Infection Control

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Infection Control
JCAHO Mandatory
Annual Competency
Chesapeake Medical Staffing

Introduction
Infection control is a critical concern for patients,
healthcare workers, facility administrators, and
government agencies. Infection control measures
are designed to combat everything from the
spread of colds and flu to hepatitis B and C, SARS,
HIV/AIDs, and other potentially life threatening
diseases. Appropriate infection control measures
may range from something as simple as following
proper hand washing hygiene to coordinated
policies involving worker health screening,
immunization, and treatment. All of these
measures should be incorporated into
synchronized, organization-wide infection control
programs at healthcare facilities of all sizes and
types.

Current Statistics
More than 2 million hospital patients each
year get an infection while being treated for
another illness or injury and 90,000 of them
die as a direct or indirect cause of their
infection. Healthcare-associated infections not
only inflict suffering and death but also cost
the United States in excess of $5 billion each
year due to the extra days or weeks of
hospitalization needed to treat the infection
(Rutala et al., 2006).

Goals of Infection
Control Training
• Ensure that health professionals understand how
bloodborne and other pathogens can be transmitted
in the work environment: patient to healthcare
worker, healthcare worker to patient, and patient to
patient
• Apply current scientifically accepted infection control
principles as appropriate for the specific work
environment
• Minimize opportunity for transmission of pathogens
to patients and healthcare workers

CDC Recommendations
This section is based on the CDC Recommendations for
Isolation Precautions in Hospitals, which is available at
http://www.cdc.gov/ncidod/dhqp/gl_isolation.html.
The Centers for Disease Control (CDC) describe four
types of precautions, based on the mode of
transmission of the organism known or suspected to be
present. CDC Guidelines are not regulations, but they
are evidence-based recommendations. These
guidelines were developed for hospitalized inpatients,
and the principles can be applied in outpatient settings.

Standard Precautions
Standard Precautions are to be used with all
patients, regardless of diagnosis. Standard
Precautions, formerly known as Universal Precautions,
were initially designed to minimize risk to staff from
unknown carriers of bloodborne pathogens, such as
hepatitis B, hepatitis C, or HIV. In addition to
protecting staff, Standard Precautions also protect
patients from organisms shed in the body fluids of
other patients. Standard Precautions are required by
by federal law and the OSHA Bloodborne Pathogens
Standards.
*A complete description of Standard Precautions may be found at
http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html.
Source: CDC, 2006.

Ten Standard
Precautions
The following slides will review the ten
Standard Precautions recommended by the
CDC for health care workers. Chesapeake
Medical Staffing encourages all employees to
follow these recommendations to reduce your
risk of occupational hazards.

Hand Hygiene
Hand hygiene is still the single most important
procedure for preventing the spread of infection! This
is because healthcare facilities bring many reservoirs
(the patients and staff) into close contact with many
susceptible hosts (the patients and staff). We cannot
eliminate the reservoirs and susceptible hosts, so we
must eliminate the mode of transmission.
We must not carry
germs from reservoir
to susceptible host!

#1: Handwashing
Wash hands with plain soap or waterless antiseptic
agent (alcohol-based product) after touching blood,
body fluids, and contaminated items, whether or not
gloves are worn. Wash hands immediately after gloves
are removed, between patient contacts, and when
otherwise indicated. It may be necessary to wash
hands between tasks and procedures on the same
patient to prevent cross-contamination of different
body sites.

Hand Hygiene Products
Hand hygiene includes both using alcohol-based hand
hygiene products and washing with soap and water.
Alcohol-based hand hygiene products are preferred
over soap and water when hands are not visibly soiled.
Alcohol-based products are better in three ways:
• they kill the germs better
• they leave skin in better condition
• they are quicker and easier to use, so people use
them more
Use hand hygiene products only on dry hands. Use
enough of the product so that hands are dry again in
15 seconds, and rub hands together until they are
completely dry.

Handwashing
Hand washing should be done at all of the following
times:
• When hands are visibly dirty or are visibly soiled
with blood or other body fluids, wash hands with
soap and water
• If hands are not visibly soiled, use an alcohol-based
hand rub for routinely decontaminating hands in all
other clinical situations
• Before having direct contact with patients
• Before donning sterile gloves for any invasive
procedure
• After contact with a patient's intact skin (taking a
pulse or blood pressure, lifting a patient)

Handwashing (cont)
• After contact with body fluids or excretions, mucous
membranes, nonintact skin, and wound dressings
• If moving from a contaminated body site to a clean
body site
• After contact with contaminated items or
environments
• After removing gloves
• Before eating and after using a restroom, wash
hands with soap and water
• Wash hands with soap and water if exposure to
Bacillus anthracis (anthrax) is suspected or proven.
The physical action of washing and rinsing hands
under such circumstances is recommended because
alcohols, chlorhexidine, iodophors, and other
antiseptic agents have poor activity against spores.

CDC: No Acrylic Nails
The CDC Hand Hygiene Guideline specifies "Do not wear
artificial fingernails or extenders when having direct
contact with patients at high risk.“ Nails should be
unpolished and less than one-quarter inch long. Chipped
nail polish, long nails, artificial fingernails, or nail
extenders may tear gloves and can harbor pathogens,
even after careful handwashing or the use of surgical
scrubs. CMS endorses the CDC Hand Hygiene Guideline.
No artificial nails or extenders are permitted.
* The complete CDC Guidelines on hand hygiene may be
found at
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.
htm.
Source: CDC, 2006.

#2: Gloves
Wear clean gloves when touching blood, body fluids,
and contaminated items. Put on clean gloves just
before touching mucous membranes and non-intact
skin. Change gloves between tasks and procedures on
the same patient after contact with material that may
contain a high concentration of microorganisms.
Remove gloves promptly after use, before touching
non-contaminated items and environmental surfaces,
and before going to another patient, and wash hands
immediately.

#3: Mask, Eye
Protection, Face Shield
Wear a mask and eye protection or a face
shield to protect mucous membranes of the
eyes, nose, and mouth during activities that
are likely to generate splashes or sprays of
blood or body fluids
(such as suctioning,
irrigation, or delivery
of the newborn).

#4: Gown
Wear a gown to protect skin and to prevent
soiling of clothing during activities that are
likely to generate splashes or sprays of blood
or body fluids. Select a gown that is
appropriate for the amount of fluid likely to
be encountered. Remove the soiled gown as
promptly as possible and wash hands .

# 5: Patient-care
Equipment
Handle used patient-care equipment soiled
with blood or body fluids in a manner that
prevents skin and mucous membrane
exposures, contamination of clothing, and
transfer of microorganisms to other patients
and environments. Clean or reprocess
reusable equipment before using it for the
care of another patient. Ensure that single-
use items are discarded properly.

#6: Environmental
Control
Follow hospital procedures for the routine
care, cleaning, and disinfection of
environmental surfaces, beds, bedrails,
bedside equipment, and other frequently
touched surfaces.

#7: Linen
Handle, transport, and process used linen
soiled with blood or body fluids in a manner
that prevents skin and mucous membrane
exposures and contamination of clothing and
that avoids transfer of microorganisms to
other patients and environments.

#8: Sharps
Take care to prevent injuries when using or disposing
of needles, scalpels, and other sharp instruments or
devices. Never recap used needles using both hands or
use any other technique that involves directing the
point of a needle toward any part of the body. Do not
manipulate used needles by hand. Place used
disposable syringes and needles, scalpel blades, and
other sharp items in appropriate puncture-resistant
containers that are located as close as practical to the
area in which the items were used.

#9: Ventilation Devices
Use mouthpieces, resuscitation bags, or other
ventilation devices as an alternative to
mouth-to-mouth resuscitation methods in
areas where the need for resuscitation is
predictable.

#10: Patient Placement
Place a patient who contaminates the environment or
who does not assist in maintaining appropriate hygiene
(children, patients with altered mental status) in a
private room. If a private room is not available, consult
with infection control professionals regarding patient
placement or other alternatives. If it is necessary for
an infected patient to share a room with a noninfected
patient, it is important that roommates are selected
carefully and that patients, personnel, and visitors take
precautions to prevent the spread of infection.

Transmission Based
Precautions
In addition to Standard Precautions, which
are used with all patients, some patients
require additional precautions, known as
Transmission-Based Precautions. There are
three types of transmission-based
precautions:
• contact
• droplet
• airborne

Contact Precautions
Contact Precautions are designed to minimize
transmission of organisms that are easily
spread by contact with hands or objects. The
following five actions are recommended
when caring for patients with contact
isolation.

Contact Precaution #1:
Patient Placement
Place the patient in a private room. When a
private room is not available, place the patient
in a room with a patient(s) who has active
infection with the same microorganism but with
no other infection (cohorting ). Consultation
with infection control professionals is advised
before cohorting.

Gloves and Handwashing
In addition to wearing gloves, as outlined under
Standard Precautions, wear gloves when entering
the room. Change gloves after contact with
infective material that may contain high
concentrations of microorganisms, such as fecal
material or wound drainage. Do not soil the
environment with used gloves. Remove gloves
before leaving the patient's room and wash hands
immediately. After glove removal and
handwashing, ensure that hands do not touch
potentially contaminated environmental surfaces
or items in the patient's room.

Gown
Wear a gown when entering the room if you
anticipate that your clothing will have
substantial contact with the patient,
environmental surfaces, or items in the
patient's room, or if the patient is incontinent
or has diarrhea, an ileostomy, a colostomy, or
wound drainage not contained by a dressing.
Remove the gown before leaving the patient's
environment. After gown removal, ensure
that clothing does not contact potentially
contaminated environmental surfaces.

Patient Transport
• Appropriate barriers (eg, masks, impervious
dressings) should be worn or used by the patient to
reduce transmission of infection to other patients,
personnel, and visitors, and to avoid contamination
of the environment.
• Personnel in the area to which the patient is to be
taken should be notified of the impending arrival of
the patient and precautions to be used to reduce the
risk of transmission.
• Patients are informed of ways in which they can
assist in preventing the transmission of their
infection to others.

Patient-care Equipment
When possible, dedicate the use of non-
critical patient-care equipment (stethoscope,
BP cuff, thermometer, etc.) to a single patient
or cohort of patients to avoid sharing among
patients. Clean and disinfect any equipment
that must be brought out of the room before
use with others.

Airborne Precautions
Airborne Precautions are designed to prevent
transmission of diseases spread by the true airborne
route. These organisms are released from the patient
in respiratory droplets, which evaporate shortly after
release. Most organisms die when they dry out, but the
organisms of these few diseases—tuberculosis,
chickenpox, measles, SARS, and smallpox—can survive
drying out. The droplet nuclei (small-particle residue of
evaporated droplets) remain suspended in the air and
can be dispersed widely by air currents within a room
or even over a long distance. Airborne Precautions are
the only type that requires a negative-pressure room
with door kept closed and use of an N-95 respirator.

Recommendations
The following three precautions are
recommended when caring for patients with
contact isolation:
1. Patient Placement
2. Respiratory Protection
3. Patient Transport

Airborne Precaution #1:
Patient Placement
Place the patient in a designated negative
pressure room. Keep the room door closed
and the patient in the room, as feasible.

Respiratory Protection
Wear an N95 respirator when entering the room
of a patient with known or suspected infectious
pulmonary tuberculosis. Susceptible persons
should not enter the room of patients known or
suspected to have measles or chickenpox if
immune caregivers are available. If susceptible
persons must enter the room of a patient
with measles or chickenpox, they should wear an
N95 respirator. Persons immune to measles or
chickenpox do not need to wear respiratory
protection.

N-95 Respirators
N-95 respirators are required for staff sharing
air space with the patient in Airborne
Precautions. They must make a tight seal
against the face, and must be fit tested. This
type of respirator protects the person wearing
it from possible pathogens in the air of the
room, protecting their portal of entry. Some
N-95 respirators have an exhalation valve,
and these do not prevent contamination of a
sterile field and so should not be worn alone
in the OR.

Patient Transport
Limit the movement and transport of the
patient from the room to essential purposes
only. If transport or movement is necessary,
place a surgical mask on the patient, if
possible. Notify the receiving department of
precautions prior to transport.
* A complete description of Airborne Precautions may
be found at
http://www.cdc.gov/ncidod/dhqp/gl_isolation_airborne.html.
Source: CDC, 2006.

Respiratory Hygiene
Respiratory Hygiene is a relatively new concept, which
recommends use of Droplet Precautions by healthcare
workers when providing care to any patient with
symptoms of respiratory infection, such as coughing.
In addition, signs are posted asking patients to cover
their nose and mouth with a tissue when coughing or
sneezing or to wear a surgical mask. Patients are also
asked to perform hand hygiene after contact with
their own secretions.
Complete details on Respiratory Hygiene may be found at
http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.
htm.

Engineering Controls
Engineering controls include equipment, devices or
instruments that remove or isolate (contain) a hazard.
For example, the puncture-resistant containers
required by Standard Precautions for the disposal and
transport of needles and other sharps are an
engineering control. Splatter shields on medical
equipment associated with risk-prone
procedures, such as locking centrifuge
lids, isolate or contain the hazard.
Hand hygiene is also an
engineering control, since it
removes the microorganisms
from the workplace.

Engineering Control of
Airborne Infections
Engineering controls used to prevent
transmission of airborne infections include:
 Isolation rooms with appropriate air exchanges
(negative pressure or direct exhaust)
 HEPA filtration
 Ultraviolet irradiation

Sharps Safety
Safety sharps devices and containers are another type
of engineering control, since they isolate or contain the
hazard—used sharps. OSHA requires the use of safety
sharps when feasible. Healthcare workers may be
exposed percutaneously (through the skin) by sharps
or needle sticks to HIV, hepatitis B and C, and other
bloodborne pathogens. When using a safety sharp
device, be sure to activate the safety feature before
discarding. The stick you prevent may be your own!

Specific Practices to Avoid
Exposure and Injury
• Avoiding unnecessary use of needles and other sharps
• Using care in the handling and disposal of needles and
other sharps
• Not recapping unless absolutely medically necessary and
then using one-hand technique or safety device to recap
• Passing sharp instruments by use of designated "safe
zones"
• Disassembling sharp equipment by using forceps or other
devices
• Closing and replacing sharps containers when they are full
(rather than overfilling) according to the manufacturer's
instructions

Exposure Incident
If you experience a needle stick or other sharps injury or
are exposed to the blood or other body fluids of a patient
during the course of your work, immediately follow these
steps:
• Wash needle sticks and cuts with soap and water.
• Flush splashes to the nose, mouth, or skin with water.
• If your eyes were involved in the exposure, irrigate your
eyes with clean water, saline, or sterile irrigation solution.
• Report the incident to a supervisor—including how, when,
where, and who, describing the events in as much detail
as possible.
• Immediately seek medical treatment.
• Notify CMS as soon as possible (410-321-4267) and
complete a CMS Incident Sheet

Work Practice Controls
Work practice controls are modifications in
technique that reduce or eliminate the
likelihood of exposure by altering the manner
in which a task is performed. These are the
workplace procedures that tell you how to do
the job safely.

Work Practice
Recommendations
Work practices recommendations include:
• proper and timely hand washing
• spraying of any potentially infectious material
• proper decontamination and sterilization of equipment
and supplies
• cleanup, care, and maintenance of supplies and
equipment
• no eating, drinking, smoking, applying cosmetics or lip
balm, or handling contact lenses where there is a risk
of contamination minimize splashing
• proper disposal of used supplies and equipment
• keeping all food and drink away from areas where
blood or potentially infectious materials are present.

Environmental Control
Measures
Environmental control measures also help
prevent the transmission of infection. These
measures include:
• Environmental cleaning (housekeeping)
• Waste management
• Linens (textiles) and laundry management

Personal protective
equipment (PPE)
PPE is specialized clothing or equipment worn
by a healthcare worker for protection against
a hazard. OSHA guidelines state that PPE will
be considered "appropriate" only if it does
not permit blood or other potentially
infectious materials to pass through or reach
the employee's work clothes, street clothes,
undergarments, skin, eyes, mouth, or other
mucous membranes under normal conditions
of use and for the duration of time which the
protective equipment will be used.

PPE
Personal protective equipment includes:
 gloves
 cover garb (gowns, aprons, fluid-resistant
laboratory coats, foot covers)
 face shields
 masks
 eye protection
 caps and hoods

Use of PPE
Use of PPE is built into the descriptions of all
four kinds of isolation precautions (Standard,
Contact, Droplet, and Airborne) described by
the CDC. Use appropriate barriers and/or PPE
whenever you may have contact with the
blood or body fluids of any patient and to
prevent exposure to the droplets of patients
with respiratory symptoms.

Barriers and PPE
Barriers and PPE are most effective when
appropriately selected, properly fitted, worn
according to manufacturer's instructions,
inspected frequently to verify integrity of the
barrier and changed between patients. The
cost of barriers and PPE are far less than the
cost of treating preventable infections of
patients and personnel.

Types of PPE Selected
The type of PPE selected should be based on
the procedure and reasonably anticipated
events such as:
 blood or body fluid splash
 contact with minimal bleeding/drainage/body
substance
 contact with large volume
bleeding/drainage/body substance that is likely
to soak through the contact area
 respiratory droplet pathogens
 airborne pathogens

Prevention of Infectious or
Communicable Diseases in
Healthcare workers.
Protecting health care workers from disease
is accomplished in many ways, including:
• use of Standard Precautions with all patients
• use of additional isolation precautions to protect
HCWs as well as patients
• influenza vaccine

Conclusion
You have a professional responsibility to
yourself and to your patients regarding
infection control. It takes diligence and effort
on your part to follow the recommendations
of the CDC to maintain safe clinical
practices and reduce occupational hazards.

Infection Control

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