Infection control and prevention
Infection control principles and practices for local health
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TB | Transmission-based
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.
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 clients.
Hand hygiene should be performed before and after contact with a
client, 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 client care, after
touching objects and medical equipment in the immediate client-care
vicinity, before eating, after using the restroom, and after coughing or
sneezing into a tissue as part of respiratory hygiene.
CDC guidelines - Hand Hygiene
in Health Care Settings
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 client
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
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. The CDC has suggested steps for correctly Donning
and Removing PPE.
If PPE or other disposable items are saturated with blood or body
fluids such that fluid may be poured, squeezed, or dripped from the
item, discard into a biohazard bag. PPE that is not saturated may be
placed directly in the trash. Saturated waste generated from the home
should be placed in sealable leak-proof plastic bags before placing in
regular trash bags for disposal.
The OSHA PPE Standards 1910.132
require employers to provide PPE
for employees with hazard exposure in the workplace, train employees on
the proper use of PPE, and properly maintain, store, and dispose of PPE.
Needlestick 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. The Needlestick
Safety and Prevention Act mandates the use of sharps with engineered safety devices when suitable
- 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
- 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
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
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
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
Respiratory Hygiene (Cough Etiquette)
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.
- 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
- 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 cough
etiquette signs where
the general public can see them.
The Wisconsin Department of Natural Resources (DNR) regulates the
management of medical waste under
526 (PDF, 189 KB) of the Wisconsin
Administrative Codes. Anyone handling, storing, or disposing of
medical waste is covered under this chapter. Home generators of
medical waste are exempt except for rules related to the safe 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. Items generated by local public health agencies that
should be discarded into sharps containers include contaminated items
that may easily cause cuts or punctures in the skin (used needles,
lancets, broken glass or rigid plastic vials) and unused needles and
lancets that are being discarded. Syringes or blood collection tube
holders attached to needles must also be discarded still attached to
Non-sharp disposable items saturated with blood or body fluids
(i.e. fluid can be poured or squeezed from the item or fluid is
flaking or dripping from the item) should be discarded into biohazard
bags that are puncture resistant, leak-proof, and labeled with a
biohazard symbol or red in color. Such items may include used PPE and
disposable rags or cloths.
Local public health agency staff can transport infectious waste
themselves or contract with a waste hauler to collect and transport
waste. Agencies that generate less than 50 pounds of infectious waste
per month do not need a license from the DNR to haul infectious waste
from their facility to a waste disposal site.
A local public health agency that generates infectious waste is
required to maintain a log of waste that is transported from the
agency, regardless of the amount or how it is transported. The log
must contain the following information: date of disposal, location to
which waste is transported, name of person transporting the waste, and
the amount and type of waste transported (e.g. three sharps
containers, or five biohazard bags). Care must be taken to contain the
waste during transport, keep waste separate from clean items in the
transport vehicle, and to clean and disinfect areas of the vehicle
containing infectious waste before hauling clean items and materials.
Safe Injection Practices
Outbreaks of hepatitis B and hepatitis C infections in US
ambulatory care facilities have prompted the need to re-emphasize safe
injection practices. All health care personnel who give injections
should strictly adhere to the CDC recommendations - Safe
Injection Practices which
- 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
Also see the CDC Guideline for Isolation
Gwen Borlaug, Infection Control Epidemiologist
Wisconsin Division of Public Health
Bureau of Communicable Diseases and Emergency Response
(Phone 608-267-7711) (Fax 608-261-4976)
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January 16, 2013