INFECTION PREVENTION MEASURES IN HEALTHCARE SETTINGS

Both the annual influenza season and the COVID-19 pandemic create additional challenges in preventing infection, how healthcare is delivered, and the operations of healthcare facilities. The ways both diseases spread (droplets, close contact, etc.) may put healthcare professionals at higher risk since they work not only with patients who are known to be infected but with patients who may be asymptomatic as well.

Prevention Strategies for Seasonal Influenza in Healthcare Settings

A summary of CDC recommendations for prevention of flu transmission in healthcare settings is provided below. (This list is not complete; see “Resources” at the end of this course for a link to the complete CDC recommendations.)

Provide opportunities for all employees to receive the flu vaccine at work.
Before patients and visitors arrive at a healthcare setting, instruct them to inform healthcare personnel if they have symptoms of any respiratory infection and to take appropriate prevention actions (e.g., wear a mask).
During periods of influenza activity, limit elective visits by patients with suspected or confirmed influenza.
Take steps to ensure all persons with symptoms of a respiratory infection adhere to respiratory hygiene, cough etiquette, hand hygiene, and triage procedures throughout the visit.
Post visual alerts about the steps described above in strategic locations throughout the healthcare facility.
Provide facemasks.
Provide supplies to perform hand hygiene.
Provide social distancing in common areas (e.g., waiting rooms).
Instruct staff members not to report to work, or if at work, to stop patient-care activities, don a facemask, and notify their supervisor and infection control personnel before leaving work. (Staff members should not return to work until at least 24 hours after they no longer have a fever without the use of fever-reducing medicines.)
Develop sick-leave policies for staff members that are nonpunitive.
Develop employee procedures for tracking absences.
Adhere to Standard Precautions.
Adhere to Droplet Precautions.
Use caution when performing aerosol-generating procedures.
Manage visitor access and movement within the facility.
Train and educate healthcare personnel on the prevention of infectious agents, including influenza.
Develop an influenza strategy that can be applied across the entire spectrum of health settings.
(CDC, 2021k)

Infection Prevention and Control (IPC) Recommendations during the COVID-19 Pandemic

To avoid the spread of SARS-CoV-2 in the healthcare setting, the CDC provides guidance based on currently available information about COVID-19 and the current situation in the United States. Several of the IPC measures are influenced by levels of SARS-CoV-2 transmission in the community.

This guidance is applicable to all U.S. settings where healthcare is delivered (including home health). Employers should be aware that other local, state, and federal requirements may apply, including those promulgated by OSHA (CDC, 2022m).

A summary of CDC recommendations for prevention of COVID transmission in healthcare settings is provided below. (This list is not complete; see “Resources” at the end of this course for a link to the complete and most up-to-date CDC recommendations.)

RECOMMENDED ROUTINE IPC PRACTICES

Establish a process to identify and manage individuals entering the facility with suspected or confirmed SAR-CoV-2 infection regardless of vaccination status.
Implement source control measures (i.e., use of respirators or well-fitting facemasks or cloth masks) and physical distancing for everyone in a healthcare setting regardless of their vaccination status.
Implement universal use of personal protective equipment for healthcare providers (HCP).
Encourage physical distancing.
Optimize the use of engineering controls (e.g., physical barriers) and indoor air quality. Ensure everyone is aware of recommended IPC practices in the facility.
Perform SARS-CoV-2 testing on anyone with even mild COVID-19 symptoms, regardless of vaccination status.
Create a process to respond to SARS-CoV-2 exposures among HCPs and others.
(CDC, 2022m)

SOURCE CONTROL OPTIONS

Source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing. Source control options for HCP include:

A NIOSH-approved N95 or equivalent or higher-level respirator, or
A respirator approved under standards used in other countries that are similar to NIOSH-approved N95 filtering facepiece respirators (note: these should not be used instead of a NIOSH-approved respirator when respiratory protection is indicated), or
A well-fitting facemask

When used solely for source control, any of the options listed above could be used for an entire shift unless they become soiled, damaged, or hard to breathe through. If they are used during the care of a patient for which a NIOSH-approved respirator or facemask is indicated for personal protective equipment (e.g., NIOSH-approved N95 or equivalent or higher-level respirator during the care of a patient with SARS-CoV-2 infection, facemask during a surgical procedure or during care of a patient on Droplet Precautions), they should be removed and discarded after the patient care encounter and a new one should be donned (CDC, 2022m).

RECOMMENDATIONS FOR FULLY VACCINATED INDIVIDUALS

CDC recommendations for work restriction for healthcare providers who are up to date with all recommended COVID-19 vaccines doses or who have recovered from SARS-CoV-2 infection in the prior 90 days include:

No work restrictions or testing
Following all recommended infection prevention and control practices, including monitoring oneself for fever or symptoms consistent with COVID-19 and not reporting to work when ill
In cases of fever or symptoms consistent with COVID-19, immediately self-isolating and contacting an established point of contact (e.g., occupational health program) to arrange for medical evaluation and testing

(CDC, 2022m)

RECOMMENDED IPC PRACTICES WHEN CARING FOR PATIENTS WITH SUSPECTED OR CONFIRMED SARS-CoV-2 INFECTION

The CDC provides detailed guidance on infection control when caring for patients with suspected or confirmed COVID-19 infection. These recommendations apply to patients with COVID-19 symptoms as well as asymptomatic patients who have had close contact with someone who is infected. This guidance covers various aspects of patient care, including:

Patient placement, transport, and movement in the facility
Use of personal protective equipment and Standard Precautions
Procedures that could generate infectious aerosols
Visitation to patients’ rooms and lower-risk alternatives
Duration of transmission-based precautions
Environmental infection control, including medical equipment, cleaning/disinfection, etc.
(CDC, 2022n)

(See “Resources” at the end of this course for a link to the CDC’s detailed recommendations.)