A 13-year-old female presents to the emergency department (ED) with 8 hours of fever, headache, and increased confusion. Her mother relays to ED staff that her daughter came home from school early that day, complaining of headache and body aches. She instructed her daughter to lay down, and when she came back to check on her two hours later, she was sweaty and confused. She contacted her pediatrician, who recommended to take her to the nearest ED immediately. Upon arrival, the patient is hypotensive and tachycardic, with a hemorrhagic rash. She is confused, combative, and unable to follow commands. The ED nurse places the patient on isolation precautions. The ED physician suspects bacterial sepsis and/or meningitis. Stat orders include a CBC, a comprehensive metabolic panel, blood cultures, intravenous fluids, and 2 grams of ceftriaxone. The patient is too unstable for a lumbar puncture (LP). Initial labs show a leukocytosis. She is admitted to the pediatric intensive care unit (PICU). She initially placed on droplet precautions for the first 24 hours. She improves slightly. An LP is done at this point. Cerebrospinal fluid (CSF) is cloudy. Lab analysis shows a low glucose, elevated protein, a high WBC count (mostly neutrophils), and the Gram stain shows gram-negative diplococci. A tentative diagnosis of meningococcal meningitis and sepsis is made. Her blood and CSF cultures later return positive for Neisseria meningitidis. The patient received 10 days of intravenous ceftriaxone with gradual improvement. Of concern is the contact transmissibility of N. meningitides. Her parents and older sibling are treated with single dose ciprofloxacin 500 mg as prophylaxis. The school was alerted of the case and an investigation was initiated at the hospital to detect any students or employees who may have been exposed. 38 employees were interviewed and 2 received prophylaxis. Student contacts were evaluated by their primary care physician for prophylaxis recommendations.

Hospital infection prevention (formerly called infection control) is a practical, evidence-based approach used to prevent the spread of infections within the hospital and other patient care areas. Adherence to infection prevention and control practices is critical to providing safe patient care across all healthcare settings. It protects the patient, the healthcare personnel, and the visitors. The Centers for Disease Control and Prevention (CDC) follows a 2-tier system of precautions to prevent infections from spreading: Standard Precautions, and Transmission-Based Precautions (1).

I. Standard Precautions

The CDC introduced Standard Precautions (formerly called Universal Precautions) in 1985 in response to the human immunodeficiency virus (HIV) epidemic, following needlestick injuries in which healthcare workers were infected with HIV from their positive patients (2). Prior to the HIV epidemic, healthcare workers did not routinely wear personal protective equipment (PPE) when performing basic patient care tasks, such as starting intravenous (IV) catheters, changing dressings, applying pressure to wounds, etc. (3) Standard precautions apply to all patients, in any setting where healthcare is delivered, regardless of diagnosis or suspected/confirmed infection status. Standard precautions should be used 100% of the time, for every patient, without exception. When implemented properly, these practices protect healthcare workers, as well as prevent healthcare workers from transmitting infections to patients (4).

Standard precautions are based on a risk assessment, making use of common sense practices and PPE. They are the first line of defense, and are considered the minimum infection prevention practices in healthcare. They are aimed at breaking the chain of infection, and apply to blood, body fluids, secretions and excretions, non-intact skin, and mucous membranes. The elements of Standard Precautions include hand hygiene, PPE use, respiratory hygiene/cough etiquette, safe injection practices, sterilization of instruments, and cleaning/disinfection (4).

I.A. Hand hygiene:

Hand hygiene is the best way to prevent the spread of infections in healthcare. It is an inclusive term, and includes hand washing with soap and water, and/or using an alcohol-based hand sanitizer (greater than 60% alcohol). The CDC recommends hospitals make these supplies readily available for healthcare workers. Hand hygiene should be part of routine care and performed many times in a day. Table 1 below lists some common examples when hand hygiene should be performed (5-8). Note that the list is not all inclusive and that many more situations may be encountered as part of daily work.

Table 1. Opportunities to Perform Hand Hygiene in the Healthcare Setting (examples)

- Before and after patient care - After contact with blood or body fluids - After contact with a patient’s intact skin (e.g., taking a pulse or blood pressure, or lifting a patient) - Before performing a clean or aseptic procedure - When moving from a soiled body site to a clean body site on the same patient - After contact with the patient’s environment (bedside table, bedrails, IV pumps, water pitcher, etc.) - Immediately after PPE removal, including gloves - Before touching your face or eating

Due to its simplicity, speed, increased compliance, and high efficacy, the CDC recommends that healthcare workers preferentially perform hand hygiene using alcohol sanitizer over soap and water hand washing. To perform appropriate hand hygiene using alcohol-based hand sanitizer, place it on both hands and rub together, making sure to cover all surfaces of the hands until they feel dry;, taking approximately 20 seconds (9).

The old, traditional method for hand hygiene using soap and water; while effective, its proper performance is slow and more difficult to perform frequently since it requires a nearby sink and drying appliances. If performed correctly, soap and water hand washing should take a full 60 seconds from start to finish (10). While a second choice for hand hygiene, soap and water may be preferred in select situations, such as when hands are visibly soiled or when caring for patients with Clostridioides difficile (formerly Clostridium difficile) diarrhea (10). Table 2 shows the many steps for proper hand washing when using soap and water and their rationale.

Table 2. Soap and water hand washing in the healthcare setting

Step 1: Wet hands with lukewarm water: Temperature does not make a difference in the removal of microorganisms when performing hand hygiene (11). Yet, very hot or very cold water can dry the skin, damage the skin, cause pain and lead to decreased compliance (12)

Step 2: Apply soap: Use plenty of soap. Soap allows for friction and reduces more bacteria on hands than water alone (13)

Step 3: Scrub hands using vigorous friction for 15 seconds, getting between the fingers, around the wrists, the tops of the hands, and around the nail region: Some skin microorganisms stick to hands tightly; vigorous friction helps loosen and remove them more efficiently. Wear minimal to no jewelry; bacteria counts on hands and wrists are significantly reduced when jewelry is not worn (14)

Step 4: Rinse hands under warm water for 15 seconds: Microorganisms are loosened from hands during scrubbing, but they are not removed until hands are rinsed. Ensure no soap is left on hands (leftover = microorganisms)

Step 5: Gently dry hands with a paper towel, patting hands dry: Gently drying patting with paper towel avoids shearing off additional layers of skin

Step 6: Use the paper towel to turn off the faucet: The paper towel acts as a barrier between your clean hands and the dirty faucet

Step 7: If in a bathroom setting, use the paper towel to open the door: The paper towel acts as a barrier between your clean hands and the dirty doorknob

I.B. Personal Protective Equipment (PPE):

The use and selection of PPE should be based on the level of anticipated contact and the potential for exposure to blood and body fluids. Prior to every patient interaction, all healthcare workers have the responsibility to assess the infectious risk posed to themselves, other healthcare workers, patients, and visitors. PPE can include various combinations of gloves, gowns, eye protection, and masks/respirators. Select gloves, masks, goggles, face shields, gowns, and combinations of each, according to the need anticipated by the task performed, according to the following (15):

- Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials to mucous membranes, non-intact skin, potentially contaminated skin or contaminated equipment could occur.

- Wear a gown to protect skin and prevent soiling of clothing during procedures and activities that could cause contact with blood, body fluids, secretions, or excretions.

- Use protective eyewear and a mask, or a face shield, to protect the mucous membranes of the eyes, nose and mouth during procedures and activities that could generate splashes or sprays of blood, respiratory particles, body fluids, secretions, and excretions.

- Other than respirators, remove and discard PPE upon completing a task and before leaving the patient’s room or care area. If a respirator is used, it should be removed and discarded (or reprocessed if reusable, for example, a CAPR (controlled air purifying respirator) after leaving the patient room or care area and closing the door.

- Note that personal eyeglasses do not provide adequate protection and should never be used as a substitute for hospital approved eye protection.

It is important to remember that PPE is designed to protect, but once contaminated, it can become a means for spreading infectious diseases to yourself, other patients and environmental surfaces. Always work from clean to dirty, and limit the opportunities for cross contamination. Avoid touching your face, adjusting your glasses, rubbing your nose, or adjusting PPE with dirty gloves. Touching environmental surfaces should be limited to necessary items, in order to avoid cross-contamination. Surfaces such as light switches, doorknobs, countertops, and computer keyboards, etc., can become contaminated if touched by soiled gloves. PPE should always be changed in between patients, or if torn, damaged, or heavily soiled. The use of gloves does not replace hand hygiene, and hand hygiene should be performed immediately after PPE removal. When removing PPE, it is critical to avoid contaminating the eyes, nose, or mouth (16). Table 3, below, lists some important, practical tips in the proper use of PPE

Table 3. Practical tips in the proper use of PPE

DO NOT:	DO:
Don’t wash gloves, or apply alcohol-based hand sanitizer to gloves	Do remove and discard disposable gloves upon completion of a task or when soiled during patient care
Don’t re-use the same gown or pair of gloves for the care of more than one patient	Do use a fresh gown and fresh pair of gloves for each patient
Don’t wear contaminated PPE outside the patient’s room	Do remove the gown by slowly rolling it inside out and away from your body
Don’t push or roll gown sleeves up your forearm	Do make sure the gown completely covers your clothing and is tied properly
Don’t use personal eyeglasses as PPE	Do obtain hospital approved eye protection from the hospital
Don’t substitute glove use for hand hygiene	Do perform hand hygiene before putting on gloves and after removing gloves
Don’t touch your face when wearing gloves	Do keep contaminated PPE away from your mucous membranes (eyes, nose and mouth)
Don’t touch the front of the mask, as it is highly contaminated after use	Do properly dispose of the mask by handling only the ear loops or ties, and perform hand hygiene immediately after discarding
Don’t wear a mask if it is wet or soiled	Do check to make sure the mask is intact, and free from defects such as holes or torn straps
Don’t leave a mask hanging around your neck or from one ear, or resting on your chest	Do discard PPE promptly after removal

I.C. Respiratory Hygiene/Cough Etiquette:

Respiratory hygiene/cough etiquette was a measure added to Standard Precautions in 2007 as a means to limit the transmission of respiratory pathogens spread by droplet or airborne routes. This measure targets patients who may have undiagnosed infectious respiratory illnesses, with a focus on source control (4). Respiratory hygiene and cough etiquette includes:

- Educating patients to cover their mouths/noses when coughing or sneezing, to use and dispose of tissues and to perform hand hygiene after their hands have been in contact with respiratory secretions.

- Wearing a mask when a patient is coughing.

- Providing tissues and no-touch receptacles for disposal of tissues.

I.D. Sharps Safety and Safe Injection Practices:

Sharps Safety was added to Standard Precautions to reduce exposures to blood and body fluids from sharp instruments and needles. Sharps safety can be accomplished using engineering controls and work practice controls.

Engineering controls remove or isolate a hazard in the workplace; they are often technology-based, for example, self-sheathing needles, safety scalpels, needleless IV ports, sharps containers and needle recapping devices. Engineering controls can be used in conjunction with work practice controls.

Work practice controls are behavior-based and intended to reduce the risk of blood exposure by changing the way healthcare workers perform tasks. Work practice controls include practices like using a one-handed scoop technique for recapping needles before disposal, not bending or breaking needles before disposal, and not passing a syringe with an unsheathed needle by hand.

Safe Injection Practices was added to Standard Precautions to prevent transmission of infectious diseases between patients, or between a patient and the HCW during preparation and administration of parenteral (such as IV or IM) medications. Safe injection practices are a set of measures healthcare workers must follow to perform injections in the safest manner possible. Examples of injection safety practices include (but not limited to): never administering medications from the same syringe to more than one patient, even if the needle is changed; never entering a vial with a used syringe or needle; never using medications labeled as single-use on more than one patient; and, never using bags or bottles of IV solution as a common source of supply for more than one patient (4).

I.E. Sterilization of Instruments and Disinfection of Patient Care Devices:

This principle relates to the cleaning and reprocessing of reusable equipment before using it on another patient. Earle H. Spaulding created an approach to disinfection and sterilization over 30 years ago based on the degree of risk for infection involved in use of the items. Any HCW who uses medical equipment on patients has the responsibility to understand and adhere to the Spaulding Classification. The three categories in the Spaulding classification are critical, semi-critical, and noncritical (17).

Critical items are those that enter sterile tissue, bone, or vascular systems. They represent a high risk and must be sterilized. Some examples are: surgical instruments, urinary catheters, implants and ultrasound probes used in sterile cavities.

Semi-critical items are those that come in contact with mucous membranes or non-intact skin. They represent an intermediate risk and require high level disinfection. Some examples are: respiratory therapy equipment, anesthesia equipment, and certain endoscopes.

Noncritical items are those that only come in contact with intact skin. They represent the lowest risk and require low level disinfection. Some examples are: bedpans, blood pressure cuffs, wheelchairs and stethoscopes.

I.F. Cleaning and Disinfection of the Environment

Although hand hygiene is critical to minimize the spread of microorganisms, the patient care environment should also be cleaned and disinfected regularly and between patients (18). Effective and consistent cleaning of the environment in health care is essential to reduce the incidence of hospital acquired infections (19). Environmental surfaces such as bedrails, bedside tables, counters, call buttons, and remote controls can serve as reservoirs for microorganisms that can be transmitted to patients or HCW’s when environmental cleaning is inadequate (20).

All disinfectants intended for use in health care settings, must have label claims (also called kill claims) listing the microorganisms that are killed by this agent. When using US Environmental Protection Agency (EPA) registered products, always follow the label directions, and pay close attention to the contact (or dwell) time, which is the amount of time disinfectants need to remain wet on surfaces to properly disinfect. Dwell times vary by disinfectant and target microorganism type, such as bacteria, virus or fungi (21).

Toys are an established part of child friendly environments in the hospital setting, and they can offer comfort and security to pediatric patients as well as their parents; however, they can also act as a source of healthcare associated infections (22). Toys must be cleaned in between patients to avoid transmission of microorganisms (23). Harsh chemicals should not be used on toys that are likely to be mouthed by patients. Hospitals should select toys that can easily be cleaned and disinfected. Toys that cannot be cleaned, such as stuffed animals, should be avoided in the hospital setting unless they are brand new and single patient use only (22).

II. Transmission-Based Precautions

If Standard Precautions are the foundation of infection prevention in healthcare, Transmission-Based Precautions are the next level of protection. Standard precautions, when applied correctly, will decrease the chance of transmitting the majority of infections; however, there are situations that will require more targeted precautions in order to protect the patient, healthcare worker, visitor, and the environment. This second tier of infection prevention is used when patients have diseases that can be predicted to spread through specific modes (e.g., contact, droplet, or airborne), and are always used in addition to Standard Precautions (24).

The category the infectious disease or microorganism is assigned to reflects the predominant mode or modes of transmission; when more than 1 mode of transmission is significant, more than 1 category may be assigned. There are 3 types of transmission-based precautions: contact, droplet and airborne.

Contact precautions prevent the spread of organisms that are transmitted by touch. Examples include lice, scabies, respiratory syncytial virus (RSV) and multidrug resistant organisms (MDRO) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant organisms (CRO). The minimum PPE required include gown and gloves.

Droplet precautions prevent the spread of organisms that are spread in relatively large droplet particles when a person coughs, sneezes, spits, etc. Examples include pertussis, meningitis (by Neisseria meningitidis or Haemophilus influenzae), influenza, Streptococcus pyogenes (a.k.a. Group A Streptococcus; in throat or blood), and mumps. The minimum PPE required include gown, gloves and surgical mask.

Airborne precautions prevent the spread of organisms that are spread in small aerosol particles when a person breathes, coughs, sneezes, etc. Examples include tuberculosis (TB), COVID-19, measles, and varicella virus (presenting as chickenpox or disseminated shingles).

The list of potential infection conditions is vast and cannot be summarized here. Fortunately, a comprehensive list is provided by the CDC (25, Appendix A) in a document that lists the many situations, the type of isolation recommended and the duration of isolation.

It should be noted, though, that due to its novelty, COVID-19 (the disease caused by SARS-CoV-2) is not listed. For COVID-19, a combination of airborne, droplet and contact precautions (with emphasis on routine use of N95 or higher level respirators, and eye protection) are recommended. The duration of isolation is 10 days for mild or moderate cases occurring in persons with a functioning immune system, or 20 days in severe or critical cases and/or cases occurring in persons with a deficient immune system (in cases of persons with severely compromised immune system, isolation may have to be extended, and contingent to repeat testing until negativity is demonstrated) (26).

Questions
1. How many tiers of precautions does the CDC use to prevent hospital-acquired infections?
2. What is a healthcare worker’s first line of defense against infectious diseases?
3. True/False: The CDC created Standard Precautions in response to the HIV epidemic.
4. True/False: Standard Precautions only apply to patients who you suspect have HIV.
5. What is the best way to prevent the spread of infections?
6. True/False: The CDC recommends alcohol sanitizer (over soap and water) in most clinical settings.
7. What is the ideal temperature for washing hands with soap and water?
8. True/False: Consistent wearing of gloves replaces the need for frequent hand hygiene.
9. True/False: Respiratory hygiene/cough etiquette targets patients who may have undiagnosed infectious respiratory infections, and focuses on source control.
10. True/False: You should never use a bag or bottle of IV solution as a common source of supply for more than one patient.
11. True/False: HCW’s do not need to observe the dwell time of a disinfectant cleaner when they are busy.
12. True/False: Stuffed animals are permitted in pediatric settings as long as they are cleaned in between patients.
13. What are the three categories of Transmission Based Precautions?
14. True/False: A surgical mask should be worn when ruling out an airborne infectious disease, such as tuberculosis.
15. True/False: Personal eyeglasses are considered just as safe as hospital-issued goggles to protect a healthcare worker’s eyes from splashes, sprays, or aerosols.

References
1. Centers for Disease Control and Prevention. Infection Control Basics (January 5, 2016). Available at: https://www.cdc.gov/infectioncontrol/basics/index.html. Accessed 04/30/2022.
2. Broussard IM, Kahwaji CI. Universal Precautions (December 15, 2021). Stat Pearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470223/. Accessed 04/30/2022.
3. Segal, P. The Role of Personal Protective Equipment in Infection Prevention History (October 17, 2016) Infection Control Today. Available at: https://www.infectioncontroltoday.com/view/role-personal-protective-equipment-infection-prevention-history. Accessed 04/30/2022.
4. Centers for Disease Control and Prevention. Standard Precautions for All Patient Care (January 26, 2016). Available at: https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html. Accessed 04/30/2022.
5. Mathur P. Hand hygiene: back to the basics of infection control. Indian J Med Res. 2011;134(5): 611-620.
6. Kwok YLA, Gralton J, McLaws ML. Face touching: a frequent habit that has implications for hand hygiene. Am J Infect Control. 2015;43(2):112-114.
7. World Health Organization. Global report on infection prevention and control (May 5, 2022). Available at https://www.who.int/publications/m/item/global-report-on-infection-prevention-and-control. Accessed 05/13/2022.
8. Centers for Disease Control and Prevention. Hand Sanitizer Use Out and About (August 10, 2021). Available at: https://www.cdc.gov/handwashing/hand-sanitizer-use.html#:~:text=Cleaning%20hands%20at%20key%20times,germs%20to%20those%20around%20you. Accessed 04/30/2022.
9. Centers for Disease Control and Prevention. Hand Hygiene in Healthcare Settings for Healthcare Providers (January 8, 2021). Available at: https://www.cdc.gov/handhygiene/providers/index.html. Accessed: 04/30/2022.
10. Centers for Disease Control and Prevention. Hand Hygiene Guidance (January 30, 2020). Available at: https://www.cdc.gov/handhygiene/providers/guideline.html. Accessed 04/30/2022.
11. Jensen, Dane A. Quantifying the Effects of Water Temperature, Soap Volume, Lather Time, and Antimicrobial Soap as Variables in the Removal of Escherichia coli ATCC 11229 from Hands. J Food Prot. 2017;80(6): 1022-1031.
12. Herrero-Fernandez M, Montero-Vilchez T, Diaz-Calvillo P, Romera-Vilchez M, Buendia-Eisman E, Arias-Santiago S. Impact of Water Exposure and Temperature Changes on Skin Barrier Function. J Clin Med. 2022;11(2):298.
13. Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt WP. The Effect of Handwashing with Water or Soap on Bacterial Contamination of Hands. Int J Environ Res Public Health. 2011;8(1):97-104.
14. Greenshield K, Chavez J, Nial KJ, Baldwin K. Examining bacteria on skin and jewelry since the implementation of hand sanitizer in hospitals. Am J Infect Control. 2020;48(11): 1402-1403.
15. Centers for Disease Control and Prevention. Recommendations for Application of Standard Precautions for the Care of All Patients in All Healthcare Settings (November 5, 2015). Available at: https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/standard-precautions.html. Accessed 04/30/2022.
16. Mody L, Centers for Disease Control and Prevention. Personal Protective Equipment (PPE): Coaching and Training Frontline Health Care Professionals. Available at: https://www.cdc.gov/infectioncontrol/pdf/strive/ppe103-508.pdf. Accessed 04/30/2022.
17. Centers for Disease Control and Prevention. A Rational Approach to Disinfection and Sterilization (September 18, 2016). Available at: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/rational-approach.html. Accessed 04/30/2022.
18. Hausemann, A, Grunewald M, Otto U, Heudorf U. Cleaning and disinfection of surfaces in hospitals. Improvement in quality of structure, process and outcome in the hospitals in Frankfurt/Main, Germany, in 2016 compared to 2014. GMS Hyg Infect Control. 2018;13:Doc06. doi: 10.3205/dgkh000312
19. Rutala WA, Weber DJ, and the Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) (Update: May 2019). Available at: http://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf. Accessed 04/30/2022.
20. The Joint Commission. Environmental Infection Prevention: Guidance for Continuously Maintaining a Safe Patient Care and Survey-Ready Environment. Joint Commission Resources (2018). Available at: https://store.jcrinc.com/environmental-infection-prevention-guidance-for-continuously-maintaining -a-safe-patient-care-and-survey-ready-environment. Accessed 04/30/2022.
21. United States Environmental Protection Agency. What’s the difference between products that disinfect, sanitize, and clean surfaces? (July 5, 2022). Available at: https://www.epa.gov/coronavirus/whats-difference-between-products-disinfect-sanitize-and-clean-surfaces. Accessed 05/13/2022.
22. McGowan, Michael. Who Cleans Your Octopus? An Observation of Cleaning Behaviours and Bacterial Colonisation of Toys in a Neonatal Unit. Ulster Med J. 2020;89(1):45-46
23. Davies MW, Mehr S, Garland ST, Morley CJ. Bacterial Colonization of Toys in Neonatal Intensive Care Cots. Pediatrics. 2000;106(2):E18.
24. Centers for Disease Control and Prevention CDC. Transmission-Based Precautions (January 7, 2016). Available at: https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html. Accessed 04/11/2022.
25. Centers for Disease Control and Prevention CDC. Appendix A Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (November 5, 2015). Available at: https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/index.html. Accessed 04/30/2022.
26. Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic (February 2, 2022). Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Accessed 05/15/2022

Answers to questions
1. Two tiers. The CDC uses a 2-tier system of precautions to prevent infections from spreading: Standard Precautions and Transmission-Based Precautions.
2. Standard Precautions which are the first line of defense, and are considered the minimum infection prevention practices in healthcare. They are aimed at breaking the chain of infection, and apply to blood, body fluids, secretions and excretions, non-intact skin, and mucous membranes.
3. True. Prior to the HIV epidemic, healthcare workers did not routinely wear personal protective equipment when performing basic patient care tasks, such as starting intravenous (IV) catheters, changing dressings, applying pressure to wounds, etc.
4. False. Standard precautions apply to all patients, in any setting where healthcare is delivered, regardless of diagnosis or suspected/confirmed infection status; they should be used 100% of the time, for every patient, without exception.
5. Hand Hygiene which is the best way to prevent the spread of infections in healthcare.
6. True. Unless hands are visibly soiled, in most clinical settings, the CDC recommends healthcare workers perform hand hygiene using alcohol sanitizer over soap and water hand washing, due to increased compliance with alcohol sanitizer, and its excellent efficacy.
7. Lukewarm water. Studies have demonstrated that temperature does not make a difference in the removal of microorganisms when washing hands with soap and water. In addition, very hot or very cold water can dry the skin on the hands, leaving it vulnerable to damage and infections. If the skin on the hands is damaged, it becomes painful to perform hand hygiene, leading to decreased compliance.
8. False. The use of gloves does not replace hand hygiene, and hand hygiene should always be performed immediately after glove removal. Once gloves become contaminated, they become a means for spreading infectious diseases to yourself, other patients, and environmental surfaces.
9. True. Respiratory hygiene/cough etiquette was added to Standard Precautions as a means to limit transmission of respiratory pathogens spread by droplet or airborne routes, and targets patients who may have undiagnosed respiratory infections, with a focus on source control.
10. True. Using a bag or bottle of IV solution as a common source of supply for more than one patient is considered an unsafe practice, and has resulted in the transmission of bloodborne pathogens to patients, including hepatitis C virus and HIV.
11. False. When using EPA-registered products, always follow the label directions, and pay close attention to the contact (or dwell) time, which is the amount of time disinfectants need to remain wet on surfaces to properly disinfect. Dwell times can vary by disinfectant and target microorganism type, such as bacteria, virus or fungi, and are always listed on the container of the cleaner.
12. False. Toys that cannot be cleaned, such as stuffed animals, should be avoided in the hospital setting unless they are brand new and single-patient use only.
13. The three categories of Transmission Based Precautions are Contact, Droplet, and Airborne precautions. A Transmission Based Precautions category (Contact, Droplet, and/or Airborne) is assigned to a microorganism/infectious disease if there is strong evidence of person-to-person transmission by that route.
14. False. A N95 respirator must be worn when ruling out an airborne infectious disease such as tuberculosis. A surgical mask is considered insufficient protection against airborne infectious diseases.
15. False. Personal eyeglasses should never be used as PPE, and do not offer the same level of protection as goggles or a face shield.