Key Infection Control Practices in Inpatient and Outpatient Medical Care Settings
- Establish and maintain infection control policies and procedures
- Implement written policies and procedures according to published guidelines.
- Ensure staff members are familiar with policies and procedures and review regularly.
- Update written policies and procedures regularly.
- Properly use and handle needles, cannulae and syringes
- Whenever possible, use sharps with engineered sharps injury protections (i.e., nonneedle sharp or needle devices with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident). Do not disable or circumvent the safety feature on devices.
- Needles, cannulae and syringes are:
- Sterile, single-use items; any use will result in these items being contaminated.
- Contaminated once used to enter or connect to any component of a patient's intravenous infusion set.
- Medication from a syringe must not be administered to multiple patients even if the needle on the syringe is changed.
- Dispose of all needles and syringes immediately into a leakproof, puncture-resistant, closable container.
- Develop policies and procedures to prevent sharps injuries among staff and review regularly.
- Properly handle medications and solutions
- Designate separate areas for preparation and disposing medications.
- Minimize use of multidose vials; use single-dose vials for parenteral medications whenever possible.
- If multidose vials must be used:
- Always use aseptic technique.
- A new needle/cannula and a new syringe must be used to access the multidose vial.
- Do not keep the vials in the immediate patient treatment area.
- Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later.
- Do not use bags or bottles of intravenous solution as a common source of medication or fluid for multiple patients.
- Use infusion sets (i.e., intravenous bags, tubing and connectors) for one patient only and dispose appropriately after use.
- Strictly adhere to aseptic technique
- Ensure all staff members perform proper hand hygiene before and after gloving, between patients, and whenever hands are soiled.
- Avoid cross contamination with soiled gloves.
- Provide adequate soap/water, disposable paper towels, and waterless alcohol-based hand rubs throughout the facility.
- Properly reprocess medical equipment
- Follow manufacturer's recommendations for proper cleaning, disinfection, and sterilization of all reusable equipment.
- Designate staff responsible for maintaining proper reprocessing procedures.
- Ensure designated staff members are properly trained in reprocessing each piece of equipment.
- Never reprocess equipment designated for single use.
- Maintain a log of all equipment reprocessing.
- Fulfill all federal and state requirements for infection control training
- All healthcare personnel must complete bloodborne pathogen control training regularly.
- All licensed healthcare professionals in New York State (physicians, physician assistants, special assistants, registered professional nurses, licensed practical nurses, podiatrists, optometrists, dentists, and dental hygienists) are required to receive training on infection control and barrier precautions every four years through a NYS-approved provider.
- Documentation of appropriate training must be maintained both by the course provider and course participant.
Bibliography: Infection Control
[Please note: The following references and websites have been updated since the original Commissioner letter distributed in 2008]
- APIC position paper: prevention of device-mediated bloodborne infections to health care workers. Am J Infect Control 1998;26:578-80.
- Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(RR16):1-44.
- Centers for Disease Control and Prevention. Immunization of healthcare workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997;46(RR-18):1-42.
- Committee on Infectious Diseases and Committee on Practice and Ambulatory Medicine. Infection Control in Physicians' Offices. Pediatrics. Pediatrics 2000;105:1361-1369.
- Department of Labor, Occupational Safety and Health Administration. (29 CFR, Part 1920.1030) Occupational exposure to bloodborne pathogens. Final Rule. Federal Register. December 6, 1991, Volume 56-64004264182.
- Guidelines for infection control in health care personnel. Am J Infect Control 1998;26:289-354.
- Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM. Guidelines for infection control in dental health-care settings--2003. MMWR Recomm Rep 2003;52(RR-17):1-61.
- Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007.
Bibiliography: Healthcare-Acquired Hepatitis
- Centers for Disease Control and Prevention. Transmission of hepatitis B and C viruses in outpatient settings - New York, Oklahoma, and Nebraska, 2000-2002. MMWR 2003;52(38):901-6.
- Centers for Disease Control and Prevention. Hepatitis C Virus Transmission at an Outpatient Hemodialysis Unit --- New York, 2001—2008. MMWR 2009;58(08):189-194.
- Comstock D, Mallonee S, et al. A large nosocomial outbreak of hepatitis C and hepatitis B among patients receiving pain remediation treatments. Infect Control and Hosp Epidemiol 2004;25:576-583.
- Counard C, Perz J, Linchangco P, et al. Acute hepatitis B outbreaks related to fingerstick blood glucose monitoring in two assisted living facilities. J Am Geriatr Soc 2010; 58:306-311.
- Fischer GE, Schaefer MK, Labus BJ, et al. Hepatitis C virus infections from unsafe injection practices at an endoscopy clinic in Las Vegas, Nevada, 2007-2008. CID. Aug 2010;51:267-273.
- Gutelius B, Perz JF, Parker MM, et al. Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures. Gastroenterology 2010;139(1):163-170.
- Maki D, Crnich C. History forgotten is history relived. Arch Int Med 2005;165:2565-2566.
- Moore ZS, Schaefer MK, Hoffmann KK, et al. Transmission of hepatitis C virus during myocardial perfusion imaging at an outpatient clinic. Am J of Cardiol. 2011;108(1):126-132
- Samandari T, Malakmadze N, et al. A large outbreak of hepatitis B virus infections associated with frequent injections at a physician's office. Infect Control and Hosp Epidemiol 2005;26:745-750.
- Thompson ND, Perz JF, Moorman AC, Holmberg SD. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med 2009;150:33-9.
- Williams IT, Perz JF, Bell BP. Viral hepatitis transmission in ambulatory settings. Clin Infect Dis 2004; 38:1592-1598.
The following websites will assist you in developing or updating your infection control policies and procedures.
Association for the Advancement of Medical Instrumentation (AAMI):
Centers for Disease Control and Prevention (CDC):
- Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care
- Infection Control in Healthcare Settings
- National Institute for Occupational Safety and Health (NIOSH). Bloodborne Infectious Diseases HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus
- Sterilization & Disinfection in Healthcare Settings, 2008
- Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program
Occupational Safety and Health Administration (OSHA):
- Bloodborne Pathogens and Needlestick Prevention
- Occupational Exposure to Bloodborne Pathogens Standard
New York State Department of Health: