Infection Control: Breaks in the Chain
The chain of infection
The chain has six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Infection control is simply breaking one link - usually the transmission link, and usually with hand hygiene.
Concepts to know cold
Standard precautions apply to every resident, every time: hand hygiene, gloves for blood, body fluids, non-intact skin, and mucous membranes; gown, mask, and eye protection when splashing is likely. Transmission-based precautions add contact (gown and gloves - MRSA, C. difficile, scabies), droplet (mask - influenza, pertussis), and airborne (fit-tested N95 and negative-pressure room - tuberculosis, measles, varicella).
Donning order: gown, mask, goggles, gloves. Doffing order: gloves, goggles, gown, mask - then hand hygiene. Do not shake linens, do not recap needles, use the sharps container at the point of use, and bag soiled items before transport.
Traps
- Believing gloves replace hand hygiene. They do not; wash before and after.
- Using alcohol rub for a resident with C. difficile - wash with soap and water because spores resist alcohol.
- Removing the mask before the gown.
- Carrying soiled linens against your uniform.
- Recapping a used needle or leaving a sharp on a meal tray.
Rule of thumb
Scrub for at least 20 seconds - about two rounds of "Happy Birthday." If you are unsure whether you need a gown or mask, add it; extra protection is cheaper than an outbreak.