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Understanding the chain of infection


reduction in risk of respiratory infection after hand washing6


amount of alcohol concentration in hand rubs as recommended by the CDC

20 sec.

at least for lathering when washing hands

Hand hygiene is key in reducing the transmission of infectious agents in the healthcare setting and is an essential element of standard precautions. Soap and water should be used when hands are visibly soiled with blood or bodily fluids, but in all other clinical situations, alcohol-based hand rub is preferred1. The CDC recommends washing hands with non-antimicrobial soap between the majority of patient contacts and washing with antimicrobial soap before and after performing invasive procedures or caring for patients at high risk. You should practice hand hygiene whenever hands are visibly dirty or contaminated and before contact with patients or performing an aseptic technique. Hand hygiene should be practiced after contact with patients, blood or bodily fluids, contact with objects in the immediate vicinity of the patient, when removing personal protective equipment (PPE) or moving from contaminated body site to clean body site.

PPE refers to a variety of barriers and respirators used alone or in combination to protect mucous membranes, airways, skin and clothing from contact with infectious agents. COVID-19 has changed the thinking about PPE estimation, usage and preparedness. Tools like the CDC’s PPE calculator can help you plan ahead for your inventory needs.

Gloves reduce hand contamination by 70-80%, preventing cross-contamination and helping ensure that you, your staff and your patients are protected from infection.5

  • Exam gloves: Generally less tight-fitting for easy donning and removal, come in fewer sizes and can be worn on either hand
  • Surgical gloves: Typically, surgical gloves are sterile, packaged in pairs and “handed” with left and right gloves in each pair. They can be made of many materials, including nitrile, neoprene, polyisoprene and latex. They come in many sizes and surgeons sometimes double-glove for extra protection from viral contamination or in procedures that involve heavy instruments, like orthopedics

Exam gloves

Surgical and isolation, or procedure, gowns are used to protect the healthcare workers’ arms and exposed body areas and prevent contamination of clothing with blood, body fluids and other potentially infectious material. If fluid penetration is likely, a fluid-resistant gown should be used. Gowns are rated according to their AAMI level, which indicates how a gown performs against a series of barrier performance criteria and ranges from 1 to 4, with level 4 providing the highest barrier to fluids and microorganisms. Most isolation gowns used in post-acute care fall into AAMI 1 or 2. AAMI levels are used in both surgical and procedure gowns.7 The highest barrier protection is in the primary “critical zones” of the gown, in the front and on the sleeves, where direct contact with blood, body fluids and other infectious material is likely to occur. Higher-level gowns have larger critical zones and the sleeves and seams are fully sealed, not sewn, to prevent fluid penetration.

AAMI Levels

AAMI level 1

Minimal risk: used during basic care, standard isolation, cover gown for visitors or in a standard medical unit

AAMI level 2

Low risk: used during blood draw, suturing, in the intensive care unit (ICU) or a pathology lab; may be appropriate for minimally-invasive or in-office procedures where fluid impact is expected to be low

AAMI level 3

Moderate risk: used for a wide range of surgeries where risk is moderate, including during arterial blood draw, inserting an intravenous (IV) line, in the emergency room or for trauma cases

AAMI level 4

High risk: used during long, fluid intense procedures, surgery, when pathogen resistance is needed or when infectious diseases are suspected (non-airborne)

Masks are used for three primary purposes in healthcare settings; to protect from contact with infectious material from patients, to protect from infectious agents and to limit potential dissemination of infectious respiratory secretions.
Industry-standard American Society for Testing and Materials (ASTM) test methods are used to measure mask performance. To carry an ASTM rating, the National Institute for Occupational Safety and Health (NIOSH) requires that masks be tested for fluid resistance, flame resistance, particulate filtration, bacterial filtration and breathability.
A mask may be rated ASTM level 1, 2 or 3, with the highest performance rated level 3. But note that not all masks in the marketplace are ASTM-rated.

Procedure Mask

Used for performing patient procedures, or when patients are in isolation, to protect them from potential contaminants. Procedure masks are used for “respiratory etiquette” to prevent people from spreading germs via talking, coughing or sneezing and have ear loops for quick donning and can be worn without a surgical cap.

Surgical Masks

Used inside the operating room or during other sterile procedure areas, these types of masks help protect the patient environment from contamination. They also help protect the clinician from contaminated fluid or debris generated during the procedure. Surgical masks have ties so they can be adjusted for fit and are tied over top of a surgical or bouffant cap.


Worn on the face or head and covering at least the nose and mouth, a respirator is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including infectious agents), gases or vapors. Respirators, including those intended for use in healthcare settings, are certified by the CDC or NIOSH.

There are seven classes of filters for NIOSH-approved filtering face-piece respirators (FFR). Ninety-five percent is the minimal level of filtration that will be approved by NIOSH. The most-used respirators in healthcare settings are the N95, N99 or N100 particulate respirators. A surgical N95 (also referred to as a medical respirator) is recommended only for use by healthcare personnel (HCP) who need protection from both airborne and fluid hazards (e.g., splashes, sprays), such as in operative or procedural settings. Respirator users should perform a user seal check to ensure proper fit each time a respirator is used. Workers must pass a fit test to confirm a proper seal before using a respirator in the workplace.


Filters at least 95% of airborne particles; not resistant to oil


Filters at least 99% of airborne particles; not resistant to oil


Filters at least 99.97% of airborne particles; not resistant to oil


Our clinical resource team is here to help

6: Centers for Disease Control and Prevention, Guide to Infection Prevention for Outpatient Settings

Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.

The product information contained in this document, including the product images and additional product materials, was collected from various supplier sources. All product claims and specifications are those of the product suppliers and have not been independently verified by McKesson Medical-Surgical or its affiliates (“McKesson”). McKesson is not responsible for errors or omissions in the product information. The properties of a product may change or be inaccurate following the posting or printing of the product information in the document, either in the print or online version. Caution should be exercised when using or purchasing any products from McKesson’s online or print documents by closely examining the product packaging and the labeling prior to use. Due to product changes, information listed in this document is subject to change without notice. This information is placed solely for your convenience in ordering and McKesson disclaims all responsibility for its completeness and accuracy, whether or not the inaccuracy or incompleteness is due to fault or error by McKesson.

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