The basics of infection prevention and control Infection prevention and control involves implementing work practices that reduce the risk of transmission of infectious agents through a two-tiered approach:
• Standard Precautions
Routinely applying basic infection prevention and control strategies to minimise infection risks to both patients and healthcare workers.
• Transmission Based Precautions
Used in addition to standard precautions when managing patients suspected or known to be being infected with particular agents transmitted by the contact, droplet or airborne routes.
Standard precautions are a set of basic infection prevention practices intended to prevent transmission of infectious diseases from one person to another. Because we do not always know if a person has an infectious disease, standard precautions are applied to every person every time to assure that transmission of disease does not occur. These precautions were formerly known as “universal precautions.”
Treating all patients in the health care facility with the same basic level of “standard” precautions involves work practices that are essential to provide a high level of protection to patients, health care workers and visitors.
Hands are the most common way in which micro-organisms, particularly bacteria, might be transported and subsequently cause infections, especially in those who are most susceptible to infection. Good hand hygiene is the most important practice in reducing transmission of infectious agents, including Healthcare Associated Infections (HCAI) during delivery of care.
cleaning hands with soap and water or an alcohol-based hand rub to prevent transmission of germs to others
- Hand washing (40–60 sec): wet hands and apply soap; rub all surfaces; rinse hands and dry thoroughly with a single use towel; use towel to turn off faucet.
- Hand rubbing (20–30 sec): apply enough product to cover all areas of the hands; rub hands until dry.
- Use soap and water instead of an alcohol-based hand rub in the following situations:
- When hands are visibly dirty, contaminated, or soiled
- After using the restroom
- Before eating or preparing food
- Before and after any direct patient contact and between patients, whether or not gloves are worn. Immediately after gloves are removed.
- Before handling an invasive device.
- After touching blood, body fluids, secretions, excretions, non-intact skin, and contaminated items, even if gloves are worn.
- During patient care, when moving from a contaminated to a clean body site of the patient.
- After contact with inanimate objects in the immediate vicinity of the patient.
Personal Protective Equipment (PPE)
The use of Personal Protective Equipment (PPE) is essential for health and safety. Selection of PPE must be based on an assessment of the risk of transmission of micro-organisms to the patient or to the carer, and the risk of contamination of the healthcare worker’s clothing and skin/mucous membranes by patients’ blood, body fluids, secretions and excretions.
The use of PPE is considered standard in certain situations and is one of the elements of Standard Infection Control Precautions (SICPs), which apply to contact with blood, body fluids, non-intact skin and mucous membranes. Everybody involved in providing care should be educated about SICPs, and trained in the use of PPE.
The benefit of wearing PPE is two-fold, offering protection to both patients/clients and those caring for them. For the purposes of this guideline, the PPE described, which might be used in general health and social care settings, includes:
- Face, mouth/eye protection, e.g. masks/goggles/visors
- Wear when touching blood, body fluids, secretions, excretions, mucous membranes, non-intact skin.
- Change between tasks and procedures on the same patient after contact with potentially infectious material.
- Remove after use, before touching non-contaminated items and surfaces, and before going to another patient. Perform hand hygiene immediately after removal.
Facial protection (eyes, nose, and mouth)
- Wear (1) a surgical or procedure mask and eye protection (eye visor, goggles) or (2) 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, body fluids, secretions, and excretions.
- Wear to protect skin and prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.
- Remove soiled gown as soon as possible, and perform hand hygiene.
Prevention of needle stick and injuries
Needle stick (or “sharps) injuries are one of the most common types of injury to be reported to Occupational Health Services by healthcare staff. The greatest occupational risk of transmission of a Blood Borne Virus (BBV) is through parenteral exposure e.g. a needle stick injury, particularly hollow bore needles.
The safety devices on needles and other sharps should be activated immediately after use.
- Used needles should be discarded immediately after use and not recapped, bent, cut, removed from the syringe or tube holder, or otherwise manipulated.
- Any used needles, lancets, or other contaminated sharps should be placed in a leak-proof, puncture-resistant sharps container that is either red in color or labeled with a bio-hazard label.
- Do not overfill sharps containers. Discard after 2/3 full or when contents are at the full line indicated on the containers.
- Used sharps containers may be taken to a collection facility such as an area pharmacy, hospital, or clinic that provides this service.
Respiratory hygiene and cough etiquette
Respiratory hygiene has been added to SICPs due the recent global influenza pandemic. Respiratory hygiene and cough etiquette should be applied as a standard infection control precaution at all times
Clients in waiting rooms or other common areas can spread infections to others in the same area or to local public health agency staff. Measures to avoid spread of respiratory secretions should be promoted to help prevent respiratory disease transmission. Elements of respiratory hygiene and cough etiquette include:
- Covering the nose/mouth with a tissue when coughing or sneezing or using the crook of the elbow to contain respiratory droplets.
- Place acute febrile respiratory symptomatic patients at least 1 metre (3 feet) away from others in common waiting areas, if possible.
- Post visual alerts at the entrance to health-care facilities instructing persons with respiratory symptoms to practice respiratory hygiene/cough etiquette.
- Consider making hand hygiene resources, tissues and masks available in common areas and areas used for the evaluation of patients with respiratory illnesses.
- Education of patients, families, visitors, and care providers about how respiratory infections are transmitted and how respiratory illness can be prevented. Ask family members, visitors, and care providers to stay home if they are sick.
- Use of posted signs with instructions and pictures about how to cover your cough and wash your hands.
- Availability and use of tissues when coughing and sneezing, and reminders to dispose of used tissues properly.
- Use of a mask for a person who is coughing.
- Physical separation of the person with a respiratory infection from others.
- Stressing hand hygiene after contact with respiratory secretions. This applies to the patient, family members, visitors, employees, and care providers.
- Using tissues to contain respiratory secretions and discarding in the nearest waste receptacle after use.
- Performing hand hygiene (hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic hand wash) immediately after contact with respiratory secretions and contaminated objects/materials.
- Asking clients with signs and symptoms of respiratory illness to wear a surgical mask while waiting common areas or placing them immediately in examination rooms or areas away from others. Provide tissues and no-touch receptacles for used tissue disposal.
- Spacing seating in waiting areas at least three feet apart to minimize close contact among persons in those areas.
- Supplies such as tissues, waste baskets, alcohol gel, and surgical masks should be provided in waiting and other common areas in local public health agencies. Place where the general public can see them.
The healthcare setting, in particular, contains a diverse population of microorganisms and this must be considered when caring for those who are susceptible to infection. Although potentially pathogenic microorganisms can be detected in air, water and on surfaces, determining their role in infection can be difficult. It must be considered that contamination of all patient/resident/client environments will occur and must, therefore, be controlled.
Client care areas, common waiting areas, and other areas where clients may have potentially contaminated surfaces or objects that are frequently touched by staff and clients (doorknobs, sinks, toilets, other surfaces and items in close proximity to clients) should be cleaned routinely with EPA registered disinfectants, following the manufacturers instructions for amount, dilution, and contact time.
- Housekeeping surfaces such as floors and walls do not need to be disinfected unless visibly soiled with blood or body fluids. They may be routinely cleaned with a detergent only or a detergent/disinfectant product.
- Most disinfectants are not effective in the presence of dirt and organic matter, therefore cleaning must occur first before disinfection. Wet a cloth with the disinfectant, wipe away dirt and organic material, then with a clean cloth apply the disinfectant to the item and allow to air dry for the time specified by the product manufacturer.
- Some pathogens such as norovirus and Clostridium difficile are not inactivated by commercial disinfectants routinely used in local public health settings. In situations where contamination with these pathogens is suspected, a bleach solution (1:10) is recommended for disinfecting contaminated surfaces and items.
- Some patient care items may be damaged or destroyed by certain disinfectants. Consult with the manufacturer of the items before applying disinfectants.
It has been shown that soiled fabric/linen within healthcare settings in particular, can harbour large numbers of potentially pathogenic microorganisms however it is not considered that uniforms are a serious source of infection. It is important to ensure that the appropriate precautions are taken to ensure that contamination to and from fabric/uniforms does not occur, as this might lead to the transmission of microorganism to people or the environment potentially causing infection. Everyone has an important part to play in improving patient/client safety. Undertaking SICPs are crucial elements in ensuring everyone’s safety. Main categories of linen applicable to this guideline are:
This refers to all used linen, irrespective of state, except linen from infectious (or isolated) patients/clients or those suspected of being infectious
This specifically applies to linen that has been used by a patient or client who is known or suspected to be carrying potentially pathogenic microorganisms. Normally a risk assessment will have been carried out and additional precautions put in place to prevent transmission of microorganisms and subsequent infection of others. Local infection control teams will give specific advice.
This term refers to linen contaminated with blood or other body fluids, e.g.faeces. This term is often used in practice and local policy will determine into which category the linen will be placed e.g. used or infected
Protection when handling used linen
- A disposable plastic apron should always be worn when handling used linen (and disposable gloves where linen is soiled/foul) e.g. during bed making. In some areas this can be a colour coded apron specifically for linen handling.
- Always hold used linen away from yourself to avoid contamination of clothing from linen
- Hand hygiene should be performed following handling of linen and removal of apron
- Further guidance for infected linen should be provided locally.
- Handle used linen in a manner that will prevent microorganism dispersal
- Wear PPE where appropriate when handling linen soiled with blood or body fluids.
- Prevents skin and mucous membrane exposures and contamination of clothing.
- Avoids transfer of pathogens to other patients and or the environment.
The safe disposal of all waste by those involved in the handling, transporting or processing of it is an essential part of health and safety and general good hygiene, and is covered by legislation.
By disposing of waste safely and appropriately it is intended that the risk of transmitting microorganisms , and potential infection, via this route will be avoided or minimised.
- Wear appropriate PPE when you anticipate contact with blood and/or body fluids.
- PPE includes gloves, fluid resistant gowns and/or aprons, eye protection, face shields and surgical masks.
- PPE must be changed between patients and/or when soiled. Safe use and disposal of sharps
- Handle sharps safely during and after procedures, when cleaning used instruments and during disposal of used sharps.
- Do not recap, bend or break used needles after use.
- The person who has used a sharp is responsible for its safe disposal.
- Discard used disposable sharps at the point of use into an approved sharps container.
- Never dispose of waste into an already full recepticle
- Bags should be no more than ¾ full. Sharps bins should be no more than ¾ full /past manufacturers fill line.
- Where patients can dispose of their own waste e.g tissues they should be encouraged to do so and provided with appropriate waste receptacles for this e.g leak proof.
- Ensure safe waste management.
- Treat waste contaminated with blood, body fluids, secretions and excretions as clinical waste, in accordance with local regulations.
- Human tissues and laboratory waste that is directly associated with specimen processing should also be treated as clinical waste.
- Discard single use items properly.
Patient care equipment
- Handle equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of pathogens to other patients or the environment.
- Clean, disinfect, and reprocess reusable equipment appropriately before use with another patient.
Aseptic non-touch technique
- Use aseptic technique to prevent micro-organisms being introduced into a susceptible site by hands, equipment and the environment.
Safe Injection Practice
- Use of a new needle and syringe every time a medication vial or IV bag is accessed
- Use of a new needle and syringe with each injection of a client
- Using medication vials for one client only, whenever possible
- Safe injection practices packet