Infection Prevention and Control
USE ROUTINE PRACTICES AND PRECAUTIONS FOR EVERY CONTACT AND ALL INDIVIDUALS RECEIVING CARE.
NB: Infection Control in the OFFICE SETTING should focus on ROUTINE PRACTICES, including hand hygiene, personal protective equipment, handling of sharps, syringe and multi-dose vial safety (New Needle. New Syringe. Every Time) and Reprocessing of Medical Equipment (cleaning, disinfection, sterilization) – Who is responsible for reprocessing? Is their training adequate? Has the office sterilizer been approved for the tasks expected? How are sterilization parameters monitored? Do Not Re-use Single-Use Medical Devices.
HAND HYGIENE IS THE SINGLE MOST IMPORTANT STEP IN PREVENTING THE TRANSMISSION OF INFECTION.
Perform Hand Hygiene: (the Canadian Patient Safety Institute “4 Moments of Hand Hygiene”)
Before contact with patients or their environment (including before putting on gloves)
Before an aseptic procedure (e.g. placement or handling of intravascular lines or urinary catheters)
After contact with body fluids/blood/mucous membranes/non-intact skin
After contact with patients or their environment (including after removing gloves)
Hand Hygiene Products:
The type of hand hygiene product selected depends on the clinical setting.
Waterless Antiseptic Hand Agents (alcohol-based hand sanitizers/rubs – ABHR)
Preferred product in most situations, e.g. before/after care of all patients including individuals with antibiotic resistant organisms, immunosuppression, or those at higher risk of infection (e.g. neonatal/pediatric/adult intensive care, burn units, dialysis units, transplant units) and where invasive procedures are performed (e.g. operating rooms, delivery rooms, treatment rooms).
Plain Soap and Water is preferred in 3 situations:
When hands are visibly dirty or contaminated with blood or body fluids.
During food handling
When caring for patients with vomiting or diarrhea (soap & water may be more effective than ABHR for Noroviruses and Clostridioides (Clostridium) difficile)
Antiseptic Agents may be an option but should be restricted to the following higher risk clinical areas or situations:
where there are patients who are immunosuppressed or at high risk of infection (e.g. neonatal/pediatric/adult intensive care, burn units, dialysis units, transplant units)
where invasive procedures are performed (e.g. operating rooms, delivery rooms, treatment rooms)
NB: Antibacterial soaps may promote antimicrobial resistance and are NOT effective against viruses or fungi.
APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT/BARRIERS (GLOVES, GOWNS, MASKS, AND EYE PROTECTION) MUST BE WORN TO PREVENT EXPOSURE TO BLOOD OR BODY FLUIDS.
NB: Gloves do not replace hand hygiene.
Perform hand hygiene before and after using gloves
Are worn to prevent gross soiling of hands with blood and body fluids and excretions
Must always be changed between each patient contact
Should be used only once and thrown out
Are worn to protect clothing and exposed skin from soiling and/or contamination
Should be fluid-resistant if exposure to significant amounts of blood or body fluids is anticipated
Should be used only once and then placed in the appropriate receptacle
A surgical/procedure mask should be worn:
if splashing or aerosolization of blood and/or body fluids is anticipated
when performing invasive procedures on the respiratory tract (e.g. suctioning, intubating)
when caring for individuals with cough and fever of unknown etiology
A fit-tested N95 respirator/mask should be worn for infections spread by the airborne route, whether suspected or confirmed (e.g. tuberculosis, chicken pox, measles)
Masks should be removed (by handling ties or elastics), and discarded following use (followed by hand hygiene)
Eye Goggles/Face Shield
Should be worn to protect eyes from splashes or aerosols of blood or body fluids
Should protect from the sides as well as the front
NB: Prescription eye glasses do not provide adequate eye protection.
Colonization and/or infection with:
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Vancomycin-intermediate or resistant Staphylococcus aureus (VISA/VRSA)
- Vancomycin-resistant Enterococci (VRE)
- Extended-spectrum ß-lactamases (ESBL)
- AmpC cephalosporinase-producing Klebsiella spp, Salmonella spp, & Proteus mirabilis
- Carbapenemase-producing Enterobacteriaceae
- Infections with: Clostridioides (Clostridium) difficile