Infection Control and Prevention

Isolation precautions are used to reduce transmission of microorganisms in healthcare and

residential settings. These measures are designed to protect patients/residents, staff, and visitors
from contact with infectious agents. There are two categories of isolation precautions: Standard
Precautions and Transmission-Based Precautions.

STANDARD PRECAUTIONS

Standard precautions are a set of infection control practices used to prevent transmission of
diseases that can be acquired by contact with blood, body fluids, non-intact skin (including
rashes), and mucous membranes. These measures are to be used when providing care to all
individuals, whether or not they appear infectious or symptomatic.  Standard precautions are
the basic level of infection control that should be used in the care of all patients all of the
time.

Hand Hygiene

Hand hygiene refers to both washing with plain or anti-bacterial soap and water and to the use of
alcohol gel to decontaminate hands. When hands are not visibly soiled, alcohol gel is the
preferred method of hand hygiene when providing health care to patients.

Hand hygiene should be performed before and after contact with a patient, immediately after
touching blood, body fluids, non-intact skin, mucous membranes, or contaminated items (even
when gloves are worn during contact), immediately after removing gloves, when moving from
contaminated body sites to clean body sites during patient care, after touching objects and
medical equipment in the immediate patient-care vicinity, before eating, after using the restroom,
and after coughing or sneezing into a tissue as part of respiratory hygiene.

Personal Protective Equipment (PPE)

PPE includes items such as gloves, gowns, masks, respirators, and eyewear used to create
barriers that protect skin, clothing, mucous membranes, and the respiratory tract from infectious
agents. PPE is used as a last resort when work practices and engineering controls alone cannot
eliminate worker exposure. The items selected for use depend on the type of interaction a public
health worker will have with a patient and the likely modes of disease transmission.

Wear gloves when touching blood, body fluids, non-intact skin, mucous membranes, and
contaminated items. Gloves must always be worn during activities involving vascular access,
such as performing phlebotomies.

Wear a surgical mask and goggles or face shield if there is a reasonable chance that a splash or
spray of blood or body fluids may occur to the eyes, mouth, or nose.

Wear a gown if skin or clothing is likely to be exposed to blood or body fluids.

Remove PPE immediately after use and wash hands. It is important to remove PPE in the proper
order to prevent contamination of skin or clothing.

Needle Stick and Sharps Injury Prevention

Safe handling of needles and other sharp devices are components of standard precautions that are
implemented to prevent health care worker exposure to blood-borne pathogens.

 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 biohazard
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.

Cleaning and Disinfection

Patient care areas, common waiting areas, and other areas where patients may have potentially
contaminated surfaces or objects that are frequently touched by staff and patients (doorknobs,
sinks, toilets, other surfaces and items in close proximity to patients) should be cleaned routinely
with 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.

Respiratory Hygiene (Cough Etiquette)

Patients in waiting rooms or other common areas can spread infections to others in the same area
or to health care 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.
 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 patients with signs and symptoms of respiratory illness to wear a surgical mask
while waiting in 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.

Waste Disposal

Sharp items should be disposed of in containers that are puncture resistant, leak-proof, closable,
and labeled with the biohazard symbol or are red in color. Sharps containers should be replaced
when filled up to the indicated “full” line. Syringes or blood collection tube holders attached to
needles must also be discarded still attached to the needles.
Safe Injection Practices

All health care personnel who give injections should strictly adhere to the Safe Injection
Practices which include:

 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 patient
 Using medication vials for one patient only, whenever possible

TRANSMISSION-BASED PRECAUTIONS

There are three types of transmission-based precautions: contact precautions (for diseases spread
by direct or indirect contact), droplet precautions (for diseases spread by large particles in the
air), and airborne precautions (for diseases spread by small particles in the air). Each type of
precautions has some unique prevention steps that should be taken, but all have standard
precautions as their foundation.

Contact Precautions

 Used for patients/residents that have an infection that can be spread by contact with the
person’s skin, mucous membranes, feces, vomit, urine, wound drainage, or other body
fluids, or by contact with equipment or environmental surfaces that may be contaminated
by the patient/resident or by his/her secretions and excretions.
 Examples of infections/conditions that require contact precautions: Salmonella, scabies,
Shigella, and pressure ulcers.
 In addition to standard precautions:
o Wear a gown and gloves upon room entry of a patient/resident on contact
precautions.
o Use disposable single-use or patient/resident-dedicated noncritical care equipment
(such as blood pressure cuffs and stethoscopes).
 For certain organisms likely to have spores (like Clostridium difficile) and some disease
with ongoing transmission (like Norovirus), “special” contact precautions are needed. In
addition to the measures above, perform hand hygiene using soap and water and consider
use of a hypochlorite solution (e.g., bleach) for environmental cleaning.

Droplet Precautions

 Used for patients/residents with an infection that can spread through close respiratory or
mucous membrane contact with respiratory secretions.
 Examples of infections/conditions that require droplet precautions: influenza, N.
meningitidis, pertussis and rhinovirus (also known as the “common cold”).
  In addition to standard precautions:
o Wear a mask upon room entry of a patient/resident on droplet precautions.
 A single patient/resident room is preferred. If not available, spatial separation of more than
3 feet and drawing the curtain between beds is especially important.
 Patients/residents on droplet precautions who must be transported outside of the room
should wear a mask if tolerated and follow respiratory hygiene/cough etiquette.

Airborne Precautions

 Used for patients/residents with an infection that can spread over long distances when
suspended in the air. These disease particles are very small and require special respiratory
protection and room ventilation.
 Examples of infections/conditions that require airborne precautions: chickenpox, measles,
and tuberculosis.
 In addition to standard precautions:
o Wear a mask or respirator prior to room entry, depending on the disease-
specific recommendations.
o Place patient/resident in an airborne infection isolation room – a single-person
room that is equipped with special air handing and ventilation capacity. If the
facility does not have such room, place the patient in a private room with the door
closed.
 When possible, non-immune healthcare workers should not care for patients/residents with
vaccine preventable airborne diseases (like measles and chickenpox).
 Levels of Biohazard
The United States’ Centers for Disease Control and Prevention (CDC) categorizes various
diseases in levels of biohazard, Level 1 being minimum risk and Level 4 being extreme risk.
Laboratories and other facilities are categorized as BSL (Biosafety Level) 1-4 or as P1 through
P4 for short (Pathogen or Protection Level).

 Biohazard Level 1: Bacteria and viruses including Bacillus subtilis, Escherichia coli,
varicella (chicken pox), as well as some cell cultures and non-infectious bacteria. At this
level precautions against the biohazardous materials in question are minimal, most likely
involving gloves and some sort of facial protection.

 Biohazard Level 2: Bacteria and viruses that cause only mild disease to humans, or are
difficult to contract via aerosol in a lab setting, such as hepatitis A, B, and C, influenza A,
salmonella, mumps, measles, dengue fever. "Routine diagnostic work with clinical
specimens can be done safely at Biosafety Level 2.

 Biohazard Level 3: Bacteria and viruses that can cause severe to fatal disease in humans,
but for which vaccines or other treatments exist, such as anthrax, tuberculosis, typhus, HIV,
yellow fever, and malaria. Among parasites Plasmodium falciparum, which causes
Malaria, also comes under this level.

 Biohazard Level 4: Viruses and bacteria that cause severe to fatal disease in humans, and
for which vaccines or other treatments are not available, such as Marburg virus, Ebola
virus, hantaviruses, Lassa fever virus, Crimean–Congo hemorrhagic fever, and other
hemorrhagic diseases. Variola virus (smallpox) is an agent that is worked with at BSL-4
despite the existence of a vaccine. When dealing with biological hazards at this level the
use of a positive pressure personnel suit, with a segregated air supply, is mandatory. The
entrance and exit of a Level Four biolab will contain multiple showers, a vacuum room, an
ultraviolet light room, autonomous detection system, and other safety precautions designed
to destroy all traces of the biohazard. Multiple airlocks are employed and are electronically
secured to prevent both doors opening at the same time. All air and water service going to
and coming from a Biosafety Level 4 (P4) lab will undergo similar decontamination
procedures to eliminate the possibility of an accidental release.