This website provides information about infection control to protect persons from the transmission of infectious disease and other communicable conditions. Overviews and prevention of specific pathogens are discussed. Interactive and educational PowerPoints, detailing precautions and proper use of personal protective equipment, are also available.
Evidence-based best practice: Preventing transmission of infectious agents
- To provide infection control recommendations for all components of the healthcare delivery system, including hospitals, long-term care facilities, ambulatory care, home care, and hospice.
- To reaffirm Standard Precautions as the foundation for preventing transmission during administration of care in all healthcare settings.
- To reaffirm the importance of implementing Transmission-Based Precautions based on the clinical presentation or syndrome and likely pathogens until the infectious etiology has been determined.
- To provide epidemiologically sound and, whenever possible, evidence-based recommendations.
- Individuals and healthcare personnel in all settings.
Interventions and practices considered
Standard precautions for infection control; include these nine items:
- Hand hygiene
- Personal protective equipment (PPE)
- Respiratory hygiene/cough etiquette
- Person placement
- Care of equipment and instruments/devices
- Care of the environment
- Textiles and laundry
- Safe injection practices
- Worker safety
Assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting and apply the following infection control practices during the delivery of healthcare.
1. Hand hygiene
During the delivery of healthcare, avoid unnecessary touching of surfaces in close proximity to the individual to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces. When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water. If hands are not visibly soiled, the preferred method of hand decontamination is with an alcohol-based hand rub. Alternatively, hands may be washed with an antimicrobial soap and water. Frequent use of alcohol-based hand rub immediately following hand-washing with non-antimicrobial soap may increase the frequency of dermatitis. Decontaminate hands in the clinical situations listed below.
Perform hand hygiene:
- Before having direct contact with individuals.
- After contact with blood, body fluids or excretions, mucous membranes, non-intact skin, or wound dressings.
- After contact with an individual's intact skin (e.g., when taking a pulse or blood pressure or lifting an individual).
- If hands will be moving from a contaminated-body site to a clean-body site during care.
- After contact with inanimate objects (including medical equipment) in the immediate vicinity of the individual.
- After removing gloves.
Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if contact with spores (e.g., Clostridium difficile or Bacillus anthracis) is likely to have occurred. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor action against spores.
2. Personal protective equipment (PPE):
Observe the following principles of use:
- Wear PPE when the nature of the anticipated individual interaction indicates that contact with blood or body fluids may occur.
- Prevent contamination of clothing and skin during the process of removing PPE.
- Before leaving the individual's room, remove and discard PPE.
- Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, or potentially contaminated intact skin (e.g., of an individual incontinent of stool or urine) could occur. Wear gloves with fit and durability appropriate to the task.
- Wear disposable medical examination gloves for providing direct care.
- Wear disposable medical examination gloves or reusable utility gloves for cleaning the environment or medical equipment.
- Remove gloves after contact with an individual and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination.
- Do not wear the same pair of gloves for the care of more than one person.
- Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens.
- Change gloves during care if the hands will move from a contaminated body-site (e.g., perineal area) to a clean body-site (e.g., face).
- Wear a gown that is appropriate to the task to protect skin and prevent soiling or contamination of clothing during procedures and activities when contact with blood, body fluids, secretions, or excretions is anticipated.
- Wear a gown for direct contact if the individual has uncontained secretions or excretions. Remove gown and perform hand hygiene before leaving the individual's environment.
- Do not reuse gowns, even for repeated contacts with the same person.
Mouth, nose, eye protection:
- Use PPE to protect the mucous membranes of the eyes, nose and mouth during procedures and activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed.
- During aerosol-generating procedures (e.g., bronchoscopy, suctioning of the respiratory tract [if not using in-line suction catheters], endotracheal intubation) in individuals who are not suspected of being infected with an agent for which respiratory protection is otherwise recommended (e.g., Mycobacterium tuberculosis, severe acute respiratory syndrome [SARS], or hemorrhagic fever viruses), wear one of the following: a face shield that fully covers the front and sides of the face, a mask with attached shield, or a mask and goggles (in addition to gloves and gown).
3. Respiratory hygiene/cough etiquette
Educate healthcare personnel on the importance of source control measures to contain respiratory secretions to prevent droplet and fomite transmission of respiratory pathogens, especially during seasonal outbreaks of viral respiratory tract infections (e.g., influenza, respiratory syncytial virus (RSV), adenovirus, parainfluenza virus) in communities
Implement the following measures to contain respiratory secretions in individuals and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at the point of initial encounter in a healthcare setting (e.g., triage, reception and waiting areas in emergency departments, outpatient clinics, and physician offices):
- Post signs at entrances and in strategic places with instructions to individuals and other persons with symptoms of a respiratory infection to cover their mouths/noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after hands have been in contact with respiratory secretions
- Provide tissues and no-touch receptacles (e.g., foot-pedal-operated lid or open, plastic-lined waste basket) for disposal of tissues
- Provide resources and instructions for performing hand hygiene
- Provide conveniently-located dispensers of alcohol-based hand rubs and, where sinks are available, supplies for hand-washing
- During periods of increased prevalence of respiratory infections in the community, offer masks to coughing individuals
4. Person placement
Include the potential for transmission of infectious agents in person-placement decisions. Place individuals who pose a risk for transmission to others in a single-person room when available.
Determine person placement based on the following principles:
- Route(s) of transmission of the known or suspected infectious agent
- Risk factors for transmission in the infected person
- Risk factors for adverse outcomes resulting from a healthcare-associated infection (HAI) in other individuals in the area or room being considered for person placement
- Availability of single-person rooms
- Individual options for room-sharing (e.g., cohorting individuals with the same infection)
5. Equipment, instruments and devices
- Establish policies and procedures for containing, transporting, and handling equipment, instruments, and devices that may be contaminated with blood or body fluids
- Remove organic material from critical and semi-critical instrument and devices, using recommended cleaning agents before high level disinfection and sterilization to enable effective disinfection and sterilization processes
- Wear PPE (e.g., gloves, gown), according to the level of anticipated contamination, when handling equipment, instruments, and devices that is visibly soiled or may have been in contact with blood or body fluids
6. Care of the environment
- Establish policies and procedures for routine and targeted cleaning of environmental surfaces as indicated by the level of contact and degree of soiling
- Clean and disinfect surfaces that are likely to be contaminated with pathogens, including those that are in close proximity to the individual and frequently-touched surfaces in the environment (e.g., door knobs, surfaces in and surrounding toilets) on a more frequent schedule compared to that for other surfaces
- Review the efficacy of in-use disinfectants when evidence of continuing transmission of an infectious agent (e.g., rotavirus, C. difficile, norovirus) may indicate resistance to the in-use product and change to a more effective disinfectant as indicated
- In facilities that provide healthcare to pediatric individuals or have areas with child play toys, establish policies and procedures for cleaning and disinfecting toys at regular intervals
Use the following principles when developing these policies and procedures:
- Select play toys that can be easily cleaned and disinfected.
- Do not permit use of stuffed furry toys if they will be shared.
- Clean and disinfect large stationary toys (e.g., climbing equipment) at least weekly and whenever visibly soiled.
- If toys are likely to be mouthed, rinse with water after disinfection; alternatively wash in a dishwasher.
- When a toy requires cleaning and disinfection, do so immediately or store in a designated labeled container separate from toys that are clean and ready for use.
- Include multi-use electronic equipment in policies and procedures for preventing contamination and for cleaning and disinfection, especially those items that are used by individuals, those used during delivery of care, and mobile devices that are moved in and out of individual rooms frequently (e.g., daily).
7. Textiles and laundry
- Handle used textiles and fabrics with minimum agitation to avoid contamination of air, surfaces and individuals
- If laundry chutes are used, ensure that they are properly designed, maintained, and used in a manner to minimize dispersion of aerosols from contaminated laundry
8. Safe injection practices
The following recommendations apply to the use of needles, cannulas that replace needles, and, where applicable, intravenous delivery systems:
- Use aseptic technique to avoid contamination of sterile injection equipment
- Do not administer medications from a syringe to multiple individuals, even if the needle or cannula on the syringe is changed. Needles, cannula, and syringes are sterile, single-use items; they should not be reused for another individual nor to access a medication or solution that might be used for a subsequent person
- Use fluid infusion and administration sets (i.e., intravenous bags, tubing, and connectors) for one person only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a person's intravenous infusion bag or administration set
- Use single-dose vials for parenteral medications whenever possible
- Do not administer medications from single-dose vials or ampules to multiple individuals or combine leftover contents for later use
- If multi-dose vials must be used, both the needle or cannula and syringe used to access the multi-dose vial must be sterile
- Do not keep multi-dose vials in the immediate treatment area and store in accordance with the manufacturer's recommendations; discard if sterility is compromised or questionable Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients
- Infection Control Practices for Special Lumbar Puncture Procedures
- Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space
9. Worker safety
Adhere to federal and state requirements for protection of healthcare personnel from exposure to blood-borne pathogens.
Subject Matter Expertise from National Guideline Clearinghouse. For a printable version of this information in PDF, please click here.
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Agency for Healthcare Research and Quality (AHRQ) publications
Preventing Healthcare Associated Infections (PDF format)
Chapter 41 in Patient Safety and Quality: An Evidence-Based Handbook for Nurses, 2008. This chapter, written by Amy S. Collins, B.S., B.S.N., M.P.H., discusses the responsibilities of risk reduction, infection control program responsibilities, and infection control personnel responsibilities. Appendixes include resources of federal agencies and their web addresses and a table titled “Campaign To Prevent Resistance in Health Care Settings”.
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Targeting Health Care-Associated Infections: Evidence-Based Strategies (PDF format)
Chapter 42 in Patient Safety and Quality: An Evidence-Based Handbook for Nurses, 2008. This chapter, written by Ruth M. Kleinpell, Ph. D., R.N., F.A.A.N., Cindy L. Munro, R.N., A.N.P., Ph.D., F.A.A.N., and Karen K. Giuliano, R.N., Ph.D., F.A.A.N., discusses pneumonia, urinary tract infections, sepsis, and antibiotic-resistant infections. Tables include evidence-based prevention measures for above conditions and guidelines for general infection-prevention measures.
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Centers for Disease Control and Prevention
Centers for Disease Control and Prevention (CDC)
The CDC has a web page devoted to infection control, provided by the Division of Healthcare Quality Promotion (DHQP). On this site, a collection of guidelines are designed to protect individuals and healthcare workers. Sections are divided into management of featured items, an alphabetical listing of specific pathogens, and educational and training tools. Subjects of special interest may include Community-Associated Methicillin Resistant Staphylococcus aureus (CA-MRSA), Clostridium difficile (C-diff), Tuberculosis, and Get Smart: Know When Antibiotics Work; a campaign regarding antibiotic resistance. Get Smart is also available en español.
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Medline Plus offers a web page in their health topics section, highlighting the four main “germs” and related issues. This site has a link for children and seniors and is available en español. Medline Plus also has a medical encyclopedia with comprehensive information. For your convenience, a link directly to Pneumonia is provided. This page has illustrations, and includes links and definitions of signs and symptoms. Pneumonia is also available en español.
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Infectious Disease Control Unit (IDCU)
Infectious Disease Control Unit
This link on the Department of State Health Services’ website includes a state plan for Methicillin Resistant Staphylococcus Aureus (MRSA), community preparedness, and reporting. There are also sections on “infectious diseases A-Z” and Foodbourne illness under their
Health Topics link. Some information is also provided en español.
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Hand Hygiene Interactive Training
A resource web page, provided by the Centers for Disease Control and Prevention that reviews key concepts of hand hygiene and Standard Precautions.
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Personal Protective Equipment (PPE) in Healthcare Settings
This resource, developed by the Centers for Disease Control and Prevention, provides guidance for staff to select and use protective equipment. The goal is to increase safety.
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Posters and brochures
Sequence for Donning and Removing Personal Protective Equipment (PPE)
This poster, provided by the Centers for Disease Control and Prevention CDC, offers illustrated instructions on donning and removing PPE. This information is also available en español.
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Your 5 Moments for Hand Hygiene
This resource, provided by the World Health Organization (WHO), offers illustrated instructions on “when” and “why” to perform hand hygiene.
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Hand Hygiene Saves Lives
This brochure, provided by the Centers for Disease Control and Prevention, answers “why,” when,” “how,” “which,” and “who,” regarding hand hygiene. This information is also available en español.
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Sharing Isn’t Always Caring
This poster, provided by the Centers for Disease Control and Prevention, displays images of personal items known to spread infection. This information is also available en español.
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Cover Your Cough
This poster, provided by the Centers for Disease Control and Prevention, illustrates preventative measures on respiratory and hand hygiene. This information is also available en español.
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Mantoux Tuberculine Skin Test Wall Chart
This resource, provided by the Centers for Disease Control and Prevention, provides instructions on administration, reading, and interpretation of a tuberculin skin test.
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This poster, provided by the Centers for Disease Control and Prevention, includes a list of signs and symptoms of tuberculosis. This information is also available en español.
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Methicillin Resistant Staphylococcus Aureus Information Sheet
This resource, provided by the Centers for Disease Control and Prevention, answers common questions about Methicillin Resistant Staphylococcus Aureus.
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To learn more
For questions or comments, please contact us at TQM@dads.state.tx.us.
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December 17, 2013