In our most recent article, we discussed the topic of exposure to infectious waste and how to prevent issues that come alongside the disposal of infectious waste. Today, we are going to discuss proper infection control practices, which are once more being brought to the forefront of media attention. From January 1st through March 7th of 2019, we have 228 individual cases of measles that have been confirmed in 12 states, according to the Centers for Disease Control and Prevention (CDC). This ongoing dilemma prompts the reminder that proper infection control needs to be practiced in any facility that utilizes medical instruments or is involved in contact with bodily fluids. In this post we will discuss both:
How Infections Spread
The Two Levels of Recommended Infection Precautions
The CDC states that in order for an infection to occur, three things must be present:
Source: places where infectious agents (germs) live (e.g., sinks, surfaces, human skin)
Susceptible Person with a way for germs to enter the body
Transmission: a way germs are moved to the susceptible person
“For an infection to occur, germs must enter a susceptible person’s body and invade tissues, multiply, and cause a reaction.” Susceptible persons can be those who have not yet been vaccinated, as well as those with already-weakened immune systems. The CDC goes on to explain that in healthcare facilities, patients can become more susceptible to infection even while being treated. “Certain medications used to treat medical conditions, such as antibiotics, steroids, and certain cancer-fighting medications increase the risk of some types of infections. Lifesaving medical treatments and procedures used in healthcare such as urinary catheters, tubes, and surgery increase the risk of infection by providing additional ways that germs can enter the body.”
In regards to the transmission of germs from one person to another, the four main methods are contact, sprays and splashes, inhalation, and sharps injuries. These are defined by the CDC as such:
Contact moves germs by touch (example: MRSA or VRE). For example, healthcare providers' hands become contaminated by touching germs present on medical equipment or high-touch surfaces and then carry the germs on their hands and spread to a susceptible person when proper hand hygiene is not performed before touching the susceptible person.
Sprays and splashes occur when an infected person coughs or sneezes, creating droplets that carry germs short distances (within approximately 6 feet). These germs can land on a susceptible person’s eyes, nose, or mouth and can cause infection (for example pertussis or meningitis). Close-range inhalation occurs when a droplet containing germs is small enough to breathe in but not durable over distance.
Inhalation occurs when germs are aerosolized into tiny particles that survive on air currents over great distances and time and reach a susceptible person. Airborne transmission can occur when infected patients cough, talk, or sneeze germs into the air (example: TB or measles), or when germs are aerosolized by medical equipment or by dust from a construction zone (example: Nontuberculous mycobacteria or aspergillus).
Sharps injuries can lead to infections (for example HIV, HBV, HCV) when bloodborne pathogens enter a person through a skin punctured by a used needle or sharp instrument.
There are two levels of precautions put in place for infection control: Standard (for all patients), and Transmission-Based (to be used additionally, for those patients with known or suspected infections). The World Health Organization (WHO) outlines the ten key elements to Standard Precautions:
Hand hygiene
Facial protection (eyes, nose, and mouth)
Gown
Prevention of needle stick and injuries from other sharp instruments
Respiratory hygiene and cough etiquette
Environmental cleaning
Linens (handling, transportation, and processing)
Waste disposal
Patient care equipment
For those patients who have known or suspected infections, the CDC offers the following guidelines for Transmission-Based Precautions:
Contact Precautions:
Ensure appropriate patient placement in a single patient room if possible
Use personal protective equipment (PPE) appropriately
Limit transport and movement of patients
Use disposable or dedicated patient-care equipment
Prioritize cleaning and disinfection of the rooms
Droplet Precautions:
Source control: put a mask on the patient
Ensure appropriate patient placement in a single patient room if possible
Use personal protective equipment (PPE) appropriately
Limit transport and movement of patients
Airborne Precautions:
Source control: put a mask on the patient
Ensure appropriate patient placement in an airborne infection isolation room (AIIR)
Restrict susceptible healthcare personnel from entering the room
Use personal protective equipment (PPE) appropriately
Limit transport and movement of patients
Immunize susceptible persons as soon as possible following unprotected contact