1

Universal precautions 1 2 A set of procedures and guidelines designed to both prevent the infection of the health care worker and to break chains of transmission are together referred to as the universal precautions. 3 4 Blood: 1 2 In particular these procudures are employed to prevent the transmission of blood (and other body fluid)-borne pathogens such as HIV and hepatitis B virus. However, faithful following of these procedures will interfere with the trasmission of most pathogens. 3 "Universal Precautions apply to the following body fluids: blood, semen, and vaginal, tissue, cerebrospinal, synovial (joint cavity), pleural, peritoneal, pericardial, and amniotic fluids. The CDC has stated that Universal Precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus, as long as these do not contain visible blood. This is not to imply that no viruses are present in these fluids but rather that the risk of transmission is either very low or unproved." (p. 439, Black, 1996) 5 Generally, one: 4 should avoid direct contact with patients, fomites, or, especially, body fluids 5 should wear barriers such as gloves when contact is necessary or expected 6 should avoid puncturing oneself with anything and therefore should minimize exposure to sharp instruments, especially body fluid-contaminated sharp instruments 7 should not expose patients to the body fluids (or substances, e.g., "weeping dermatitis") of others, such as that of health care workers Preventing nosocomial infections 6 7 Methods of prevention of nosocomial infection (and breaking the chain of transmission ) include: 8 observance of aseptic technique 9 frequent hand washing especially between patients 10 careful handling, cleaning, and disinfection of fomites 11 where possible use of single-use disposable items 12 patient isolation 13 avoidance where possible of medical procedures that can lead with high probability to nosocomial infection 14 various institutional methods such as air filtration within the hospital 15 general awareness that prevention of nosocomial infection requires constant personal surveillance 16 active oversight within the hospital

Prevention
Hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing, and other preventative measures. Thorough hand washing and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections.[19] More careful use of antimicrobial agents, such as antibiotics, is also considered

vital.[20] Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed antibiotics and other antimicrobial drugs to help treat illness; this may increase the selection pressure for the emergence of resistant strains.

[edit]Isolation
Isolation precautions are designed to prevent transmission of microorganisms by common routes in hospitals. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission.

[edit]Handwashing and gloving

Handwashing frequently is called the single most important measure to reduce the risks of transmitting skin microorganisms from one person to another or from one site to another on the same patient. Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is an important component of infection control and isolation precautions. Although handwashing may seem like a simple process, it is often performed incorrectly. Healthcare settings must continuously remind practitioners and visitors on the proper procedure in washing their hands to comply with responsible handwashing. Simple programs such as Henry the Hand, and the use of handwashing signals can assist healthcare facilities in the prevention of nosocomial infections. All visitors must follow the same procedures as hospital staff to adequately control the spread of infections. Visitors and healthcare personnel are equally to blame in transmitting infections.[citation needed] Moreover, multidrug-resistant infections can leave the hospital and become part of the community flora if steps are not taken to stop this transmission. In addition to handwashing, gloves play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First, gloves are worn to provide a protective barrier and to prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin. In the USA, theOccupational Safety and Health Administration has mandated wearing gloves to reduce the risk of bloodborne pathogen infection.[21] Second, gloves are worn to reduce the likelihood that microorganisms present on the hands of personnel will be transmitted to patients during invasive or other patient-care procedures that involve touching a patient's mucous membranes and nonintact skin. Third, gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a patient or a fomite can transmit these microorganisms to another patient. In this situation, gloves must be changed between patient contacts, and hands should be washed after gloves are removed. Wearing gloves does not replace the need for handwashing, because gloves may have small, nonapparent defects or may be torn during use, and hands can become contaminated during removal of gloves. Failure to change gloves between patient contacts is an infection control hazard.

[edit]Surface sanitation

Sanitizing surfaces is an often overlooked, yet crucial component of breaking the cycle of infection in health care environments. Modern sanitizing methods such as NAV-CO2 have been effective against gastroenteritis, MRSA, and influenza. Use of hydrogen peroxide vapor has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective against endospore-forming bacteria, such as Clostridium difficile, where alcohol has been shown to be ineffective.[22] A Bio-Intervention process is effective for hard surface disinfection, providing a 6-log kill (99.9999%)for many organisms including MRSA, VRE, Psudomonas aeruginosa, Staphylococcus aureus, Rhinovirus, Salmonella enterica, H1N1, HIV-1 and Hepatitis A. The unique kill mechanism is new to the market and will be an effective method against mutation and resistance of organizations.

[edit]Aprons
Wearing an apron during patient care reduces the risk of infection.[citation needed] The apron should either be disposable or be used only when caring for a specific patient.

[edit]Mitigation
The most effective technique of controlling nosocomial infection is to strategically implement QA/QC measures to the health care sectors and evidence-based management can be a feasible approach. For those VAP/HAP diseases (ventilator-associated pneumonia, hospital-acquired

pneumonia), controlling and monitoring hospital indoor air quality needs to be on agenda in management [23] whereas for nosocomial rotavirus infection, a hand hygiene protocol has to be enforced.[24][25][26] Other areas that the management needs to be covered include ambulance transport.[citation needed]