Healthcare Consideration: Routine environmental cleaning and disinfecting in healthcare settings reduce HAIs by secondary transmission. Environmental services and nursing personnel should be knowledgeable in cleaning and disinfecting, as doing so is essential in reducing HAIs. The housekeeping department is usually responsible for routine (daily) cleaning and disinfecting patient rooms and other shared spaces. The nursing staff is usually responsible for cleaning and disinfecting patient care items (noncritical items), those that the housekeeping department does not routinely clean. A risk-based approach can be used for every interaction with patients. For example, suppose a procedure is being performed on a patient (e.g., assisting with bathing or toileting, wound care, respiratory therapy, or physical therapy). In that case, the patient’s area should be cleaned and disinfected afterward. The more vulnerable a patient is, the more often the environment should be cleaned. (CDC, 2020) INJECTION SAFETY
Standard precautions and safe work practices include injection safety, which protects the HCW from exposure to bloodborne pathogens (BBP). As part of the bloodborne pathogen exposure control plan, engineering controls should be in place to minimize exposure. Engineering controls include safer medical devices such as shielded needle devices (i.e., retractable needles as part of the syringe). The Needlestick Prevention Act became law in 2000 as sharps injuries increased (OSHA, n.d.a). The act required employers to maintain a sharps injury log, review work practices that led to the injury, and find lessons learned. The employer must also identify safer sharp devices, evaluate current and new devices, and implement safer devices with input from HCWs. Safe injection practices are recommended to prevent injury and potential transmission of infection (CDC, 2022). Key strategies to prevent sharps and needlestick injuries are to (1) plan safe handling and disposal before any procedure, (2) use safe and effective alternatives to needles if available, (3) ensure activation of the device’s safety feature, (4) immediately dispose of contaminated sharps in a sharps container, and (5) complete on-hire and annual bloodborne pathogen training and ensure understanding of steps to take if an accidental needlestick occurs (OSHA, n.d.c). Outbreaks from unsafe injection practices have occurred and are a reminder for all healthcare providers and facilities to ensure safe practices are in place to maintain patient and HCW safety. An outbreak of hepatitis C occurred in an endoscopy clinic in Las Vegas due to the reuse of a contaminated medication vial during the administration of anesthesia (Fischer et al., 2010). Initially, there were three cases; then through case finding, there were Conclusion The core infection prevention and control practices should be followed with every patient. Patient safety is the primary goal, and infection prevention strategies reduce HAIs. While the impact of the pandemic improved certain infection prevention practices (hand hygiene and PPE use), device-related infections have been increasing in acute care facilities. The pandemic also highlighted the need to strengthen the core principles of public health to provide an improved response to the next pandemic. Key infection prevention strategies include performing hand hygiene at the right moment and ensuring high-touch surfaces are cleaned regularly, and more often if caring for a patient at high risk of acquiring an infection. Healthcare workers’ perceived hand hygiene compliance is higher than their actual compliance; therefore, HCWs still need to be regularly educated about Ackerman, L., Thum, A., Meagher, K., Molyneaux, D., Neff, R., Zabriskie, K., Shimada, A. & Riggio, J. (2022). Video engagement to improve handwashing duration: A longitudinal study assessing creative and messaging fatigue. American Journal of Infection Control, 50 (3), 295-299. • Alfa, M. (2019). Biofilms on instruments and environmental surfaces: Do they interfere with instrument reprocessing and surface disinfection? Review of the literature. American Journal of Infection Control, 47 (S), A39-A45. • Alsuhaibani, M., Kobayashi, T., McPherson, C., Holley, S., Marra, A., Trannel., A., Dains, A., Abosi, O., Jenn, K., Meacham, H., Sheeler, L., Etienne, W., Kukla, M., Wellington, M., Edmond, M., Diekema, D., & Salinas, J. (2022). Impact of COVID-19 on an infection prevention and control program. American Journal of Infection Control, 50 (3), 277-282. • Arntz, P., Hopman, J., Nillesen, M., Yalcin, E., Bleeker-Rovers, C., Voss, A., Edwards, M., & Wie, A. (2016). Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department. American Journal of Infection Control , 44 (11), 1203-1207. • Assadian, O., Harbarth, S., Vos, M., Knobloch, J., Asensio, A., & Widmer, A. (2021). Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review. Journal of Hospital Infection, 113 , 104-114. • Baier, C., Albrecht, U., Ebadi, E., Vonberg, R., & Schilke, R. (2020). Knowledge about hand hygiene in Generation Z: A questionnaire-based survey among dental students, trainee nurses and medical technical assistants in training. American Journal of Infection Control , 48 , 708-712. References •
five more cases. This example and others led to the requirement that patients be notified of potential exposure to a BBP. Guh and colleagues (2012) identified 35 patient notification events over 10 years (2001–2011), estimating that over 130,000 patients were notified (in 17 states) of potential exposures. The primary breach was the reuse of syringes to access shared medications. The CDC’s One and Only campaign was implemented to reduce unsafe injection practices (CDC, 2019). The campaign provides targeted education about the basics of injection safety. The campaign is One Needle, One Syringe, and Only One Time. Recommended steps for HCWs and providers are to follow all infection control practices and maintain aseptic technique during medication preparation and administration. Examples are: ● Never administer medication from the same syringe to another patient. ● Never enter a vial with a used syringe or needle. ● Never use single-use or single-dose medications for more than one patient. ● Never use bags of IV solution for more than one patient. ● Limit the use of multidose vials for a single patient if possible. ● Always use a face mask when injecting medication or inserting a catheter into a sterile space (epidural or subdural space). Injection safety is critical for patient and HCW safety and is now included under standard precautions. Outbreaks have occurred with improper practices. Regular training, monitoring, and feedback will improve injection safety practices and decrease unsafe events and potential exposures to BBP. hand hygiene performance and provide return demonstrations to ensure competency. Understanding the reservoirs and risks of transmission with the tasks that are performed should help HCWs take steps to minimize the potential to spread pathogens. Transmission-based precautions are implemented based on the MDRO, which guides the proper PPE to wear to prevent transmission to another patient. Glove misuse occurs; therefore, HCWs should be reminded of best practices for donning and doffing PPE. Enhanced barrier precautions are a new precaution type targeted for LTCF to reduce MDRO colonization and infections. Respiratory hygiene/cough etiquette and injection safety are strategies that have recently been added to standard precautions. Implementing these key strategies reduces the risk of transmission of infections to patients and HCWs. • Baker, M., Sands, K., Huang, S., Kleinman, K., Septimus, E., Varma, N., Blanchard, J., Poland, R., Coady, M., Yokoe, D., Fraker, S., Froman, A., Moody, J., Goldin, L., Isaacs, A., Kleja, K., Korwek, K., Stelling, J., Clark A., Platt, R., Perlin, J. & CDC Prevention Epicenters Program. (2021). The impact of COVID-19 on healthcare-associated ifections. Clinical Infectious Disease , 1-21. • Baloh, J., Thom, K., Perencevich, E., Rock, C., Robinson, G., Ward, M., Herwaldt, L., & Reisinger, H. (2019). Hand hygiene before donning nonsterile gloves. American Journal of Infection Control, 47 (5), 492-497. • Barker, J., Vipond, I., & Bloomfield, S. (2004). Effects of cleaning and disinfection in reducing the spread of norovirus contamination via environmental surfaces. Journal of Hospital Infection, 58 (1), 42-49. • Berrios-Torres, S., Umscheid, C., Bratzler, D., Leas, B., Stone, E., Kelz, R., Reinke, C., Morgan, S., Solomkin, J., Mazuski, J., Dellinger, P., Itani, K., Berbari, E., Segreti, J., Parvizi, J., Blanchard, J., Allen, G., Kluytmans, J., Donlan, R., & Schecter, W. (2017). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection. Journal of American Medical Association (JAMA), 152 (8), 784-791. • Bingham, J., Abell, G., Kienast, L., Lerner, L., Matuschek, B., Mullins, W., Parker, A., Reynolds, N., Salisbury, D., Seidel, J., Young, E., & Kirk, J. (2016). Health care worker hand contamination at critical moments in outpatient settings. American Journal of Infection Control , 44 (11), 1198-1202.
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