GENERAL

INFECTION
CONTROL
 Hand Hygiene
• Proper hand hygiene is the most effective way to prevent
the spread of infection.
Hand
Hygiene
To properly wash and clean hands, the following procedure
should be followed:
• Wash hands when they are visibly dirty or soiled
with blood or other body fluids.
• Wash hands with either a non-antimicrobial soap or
an antimicrobial soap and water.
• When washing hands with soap and water, wet
hands first with water, apply to hands the amount of
product recommended by the manufacturer, and rub
hands together vigorously for at least 15 seconds,
covering all surfaces of the hands and fingers.
Hand
Hygiene
To properly wash and clean hands, the following procedure
should be followed:
• If hands are not visibly soiled, an alcohol-based hand
rub or gel may be used in place of soap and water in
most circumstances. When using an alcohol-based hand
rub or gel, apply product to the palm of one hand and
rub hands together, covering all surfaces of hands and
fingers, until the hands are dry.
• Avoid wearing artificial fingernails when caring for
patients at high risk for infection, and keep natural nail
tips less than 1/4-inch long.
Hand
Hygiene
To properly wash and clean hands, the following procedure
should be followed:
• Wear gloves when contact with blood or other
potentially infectious materials, mucous membranes,
and non-intact skin could occur.
• Remove gloves after caring for a patient. Always
perform hand hygiene after removing gloves. Do not
wear the same pair of gloves for the care of more than
one patient, and do not wash gloves between uses with
different patients.
• Change gloves during patient care if moving from a
contaminated body site to a clean body site.
 Standard Precaution
• Designed to prevent the transmission of infectious
agents.
• It requires the use of work practice controls and
protective
apparel for all contact with blood and body substances,
but uses Airborne Infection Isolation, Droplet, and
Contact Precautions for patients with diseases known to
be transmitted in whole or in part by those routes.
 GLOVES
Wear gloves (clean, nonsterile gloves are adequate) when
touching blood, body fluids, secretions, excretions, or
contaminated items.
Put on clean gloves just before touching mucous membranes and
non-intact skin. Change gloves between tasks and procedures.
Practice hand hygiene whenever gloves are removed.
 Hand Hygiene
Practice hand hygiene after touching blood, body fluids,
secretions, excretions, or contaminated items, whether or
not gloves are worn. Wash hands immediately after gloves
are removed, between patient contacts, and when
otherwise
indicated to avoid transfer of microorganisms to other
patients or environments.
 MASK, EYE
PROTECTION/FACE
SHIELD
Wear a mask and adequate eye protection (eyeglasses are
not acceptable), or a face shield to protect mucous
membranes of the eyes, nose, and mouth during procedures
and patient care activities that are likely to generate
splashes or sprays of blood, body fluids, secretions, or
excretions.
 GOWN
to protect skin and to prevent soiling of clothing
during procedures and patient care activities that
are likely to generate splashes or sprays of blood,
body fluids, secretions or excretions. Carefully,
remove a soiled gown as promptly as possible, to
avoid contamination of personal clothing, and
wash hands
 Patient care equipment
Handle used patient care equipment soiled with blood,
body fluids, secretions, or excretions in a manner that
prevents skin and mucous membrane exposures,
contamination of clothing, and transfer of microorganisms
to one’s self, other patients and the environment. Ensure
that reusable equipment is not used for the care of another
patient until it has been cleaned and sanitized
appropriately. Ensure that single-use items are discarded
properly.
 Contact
Precautions
-used for the care of patients known or suspected to have
illnesses that could be spread by usual contact with an infected
person, or by the contaminated environmental surfaces or
patient care items in the room.
Example of diseases/organisms requiring
Contact Precautions include:
• Severe Acute Respiratory Syndrome (SARS)
• Parainfluenza virus
• Respiratory syncytial virus
• Varicella (chickenpox)
• Herpes Zoster (disseminated or in the
immunocompromised host)
 Gown
Wear a gown when entering the room.
Remove the gown before leaving the
patient’s environment. After gown removal,
ensure that clothing does not contact
potentially contaminated environmental
surfaces. Wash hands.
 Patient
Limit theTransport
movement of the patient from the
room to essential purposes only. During
transport, ensure that all precautions are
maintained.
 PATIENT CARE
EQUIPMENT
When possible, dedicate the use of noncritical
patient care equipment to a single patient (or
cohort of patients infected or colonized with
the pathogen requiring precautions) to avoid
sharing between patients. If use of common
equipment or items is unavoidable, then
adequately clean and disinfect them before
use for another patient.
PATIENT PLACEMENT
Place(PRIVATE
the patient in a ROOM)
private room. If a
private room is not available, place the patient
in a room with other patients with the same
illness (cohorting).
 CONTACT
PRECAUTIONS
• Gloves, gown and hand hygiene.
- Wear glovesINCLUDE::
when entering the room. During the
course of providing care for a patient, change gloves
after having contact with infective material.
- Wear gown to protect clothing if contact with body
fluids is anticipated.
- Remove gloves and gown before leaving the patient’s
room and practice hand hygiene immediately with an
antimicrobial agent or a waterless antiseptic agent.
After glove removal and hand hygiene, ensure that
hands do not touch potentially contaminated surfaces
or items in the patient’s room.
 Droplet Precautions
In addition to Standard Precautions, use Droplet
Precautions for a patient known or suspected to be infected
with microorganisms transmitted by droplets (large-particle,
wet droplets [larger than 5µm in size]) that can be generated
by the patient during:
1. Coughing
2. sneezing
3. talking
4. performance of procedures
Examples of
diseases/organisms
requiring Droplet
• Invasive Hemophilus influenzae disease: meningitis,
Precautions include:
pneumonia (in infants and small children), epiglottitis
• Invasive Neisseria meningitidis disease: meningitis,
pneumonia, and bacteremia
• Mycoplasma pneumonia
• Group A streptococcal pneumonia, pharnygitis, or
scarlet fever in infants and young children
• Influenza
• Adenovirus: Also requires Contact Precautions
• Parvovirus B19
 Droplet
Precautions
1. Patient placement
2. Mask
3. Patient transport
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).
• When a private room is not available and
cohorting is not achievable, maintain spatial
separation of at least three feet between the
infected patient and other patients and visitors.
• Special air handling and ventilation are not
necessary, and the door may remain open.
2. MASK
Wear a mask or respirator when working within three feet
of the patient. (Hospitals may want to implement the
wearing of a mask to enter the room.)
3. Patient Transport
• Limit the movement and transport of the patient from
the room toessential purposes only.
• If transport or movement is necessary, minimize
patient dispersal of droplets by masking the patient, if
possible.
 Respiratory
Hygiene/Cough
Etiquette
Measures that can be taken to decrease the risk of spreading
respiratory pathogens
STRATEGIES
• Place signs at the entrances of all outpatient facilities
requesting that patients and visitors inform healthcare
personnel of respiratory symptoms upon registration.
• Provide masks (e.g., surgical) for all patients presenting
with respiratory symptoms (especially cough) and
provide instructions on the proper use and disposal of
masks.
• If a patient cannot wear a mask, provide tissues and
instructions on when to use them (i.e., when coughing,
sneezing or controlling nasal secretions), how and where
to dispose of them, and the importance of hand hygiene
after handling this material (cough etiquette).
• Provide hand hygiene materials in waiting room areas
and encourage patients with respiratory symptoms to
wash their hands.
• If possible, designate an area in waiting rooms where
patients with respiratory symptoms can be segregated
(ideally by more than three feet) from other patients
without respiratory symptoms.
• Place patients with respiratory symptoms in a private
room or cubicle as soon as possible for further
evaluation.
• Healthcare workers evaluating patients with
respiratory symptoms should wear a surgical or
procedure mask.
• Consider the installation of Plexiglas barriers at
the point of triage or registration to protect
healthcare workers.
• If a physical barrier is not possible, instruct
registration and triage staff to remain at least
three feet from unmasked patients. Staff should
consider wearing a surgical mask during
registration and triage.
• Continue to use Droplet Precautions to manage
patients with respiratory symptoms until it is
determined that the cause of symptoms is not an
infectious agent that requires precautions beyond
Standard Precautions.
 Airborne Infection
Isolation
• designed to reduce the risk of transmission of
infectious agents that may be suspended in the air in
either small particle aerosols or dust particles.
• Patients requiring Airborne Infection Isolation must
be given a private room with special air handling and
ventilation (negative pressure).
• Respiratory protection for healthcare workers is
necessary when entering the patient’s room.
Examples of
diseases/organisms requiring
Airborne Infection Isolation
include
• SARS
• Tuberculosis (pulmonary or laryngeal, suspected or
confirmed)
• Varicella: Also requires Contact Precautions
• Herpes Zoster (shingles) in an immunocompromised
patient: Also requires Contact Precautions
• Measles (rubeola)
Airborne Infection Isolation
• Patient placement
• Respiratory protection
Patient Placement
• Airborne Infection Isolation requires a negative
pressure room in addition to a private room.
Keep the room door closed and the patient in the
room.
• When a private room is not available, place the
patient in a room with a patient who has active
infection with the same microorganism, but with
no other infection (cohorting).
Respiratory Protection
• Respiratory protection must be worn when entering the
room of a patient in Airborne Infection Isolation.
• A NIOSH -certified, fit-tested disposable N-95 respirator
mask is recommended for all persons entering the room,
including visitors.
• The use of higher-level respirators may be considered
for certain procedures. If a particulate respirator with
filter efficiency of 95% or greater is not available, a
surgical mask should be worn. The mask should fit
tightly around the nose and mouth to protect against
large droplet transmission.
Respiratory
Hygiene/Cough Etiquette
“Respiratory hygiene”
– is a term that has been adopted by the Centers for
Disease Control and Prevention (CDC) and the Iowa
Department of Public Health (IDPH) to describe
measures that can be taken to decrease the risk of
spreading respiratory pathogens.
 Universal “Respiratory
Hygiene/
Cough Etiquette”
•
Strategies
Place signs at the entrances of all outpatient facilities
requesting that patients and visitors inform healthcare
personnel of respiratory symptoms upon registration.
• Provide masks (e.g., surgical) for all patients presenting
with respiratory symptoms (especially cough) and
provide instructions on the proper use and disposal of
masks.
• If a patient cannot wear a mask, provide tissues and
instructions on when to use them how and where to
dispose of them, and the importance of hand hygiene
after handling this material
• Provide hand hygiene materials in waiting room areas
and encourage patients with respiratory symptoms to
wash their hands.
• If possible, designate an area in waiting rooms where
patients with respiratory symptoms can be segregated
(ideally by more than three feet) from other patients
without respiratory symptoms.
• Place patients with respiratory symptoms in a private
room or cubicle as soon as possible for further
evaluation.
• Healthcare workers evaluating patients with
respiratory symptoms should wear a surgical or
procedure mask.
• Consider the installation of Plexiglas barriers at the
point of triage or registration to protect healthcare
workers.
• If a physical barrier is not possible, instruct registration
and triage staff to remain at least three feet from
unmasked patients. Staff should consider wearing a
surgical mask during registration and triage.
• Continue to use Droplet Precautions to manage patients
with respiratory symptoms until it is determined that
the cause of symptoms is not an infectious agent that
requires precautions beyond Standard Precautions.