Introduction there is a high risk of transmission of pathogens causing infections in the healthcare setting techniques to prevent health-care associated infection in patients, healthcare providers, and other hospital staff standard precautions hand hygiene personal protective equipment (PPE) respiratory hygiene etiquette safe injection and sharps practices disinfection/cleaning sterilization of hospital equipment isolation precautions key terms sterilization to kill or eliminate all pathogens e.g., autoclave process disinfection to eliminate or neutralize pathogens to reduce possible contamination to a safe level e.g., hand washing Standard Precautions Hand hygiene handwashing with soap and water more dehydrating with repeated use drying with paper towels reduces the total number of bacteria on hands disinfecting agents (often alcohol-based) risk of contact dermatitis and irritation artificial nails should not be present PPE should be worn when hospital staff are exposed to any body secretions gloves masks safety glasses/face shield gowns Respiratory hygiene etiquette covering nose and mouth while coughing hand hygiene after contact with any respiratory secretions using mask as needed Safe injection and sharps practices prompt and safe disposal of sharps Disinfection Skin or mucous membranes alcohol prior to puncturing the skin with a needle dissolves lipid bilayer membranes and denatures proteins ineffective against protozoan oocysts, some nonenveloped non-lipophilic viruses, and bacterial spores chlorhexidine disinfection of hands prior to surgery prep a body area for a procedure. Chlorhexidine-alcohol solutions significantly decrease the risk for central line associated bloodstream infections (CLABSI). wound cleaning iodine wound cleaning or prevention of infection Surfaces aldehydes, halogens, hydrogen peroxide, and halogens denatures cell components effective against spores and all viruses Sterilization Sterilization techniques are used to kill or eliminate all pathogens, including its spores, on equipment, e.g., surgical instruments that come into contact with sterile body parts or fluids Autoclave direct high-pressure steam at > 121°C denatures enzymes and proteins in pathogens not effective against prions prions must be sterilized at higher temperatures for longer periods of time most commonly used Dry heat or “oven” sterilization temperatures of 150-170°C denatures and oxidizes cell parts used only on instruments made of metal or glass Chemical sterilizing agents aka “cold sterilization” ethylene oxide gas alkylation of proteins and genetic material spores may resist this process hydrogen peroxide gas plasma free radical damage to cell parts used when autoclave and dry heat cannot be used for heat- and moisture-sensitive instruments Radiation not commonly used Isolation Precautions Contact precautions for patients with multi-drug resident (MDR) pathogens gowns and gloves for all hospital staff medical equipment should be dedicated to the single patient Droplet precautions droplets: respiratory secretions ≥ 5 microns surgical mask Airborne precautions airborne droplet nuclei: respiratory secretions < 5 microns respirator mask with 95% filtering capacity requires a fit testing to ensure tight seal over nose and mouth Pathogens with Specific Isolation Precautions Contact Precautions Droplet Precautions Airborne Precautions MDR bacteria MRSA VRE Enteric infections norovirus E. coli Viruses VZV HSV RSV parainfluenza enterovirus rhinovirus Scabies Skin and soft tissue infections S. aureus group A streptococcus Bacteria Neisseria meningitides Mycoplasma pneumoniae Haemophilus influenzae type B Bordetella pertussis group A streptococcus Diphtheria Viruses influenza rubella mumps adenovirus rhinovirus parvovirus B19 Tuberculosis VZV Measles Smallpox SARS Ebola virus