suspected infection or disease that can be spread by contact, airborne or droplet.

Contact  Precautions

Contact Precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient’s environment. Contact Precautions also apply where the presence of excessive wound drainage, fecal incontinence, or other discharges from the body suggests an increased potential for extensive environmental contamination and risk of transmission. Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient’s environment.

Droplet precautions

Droplet Precautions are intended to prevent transmission of pathogens through close respiratory or mucous membrane contact with respiratory secretions. Healthcare personnel wear a mask (a respirator is not necessary) for close contact with infectious patients.

Airborne precautions

Airborne Precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air. Examples include TB, chickenpox, measles, and possibly SARS-CoV.  People with actual or potential airborne disease should be in a specially ventilated room in which circulated air is exhausted directly to the outside, the door to their room should remain closed and the use of an N95 mask or equivalent is required for direct care workers. In inpatient homes, this is not feasible so the patient is asked to wear a mask and the direct care worker must wear an N95 or equivalent. Whenever possible, non-immune direct care workers should not care for patients with vaccine-preventable airborne diseases (e.g., measles, chickenpox, and smallpox).

Discontinuation of Transmission-Based Precautions

Transmission-based precautions remain in effect for limited periods (i.e., while the risk for transmission of the infectious agent persists or for the duration of the illness (Appendix A). For most infectious diseases, this duration reflects known patterns of persistence and shedding of infectious agents associated with the natural history of the infectious process and its treatment. For some diseases (e.g., pharyngeal, or cutaneous diphtheria, RSV), Transmission-Based Precautions remain in effect until culture or antigen-detection test results document eradication of the pathogen, and, for RSV, symptomatic disease is resolved. For other diseases, (e.g., M. tuberculosis) state laws and regulations, and healthcare facility policies, may dictate the duration of precautions12). In immunocompromised patients, viral shedding can persist for prolonged periods (many weeks to months) and transmission to others may occur during that time; therefore, the duration of contact and/or droplet precautions may be prolonged for many weeks.