Infection Control: Best Practices and Protocols

With the CDC (Centers for Disease Control and Prevention), reporting cases of the Novel Coronavirus in countries around the world, infection control procedures are the forefront of every person’s mind.

How do we as providers keep ourselves free of disease and, just as importantly, how do we keep from spreading this virus and many other microorganisms to other patients, coworkers, our families, and friends? We must employ infection prevention.

We must make certain that healthcare providers understand the inherent dangers of improper infection control practices and what steps to take in the event that they are exposed to an infectious agent. This is where a dedicated infection control officer (DICO), makes a great impact on the knowledge base of providers, reporting of instances, and facilitating post-exposure care for healthcare providers.

To control transmission of microorganisms, we must first understand the basics about bloodborne diseases, airborne diseases, and uncommon diseases; how these germs are acquired, transmitted and how they behave outside the body; and finally, how to destroy them.

Common Infectious Diseases

Anthrax	Diphtheria	Hepatitis A – G
HIV/AIDS	Influenza (all strains)	Measles
Meningococcal	Pertussis	Plague, pneumonic
Rabies	Rubella	SARS
Smallpox	Tuberculosis	Vaccinia (cowpox)
Varicella Disease	Viral Hemorrhagic Fevers

The diseases listed above can be categorized via their routes of transmission. Droplet transmission is how diphtheria, meningococcal disease, influenzas, mumps, pertussis, SARS, and the pneumonic plague are transmitted from person to person.

Airborne diseases are those that are aerosolized and include: tuberculosis, measles, and varicella disease.

Those infections passed through bodily fluid contact are HIV/AIDS, hepatitis, and rabies. Bodily fluids that can carry these microorganisms include: semen, vaginal secretions, blood, any fluids/feces/sputum containing blood, amniotic fluid, peritoneal fluid, pleural, synovial, and pericardial.

Feces, nasal secretions, sputum, saliva, tears, sweat, urine, and vomit are not considered potentially infectious bodily fluids.

PPE and Proper Hand Washing

Coughing and sneezing into our hands and then touching surfaces such as door handles, steering wheels, shared keyboards, another person’s hands is one of the biggest ways we transmit microorganisms. We must learn proper hand hygiene to reduce the transmission of these germs.

Most individuals do not use proper hand-washing techniques, in part because they were never taught the importance of it to their health and because they were never taught proper technique.

Proper hand washing entails friction on ALL surfaces of the fingers, hands, and up past the wrists for at least 20 seconds with water and soap. This should take you approximately 2 minutes. The water does not have to be hot or even lukewarm. Friction and soap are the tools needed to break down the cell walls of microorganisms. No soap and water? Then employ the use of hand sanitizers with at least 60% alcohol. While hand sanitizer does not kill all germs or any viruses, it does make your skin surface inhospitable to these bugs. Ultimately, soap and water with the proper length of friction is the key to reducing germ transmission, so wash your hands as soon as is practical.

Along with hand washing, employing the use of personal protective equipment (PPE) and understanding the inherent dangers of exposure to bodily fluids is important to protecting providers. PPE is one of the easiest ways to reduce the chance for accidental exposure. Masks should be worn whenever there is a chance that your patient has a contagious infectious agent, such as the flu. Goggles are appropriate whenever there is a chance of ocular exposure. You may be surprised to know that there are a large number of infectious agents that can be acquired through ocular contact, such as hepatitis, influenza, HIV, and herpes. Goggles or shields should be worn whenever you may need to suction a patient, intubate a patient, or there is any chance that bodily fluids could come in contact with your eyes, nose, and mouth (i.e. combative patients, spitting patients, etc).

Gowns should be employed in the same circumstances as well as to protect your clothing to reduce the chances of transmission from soiled clothing. I mention gloves last because many healthcare providers use gloves regularly. Gloves must be worn any time you encounter a patient and you have the potential to be exposed to bodily fluids.

This includes: during an exam, when starting an IV, or completing any other invasive procedure. One of the most important things to remember is to remove those gloves when you leave the work area and to wash your hands as soon as practical or use hand sanitizer. Using PPE does not protect you from all potential exposure to pathogens, but it certainly reduces your chances of an occupationally acquired infectious disease.

It is incumbent upon the provider to understand each infectious disease, its signs and symptoms, mode of transmission, and how to protect themselves from acquiring the infection, along with knowing how to reduce or eliminate the transmission of the agent.

Proper Disposal of Equipment

The proper donning and doffing of PPE are also important to ensure that there is no contamination that takes place during removal procedures. Learning proper doffing and donning techniques should take place during your annual bloodborne pathogens training, along with instruction on proper hand washing and decontaminating your equipment and your ambulance. The correct handling and disposing of biohazardous waste and sharps also helps to reduce transmission of disease and moves towards eliminating the danger of needlestick accidents.

Soiled products with blood, or bodily fluids containing blood, will need to be placed in a biohazard bag. Any sharp object, such as needles, angiocaths, ampules, and scalpels will be disposed of in hardened containers to reduce the chance of an accidental needlestick.

Your DICO, will provide educational materials on the best practices for reducing transmission of communicable diseases and information about the trending germs for each season. Your personal responsibility for your health lies in hygiene, physical fitness, annual physicals, and vaccinations. That means eating well, getting rest, exercising, and seeking medical assistance when appropriate. Your personal well-being also includes staying home from work when you have something potentially contagious, like a cold or the flu.

The CDC recommends the following vaccinations, for healthcare providers:

MMR (measles, mumps, rubella)
HEP B
HEP A
Influenza (annually)
DTAP (diphtheria, tetanus, pertussis)
Varicella (chickenpox)
Meningococcal

It is important to understand the symptoms associated with each disease so that you can better protect yourself and others from contracting any of the following diseases. If you are ever in doubt, err on the side of caution and get the mask, gloves, gown, and goggles donned and take precautions. Only testing can rule out the presence of these diseases, and it is always better to be cautious.

In the Event of Suspected Exposure

Just as important as knowing how to protect yourself from infectious agents, a provider must know what to do in the event there is an exposure or suspected exposure.

Let us begin with a suspected exposure to an infectious microorganism. Your patient is loaded onto the cot and into the ambulance.

During your assessment and interview, the patient reveals to you that he has been suffering with:

Weight loss that is not explained
Night sweats
A persistent cough lasting at least three weeks

You realize that your patient could potentially have tuberculosis. What steps do you take?

Place an N95 respirator on your patient
Place an N95 respirator on yourself
Contact receiving facility
Contact your dedicated infection control officer (DICO)

What information does your dedicated infection control officer need to know:

Date and time of exposure
Details of procedure being performed
Details of exposure
Details of exposure source
Exposed person’s details
Details of post-exposure management

What happens next?

Receiving facility prepares a negative pressure room for patient arrival
DICO prepares to have you and your partner evaluated, tests administered
Prophylactic medications may be ordered
Test on patient will be ordered to determine diagnosis of infection is accurate
Your equipment and ambulance will need proper decontamination protocol
DICO reports the case to appropriate governing bodies
DICO will follow up with you and partner as appropriate
Follow up counseling
If infection is confirmed, referral to a specialist
Monitoring of your health

You have a responsibility to yourself, your colleagues, your family, and the general public to report any exposures so that you can reduce the transmission of these communicable diseases. Along with proper reporting, the use of PPE and decontamination procedures for your equipment and ambulance are also going to go a long way toward the end goal of reduction of microorganisms in your work area. The earlier you report your exposure, the more likely that prophylactic treatment will be effective.

A needlestick or potentially infectious body substance exposure to compromised skin will require the same notification to hospital staff and your dedicated infection control officer. It will also require you to clean the area with soap and water as soon as practical. When washing the affected area, use warm but not hot water; hot water can open the pores and consequently allow entry of the microorganism. Also, friction is important, but you do not want to be too aggressive with the friction as it can cause the area to become more abraded and allow for entry of the germs into a larger area.

Should you have an exposure through the eyes, nose, or mouth, flush the area repeatedly with copious amounts of water.

It is NEVER recommended to use caustic agents on the skin or mucosal membranes or to inject antiseptics or disinfectants into wounds during the post-exposure period.

Exposure to contaminated blood or bodily fluids, whether you have been vaccinated or not, requires reporting to your Dedicated Infection Control Officer (DICO) and protocols must still be followed to ensure that you are receiving adequate care to maintain your health and well-being, both physical and psychological.

Sources

Symptomology of communicable diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/.

Novel Coronavirus2019. World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019.

Bloodborne pathogen training and guidelines. Occupational Safety and Health Administration. https://www.osha.gov/SLTC/bloodbornepathogens/index.html.

Anne Margaret Perry—NRP, CET, CPT, LPN—is the clinical program director for CareerCert and has worked in the medical field for over 25 years. Anne began her career in medicine in 1992 in New York state as a basic EMT. She gained her paramedic license in 1998 and nursing license in 2005. She recently moved to South Carolina, where she acquired her National Registry Paramedic and is working on her master’s in nursing education.