What are the main elements of infection prevention in healthcare?

Main Elements of Infection Prevention in Healthcare

The main elements of infection prevention in healthcare include hand hygiene, personal protective equipment (PPE), environmental cleaning and disinfection, respiratory hygiene/cough etiquette, safe handling of sharp instruments, proper sterilization and disinfection of medical equipment, and appropriate isolation precautions for infectious patients. 1

Hand Hygiene

Hand hygiene is the cornerstone of infection prevention in all healthcare settings:

• Use alcohol-based hand rubs or wash hands with soap (plain or antimicrobial) and water before and after every patient contact 1
• Follow the World Health Organization's "My Five Moments for Hand Hygiene": before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching patient surroundings 1
• Keep fingernails short with smooth, filed edges to allow thorough cleaning and prevent glove tears 1
• Do not wear artificial fingernails when having direct contact with high-risk patients 1
• Use hand lotions to prevent skin dryness associated with handwashing 1
• Store liquid hand-care products in disposable closed containers or closed containers that can be washed and dried before refilling 1

Despite being the simplest and most cost-effective intervention, hand hygiene compliance rates rarely exceed 70% even in high-income countries 1, 2. Studies suggest that HAI incidence rates are lower when hand hygiene compliance reaches approximately 60% 2.

Personal Protective Equipment (PPE)

Proper use of PPE is essential for preventing transmission of infectious agents:

• Wear appropriate gloves when potential exists for contacting blood, saliva, other potentially infectious materials (OPIM), or mucous membranes 1
• Change gloves between patients and remove them promptly after use 1
• Wear protective clothing (gowns, lab coats) that covers personal clothing and skin likely to be soiled with blood or other potentially infectious materials 1
• Use surgical masks and eye protection with solid side shields or face shields during procedures likely to generate splashing of blood or body fluids 1
• Remove all PPE before leaving patient care areas 1
• Use appropriate gloves (puncture and chemical-resistant utility gloves) when cleaning instruments and performing housekeeping tasks involving contact with blood or OPIM 1

Environmental Cleaning and Disinfection

Proper environmental cleaning reduces the risk of pathogen transmission:

• Keep housekeeping surfaces (floors, walls, tabletops) visibly clean and promptly clean up spills 1
• Clean and disinfect high-touch surfaces (doorknobs, bed rails, light switches, surfaces around toilets) more frequently than minimal-touch surfaces 1
• Use EPA-registered hospital disinfectants according to manufacturer's instructions 1
• Use surface barriers to protect clinical contact surfaces that are difficult to clean and change these barriers between patients 1
• Follow proper procedures for effective use of mops, cloths, and solutions:
  • Prepare cleaning solutions daily or as needed 1
  • Change mop heads at the beginning of each day and after cleaning large spills 1
  • Clean mops and cloths after use and allow to dry before reuse, or use single-use disposable items 1
• Avoid cleaning methods that produce mists, aerosols, or disperse dust in patient care areas 1

Respiratory Hygiene/Cough Etiquette

Implementing respiratory hygiene protocols helps prevent transmission of respiratory pathogens:

• Educate symptomatic patients and accompanying persons about covering their mouth/nose when coughing or sneezing 1
• Provide tissues and no-touch receptacles for disposal of tissues 1
• Offer masks to persons who are coughing 1
• Encourage hand hygiene after contact with respiratory secretions 1
• Separate infected, contagious patients from uninfected patients when feasible 1

Safe Handling of Sharp Instruments

Preventing sharps injuries reduces the risk of bloodborne pathogen transmission:

• Place sharp items (needles, scalpel blades, etc.) in appropriate sharps containers that are puncture-resistant, color-coded, and leakproof 1
• Close sharps containers immediately before removal or replacement to prevent spillage or protrusion of contents 1
• Evaluate and implement needle-safety devices to reduce the risk of needlestick injuries 1

Sterilization, Disinfection, and Antisepsis

Proper processing of medical equipment prevents cross-contamination:

• Follow manufacturers' instructions for cleaning and maintaining medical equipment 1
• Use appropriate sterilization or disinfection methods based on the Spaulding classification (critical, semi-critical, or non-critical items) 1
• Do not use liquid chemical sterilants/high-level disinfectants for disinfection of environmental surfaces 1
• For surgical procedures, perform surgical hand antisepsis following manufacturer's instructions using either antimicrobial soap and water, or soap and water followed by an alcohol-based surgical hand-scrub product 1

Infection Control Risk Assessment

Proactive risk assessment helps prevent healthcare-associated infections:

• Establish a multidisciplinary team to conduct infection control risk assessments, especially before construction, renovation, or demolition activities 1
• Use dust-control procedures and barriers during construction activities 1
• Implement environmental infection control measures for special areas with high-risk patients 1

Water System Management

Safe water systems prevent waterborne infections:

• Use water that meets EPA regulatory standards for drinking water for routine dental treatment and medical procedures 1
• Implement appropriate measures for equipment using water from main lines (ice machines, hydrotherapy equipment, dental unit water lines, etc.) 1
• Develop protocols for recovering from water system disruptions, leaks, and natural disasters 1

Staff Education and Training

Ongoing education is crucial for effective infection prevention:

• Educate all healthcare personnel regarding routes of transmission and techniques to prevent transmission of infectious agents 1
• Ensure policies for infection prevention and control are written, readily available, updated annually, and enforced 1
• Include all staff in infection prevention training, including support staff like cleaning staff, porters, and kitchen staff 3

Workplace Culture and Leadership Support

Organizational factors significantly impact infection prevention practices:

• Develop a supportive workplace culture that values and reinforces infection prevention practices 3
• Ensure clear communication about infection prevention guidelines from management 3
• Provide adequate resources, including sufficient PPE and appropriate physical facilities for isolation and hand hygiene 3

Healthcare workers consistently identify several barriers to infection prevention compliance, including ambiguous guidelines, increased workload, lack of training, insufficient space, inadequate PPE, and workplace culture issues 3. Addressing these barriers is essential for improving compliance with infection prevention practices and reducing healthcare-associated infections.