Deterrence/Prevention
The Healthcare Infection Control Practices Advisory Committee (HICPAC) has developed a guideline for isolation precautions to prevent transmission of infectious agents in healthcare settings. [37, 38]
Standard precautions are to be applied to the care of all patients in all healthcare settings regardless of the suspected or confirmed presence of an infectious agent. This is the primary strategy in preventing transmission of infectious agents among patients and healthcare personnel.
Transmission-based precautions are used in addition to standard precautions when caring for patients who are infected or colonized with pathogens transmitted by airborne, droplet, or contact routes.
Airborne precautions are used to prevent transmission of airborne droplet nuclei–containing microorganisms. These droplet nuclei remain suspended in air. Precautions include use of single-patient rooms, negative air-pressure ventilation, and N95 respirator masks or higher. Organisms transmitted by airborne route include Mycobacterium tuberculosis, rubeola (measles) virus, and the varicella-zoster virus. Droplet precautions are used to prevent transmission of droplets containing microorganisms propelled less than 3 feet by coughing or sneezing by an infected person. Precautions include use of mask in the room and use of single-patient room or, if not feasible, cohorting of patients separated at least 3 feet apart.
Conditions/pathogens for which droplet precautions should be used include adenovirus, diphtheria, H influenzae type b, hemorrhagic fever viruses, influenza, mumps, M pneumoniae, Neisseria meningitidis, parvovirus B19, pertussis, plague (pneumonic), rubella, severe acute respiratory syndrome (SARS), streptococcal pharyngitis, pneumonia, or scarlet fever.
Contact precautions are used to prevent transmission of microorganisms via direct or indirect contact with infected or colonized persons. Precautions include use of single-patient room (if not feasible, cohort patients infected with the same organism), use of gowns and gloves, and hand hygiene after glove removal.
Conditions/pathogens for which contact precautions should be used include multidrug-resistant bacteria (eg, vancomycin-resistant enterococci, methicillin-resistant S aureus [MRSA], multidrug-resistant gram negative bacilli), C difficile, diphtheria, enteroviruses, E coli O157:H7 and other Shiga toxin-producing E coli, hepatitis A virus, herpes simplex virus (neonatal, mucocutaneous, or cutaneous), herpes zoster in a normal host (localized with no evidence of dissemination), impetigo, noncontained abscess, cellulitis or decubitus ulcer, parainfluenza virus, pediculosis, respiratory syncytial virus, rotavirus, scabies, Shigella, S aureus (cutaneous or draining wounds), and viral hemorrhagic fevers (eg, Ebola, Lassa, Marburg).
Prevention of intravascular catheter-associated infections includes avoidance of unnecessary catheter placement, removal of catheter as soon as possible, aseptic technique during catheter insertion, and minimal manipulation of catheter. CDC guidelines address specific strategies in preventing intravascular catheter-associated infections. [39]
Over the years, increasing evidence is showing potential benefit of using antimicrobial-impregnated catheters, antimicrobial-impregnated dressings, and antimicrobial and ethanol locks in at-risk populations to decrease recurrences of catheter-related bloodstream infections. [40, 41] In addition, reduction in lumen contamination, organism density, and catheter-related bloodstream infections has been shown by scrubbing the catheter hub with devices containing isopropyl alcohol. [42, 43, 44]
Prevention of healthcare-associated bacterial pneumonia includes several category IA recommendations, including education of healthcare workers about infection control procedures, thorough cleaning of devices for sterilization or disinfection, changing the breathing circuit only when it is visibly soiled, hand hygiene, and change of soiled gloves. [45]
Prevention of catheter-associated urinary tract infections includes several category I recommendations, including education of personnel in proper techniques of catheter insertion and care, catheterizing only when necessary, emphasizing handwashing, using aseptic technique for catheter insertion, securing catheter properly, maintaining closed sterile drainage, obtaining urine samples aseptically, and maintaining unobstructed urine flow. [46]
CDC highly recommends handwashing with either a nonantimicrobial soap and water or an antimicrobial soap and water when hands are visibly dirty or soiled with blood and other body fluids. If hands are not visibly soiled, alcohol-based hand rub may be used for routine decontamination of hands. [37]
Disinfection of hospital rooms with hydrogen peroxide vapor in addition to standard cleaning reduces environmental contamination and the risk of infection with multidrug-resistant organisms. In a 30-month prospective cohort intervention study in 6 high-risk units in a 994-bed tertiary care hospital, room decontamination with hydrogen peroxide vapor reduced the risk of acquiring any multidrug-resistant organism by 64% and the risk of acquiring vancomycin-resistant enterococci by 80%. [47, 48]
In an open, prospective study, Maziade et al reported a decrease in hospital-acquired infections with the bacterial species C difficile when probiotics were added to standard preventive measures against C difficile infection in patients taking antibiotics. In the final phase of the study, over 25,000 patients on antibiotics received standard preventive care against C difficile along with a daily oral dose of a probiotic formula containing Lactobacillus acidophilus and L casei. Over a 6-year period, the rate of C difficile infections at the hospital performing the study averaged 2.7 cases per 10,000 patient-days, while the rate at similar hospitals averaged 8.5 cases per 10,000 patient-days. [49]
In a retrospective study, rates of hospital-acquired infections caused by multidrug-resistant organisms (MDRO) or C difficile decreased when an ultraviolet environmental disinfection (UVD) system was used after routine discharge cleaning of contact precautions rooms and other high-risk hospital areas. A 20% decrease in hospital-acquired MDRO and C difficile rates was observed during the 22-month period of UVD use as compared with the 30-month pre-UVD period (2.14 vs 2.67 cases per 1000 patient-days). [50, 51]
