Infection Control

Published on 22/05/2015 by admin

Filed under Physical Medicine and Rehabilitation

Last modified 22/04/2025

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Chapter 10 Infection Control

10.1 Guidelines for Hand Hygiene in Health-Care Settings

The Centers for Disease Control (CDC), Health Care Infection Control Practice Advisory Committee (HICPAC), Society for Healthcare Epidemiology of America (SHEA), Infectious Disease Society of America (DSA), and Association for Professionals in Infection Control (APIC) have made 2002 Hand Hygiene recommendations for the use of soap and water and alcohol-based rubs in the health care center.¹ Proper hand hygiene can help prevent the spread of antimicrobial-resistant infections, whereas poor hand hygiene may be a contributing factor in patient mortality. Compliance for hand hygiene is noted to be problematic among health care workers.²

Interestingly, the CDC/HICPAC recommendations address rehabilitation-related concerns such as hand hygiene management after lifting patients or touching equipment near patients. Along with guidelines below, additional recommendations for health care workers include keeping nail tips <¼ inch length; not using same gloves on more than one patient; changing gloves when moving from a contaminated to an uncontaminated body site; wearing gloves if contacting blood, mucous membranes, non-intact skin or other infectious material; and not wearing artificial fingernails or extenders if one has direct contact with high-risk patients (e.g., ICU, operating rooms).

SOAP AND WATER

The CDC/HICPAC recommends you wash with soap (non-antimicrobial or antimicrobial) and water under the following circumstances.

Use soap (non-antimicrobial or antimicrobial) and water if:

Procedure: Using Soap and Water

CDC/HICPAC recommends you wash with soap and water in the following manner: (1) Wet hands. (2) Apply amount of soap recommended by manufacturer. (3) Rub hands together vigorously for at least 15 seconds. (4) Rinse hands with water. (5) Dry hands thoroughly with a disposable towel. (6) Use towel to shut off faucet. (7) Avoid hot water (because repeated exposure increases risk of dermatitis). (8) If soap bar is used, drain soap on rack and use small bars. (9) Avoid multiple use of cloth towels (handing type; roll type)—they are not recommended in a health care setting.

ALCOHOL-BASED HAND RUB

The CDC/HICPAC recommends you use alcohol-based hand rubs under the following circumstances.

Use an alcohol-based hand rub if:

Procedure: Using an Alcohol-Based Hand Rub

The CDC/HICPAC recommends the following technique for using alcohol-based hand rubs: (1) Apply the alcohol-based hand rub to one palm. Follow the manufacturer’s recommended volume to use. (2) Rub hands together. (3) Cover all surfaces of your hands and fingers until hands are dry.

REFERENCES

1 Guidelines for Hand Hygiene in Health-Care Settings. MMWR Recommendation and Reports Oct 25, 2002/51 (RR16)/1-44.

2 Trampuz A, Widmer AF. Hand hygiene: A frequently missed lifesaving opportunity during patient care. Mayo Clin Proc. 2004;79(1):109-116.

10.2 Universal Precautions

The Centers for Disease Control (CDC) made 1987 recommendations for the prevention of HIV, hepatitis B virus, and other pathogens (blood-borne) transmission when providing health care or first aid.¹^–³ These recommendations, known as Universal Precautions (or Universal Blood and Body Fluid Precautions), are briefly summarized below. For detailed guidelines of these and other precautions involving invasive procedures, dentistry, mortician services, dialysis, laboratories, and environmental considerations for HIV transmission (such as infection, housekeeping, decontamination of spills, and laundry) consult the CDC 1987¹ (and CDC 1988 supplement & clarification³) publications at www.cdc.gov/mmwr/preview/mmwrhtml/00023587.htm and www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm.

PROCEDURAL

Universal Precautions: Appropriate barrier precautions should be routinely used by all health care workers to prevent skin and mucous membrane exposure when contact with patient’s blood or other body fluids is anticipated. Blood and body fluid precautions should be consistently used for all patients.	CDC, 1987¹^–³	Medical history and examination cannot reliably identify all patients infected with blood-borne pathogens or HIV.
Use gloves for touching blood, body fluids, mucous membranes, or non-intact skin of all patients, or when performing procedures for vascular access. Change gloves after contact with each patient.
Use masks and protective eyewear or face shield if the procedure is likely to generate droplets of blood or fluids to prevent exposure of mucous membranes of mouth, nose, and eyes.
Use gowns or aprons if procedure generates splash of blood or other body fluids.
Wash skin surfaces (e.g., hands) immediately/thoroughly if contaminated with blood or other body fluids.
Wash hands immediately after glove removal.
Prevent injuries with sharp instruments (i.e., needles, scalpels). Do not recap needles or manipulate them with your hand. All sharp instruments and disposable syringes should be disposed of in puncture-resistant containers as close to the use area as practically possible.
Mouthpieces, resuscitation bags, and other ventilation devices should be available in areas anticipated. Even though saliva is not implicated in HIV transmission, minimize need for emergency mouth-to-mouth resuscitation.
Health care workers with exudative lesions or weeping dermatitis should refrain from all direct patient contact and equipment until condition is resolved.
Pregnant health care workers should be familiar with precautions to minimize risk of HIV transmission because of risk to the fetus from perinatal transmission.