Infection Control Measures in Healthcare

Infection Control Measures in Healthcare Settings

• Protective environments are recommended for allogenic hematopoietic stem cell transplant (HSCT) recipients to reduce the risk of invasive environmental fungal infections.
• Environmental controls, such as HEPA filtration and air pressure monitoring, should be implemented in protected environments.
• Environmental measures, such as minimizing dust and avoiding certain furnishings and plants, should also be taken in protected environments.
• Patient transport should be limited in protected environments, and N-95 respirators may be necessary during periods of construction.
• Transmission-based precautions, including droplet and contact precautions, should be implemented in protected environments for immunocompromised patients.
• Airborne precautions may be necessary in protected environments if an anteroom is present.
• Multidrug-resistant organisms (MDROs) are microorganisms that are resistant to one or more classes of antimicrobial agents, and control methods for MDROs are complex.
• Hand hygiene is a critical component of patient and employee safety in healthcare settings.
• Hands contaminated with transient bacteria pose a significant risk for transmission of infection.
• Healthcare workers need to be educated on when and how to perform hand hygiene.
• Healthcare worker adherence to hand hygiene recommendations must be monitored and interventions implemented based on results.
• Use of alcohol-based hand rubs has increased adherence to recommended hand hygiene policies and has been associated with reduced healthcare-associated infection rates.

Hand Hygiene Guidelines for Healthcare Settings

• In 2002, the CDC published the Guideline for Hand Hygiene in Health-Care Settings to address poor adherence rates among healthcare workers.
• The guideline reviewed scientific data on the physiology of normal skin, evidence for transmission of pathogens, efficacy and adverse effects of hand hygiene products, and intervention strategies.
• The guideline recommends the preferential use of alcohol-based hand sanitizers in many situations and maintaining hand skin health.
• Waterless, alcohol-based hand rubs are now the preferred products for routine hand hygiene in healthcare settings, unless hands are visibly soiled.
• Observational studies of handwashing compliance report rates averaging less than 40% due to various reasons such as lack of knowledge, time, soap, and administrative priority.
• Artificial fingernails or nail extenders are prohibited for those having direct contact with high-risk patients.
• The CDC and WHO guidelines clearly delineate administrative responsibility for making improved hand hygiene adherence an institutional priority and providing appropriate support and resources.
• The Joint Commission’s 2009 National Patient Safety Goal 75 requires facilities to comply with the WHO’s recommendations or CDC’s Hand Hygiene Guideline.
• Recommendations for increased use of waterless hand hygiene products do not negate the need for handwashing sinks in healthcare settings.
• The American Institute of Architects’ 2006 Guidelines for Design and Construction of Health Care Facilities require handwashing stations in patient bathrooms and rooms for healthcare worker use.
• Alcohol-based hand rub is a solution containing 60% to 95% alcohol to reduce the number of viable microorganisms on hands.
• Antimicrobial soap is a soap that contains an antiseptic agent, regulated by the FDA, to reduce the number of microbial flora on the skin.

Hand hygiene guidelines for healthcare workers

• Hand hygiene should be performed with plain lotion soap and water or antimicrobial soap and water when hands are visibly soiled, before eating, after using the restroom, before and after direct patient contact, before donning sterile gloves, before inserting invasive devices, after contact with patient's intact skin, after removing gloves, and after contact with objects and equipment in the patient's immediate vicinity.
• An alcohol-based hand rub should be used in all other recommended situations, unless hands are visibly soiled or exposure to spore-forming organisms such as B. anthracis or C. difficile is suspected or proven.
• The appropriate amount of hand rub should be dispensed according to the manufacturer's recommendation, and all areas of hand surfaces should be rubbed together until they are dry.
• When using soap and water, hands should be wet with water that is not too hot, then product should be applied per manufacturer's recommendations, and hands should be rubbed together vigorously for at least 15 seconds.
• Either an antimicrobial soap or an alcohol-based surgical hand rub with persistent activity may be used for surgical hand antisepsis.
• Alcohol-based formulations are the most effective at immediately lowering bacterial counts, followed by CHG, iodophors, triclosan, and plain soap.
• Persistent antimicrobial activity is important for a surgical scrub, and the most effective are CHG (2% or 4%), triclosan, and iodophors.
• Combination formulations of 60% to 90% alcohol and 0.5% to 1% CHG equal or exceed the persistence of CHG alone and are approved for surgical hand antisepsis.
• Users should be involved in the selection of surgical hand antiseptic products, and cost should not be the primary factor influencing product selection.
• Hand and arm jewelry should be removed before the surgical scrub, and debris should be removed from underneath fingernails using a nail cleaner under running water.
• Artificial fingernails or nail extenders are not to be worn by personnel in operating rooms.
• Healthcare personnel should be provided with evidence-based information about hand contamination, the effects of hand hygiene products on the skin, and the importance of hand hygiene adherence.