Infection Prevention and Control in Hospitals

There are many precautions and protocols that doctors, nurses, and other hospital staff follow to help prevent the spread of infections within a medical facility.

Healthcare workers are trained to adhere to rules outlined by the Centers for Disease Control and Prevention (CDC) known as standard precautions.

Standard precautions apply to all patients and their care. They include basic hygiene practices, such as hand washing and disinfecting equipment, and safety guidelines that must be used when dealing with blood or handling needles.

This article explores the many simple, though strict, standard precautions that medical staff follow to protect patients and themselves from getting infections. It also discusses additional measures that are taken in certain circumstances.

Types of Transmission

Any infection that you get after you were exposed to germs while in a hospital is known as a hospital-acquired infection (a.k.a. nosocomial infection).

To understand the “why” behind standard precautions, it helps to first review all of the ways germs can be passed along, or transmitted, in a medical setting.

Indirect Contact

This is a frequent way illness is spread in hospitals. It is when an infected person touches and contaminates an object or a surface that an uninfected person then touches.

This is referred to as fomite transmission. It commonly occurs with bacterial infections, such as Escherichia coli (E. coli) or Staphylococcus (staph), and viral infections, such as the flu or norovirus.

Direct Contact

Spread can occur when a sick person touches someone else. In a hospital, this commonly results in the same types of viral and bacterial infections that can be spread via indirect contact.

Sprays or Splashes

When someone sneezes or coughs, they expel droplets that can reach another person’s eyes, nose, or mouth, or get inhaled within about 6 feet. COVID-19 and the common cold can spread this way.

Medical procedures such as extubation (removing a tube placed to aid breathing) also commonly cause sprays and splashes, which is why healthcare workers wear protective equipment.

Inhalation

Certain bacteria or viruses can become airborne, or suspended in the air, including the bacterial infection tuberculosis (TB) and the viral infection measles.

The particles can linger and travel on air currents over great distances, such as from one room to another, and get inhaled by other people.

Sharps Injuries

This is when a bloodborne pathogen, or a germ carried in one’s blood, enters a person through a used needle or instrument that wasn’t properly handled or cleaned. Examples include the human immunodeficiency virus (HIV) and the hepatitis B virus.

Standard Precautions

Standard precautions are the minimum precautions that are used for all patients to prevent the spread of infections. In addition to hospitals, they are used in all forms of healthcare settings, including doctor’s offices and long-term care facilities.

As a rule, every patient is treated as if they have an infection even if they have no disease. This means that standard precautions are followed without exception.

Bloodborne Infection Protocols

In order to prevent the spread the spread of pathogens that can be carried in blood, precautions are taken with all patients to avoid direct contact with:

• Blood
• Semen
• Vaginal secretions
• Amniotic fluid
• Cerebrospinal fluid
• Extracted tissues or organs
• Fluids extracted from the joints, lungs, heart, or abdominal cavity (peritoneum)

Standard precautions are especially important for protecting hospital workers and patients from an ever-widening range of drug-resistant bacteria. These are pathogens that have evolved to the point that they are no longer effectively treated with standard drugs.

Drug-resistant bacteria include methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacterales (CRE), and vancomycin-resistant Enterococci (VRE).

Hygiene Protocols

Hygiene protocols were added to the above standard precautions to account for all types of bodily fluids and substances that can carry infections. This includes saliva, sputum, urine, feces, vomit, and nasal secretions.

These are strictly followed as part of the standard precautions and include:

• Regularly cleaning surfaces, instruments, and objects with chemical disinfectants or sterilizing techniques, such as steaming
• Frequent hand hygiene using alcohol-based hand sanitizer, plain soap, or antimicrobial soap
  
• Recommending certain vaccinations for hospital staff, including for hepatitis B and the annual flu shot
• Isolating patients with certain infections or quarantining those who were exposed to a contagious disease to see if they become sick

Respiratory hygiene is also a standard precaution. It is to help reduce infections spread by coughing and sneezing. Hospitals will often give instructions to patients and staff about covering a cough and alerting staff immediately about respiratory symptoms.

During the early part of the COVID-19 pandemic, about 6% of hospitalizations documented in 13 states were hospital employees. Without standard precautions, including hygiene protocols, the rate could have been higher.

Examples of Rules That Are Followed

Some of the key rules that are part of standard precautions include:

• Use barrier protection at all times.
• Use disposable gloves when working around blood and body fluids.
• Change gloves between patients.
• Immediately wash hands after removing gloves or when exposed to blood or bodily fluids.
• Use glasses, goggles, masks, face shields, and waterproof gowns to protect from splashes.
• Develop procedures for routine care, cleaning, and disinfection of surfaces, especially frequently touched surfaces.
• Carefully handle equipment and laundry and wear gloves to handle any soiled items.
• Use puncture-resistant sharps disposal containers.
• Never bend, break, or put a cap back on a needle.
• Use resuscitation equipment in place of mouth-to-mouth resuscitation.
• Immediately sterilize all overtly contaminated surfaces and devices.

Transmission-Based Precautions

Transmission-based precautions are a second tier of precautions that are specifically for patients who are known or suspected to have certain types of infections. They are used in addition to the standard precautions for these patients.

These include potentially serious airborne infections like COVID-19, tuberculosis (TB), and measles.

Among the precautions that hospital staff use if there is a known or suspected risk of such transmission:

• Isolate the patient from others (although patients with the same infection, such as COVID-19, can share a room).
• Stand at least three feet (and ideally six feet) from the patient.
• Wear a medical mask or other specified personal protective equipment (PPE) before entering the room.
• Avoid touching surfaces unnecessarily.
• Wash hands vigorously after leaving the room.

In cases where a serious pathogen is involved or an epidemic has been declared, other precautions may be implemented. Among them:

• The patient may be isolated in a negative pressure room. These are rooms in which the air is drawn out and not redirected into any adjoining rooms or hallways.
• Special ultraviolet (UV) lights may be installed to help kill the offending pathogen.
• If an airborne pathogen is involved, anyone entering the room may be required to wear a special N95 mask that can filter out particles as small as 0.1 to 0.3 microns.

Summary

Standard precautions are precautions that hospital staff use in all patient care to prevent the spread of infections.

This includes hand washing, proper handling and disinfecting of equipment, and the use of protective gear whenever there is the potential for exposure to infectious material.

When a patient is known or suspected to have certain infections, such as TB or COVID-19, there are additional transmission-based precautions that are taken, such as patient isolation and use of personal protective equipment.

A Word From Verywell

Hospital-acquired infections are a concern for both patients and hospital staff. While healthcare workers are required to follow these protocols, remember that you also play a role in preventing infections if you are a patient or even a visitor.

And these steps are useful even out of a medical setting. Many of the same precautions taken by hospital staff, such as hand washing and disinfecting surfaces, can be applied at home if a family member falls ill or an outbreak of infection is declared by your local health department.