What are the two tiers of precautions to prevent the transmission of infectious agents?

21 Dec Infection Control: Breaking the Chain of Infection

Posted at 18:15h in All Settings

The healthcare industry is constantly changing. New infectious diseases are discovered and, thanks to human ingenuity in terms of innovative research, new treatments and vaccines are created. Although infections are different from one to the next, the chain of infection explains how infectious diseases spread in general and can help prevent them from spreading. Understanding how the chain of infection works in a healthcare setting is the first step towards breaking it. The next step is implementing infection control education to learn about the chain of transmission related to infectious disease, why it’s important, and how you can actually break it.

The Chain of Infection Explained

The chain of infection outlines the conditions that foster the spread of infectious disease. To understand how to break the chain of infection, we must first understand the intricacies of the links in the chain.

The chain of infection can be detailed in six steps:

1. The microorganism is the infectious agent introduced. Some are more infectious than others, and some people are more susceptible to certain microorganisms than others.
2. The reservoir is the microorganism source, which can include humans, plants, animals, the environment, food, or water. Common reservoirs in healthcare include patients, healthcare personnel, medical equipment, and the environment. Reservoirs can carry the infection without symptoms but still pass it along.
3. The portal of exit is the way the microorganism leaves the reservoir to solidify its position as an infection. The portal of exit depends on where the organism is located in the body, which can include the GI tract (mouth or rectum), respiratory tract (nose or mouth), genitourinary tract (urinary diversion), blood, skin or mucous membrane (e.g., eyes, mouth) or  transplacental (mother to fetus).
4. The mode of transmission is the way the microorganism travels from person to person. There are three types of infection transmission: direct (person-to-person), indirect (vehicle-borne or object-to-person), and airborne (droplets or dust in the air). In healthcare, the primary method of organism spread is direct contact (person to person) or indirect contact (person to intermediate object such as medical equipment to person.)
5. The portal of entry is how a microorganism enters the body.
6. Infection of a susceptible host is the final step in this cycle (or the first step of the next infection, depending on how you look at it.) What traits define a susceptible host?

• Age (either end of the spectrum poses a risk)
• Receiving immunosuppressive treatment
• Having an immune deficiency condition
• Having a chronic disorder of any type
• Being a hospitalized patient

What is Infection Control?

According to the CDC, infection control prevents or stops the spread of infections in healthcare settings. Infection control is absolutely essential to a safe healthcare setting. The nature of the healthcare setting makes all patients and workers vulnerable to infection. The scientific and practical solutions that infection prevention and control are based upon aim to decrease that vulnerability and protect our communities. Infection control procedures are based on infectious disease knowledge, epidemiology, and social science.

Why is Infection Control Important?

The procedures are designed to reduce the risk of infections associated with hospital stays and promote a safe and healthy care environment. Approximately 1 in 31 people die from a — usually– preventable death had proper infection control practices been followed. Because of this, healthcare facilities hire infection preventionists to minimize accidental and unnecessary infections.

How to Break the Chain

The best way to break the chain of infection is to break one or more of the links to prevent spread or transmission. If left unchecked, some infections spread quickly through the chain and grow beyond control. The CDC describes two tiers of recommended precautions against this vicious chain of infection that promotes infectious disease spread. By following these precautions, you can break the chain.

Standard Precautions for All Patient Care

Standard precautions are the first tier of infection prevention and control. They’re used for all patient care and are based on risk assessment, common sense, and PPE use. The standard precautions are:

• Execute hand hygiene
• Make use of personal protective equipment (PPE) when exposure to infection is possible
• Observe respiratory hygiene (cough etiquette)
• Practice proper patient placement
• Handle, clean, and disinfect patient care equipment and environment properly
• Carefully handle laundry
• Practice safe injections
• Handle needles and sharps safely

Transmission-Based Precautions

Transmission-based precautions are the second tier of basic infection prevention and control. These are meant to be used in addition to first-tier precautions for patients who may be infected with a certain microorganism whose infection prevention requires extra care. There are three different types of transmission-based precautions:

Contact precautions are for patients with infections that have a high risk for contact-transmission. The chain of contact-based infections can be broken by following these measures:

• Good hand hygiene
• Practice proper patient placement.
• Use appropriate PPE
• Move the patient around the facility as little as possible
• Use disposable or dedicated equipment when working with the patient
• Make room and shared medical equipment cleaning and disinfection a priority

Droplet precautions are for patients with infections that show a high risk for transmission by respiratory droplets. The chain of respiratory-based infections can be broken by following these measures:

• Good hand hygiene
• Practice proper patient placement
• Wear a mask to enter the room or patient environment
• Move the patient around the facility as little as possible (If movement is required, instruct the patient to wear a mask and practice good respiratory hygiene)
• Mask the patient in the ambulatory setting

Airborne precautions are for patients with infections that show a high risk for airborne-transmission. The chain of airborne-based infections can be broken by following these measures:

• Practice proper patient placement in an airborne infection isolation room
• Limit healthcare staff from entering the room, especially those vulnerable to infection
• Use appropriate PPE such as an N95 or equivalent respirator
• Move the patient around the facility as little as possible (If movement is required, instruct the patient to wear a procedure mask and practice good respiratory hygiene)
• When possible, immunize vulnerable people

Protect Those Around You

Basic infection control practices are simple, effective, and mostly common sense. By taking these practices seriously and enforcing the right precautions, many lives can be saved in and outside healthcare settings. The general population can even use these bits of advice that have been outlined to promote public health. If your healthcare facility is looking for an infection control consultant to partner with, visit our website to learn more and get in touch.