In order to keep patients and coworkers safe, healthcare providers across care settings – from physicians and pharmacists to home health nurses – should follow infection prevention and control protocols with every patient and every time. This requires thorough infection control training and a safety-first culture among staff.
Here's a quick refresher on infection prevention and control for healthcare workers.
Focus on hand hygiene & cough etiquette
The Centers for Disease Control and Prevention (CDC) reports that healthcare providers clean their hands less than half the number of times recommended.1 And yet, hand washing is a simple and effective way to prevent infection and microbial colonization, indicating that there is a need for increased infection control training and awareness.
The CDC has identified alcohol-based hand sanitizers as preferable to handwashing for healthcare providers.2 That's because alcohol-based hand sanitizers have been shown to be the most effective at reducing germs on hands. However, the CDC continues to recommend soap and water handwashing in certain clinical situations such as:
- When hands are visibly dirty
- After caring for a patient with infectious diarrhea or suspected infectious diarrhea
- After possible or confirmed exposure to spores like C. difficile
Additionally, the recommendation is to wash hands with soap and water before eating and after using the toilet.
Use alcohol-based hand sanitizer in other routine patient care situations, including:
- Before touching a patient
- Before touching an invasive medical device or performing an aseptic task
- After completing work on a patient's soiled body site
- After touching a patient
- After contact with blood, body fluids, or contaminated surfaces
- After glove removal
If you cough or sneeze, be sure to cover your mouth and nose with a tissue and then use the nearest trashcan to dispose of it, followed by hand hygiene using a sanitizer. Perform hand hygiene after having contact with respiratory secretions and contaminated objects and materials, whether your own or a patient's.
Use personal protective equipment (PPE)
As a healthcare provider, it's important to understand how the CDC and the Occupational Safety and Health Administration (OSHA) work together to establish infection prevention guidance. In general, OSHA develops workplace regulations that require employers to protect their employees, and training on the use of personal protective equipment (PPE) is a requirement to prevent exposure to bloodborne and other infectious pathogens.
The CDC issues guidance regarding which PPE is preferable in specific circumstances.3 Recommended PPE during patient care includes some or all the following, depending on the specific risk and exposure:
- Sterile or non-sterile gloves
- Procedure gowns and or aprons
- Procedural or surgical masks or respirators
- Face shields and goggles
- Changing headcovers and shoe covers
Specific recommendations are offered for PPE selection based on the specific risk and exposure, as well as how to don and doff PPE correctly.4 In general, these principles apply to all patient care activities:
- Put on PPE before approaching or touching the patient
- Avoid contaminating PPE during use
- Remove and discard PPE carefully, being careful not to spread contaminants
- Immediately clean hands with alcohol-based hand sanitizer
Recommended PPE donning sequence:
- Perform hand hygiene using hand sanitizer
- Don isolation or procedure gown
- Place face mask or N95 respirator on face
- Put on face shield or goggles
- Don gloves covering the cuff of the gown to the sleeve
Recommended PPE doffing (removal) sequence:
- Remove gloves and then gown before exiting a patient's room and discard these items in an appropriate receptacle
- Perform hand hygiene prior to removal of face shield or goggles
- Remove respiratory protection
- Repeat hand hygiene
Use sharps, needles & syringes safely
The CDC reports that needles, syringes and sharps cause approximately 385,000 injuries each year among hospital-based healthcare workers, and many of these injuries are due to needlesticks.5
Occupational transmission of bloodborne diseases is the main risk from these types of injuries, with the top bloodborne diseases being transmitted with needlestick injuries including Hepatitis B and C and HIV.
OSHA regulations require healthcare facilities to implement an exposure control plan covering the following items:
- Engineering and work practice controls
- Providing staff with appropriate PPE and equipment
- Regular training
- Employee vaccinations for Hepatitis B
- Other required OSHA Bloodborne Pathogen Standards6
Annual review of new sharps technologies to reduce or eliminate needles and sharps Standard precautions call for the use of barrier PPE to help protect workers against sharps injuries, but that's only part of the prevention picture.7 Creating a safer workplace includes using a hierarchy of controls:
- Reduce or eliminate the use of needles or sharps where possible
- Isolate the hazard, for example, by using needle guards and other injury-prevention features
- Continue to focus on safe work practices and PPE
Follow safe injection practices
Unsafe injection practices are found all too often in a wide variety of healthcare environments, including home-based infusion settings.8 Some of the most important principles of safe injection include:
- Use proper hand hygiene immediately before preparing and administering medications
- Use aseptic techniques in a clean area for injection preparation
- Use a new needle for each patient
- Disinfect the vial top before each use
- Dedicate multi-use vials to a single patient whenever possible
- Use a new needle and a new syringe each time you enter a medication vial, even if the same patient will receive multiple doses
- Dedicate single-use medication vial, ampules and bags or bottles of IV solutions
- Provide each patient with their own tubing and connectors
Clean & disinfect surfaces properly
Just as with PPE selection, proper surface disinfection is essential as well as regular cleaning and disinfecting of surfaces.9 Choosing the appropriate surface disinfectant is dependent on surface type, frequency of contact with the surface, the type of contaminants and the level of disinfection required. Once selected, the product should be applied carefully following the manufacturer's "instructions for use" (IFU), normally located on the container label.
Cleaning refers to the removal of organic and inorganic soil. This is usually done using water and detergents or enzyme-based products. Surface cleaning is essential before an item is properly disinfected or sterilized.
Though the distinction is often overlooked, cleaning, sanitizing and disinfection are not one and the same. Sanitizing reduces the number of germs on a surface, while cleaning removes dirt, dust, and germs. Disinfecting, on the other hand, is the act of killing germs on surfaces with chemicals such as alcohol or bleach. However, for effectiveness, these products should often remain on a surface for a minimum period of time, often referred to as the "dwell time."
High-level disinfection will kill most microbes, except for bacterial spores. Intermediate-level disinfectants should kill mycobacteria, vegetative bacteria, most viruses, and most fungi. Low-level disinfectants kill most vegetative bacteria, some fungi, and some viruses.10
The CDC recommends that high-touch surfaces be cleaned at least once daily if there is low risk of disease transmission in your practice or community. However, even so, high traffic areas may require increased cleaning frequency.11 Remember to also wear PPE recommended by the product's manufacturer when using any cleaning, sanitizing, or disinfection chemicals and to perform hand hygiene when done.
Meanwhile, home infusion providers will routinely handle patient care items that run the gamut from critical, meaning the item carries a high risk of infection if contaminated with any microorganism, to noncritical, referring to items that come in contact with intact skin but not mucous membranes. Semi-critical items come in contact with both nonintact skin and mucous membranes.12
Be especially aware of items that can cause cross-contamination, including bed rails and patient furniture such as bedside tables – and clean and disinfect as needed.
Increase motivation to ensure compliance
Numerous studies have reported that infection is a leading cause of hospitalization among home healthcare patients. More than 17 percent of unplanned hospitalizations among home healthcare patients are estimated to be linked to these top infection sources:13
- Respiratory infections
- Urinary tract infections
- Intravenous catheter infections
- Wound infections
Infection control programs are essential for helping to minimize the risk of infection for patients and healthcare providers. While government guidelines and regulations provide a baseline for allowing employers to develop related policies and procedures, employers have the additional burden of providing their employees with the appropriate equipment, training and documentation, and ongoing evaluations to assess the effectiveness of their infection control programs and to make revisions and updates as necessary.
Government guidelines and regulations vary in their specifics but have important features in common. Healthcare infection control programs should include:
- Baseline assessment of current conditions
- Creation of infection control policies that comply with all applicable guidelines and regulations
- Regular and thorough infection control training for all healthcare providers
- Regular evaluation of infection control policies
When these elements are in place, healthcare employers begin to create a culture of safety. Healthcare providers who work in such a culture may find they are:
- Able to focus on improving hand hygiene compliance to protect patients and coworkers
- Encouraged to avoid infection control shortcuts
- Empowered to prioritize safe behaviors in themselves and others
- Able to give management feedback about infection control policies and training
- Comfortable asking for clarification when they encounter unexpected conditions
- Confident in their clinical abilities, yet humble about double-checking their infection control knowledge
- Aware that complacency about infection control can lead to safety lapses
Infection control is a complex discipline. Achieving optimal infection control compliance and employee training requires ongoing commitments from both institutions and individual healthcare providers across patient settings.
© 2021 McKesson Medical-Surgical Inc.
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.