+ Importance of infection control
- 30 -50% of infections resulting from exposure in healthcare facilities are preventable, and are primarily caused by problematic patient care practices, such as poor hand washing.1
- Recent data show that in Canada, one in every nine hospital in-patients acquires a nosocomial infection2,3
- The Public Health Agency of Canada and the World Health Organization (WHO) recommend that all healthcare facilities put an efficient infection control program into place to prevent the spread of disease.4,5
- Full participation in infection control is the responsibility of every health care worker
- Good infection control practices instil confidence in patients6
- Education (for healthcare professionals, patients and hospital visitors) is an important component of infection control
+ Routine practices
- Routine practices should be the minimum level of precautions used when providing care for all patients.7
- Routine practices are an element of best practice followed by all MRTs, including proper hand hygiene according to the guidelines set out by their facility.8
- MRTs’ duty to their patients include familiarity with institutional procedures and policies regarding standard and special precautions (contact, droplet or airborne), including the proper use of personal protective equipment.9
- Hand hygiene is a major component of routine practices and one of the most effective methods to prevent transmission of pathogens associated with healthcare.7
- Like all healthcare professionals, MRTs are expected to learn and adhere to hand hygiene techniques.7
- Five moments for hand hygiene include:10
- Before touching a patient
- Before clean aseptic procedure
- After body fluid exposure risk
- After touching a patient
- After touching patient surroundings
- Gloves are also worn during certain procedures, particularly those where contact with a patient’s bodily fluids is likely.7
- Gloves are not a replacement for hand washing -- hands should be washed prior to putting on, and after removing gloves
+ Additional precautions
- Depending on the route of transmission (airborne, contact or droplet) a different set of additional precautions is employed for people with documented or suspected infection.11
Additional airborne precautions
- Examples of diseases which are transmitted via the airborne route include:11
- Measles (rubeola)
- Varicella (including disseminated herpes zoster)
- Additional airborne precautions include:4,11,12
- Using N95 masks for MRTs, where fit-testing has been completed
- Using surgical masks for patients, MRTs without N95 fit-testing, and others coming into contact with the infectious agent
- Instructing patients to observe respiratory hygiene/cough etiquette
- Limiting on the movement and transport of patients
- Keeping doors to rooms closed
- Airborne pathogens stay suspended in the air for long periods of time – ventilation of the environment may be required.12
Additional contact precautions
- Examples of diseases which are transmitted via contact include:
- Methycillin-resistant staphylococcus aureus (MRSA)
- Vancomycin-resistant enterococcus (VRE)
- Clostridium difficile (C. difficile)
- Contact transmission may occur directly (infected person to person) or indirectly (contaminated equipment, etc.).11
- Additional contact precautions include:4,11,12
- Strict hand hygiene for all those who come into contact with the patient
- Using personal protective equipment such as gloves and gowns
- Carefully disposing of gloves and other items that come into contact with the patient
- Proper cleaning of equipment, according to facility policy
Additional droplet precautions
- Examples of diseases which are transmitted via the droplet route include:11
- Influenza virus
- Neisseria meningitidis
- Bordetella pertussis (whooping cough)
- Additional droplet precautions include:4,11,12
- Using a surgical mask (patient, MRT and others coming into contact with the patient)
- Using gloves and gowns
- Instructing patients to observe respiratory hygiene/cough etiquette
- Using eye protection when within 1-2 meters of patient
- Limiting the movement and transport of patients
+ Facility-level precautions
- Good housekeeping in the workplace helps to reduce the prevalence of pathogens and discourage the growth of microorganisms.13
- Equipment is wiped with disinfectant between patients.7
- Fresh linens are used for each new patient and used linens are handled and transported in a way that avoids exposure to other patients or staff.7
- Safe waste management techniques are employed.7
- Some waste may be disposed of in the regular garbage
- Biomedical waste is disposed of according to established guidelines and standards
- Infectious patients are scheduled for the end of the day where possible.
- This allows a thorough cleaning of the room (while it remains unoccupied over a prolonged period of time), allowing the air filtration system to remove any airborne contaminants
- Airborne precautions often include a period of time where a room is left empty after an infectious patient followed by thorough cleaning
+ Communication and education
- An effective infection control program requires good communication with patients and education regarding the importance of institutional practices.14,15
- MRTs explain the importance of hand washing when entering and leaving the facility and hand hygiene awareness information is available to patients
- Family and visitors are also given instructions regarding hand hygiene and the appropriate use of Personal Protective Equipment as appropriate11
- Patients who require additional precautions should have the importance of these measures explained to them.16
- Effective communication between staff is also essential.17
- Precaution patients are clearly identified and recorded
- Additional precautions are communicated at every patient handover
- Bennett JV, Brachman PS, eds: Hospital Infections, 3rd ed, Boston. Little, Brown and co., 1992.
- Zoutman DE, Ford BD, Bryce E, et al. The state of infection surveillance and control at Canadian acute care hospitals. Am J Infect Control 2003;31:266-275.
- Canadian Union of Public Employees. Health care associated infections: a backgrounder. Available at: http://cupe.ca/health-care/health-care-associated-infections#ftn5. Accessed April 3, 2012.
- World Health Organization. Practical Guidelines for Infection Control in Health Care Facilities, 2004. Available at: http://www.searo.who.int/LinkFiles/Publications_PracticalguidelinSEAROpub-41.pdf. Accessed April 3, 2012.
- Public Health Agency of Canada. Infection control guidelines: Hand washing, cleaning, disinfection and sterilization in health care. Available at: http://www.collectionscanada.gc.ca/webarchives/20071124225902/http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/98vol24/index.html. Accessed April 3, 2012.
- O'Boyle CA, Henly SJ, Duckett LJ. Nurses’ motivation to wash their hands: a standardized measurement approach. Appl Nurs Res 2001;14:136-145.
- World Health Organization. Infection control standard precautions in health care: Aide-Memoire. Available at: http://www.who.int/csr/resources/publications/4EPR_AM2.pdf. Accessed April 3, 2012.
- World Health Organization. WHO guidelines on hand hygiene in health care. Available at: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. Accessed April 3, 2012.
- Canadian Association of Medical Radiation Technologists. Code of Ethics. Available at: http://www.camrt.ca/abouttheprofession/codeofethics/. Accessed April 3, 2012.
- World Health Organization. Your 5 Moments for Hand Hygiene. Available at: http://www.who.int/gpsc/5may/Your_5_Moments_For_Hand_Hygiene_Poster.pdf. Accessed May 25, 2012.
- Newfoundland and Labrador Department of Health & Community Services Disease Control Division. Guideline for Routine Practices and Additional Precautions. Available at: http://westernhealth.nl.ca/uploads/PDFs/Routine_Practices_and_Additional_Precautions.pdf. Accessed April 4, 2012.
- Ontario Infection Control Committee. Infection control for regulated professionals. Available at: http://www.cmto.com/pdfs/Infection_Control_Guidelines.pdf. Accessed April 4, 2012.
- Ehrlich RA, Daly JA. Patient Care in Radiography. With an Introduction to Medical Imaging. 7th Ed. St. Louis, MO: Mosby; 2008.
- Coulter A, Ellins J. Effectiveness of strategies for informing, educating and involving patients. BMJ 2007;335(7609):24-27.
- Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings. Infect Control Hosp Epidemiol 2002;23(12):S3-S40.
- Washington CM, Leaver D, eds. Principles and Practice of Radiation Therapy. 3rd Ed. St. Louis, MO: Mosby Elsevier; 2010.
- Siegel J et al. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. Center for Disease Control. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed April 4, 2012.