Solid waste Healthcare settings manage waste according to federal and state regulations for medical and nonmedical waste. Regulated waste is liquid or semiliquid blood or other potentially infectious materials (OPIM) (OSHA, 1991). For example, regulated waste can be created by squeezing a dressing so that it drips blood. An item is also regulated waste if it is heavily contaminated with blood or OPIM (dried or liquid state). Dishware and eating utensils No special precautions are needed for dishware or utensils for patients in TBP (CDC, 2022). The combination of hot water and detergent is enough to eliminate pathogens. Use of barrier precautions by visitors Generally, PPE is not recommended for visitors unless they assist with patient care (e.g., wound care, feeding) that is determined to be a potential for transmission (CDC, 2022). Specific recommendations for visitors wearing PPE vary by facility. Table 2. Common Examples of Precaution Type and Duration Infection/Condition Type of Precaution
Encouraging visitors to perform hand hygiene before and after exiting the patient’s room would minimize the potential spread of pathogens. Discontinuing transmission-based precautions Discontinuing transmission-based precautions (TBP) is based on pathogen type, persistence, resistance pattern, and shedding capabilities (CDC, 2022). Treatment options are also considered when determining the duration of TBP. In immunocompromised patients, viral shedding can persist for more extended periods, and precautions may be in place for more extended periods (weeks to months). The duration of precautions for patients with MDROs (colonized or infected) remains undefined; however, CDC lists criteria for discontinuing precautions in their Appendix A of the guideline (CDC, 2022). See Table 2 for common examples of the type of precautions and infection and condition durations. It is important to also refer to employer and facility policy when determining the duration of precautions.
Durations of Precaution
Clostridioides difficile
Contact + standard
Duration of illness.
Lice, head (pediculosis)
Contact + standard
Until 24 hours after initiation of effective therapy after treatment. Until 24 hours after initiation of effective therapy. Depends on local, state, and regional infection control programs; if wounds present, until able to contain drainage.
Meningitis, Neisseria
Droplet + standard
Multidrug-resistant organisms, varies
Contact + standard
Respiratory syncytial virus (RSV)
Contact + standard Note : Wear mask according to standard precautions
Duration of illness.
Scabies
Contact + standard
Until 24 hours after initiation of effective therapy. 10 days unless immunocompromised, then can be up to 20 days.
Severe acute respiratory syndrome (SARS)
Airborne (preferred) + droplet + contact + standard
Source: CDC, 2022.
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Personal protective equipment (PPE) involves barriers that protect the HCW’s mucous membranes, airways, skin, and clothing from contact with infectious pathogens (CDC, 2022; OSHA, 1991). The type of PPE worn (e.g., N95 respirator, mask only, gown and gloves) depends on whether the patient is being cared for in TBP (isolation) or to protect the HCW from exposure to bloodborne pathogens. OSHA requires employers to provide PPE, while the employee’s responsibility is to ensure that it fits and works as intended (OSHA, 1991). In the hierarchy of controls, the National Institute for Occupational Safety and Health (NIOSH) lists PPE as the least effective control measure to lower healthcare worker exposure, as it depends on HCWs using it correctly every time (CDC, 2022). The hierarchy of controls from least effective to most Gloves Gloves are used to prevent contamination of the HCW’s hands. The HCW should wear gloves if there is a possibility of encountering blood or body fluids (i.e., performing vascular access care or wound care), mucous membranes, or nonintact skin; caring for a patient with an MDRO; and/or touching visibly contaminated patient care equipment or surfaces (CDC, 2022; OSHA, 1991; WHO, 2009c). When gloves are worn, they should be put on last, with a good fit around the wrists (CDC, 2022).
effective are PPE, administrative controls (change the way people work), engineering controls (isolate people from the hazard), substitution (replace the hazard), and elimination (eliminate the hazard). An example of engineering controls is the use of protective barriers and improving ventilation. Shenoy and Weber (2021) describe lessons learned in infection prevention for Ebola virus disease (EVD) and the COVID-19 pandemic. While the primary mode of transmission is different for EVD and COVID-19, the risks for HCWs are high due to an inability to identify patients entering a healthcare facility as possibly infected (triage), an inability to isolate or quarantine appropriately, and failure to use PPE correctly. These are reasons to ensure ongoing education (competency based) and provide immediate feedback to HCWs to reduce exposure to patients and other HCWs. Glove misuse is known to happen. In one study, hand hygiene compliance was measured prior to glove use and compared to the HCW’s perceived compliance (Baloh et al., 2019). Appropriate glove use was also observed before entering the room of a patient on TBP. Results showed HCWs performing hand hygiene before gloving 42% of the time, and nonsterile gloves were donned 78% of the time before entering the room of a patient on TBP. HCWs perceived they always performed hand hygiene before gloving. Barriers reported for not gloving or performing hand hygiene prior to glove use were workload
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