Healthcare-Associated Infections: Prevention Strategies

Healthcare-associated infections (HAIs) are infections that are acquired when a patient receives healthcare in a facility such as a hospital, outpatient surgery center, or clinic. These infections can occur during procedures or soon after receiving health care from sources such as a contaminated surface, direct contact with a healthcare worker, or a medical device. Preventing these infections involves utilizing standard precautions, which are the minimum infection prevention practices that apply to all patient care. Elements of standard precautions consist of:

hand hygiene,

personal protective equipment,

safe injection practices,

proper sterilization of medical instruments and devices,

disinfecting surfaces,

respiratory hygiene/cough etiquette.

The elements this article will focus on are hand hygiene, personal protective equipment, and safe injection practices.

Healthcare-associated infections can cause extended hospital stays, extended treatment, and death. Prevention is the key to eliminating or decreasing healthcare associated infections. Following and implementing standard precautions will protect both the healthcare worker and patient in any setting where healthcare is delivered.

Hand Hygiene

Hand hygiene is considered the single most critical measure to reduce spreading infections amongst healthcare workers and patients. Hand hygiene is crucial for reducing HAIs because practicing good hand hygiene effectively removes pathogens from the hands of healthcare workers, thus preventing the spread of infections to patients within the healthcare setting. Proper hand hygiene reduces up to 50% of avoidable infections acquired during health care delivery.

Good hand hygiene includes washing your hands with soap and water or utilizing alcohol-based hand rubs (ABHR). The use of ABHR is preferred by the Center for Disease Control (CDC) and the World Health Organization (WHO) because of its activity against a broad spectrum of pathogens and it can increase compliance with hand hygiene practices. It also requires less time when utilizing the rubs, irritates hands less, and promotes hand hygiene at bedside. Soap and water should be used when hands are visibly soiled or dirty, before you eat, after using the restroom, and after caring for patients with known or suspected Clostridium difficile or norovirus.

Situations when hand hygiene should be performed in healthcare settings include:

before and after contact with a patient,

after contact with blood or body fluids,

before placing and after removal of personal protective equipment,

before performing an aseptic task (insertion of IV, preparing an injection), and

when moving from a contaminated body site to a clean body site.

Complete guidance on how and when to perform hand hygiene can be found on the CDC or WHO websites.

Personal Protective Equipment (PPE)

Personal Protective Equipment (PPE) is equipment that is worn to protect the healthcare worker from exposure to or contact with infectious pathogens and is another crucial method in reducing HAIs. PPE creates a barrier between healthcare workers and patients and, when utilized properly, prevents the spread of pathogens.

The most common PPE utilized are gloves, masks, gowns, eye protection, respirators, and face shields. Selection of PPE is based on the task that is to be performed, patient interaction, and potential for blood or body fluid contact. Each facility should evaluate the task to be performed and determine the specific needs of the worker. Sufficient and appropriate PPE must be available to workers in the correct sizes and be readily available.

All healthcare workers must be provided education regarding proper use of PPE. Workers should utilize gloves in situations involving possible contact with blood or body fluids, mucous membranes, non-intact skin, or any potentially infectious material. Gloves are single use items and must be discarded after caring for a patient. They must not be washed for reuse. A gown should cover the workers’ clothing and skin. It provides protection during procedures where contact with blood or body fluids is anticipated. A mask, respirator or face shield provides protection in procedures that generate splashes or splatters of blood or body fluids. A respirator provides protection when a pathogen is airborne, such as Mycobacterium tuberculosis or measles.

Injection Practices

Safe injection practices are intended to prevent transmission of infectious diseases from one patient to another, or between healthcare workers and patients. Unsafe injection practices have led to patient infections and are a major contributor to HAIs.

Unsafe injection practices may result in serious consequences like the transmission of Hepatitis C, B, or HIV. These unsafe practices include:

use of a single syringe (with or without the same needle) to administer medication to multiple patients,

reinsertion of a used syringe (with or without the same needle) into a medication vial to obtain medication for a single patient and then using that vial for subsequent patients, and

preparing medications in close proximity to contaminated supplies or equipment.

Safe injection practices include:

using an aseptic technique when preparing and administering medications,

cleaning the access diaphragm of the vial with alcohol before puncturing the vial,

NEVER administer medications from the same syringe to multiple patients, even if the needle is changed,

do not administer medications in a single-dose vial to multiple patients,

dispose of used sharps at the point of use in a sharps container, and

dedicate multidose vials to a single patient whenever possible.

The “One & Only Campaign” is led by the CDC and the Safe Injection Practices Coalition. The campaign is an effort to eliminate unsafe injection practices in healthcare settings.

Infection prevention must be a top priority in any healthcare setting. Standard precautions are the minimum infection prevention expectations for safe care. Practices must be diligent in using these precautions, and others, to prevent healthcare-associated infections.