Infection Prevention Control in Hospitals

Why Doctors and Nurses Don't Get Sick More Often

It seems that when one child is sick at home, everyone in the house gets sick. Yet in a hospital with possibly hundreds of patients with different kinds of illnesses and infections, doctors and nurses can usually avoid getting sick.

This is thanks to a few precautions that are simple, though strict, including hospital hygiene protocols to protect themselves from nosocomial (hospital-acquired) infections and standard precautions to prevent the spread of disease from potentially contaminated body fluids.

Dedicated adherence to these practices can keep staff well despite working with patients who are not.

Doctors and nurses walking around a hospital
Precautions for doctors and nurses. Caiaimage / Robert Daly / Getty Images

Hospital Hygiene Protocols

In hospitals, infectious microorganisms can be transmitted in several different ways. Some are transmitted while sneezing or coughing, which makes bacteria or a virus airborne. Others can be transmitted from person to person via touch.

But, the most frequent route of transmission is indirect contact. This 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.

To reduce the risk of infection not only to hospital staff but to other patients, several protocols are strictly followed.

These include:

  • Regularly disinfecting surfaces, instruments, and objects with approved antimicrobial agents or sterilizing techniques
  • Frequent handwashing (with plain soap for routine handwashing or an antimicrobial agent in specific circumstances)
  • Isolating patients with a known or suspected transmittable infection or quarantining those who were exposed to a contagious disease to see if they become sick
  • Mandating certain vaccinations for hospital staff, including for hepatitis B and the annual flu shot

Adequate handwashing with soap and water removes more than 90% of superficial contaminants. Antimicrobial soap will further remove bacteria, viruses, and other disease-causing pathogens.

Standard Precautions

Standard precautions, formerly known as universal precautions, is a term used to describe the practice of avoiding contact with a patient's bodily fluids to prevent the spread of transmittable disease.

As a rule, every patient is treated as a potential vector for infection even if they have no disease. This means that standard precautions are adhered to without exception or variation.

As a rule, no one should ever come into direct contact with blood, saliva, sputum, semen, vaginal secretions, amniotic fluid, cerebrospinal fluid, extracted tissues or organs, or fluids extracted from the joints, lungs, heart, or abdominal cavity (peritoneum).

To do so, healthcare workers are trained to adhere to standard precautions as outlined by the Centers for Disease Control and Prevention (CDC).

Standard Precaution Rules

Among the key rules governing standard precautions:

  • 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.
  • Use puncture-resistant sharps disposal containers.
  • Never recap, bend, or break needles.
  • Use resuscitation equipment in place of mouth-to-mouth resuscitation.
  • Immediately sterilize all overtly contaminated surfaces and devices.

Standard precautions also protect hospital workers and patients from an ever-widening range of drug-resistant bacteria, including methicillin-resistant Staphylococcal aureus (MRSA)carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococci (VRE).

Strictly speaking, standard precautions involve only the abovelisted bodily fluids but, in practice, the protocols also apply to urine, feces, vomit, nasal secretions, or any fluid that may be tainted with blood.

Airborne and Respiratory Droplets

There are also precautions to avoid infections spread by coughing and sneezing. These include potentially serious infections like respiratory syncytial virus (RSV), which is spread by respiratory droplets, and COVID-19, which may be spread by aerosolized particles.

Among the precautions used 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 surgical face mask before entering the room.
  • Avoid touching surfaces unnecessarily.
  • Wash hands vigorously after leaving the room.

Droplets vs. Aerosolized Particles

The precautions vary based on whether the infection involves respiratory droplets (larger than 5 microns) or aerosolized airborne particles (smaller than 5 microns). The smaller the particle is, the farther it can travel and the deeper it can go into the lungs.

Types of Airborne Infections

The types of infections that can potentially be spread by aerosolized particles include:

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, such as in certain cases of tuberculosis.
  • If an airborne pathogen is involved, anyone entering the room may be required to wear a special N-95 mask that can filter out particles as small as 0.1 to 0.3 microns.

A Word From Verywell

Hospital-acquired infections are a concern not only to patients but to hospital staff as well. During the early part of the COVID-19 pandemic, around 17% of hospitalizations in Scotland involved hospital employees, according to a 2020 study in the journal BMJ. Without adherence to hospital hygiene protocols and standard precautions, the rate could have been higher.

Many of the same precautions taken by hospital staff can be applied if ever a family member falls ill or an outbreak of infection is declared by your local health department. By understanding the principles behind these precautions, you can better protect yourself and your family from harm.

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Article Sources
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