Infection control principles and practices for local health agencies
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 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. 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 and 1910.133 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 devices exit.
- 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 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
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 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)
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 contaminated objects/materials.
- 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 Chapter NR 526 of the Wisconsin Administrative Code. 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 of sharps.
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 the needles.
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 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 client
- Using medication vials for one client only, whenever possible
- Safe injection practices packet
Also see the CDC Guideline for isolation precautions.
Gwen Borlaug, Infection Control Epidemiologist
Wisconsin Division of Public Health
Bureau of Communicable Diseases