There are many processes that must be followed in order to stop the spread of infection and prevent a susceptible individual from becoming ill. The individual could be the patient or the worker. This year is particularly challenging as we face the beginning of the influenza season while dealing with the COVID 19 pandemic.
In order to stop the spread of infection remembers these four important concepts.
- Patient safety must always be at the forefront of each patient encounter. Even though you have posted the Cover Your Cough posters, be diligent in educating and encouraging patients to wear masks appropriately when entering your practice or facility. Visitors must also be required to wear appropriate respiratory protection.
- Standard precautions provide the baseline to reduce the spread of infection to workers and patients. When used in combination, the risk of spread of infection decreases. The following actions should occur when providing patient care:
- Wash hands prior to providing care, after touching a patient or a contaminated surface, after removal of personal protective equipment (PPE).
- Utilize PPE in every situation where there is potential exposure to blood, body fluid, or respiratory secretions. The selection of PPE should be based on the risk of exposure to the worker. For instance, if there is the likelihood of a splash to the eyes, nose, or mouth, appropriate face protection (mask and safety glasses) should be utilized.
- Disinfect surfaces with a hospital-level surface cleaner/disinfectant. Be sure to follow the manufacturer’s directions for both contact time and the use of appropriate PPE. The cleaning schedule must be established based on the tasks performed and the potential for contamination during patient care.
3. Airborne precautions must be applied in addition to standard precautions when performing aerosol-generating procedures, performing COVID– 19 testing, and/or dealing with a suspected or known COVID-positive patient. The virus is spread in an airborne manner which drives a higher level of protection when involved in these activities. A NIOSH-approved respirator must be utilized to provide a higher level of protection for these workers. Respirators must be used in the context of a written respiratory protection program, medical evaluation, and fit testing.
4. Instrument processing should meet national standards outlined by the CDC and the Association for the Advancement of Medical Instrumentation (AAMI). Depending on the type of instrumentation being processed in your facility, there may be other organizational guidelines that must be considered. Patients should never wonder about the sterility of the instruments being used for a procedure. As a best practice, packages should be opened in front of the patient when the procedure is to begin. There are several other important items to remember when managing instrumentation used for procedures.
- Single-use items are designed to be used for one patient during one procedure. The item must be discarded after use; never disinfected or sterilized for reuse.
- For dental practices consider disposable tips for air/water syringes. Any non-disposable instrument which enters the patient’s mouth must be cleaned, packaged, and sterilized after patient use. This includes metal impression trays and mouth mirrors which can withstand the sterilization process.
- Utilize heavy-duty utility gloves when handling contaminated instruments. These gloves may be reused but should be surfaced disinfected or washed with soap and water after each use. Some gloves have the ability to be sterilized on a routine basis but follow the manufacturer’s direction to protect the integrity of the gloves.
- Equipment utilized for processing instruments such as an ultrasonic cleaner or washer-disinfector must be cleared by the FDA. Always follow the manufacturer’s recommendations for cleaning, maintenance, and use of the equipment.
- Monitoring of the sterilization process includes the use of internal and external chemical indicators in each package and spore testing as a general rule each week and with implantable items.
This list includes several important actions which if implemented will create a culture of safety and reduce the likelihood of spread of infection. Take the time now to compare these recommendations to the activities in your practice, making the necessary corrections that will lead to a safe environment for all.