Infection Prevention Strategies In Healthcare

By Kiran Gupta

Current infection precaution strategies consist of two main sets of precautions: standard and transmission based precautions.

Standard precautions should be used with all patients who are admitted to the hospital. Frequent hand-washing with good technique is the most important factor in effective control of horizontal transmission of most pathogens.
Hand hygiene is recommended before and after patient contacts, when moving from a contaminated to a clean body site on a single patient, after contact with any potentially contaminated fluid or environmental surfaces, and after glove removal.
Gloves are not a substitute for hand hygiene. Wearing gloves is required when health care workers (HCWs) anticipate contact with body substances, mucous membranes, and non-intact skin of patients. Additional precautions such as gowns and eye/face protection (i.e., masks and goggles) are indicated when splashes of body substances or blood are possible.
Standard precautions were developed not only for the prevention of transmission of blood-borne pathogens (e.g., HIV, hepatitis B, and hepatitis C) through percutaneous and mucous membrane contacts but also to protect against exposure to other pathogens.

Transmission-based precautions include contact precautions, droplet precautions and airborne precautions. These are designed to control the spread of infectious organisms not adequately controlled by standard precautions alone.
Contact precautions are recommended for patients infected or colonized with epidemiologically significant organisms that are transmitted by direct patient contact or by contact with items in the patient environment. The elements of contact precautions include wearing gowns and gloves when in a patient’s room, using dedicated equipment that stays in the patient’s room, and private room assignment or cohorting patients if private rooms are unavailable. Contact precautions should be used for patients with MRSA and other multi-drug resistant pathogens.
Droplet precautions are indicated for infections that are spread by large respiratory droplets, such as Neisseria meningitits, Haemophillia influenza, and influenza virus. HCWs should wear surgical/isolation masks when entering into the patient’s room on droplet precautions.
Airborne precautions are indicated for infections spread by small airborne particles. Since these infectious particles can remain in the air for prolonged periods of time, negative-pressure ventilation rooms are required and HCWs must wear an N95 mask that can filter the small particles. Tuberculosis, measles, and chicken pox (varicella zoster virus) are common pathogens requiring airborne precautions.

The CDC-Healthcare Infection Control Practices Advisory Committee (HICPAC) maintains an updated guideline for isolation precautions in hospitals that include an appendix listing the type and duration of precautions needed for selected infections and conditions.