COMMON COMPETENCIES

Module 1

IMPLEMENT AND MONITOR

INFECTION CONTROL
POLICIES AND PROCEDURES

IMPLEMENT AND MONITOR INFECTION

CONTROL POLICIES AND PROCEDURES

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INFECTION

INTRODUCTION
It is estimated that millions of patients are affected by
healthcare-associated infections every year, leading to significant
morbidity, mortality, and financial losses for healthcare systems.
Among the 100 hospitalized patients at any given time, seven in
developed and 15 in developing countries will acquire at least one
healthcare-associated infections. The endemic burden of HAIs is
also significantly (at least 2–3 times) higher in low- and
middle-income countries than in high-income nations, particularly in
patients admitted to critical care units and neonatal units.
Healthcare-associated infections are among the most common
adverse event reported worldwide.

INFECTION PREVENTION AND CONTROL

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Infection prevention and control (IPC) is a scientific approach and practical
solution designed to prevent harm caused by infection to patients and health
workers. It is grounded in infectious diseases, epidemiology, social science
and health system strengthening. IPC occupies a unique position in the field of
patient safety and quality universal health coverage since it is relevant to
health workers and patients at every single health-care encounter.

No country, no health-care facility, even within the most advanced and

sophisticated health-care systems, can claim to be free of the problem of
health care-associated infections. The need for having IPC program nationally
and at the facility level is clearly reinforced within the WHO 100 Core Health
Indicators list.

A new IPC unit has therefore been set up within the WHO Service Delivery
and Safety (SDS) department to provide a comprehensive, integrated IPC
function focused on strengthening national and international IPC capacity and
implementing safe practices at the point of care. This unit will build upon the
foundations and achievements of the Clean Care is Safer Care program
(2005-2015) and the strong leadership and technical expertise demonstrated
by the existing WHO infection prevention team, most recently during the Ebola
virus disease response and early recovery work.

The IPC global unit will lead WHO’s work on IPC and will work collaboratively
with related units in SDS, in particular the Patient Safety & Quality unit and the
newly created unit dealing with Quality Universal Health Coverage, as well as
with other related departments and units at the three levels of WHO.
Given that unsafe health care practices related to injections include the re-use
of injection equipment, the over-use of injections for certain health conditions,
accidental needle-stick injuries in health workers, and unsafe management of
sharps waste, WHO is committed to promoting safe injection practices. This
work supports a key recommendation to Member States to switch to the
exclusive use of reuse-prevention syringes (RUPs) for all injections by 2020.
WHO also recommends syringes with sharp injury protection (SIPs) features.

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The IPC global unit will deliver its work based on five main functions:
1. Leadership, connecting and coordinating
2. Campaigns and advocacy
3. Technical guidance and implementation
4. Capacity-building
5. Measuring and learning.

The key technical areas of work for the 2015-2017 period are:
● Hand hygiene
● Prevention of surgical site infections
● IPC to combat antimicrobial resistance
● Injection safety
● Burden of health care-associated infections
● Ebola response and recovery
● IPC country capacity-building
● Prevention of sepsis and catheter-associated bloodstream infections
● Prevention of catheter-associated urinary tract infections.

INFECTION
Infectious diseases are caused by pathogenic
microorganisms, such as bacteria, viruses, parasites or
fungi; the diseases can be spread, directly or indirectly,
from one person to another.
Zoonotic diseases are infectious diseases of animals
that can cause disease when transmitted to humans.

An infection occurs when another organism enters your body and causes
disease. The organisms that cause infections are very diverse and can include
things like viruses, bacteria, fungi, and parasites.

You can acquire an infection in many different ways, such as directly from a
person with an infection, via contaminated food or water, and even through the
bite of an insect.

Let’s take a closer look at infections, the types of organisms that cause them,
and actions you can take to help prevent becoming ill.

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Types of infections
Below, we’ll explore the different types of infections, list some examples you may
be familiar with, and look into some possible treatments.

Viral infections
Viruses are very tiny infectious organisms. They’re even smaller than bacteria.
On the most basic level, a virus is composed of a piece of genetic material that’s
surrounded by a protein shell. Some viruses may have an additional envelope or
other features on their surface.

Viruses are parasitic and require a host cell in which to carry out their life cycle.
Once the virus has entered the host cell, it’s able to use cellular components to
reproduce. New viruses are released from the host cell, a process that’ll
sometimes cause the host cell to die.
Some examples of viral infections include:
● influenza (the flu)
● common cold
● measles
● rubella
● chickenpox
● norovirus
● polio
● infectious mononucleosis (mono)
● herpes simplex virus (HSV)
● human papillomavirus (HPV)
● human immunodeficiency virus (HIV)
● viral hepatitis, which can include hepatitis A, B, C, D, and E
● viral meningitis
● West Nile Virus
● rabies
● ebola

Possible treatments

Most of the time, the treatment of viral infections centers on relieving symptoms
until your immune system clears the infection.

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In some cases, antiviral drugs may be available to help treat a viral infection.
Some examples of viral infections for which antivirals are available include HIV,
herpes, and hepatitis C.

Some viruses stay with you for life once you’ve been infected. They can lie
dormant within your body and may reactivate. Some examples include herpes
simplex virus (HSV) and varicella-zoster virus (VZV).

Remember
It’s important to remember that antibiotics aren’t effective in treating a viral
infection

Bacterial infections
Bacteria are single-celled microorganisms. They’re very diverse, coming in a
variety of different shapes and sizes.

Bacteria can be found in all sorts of environments, including soil, bodies of water,
and in or on our bodies. Some can survive extreme temperatures or
even radiation exposure rusted source.

Although there are a great many bacteria in and on our bodies, these bacteria
often don’t cause disease. In fact, the bacteria in our digestive tract can help us
digest our food.

However, sometimes bacteria can enter our bodies and cause an infection. Some
examples of bacterial infections include:
● strep throat
● bacterial urinary tract infections (UTIs), often caused by coliform bacteria
● bacterial food poisoning, often caused by E. coli, Salmonella, or Shigella
● bacterial cellulitis, such as due to Staphylococcus aureus (MRSA)
● bacterial vaginosis
● gonorrhea
● chlamydia
● syphilis
● Clostridium difficile (C. diff)
● tuberculosis
● whooping cough
● pneumococcal pneumonia

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 ● bacterial meningitis
● Lyme disease
● cholera
● botulism
● tetanus
● anthrax
Possible treatments
Bacterial infections are most often treated with antibiotics. Antibiotics are
medications that affect bacterial growth. They can either impede bacteria from
multiplying or kill them outright.

There are different classes of antibiotics. The one you’re prescribed will depend
on what type of bacterium is causing your infection. Additionally, misuse of
antibiotics has caused many bacteria to develop resistance to them.

TAKE AS PRESCRIBED
If you’re prescribed antibiotics for a bacterial infection, take the entire course of
antibiotics — even if you begin to feel better after a few days. Not doing this can
prevent the infection from clearing and can contribute to antibiotic resistance.

Fungal infections
Fungi are another diverse group of organisms that can include things like yeasts
and molds. They can be found throughout the environment, including in the soil,
indoors in moist areas like bathrooms, and on or in our bodies.

Sometimes fungi are so small that you can’t see them with the naked eye. Other
times, you’re able to see them, such as when you notice mold on your bathroom
tile.
Not all fungi can make you ill, but some examples of fungal infections include:
● vaginal yeast infections
● ringworm
● athlete’s foot
● thrush
● aspergillosis
● histoplasmosis
● Cryptococcus infection
● fungal meningitis

Possible treatments

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Fungal infections can be treated with antifungal medications. The type of
medication that you’re prescribed will depend on the type of fungal infection you
have.

For example, a topical antifungal cream may be prescribed for conditions like
ringworm or athlete’s foot. Oral antifungal medications are also available. More
severe fungal infections may require intravenous (IV) antifungal medication.

Parasitic infections
Parasites live on or in a host organism and get food or other nutrients at the
host’s expense. There are three types of parasites that can cause illness in
humans:
● Protozoa: small, one-celled organisms

● Helminths: larger, worm-like organisms

● Ectoparasites: organisms such as fleas, ticks, and lice

Some examples of infections that are caused by parasites include:

● malaria
● toxoplasmosis
● trichomoniasis
● giardiasis
● tapeworm infection
● roundworm infection
● pubic and head lice
● scabies
● leishmaniasis
● river blindness

Possible treatments

As with bacterial and fungal infections, there are specific drugs available to treat
a parasitic infection. The type of antiparasitic medication that you’ll need to take
will depend on the type of parasite that’s causing your infection.

Prions

Symptoms of infection
The symptoms of an infection can vary depending on the type of infection that
you have. Some general symptoms that can indicate you may have an infection
include:
● fever or chills

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 ● body aches and pains
● feeling tired or fatigued
● coughing or sneezing
● digestive upset, such as nausea, vomiting, or diarrhea

There are some situations that should always trigger a visit to your doctor.

See a doctor if you have:

● symptoms that worsen or don’t improve with at-home care

● symptoms that are prolonged or recur
● difficulty breathing
● a severe headache that occurs with a high fever
● a rash
● unexplained swelling
● a bite from an animal

It’s also possible for you to have an infection without having any symptoms.
Some examples of infections that don’t always cause symptoms include HPV,
gonorrhea, and chlamydia.

Causes of infection transmission

You can get an infection in many different ways.

Direct contact
Some, but not all, infections can spread when you come directly into contact with
a person who has an infection, whether through touching, kissing, or having sex.

Direct contact with the bodily fluids of a person who has an infection can also
spread infections in some instances. This can include things like:

● blood
● nasal secretions
● saliva
● semen
● vaginal secretions

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Lastly, some infections can be spread directly from an infected mother to her
child either through the placenta or during childbirth.

Indirect contact
Some infectious organisms can be found throughout your environment. You can
come into contact with these things and then spread the infection to yourself.

A common example of this is when someone with the flu coughs or sneezes.
Influenza virus can then be present in the air or on objects such as door and
faucet handles. If you touch a contaminated object and then touch your face,
mouth, or nose, you may become infected.

Through contaminated food or water

In some cases, food or water may be contaminated with infectious organisms.

You can get these infections by consuming things like:

● foods prepped or prepared in unsanitary conditions
● raw or undercooked foods, such as produce, meats, or seafood
● improperly canned foods
● unpasteurized milks or juices
● foods that have been improperly stored or refrigerated

From an infected animal

Some infections are spread to people from an infected animal. One example is
the rabies virus, which you can get if an infected animal bite you.

Another example is toxoplasmosis. You can come down with this parasitic
disease from changing an infected cat’s litter box.

From a bug bite

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There are many different types of biting bugs, including ticks, mosquitoes, and
lice. In some cases, you can get an infection if a bug carrying around an
infectious microorganism bite you. Some examples include malaria, Lyme
disease, and West Nile Virus.

ALL INFECTIONS ARE DIFFERENT

Not all infections are spread in the same way. While one infection may be
transmitted via infected blood, another may be transmitted by the bite of an
insect. It’s always important to consider the specific infection when talking about
transmission.

Identifying an infection

Some infections have very characteristic symptoms. Your doctor may be able to
make a diagnosis based off of these symptoms, your medical history, and a
physical examination.

In other cases, it can be hard to determine what type of organism may be

causing your condition. For example, some bacterial and viral infections can
have very similar symptoms.

In cases where it’s unclear what’s causing your infection, your doctor may take a
sample from your body to be tested in a laboratory. Where this sample is
collected from depends on your illness and the type of organism suspected.
Some sample types can include:
● blood
● urine
● stool
● nasal or throat
● sputum
● cerebrospinal fluid (CSF)
Your doctor may also use imaging tests, such as an X-ray, CT scan, or MRI scan.
In some cases, they may also want to take a biopsy of the affected tissue to
examine it.

Preventing infection

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There are many actions that you can take to prevent the spread of infections. Be
sure to follow the tips below:

● Practice good hand hygiene. Wash your hands often, especially before

eating or handling food, after using the toilet, and before touching your
face or mouth.
● Get vaccinated. Many infections can be prevented through vaccines.
Examples include, but aren’t limited to: measles, whooping cough, and
hepatitis B.
● Avoid sharing personal items. These include drinking glasses,
toothbrushes, and razor blades.
● Practice safe sex.
● Cover cuts or scrapes. This can lessen the chances that they’ll become
infected. Don’t pick or scratch them.
● Use insect repellents or sprays. These products can help you avoid
being bitten by mosquitoes or ticks.
● Be careful with food. Always prepare food in sanitary conditions, and
make sure it’s heated to the proper temperature before eating.
● Avoid wild animals. Make sure to have any animal bites examined by a
doctor.
● Know before you go. If you’re traveling, be aware of any infections
common to the area where you’ll be staying. Some of them may even
have vaccines available.
● Cover your mouth when you cough. If you’re sick, be sure to dispose of
all used tissues properly. If you don’t have a tissue, cough into the crook of
your elbow instead of your hand.
● Stay home if you’re sick. This can prevent you from spreading an
infection. Make sure to ask your doctor when you can return to work or
school.
The takeaway

Infections can be caused by a variety of different organisms, including viruses,

bacteria, fungi, and parasites. The different ways that you can get an infection
can be just as diverse as the organisms that cause them.

While some infections may be treated at home, you should always contact your
doctor if you have symptoms of an infection that aren’t getting better, are getting
worse, or recur. You may need additional medications to treat your condition.

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 IMPLEMENT AND MONITOR INFECTION
CONTROL POLICIES AND PROCEDURES

2
POLICY AND PROCEDURES OF
ORGANIZATION’S INFECTION
CONTROL

INTRODUCTION

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 The policies and procedures set out in this lesson of Infection
prevention and control strategies are designed to protect healthcare
staff from the risk of transmissible disease. A systematic approach to
infection prevention and control requires each health care provider to
play a vital role in protecting everyone who utilizes the healthcare
system. Healthcare staff must adhere to infection prevention and
control guidelines and policies at all times, and use critical thinking,
risk assessment and problem solving in managing clinical situation.

INFECTION CONTROL POLICIES AND PROCEDURES

Infection control refers to the policy and procedures implemented to control

and minimize the dissemination of infections in hospitals and other healthcare
settings with the main purpose of reducing infection rates. Infection control as a
formal entity was established in the early 1950s in the United States. By the late
1950s and 1960s, a small number of hospitals began to recognize
healthcare-associated infections (HAIs) and implemented some of the infection
control concepts. The primary purpose of infection control programs was to focus
on the surveillance for HAIs and in-cooperate the basic understandings of
epidemiology to elucidate risk factors for HAIs. However, most of the infection
control programs were organized and managed by large academic centers rather
than public health agencies which lead to sporadic efficiency and suboptimal
outcomes. It was not until the late 19th and early 20th century when the new era
in infection control was started through three pivotal events. These events
included the Institute of Medicine’s 1999 report on errors in health care, the 2002
Chicago Tribune representation on HAIs, and the 2004/2006 publications of the
significant reductions in bloodstream infection rate through the standardization of
central venous catheter insertion process. This new era in healthcare
epidemiology is characterized by consumer demands for more transparency and
accountability, increasing scrutiny and regulation, and expectations for rapid

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reductions in HAIs rates. The role of infection control is to prevent and reduce the
risk for hospital-acquired infections. This can be achieved by implementing
infection control programs in the forms of surveillance, isolation, outbreak
management, environmental hygiene, employee health, education, and infections
prevention policies and management.

Indications:

Infection control program has the main purpose of preventing and stopping the
transmission of infections. Specific precautions are needed to prevent infection
transmission depending on the microorganism.

The following are examples of indications for transmission-based precautions:

● Standard precautions: Used for all patient care. It includes hand hygiene,
personal protective equipment, appropriate patient placement, clean and
disinfects patient care equipment, textiles and laundry management, safe
injection practices, proper disposal of needles and other sharp objects.

● Contact precaution: Used for patients with known or suspected infections

that can be transmitted through contact. For those patients, standard
precautions are needed, plus limit transport and movement of patients,
use disposable patient care equipment, and thorough cleaning and
disinfection strategies. Patients with acute infectious diarrhea such
as Clostridium difficile, vesicular rash, respiratory tract infection with a
multidrug-resistant organism, abscess or draining wound that cannot be
covered need to be under contact precautions.

● Droplet precautions: Used for patients with known or suspected infections

that can transmit by air droplets through the mechanism of a cough,
sneeze, or by talking. In such cases, it is vital to control the source by
placing a mask on the patient, use standard precautions plus limitation on
transport and movement. Patients with respiratory tract infection in infants
and young children, petechial or ecchymosis rash with fever, and
meningitis are placed under droplet precautions.

● Airborne precautions: Use for patients with known or suspected infections

that can be transmitted by the airborne route. Those patients require to be
in an airborne infection isolation room with all the previously mentioned
protections. The most important pathogens that need airborne precautions
are tuberculosis, measles, chickenpox, and disseminated herpes zoster.

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 Patients with suspected vesicular rash, cough/fever with pulmonary
infiltrate, maculopapular rash with cough/coryza/fever need to be under
airborne precaution.

Multiple of those indications might require more than one precaution to ensure
efficient standard and transmission-based precautions. For example, patients
with suspected C. difficile need to be under contract and standard precautions,
tuberculosis need to be under airborne, contact, and standard precautions.

Equipment

Healthcare facilities must have the necessary equipment to implement the

standard precautions for all patient. The most significant precaution that is
effective in preventing infection transmission is hand hygiene. This is achieved by
washing hands with soap and warm water and/or by hand rubbing with alcohol or
nonalcohol based hand sanitizer. Gloves can also be used as a standard
precaution; new gloves have to be used for each patient and must be disposed of
after each patient interaction. Other personal protective equipment includes facial
protection (procedure/surgical masks, goggles, face shield) and gown before
entering the patient's room. Infection control equipment also includes the
housekeeping tools where adequate and routine disinfection of surfaces and
floors are implemented. Also, linens have to be handled and transported in a
manner which prevents skin and mucous exposure by using the appropriate
personal protective equipment.

Personnel

Hospitals need to attain hospital epidemiologists, infection preventionists, and an

infection control committee to organize a well-structured and implemented
infection control program. The hospital epidemiologist is required to interface with
many of the hospital departments and administrators to discuss their
responsibilities, expectations, and available resources. The epidemiologist
generally oversees the infection prevention program and in some cases the
quality improvement program. A physician with a subspecialty in infectious
disease usually holds the position. A registered nurse with a background in
clinical practice, epidemiology, and basic microbiology typically hold the infection
preventionist title. Hospitals can have multiple infection preventionists depending
on the number of beds available, mix of patients, and the Center for Disease
Control and Prevention (CDC) recommendations. The last aspect of a functioning
infection control program is the infection control committee, which consists of an

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interprofessional group of clinicians, nurses, administrators, epidemiologist,
infection preventionists and other representatives from the laboratory, pharmacy,
operating rooms, and central services. The responsibilities of this committee are
to generate, implement, and maintain policies related to infection control 

Technique

To achieve a successful and functioning infection control program, a hospital can

implement the following measures:

Surveillance: The primary aim of surveillance programs is to assess the rate of

infections and endemic likelihood. Generally, hospitals target surveillance for
HAIs in areas where the highest rate of infection is, including intensive care units
(ICUs), hematology/oncology, and surgery units. However, surveillance has
expanded in the recent years to include a hospital-wide based surveillance as it
is becoming a mandatory requirement by the public health authorities in multiple
states. This change has also been empowered by the wide implementation of the
electronic health records in most hospitals in the United States, and now it is
easy for any medical provider to access the electronic records at patients’
bedside and assess risks and surveillance data for each patient. Most hospitals
have developed sophisticated algorithms in their electronic health systems that
could streamline surveillance and identify patients at highest risk for HAIs.
Hence, a hospital-wide surveillance targeting a specific infection could be
implemented relatively easily. Public health agencies require that hospitals report
some specific infections to strengthen the public health surveillance system.

Isolation: The main purpose of isolation is to prevent the transmission of

microorganisms from infected patients to others. Isolation is an expensive and
time-consuming process, therefore, should only be utilized if necessary. On the
other hand, if isolation is not implemented then we risk the increase in morbidity
and mortality, henceforth, increasing overall healthcare cost. Hospitals that
operate based on single-patient per room can implement isolation efficiently,
however, significant facilities still have a substantial number of double-patient
rooms which is challenging for isolation.  The CDC and the Healthcare Infection
Control Practice Advisory Committee have issued a guideline to outline the
approaches to enhance isolation. These guidelines are based on standard and
transmission-based precautions. The standard precaution refers to the
assumption that all patients are possibly colonized or infected with
microorganisms, therefore, precautions are applied to all patients, at all times
and all departments. The main elements for standard precautions include hand

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hygiene (before and after patient contact), personal protective equipment (for
contact with anybody fluid, mucous membrane, or nonintact skin), and safe
needle practices (use one needle per single dose medication per single time,
then dispose of it is a safe container). Other countries such as the United
Kingdom have also adopted the bare below the elbows initiative that requires all
healthcare providers to wear short-sleeved garments with no accessories
including rings, bracelets, and wrist watches. As for the transmission-based
precautions, a cohort of patients is selected based on their clinical presentations,
diagnostic criteria, or confirmatory tests with specific indication of infection or
colonization of microorganisms to be isolated. In these cases, a requirement for
airborne/droplet/contact precautions is necessary. These precautions are
designed to prevent the transmission of disease based on the type of
microorganism.

Outbreak Investigation and Management: Microorganisms outbreaks can be

identified through the surveillance system. Once a particular infection monthly
rate crosses the 95% confidence interval threshold, an investigation is warranted
for a possible outbreak. Also, clusters of infections can be reported by the
healthcare providers of laboratory staff which should be followed by an initial
investigation to assess if this cluster is indeed an outbreak. Usually, clusters of
infections involve a common microorganism which can be identified by using the
pulsed-field gel electrophoresis or the whole-genome sequencing which provides
a more detailed tracking of the microorganism. Most outbreaks are a result of
direct or indirect contact involving multidrug-resistant organism. Infected patients
have to be separated, isolated if needed, and implementation of the necessary
contact precautions, depending on what the suspected cause of infection is, have
to be enforced to control such outbreaks.

Education: Healthcare professionals need to be educated and periodically

reinforce their knowledge through seminars and workshops to ensure high
understanding of how to prevent communicable diseases transmission. The
hospital might develop infection prevention liaison program by appointing a
healthcare professional who could reach out and disseminate the infection
prevention information to all members of the hospital.
Employee Health: It is essential for the infection control program to work closely
with employee health service. Both teams need to address important topics
related to the well-being of employees and infection prevention, including
management of exposure to bloodborne communicable diseases and other
communicable infections. Generally, all new employees undergo a screening by
the employee health service to ensure that they are up-to-date with their
vaccinations and have adequate immunity against some of the common

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communicable infections such as hepatitis B, rubella, mumps, measles, tetanus,
pertussis, and varicella. Moreover, healthcare employees should always be
encouraged to take the annual influenza vaccination. Also, periodic test for latent
tuberculosis should be performed assess for any new exposure. Employ health
service should develop proactive campaigns and policies to engage employees
in their wellbeing and prevent infections.
Antimicrobial Stewardship: Antimicrobials are widely used in the inpatient and
outpatient settings. Antimicrobial usage widely varies between hospitals,
commonly, a high percentage of patients admitted to hospitals are administered
with antibiotics. Increasingly, hospitals are adapting antimicrobial stewardship
programs to control antimicrobial resistance, improve outcomes, and reduce
healthcare costs. Antimicrobial stewardship should be programmed to monitor
antimicrobial susceptibility profiles to anticipate and assess any new antimicrobial
resistance patterns. These trends need to be correlated with the antimicrobial
agents used to evaluate susceptibility. Antimicrobial stewardship programs can
be designed to be active and/or passive and can target pre-prescription or
post-prescription periods. In the pre-prescription period, an active program
includes prescriptions restrictions and preauthorization, while passive initiative
includes education, guidelines, and antimicrobial susceptibility reports. On the
other hand, an active post-prescription program would focus on a real-time
feedback provision to physicians regarding antibiotic usage, dose, bioavailability,
and susceptibility with automatic conversion of intravenous to oral formulations,
while passive post-prescription involves the integration of the electronic medical
records to generate alerts for prolonged prescriptions and
antibiotic-microorganism mismatch.
Policy and Interventions: The main purpose of the infection control program is to
develop, implement, and evaluate policies and interventions to minimize the risk
for HAIs. Policies are usually developed by the hospital’s infections control
committee to enforce procedures that are generalizable to the hospital or certain
departments. These policies are developed based on the hospital’s needs and
evidence-based practice. Interventions that impact infection control can be
categorized into two categories; vertical and horizontal interventions. The vertical
intervention involves the reduction of risk from a single pathogen. For example,
the surveillance cultures and subsequent isolation of patients infected with
Methicillin-resistant Staphylococcus aureus (MRSA). Whereas, horizontal
intervention targets multiple different pathogens that are transmitted in the same
mechanism such as the handwashing hygiene, where clinicians are required to
wash their hands before and after any patient contact which will prevent the
transmission of multiple different pathogens. Vertical and horizontal interventions
can be implemented simultaneously and are not mutually exclusive. However,
vertical interventions might be more expensive and would not impact the other
drug-resistant pathogens, while horizontal intervention might be a more
affordable option with more impactful results if implemented appropriately.

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Environmental Hygiene: As the inpatient population becomes more susceptible to
infections the emphasize on environmental hygiene has increased. Hospital
decontamination through the traditional cleaning methods is notoriously
inefficient. Newer methods including steam, antimicrobial surfaces, automated
dispersal systems, sterilization techniques and disinfectants have a better effect
in limiting transmission of pathogens through the surrounding environment. The
CDC has published guidelines that emphasize the collaboration between federal
agencies and hospital engineers, architectures, public health and medical
professionals to manage a safe and clean environment within hospitals which
include air handling, water supply, and construction.
Clinical Significance

Infection control clinically translates to identifying and containing infections to

minimize its dissemination. Clinicians play a significant role in infection control by
identifying patients' signs and symptoms suspicious for a transmissible infection
such as tuberculosis. Precaution orders have to be placed and implemented
even before a confirmatory diagnosis is reached to avoid the possible
transmission of the infectious pathogen. Clinically, an efficient infection control
program results into fewer infection rates and lower risk for the development of
multidrug-resistant pathogens. Hospital-acquired infections are one of the most
common healthcare complications. Therefore, simple standard precautions such
as hand hygiene can prove to be highly effective. In fact, the most effective and
least expensive way for clinicians to also apply infection control principles is by
washing hands before and after any patient interaction. Hence, hospitals need to
promote and enable handwashing by providing reminders at all bedsides and
having sinks or hand sanitizer stations available at the entrance to each room in
the hospital. Another simple measure can be to educate patient always to try to
use their forearm to block their cough or sneeze to avoid the transmission of
droplets and the direct contamination of their hands by which pathogens can be
transferred to other surfaces.

Enhancing Healthcare Team Outcomes

Infection control has many challenges especially with the increasing number of
hospitalized patients, a greater prevalence of invasive technologies, and a higher
prevalence of immunocompromised patients. Poor infection control programs
lead to increased rates of infections, increase the likelihood of multidrug-resistant
bacteria, and increases the risk of outbreaks in specific departments that might
disseminate to the entire hospital and community. Resources are one of the
major limitations in achieving an optimal infection control program; hospital
epidemiologists should consider the balance between cost, clinical outcomes,
patient satisfaction, and economic impact when considering new interventions.
Hospital epidemiologists also need to assess the latest evidence-based literature

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to make certain that all infection control policies are up-to-date and to monitor the
newly emerging multidrug-resistant pathogens. The major direct complication of
an inappropriately managed infection control program is infection risk for the
patient. Patients might be at risk for bacterial, viral, fungal, or parasitic infection. If
the infection is severe, it can spread to the bloodstream leading to sepsis and
possible septic shock which are life-threatening. All healthcare workers have a
duty to prevent infection and maintain an aseptic environment when possible.
Nursing is on the front lines of this issue, since they routinely have the highest
level of contact with the patient, and have access to all aspects of the facility;
their observations and recommendations should be taken seriously by all
members of the interprofessional healthcare team. The most basic preventive
method is by washing hands. 

Workplace infection control – personal hygiene

practices
Infection control procedures relating to good personal hygiene include: 
● hand washing – the spread of many pathogens can be prevented with
regular hand washing. Thoroughly wash your hands with water and soap
for at least 15 seconds after visiting the toilet, before preparing food, and
after touching clients or equipment. Dry your hands with disposable paper
towels
● unbroken skin – intact and healthy skin is a major barrier to pathogens.
Cover any cuts or abrasions with a waterproof dressing
● gloves – wear gloves if you are handling body fluids or equipment
containing body fluids, if you are touching someone else's broken skin or
mucus membrane, or performing any other invasive procedure. Wash your
hands between each client and use fresh gloves for each client where
necessary
● personal items – don't share towels, clothing, razors, toothbrushes,
shavers or other personal items.

Food preparation and workplace infection control

When preparing food: 

● Wash your hands before and after handling food.

● Avoid touching your hair, nose or mouth.
21
 ● Keep hot food hot and cold food cold.
● Use separate storage, utensils and preparation surfaces for cooked and
uncooked foods.
● Wash all utensils and preparation surfaces thoroughly with hot water and
detergent after use.

Infection control and workplace cleanliness

Infection control procedures relating to cleanliness in the workplace include: 

● regularly washing the floors, bathrooms and surfaces (such as tables and
bench tops) with hot water and detergent
● periodically washing the walls and ceilings
● thoroughly washing and drying mops, brushes and cloths after every use –
drying mops and cloths is particularly important, since many pathogens
rely on moisture to thrive
● using disinfectants to clean up blood and other spills of bodily fluids
● when using disinfectants – always wearing gloves, cleaning the surfaces
before using the disinfectant, and always following the manufacturer's
instructions exactly
● spot cleaning when necessary.

Dealing with spills of body fluids

Examples of body fluids include blood, saliva, urine and feces. When dealing with
spills of body fluids, infection control procedures need to be followed carefully.
Always: 

● Isolate the area.

● Wear gloves, a plastic apron and eye protection, such as goggles.
● Soak up the fluid with disposable paper towels, or cover the spill with a
granular chlorine-releasing agent for a minimum of 10 minutes. Scoop up
granules and waste using a piece of cardboard (or similar), place in a
plastic bag and dispose of appropriately.
● Mix one part bleach to 10 parts water and apply to the area for 10
minutes.
● Wash the area with hot water and detergent.

22
 ● Dry the area.
● Dispose of paper toweling and gloves appropriately.
● Wash your hands.
● Rinse any contaminated clothing in cold running water, soak in bleach
solution for half an hour, then wash separately from other clothing or linen
with hot water and detergent.

Infection Control – disposing of infectious waste

To dispose of infectious waste that has been contaminated with blood or other
body fluids: 

● Wear heavy duty gloves.

● Place waste in plastic bags marked 'infectious waste'.
● Dispose of waste in accordance with EPA guidance.

Workplace infection control – handling contaminated sharps

Infection control procedures when handling needles and other sharp

contaminated objects include: 

● Never attempt to re-cap or bend used needles.

● Handle by the barrel.
● Place in an appropriate puncture-proof container (that meets the
Australian and New Zealand Standards AS 4031:1992 and AS/NZS
4261:1994) – this will be yellow, labelled 'Danger contaminated sharps'
and marked with a black biohazard symbol.

Infection control – occupational exposure to body fluids

If you come in contact with blood or body fluids: 

● Flush the area with running water.

● Wash the area with plenty of warm water and soap.
● Report the incident to the appropriate staff member.
● Record the incident via the Disease/Injury/Near Miss/Accident (DINMA)
reporting procedure.
● Seek medical advice.

23
Employers and occupational health and safety representatives should investigate
all incidents involving contact with blood or body fluids, and take action to prevent
a similar incident from happening again.

IMPLEMENT AND MONITOR INFECTION

CONTROL POLICIES AND PROCEDURES

24
3
INDUSTRY CODE OF
PRACTICES

INTRODUCTION

Industry codes of practice are enforceable rules and measures

that regulate industry conduct, its workers, and their relationship with
consumers. Above all, they ensure good industry practice by setting
guidelines for fair dealing between you and your customers.

Therefore, you can choose to establish your own Code of Practice, or

adopt an industry specific Code of Practice. Check out our
previous guide for more information about whether a Code of Practice
is mandatory or voluntary in relation to your business or industry.

Objectives
All industry codes contain an internal dispute resolution scheme and
provisions to establish a committee that monitors and enforces industry

25
compliance. These schemes provide an industry with measures to efficiently and
objectively respond to customer issues, as well as guidelines for imposing
sanctions for non-compliance with the code. They may, like
the Telecommunications Consumer Protections Code (TCP Code) outline that all
customer complaint processes must be easily accessible to the consumer, offer
timely responses and be free of charge.

An industry ombudsman, committee or mediator can undertake a review if

a complaint cannot be resolved. For example, the Telecommunications Industry
Ombudsman (TIO) can investigate complaints under the TCP code.

All industry codes are subject to an independent periodic review for the
reason that all procedures and industry practices remain relevant to both the
industry and its consumers.

The purpose of an industry code is to ensure industry compliance with an

agreed upon set of objectives that benefit workers, employers and consumers.
These objectives usually concern the promotion of best industry practice,
improving safety standards and enhancing consumer confidence. Similarly, the
purpose and objectives must be clear and communicated to stakeholders,
industry participants and consumers.

An industry code of conduct will set out a framework for compliance through
provisions such as:

● Specific measures for compliance, relevant guidelines, standards and

practices;
● Risk management strategies;
● Complaint handling schemes and sanctions for non-compliance; and
● An outlined process for periodic review of the code.

What are the benefits of an industry code of conduct?

26
An industry code of conduct provides a range of benefits to both industry and
consumers such as:

● The creation and enforcement of appropriate industry practices

formulated by industry experts.
● The flexibility of an industry code allows businesses to respond to
recurring market issues and adapt to changing consumer needs.
● A business-friendly alternative to legislation that can result in
reduced costs for industry and government.
● Providing safeguards and protection for consumer

THE HIERARCHY OF CONTROL

The hierarchy of control is a system for controlling risks in the workplace. The
hierarchy of control is a step-by-step approach to eliminating or reducing risks
and it ranks risk controls from the highest level of protection and reliability
through to the lowest and least reliable protection.

Eliminating the hazard and risk is the highest level of control in the hierarchy,
followed by reducing the risk through substitution, isolation and engineering
controls, then reducing the risk through administrative controls. Reducing the
risk through the use of protective personal equipment (PPE) is the lowest level of
control.

The following element shows the structure of the hierarchy of control, from most
effective control to least effective.

27
The Hierarchy of Control Structure

1. Eliminate hazards and risks

Highest level of protection and most

effective control.

Eliminating the hazard and the risk it creates is

the most effective control measure.

2. Reduce the risk

Reduce the risk with one or more of the

following controls:

● Substitution
Substitute the risks with lesser risks
● Isolation
Isolate people from the risks
● Engineering
Reduce the risks through engineering
changes or
changes to systems of work.

3. Administrative controls

Low level of protection and less reliable

control.

Use administrative actions to minimize exposure

to hazards and to reduce the level of harm.

28
 4. Personal protective equipment

Lowest level of protection and least reliable

control.

Use personal protective equipment to protect

people from harm.

Employer Duties

As an employer you have a duty under the Occupational Health and Safety Act
2004 (OHS Act) to eliminate risks to health and safety, so far as is reasonably
practicable. If it is not reasonably practicable to eliminate risks to health and
safety, you must reduce those risks, so far as is reasonably practicable.

The hierarchy of controls helps employers fulfill their OHS Act responsibilities. In
line with the OHS Act, the hierarchy of control first instructs employers to
eliminate hazards and risks. If employers cannot eliminate hazards and risks,
then they must work through the hierarchy and select controls that most
effectively reduce the risk.

Reducing the risk may involve introducing a single risk control or a combination
of two or more different controls. For example, protecting employees and others
from flying debris when using a concrete cutting saw may involve isolating the
work area, guarding the saw blade and using PPE such as face shields.

When determining the most effective and reasonably practicable risk control,
consider the time needed to introduce the control and whether it is necessary to
introduce temporary risk control measures while preparing the preferred control.
In some cases, it might be necessary to stop the activity until you can put an
appropriate risk control measure in place.

29
The following steps, based on information from Safe Work Australia, explain each
stage of the hierarchy of control, from most effective control measures to the
least effective:

Using the Hierarchy of Control

1. Eliminate the risk

The most effective control measure involves eliminating the hazard and its
associated risk. The best way to eliminate a hazard is to not introduce the hazard
in the first place. For example, you can eliminate the risk of a fall from height by
doing the work at ground level.

Eliminating hazards can be cheaper and more practical at the design or planning
stage of a product, process or workplace. In these early stages, there is more
scope to design to eliminate hazards or to include risk control measures that are
compatible with the requirements of the original design and function.

Employers can also eliminate hazards and risks by removing the hazard
completely. For example, removing trip hazards on the floor or disposing of
unwanted chemicals eliminates the risks they create.

It may not be possible to eliminate a hazard if doing so means you are unable to
make the end product or deliver the service. If it is not possible to eliminate the
hazard, then you must eliminate as many of the risks associated with the hazard
as possible.

2. Reduce the risk through substitution, isolation or engineering

controls

If it is not reasonably practicable to eliminate the hazards and associated risks,

minimize the risks by:

Substitution

Substitute the hazard with something safer. For example:

30
 ● use a scourer, mild detergent and hot water instead of caustic cleaners for
cleaning
● use a cordless drill instead of an electric drill if the power cord is in danger
of being cut
● use water-based paints instead of solvent-based paints

Isolation

Isolate the hazard. For example:

● use concrete barriers to separate pedestrians and employees from
powered mobile plant
● use remote controls to operate machines
● install guard rails around holes

Engineering Controls

An engineering control is a control measure that is physical in nature, including a

mechanical device or process. Examples of engineering controls include:
● mechanical devices such as trolleys or hoists to move heavy loads
● guards around moving parts of machinery
● pedestrian-sensing systems
● speed-governing mechanisms

3. Reduce the risk using administrative controls

Administrative controls are work methods or procedures designed to minimize

exposure to a hazard. In most cases, administrative controls use systems of work
to control the risk.  For example:
● developing procedures on how to operate machinery safely
● limiting exposure time to a hazardous task
● using signs to warn people of a hazard

4. Reduce the risk using personal protective equipment (PPE)

PPE refers to anything employees use or wear to minimize risks to their health
and safety. PPE includes but is not limited to the following:

31
 ● ear muffs and earplugs
● goggles
● respirators
● face masks
● hard hats
● safety harnesses
● gloves, aprons, body suits
● high-visibility clothing
● protective eyewear
● safety footwear
● sunscreen

PPE limits exposure to the harmful effects of a hazard but only if employees wear
and use the PPE correctly.

Using administrative controls and PPE to reduce risks does not control the
hazard at the source. Administrative controls and PPE rely on human behavior
and supervision and, used on their own, tend to be least effective in minimizing
risks.

Use administrative controls and PPE only:

● as last resorts when there are no other practical control measures
available
● as an interim measure until introducing a more effective way of controlling
the risk
● to increase the effectiveness of higher-level control measures

Choose the most effective controls

Consider various control options and choose the controls that most effectively
eliminate the hazard or, if elimination is not reasonably practicable, minimize the
risk in the circumstances. Reducing the risk may involve a single control measure
or a combination of different controls that work together to provide the highest
level of reasonably practicable protection.

As an employer you must consult your employees and their health and safety
representatives (HSRs), if there are any, when deciding on risk controls.

32
 IMPLEMENT AND MONITOR INFECTION
CONTROL POLICIES AND PROCEDURES

4
INFECTION CONTROL RISK

INTRODUCTION

Infection is caused by pathogens ('bugs') such as bacteria,

viruses, protozoa or fungi getting into or onto the body. It can take
some time before the microbes multiply enough to trigger symptoms

33
of illness, which means an infected person may unwittingly be
spreading the disease during this incubation period.  Infection control
in the workplace aims to prevent pathogens from coming into contact
with a person in the first place. Employers are obliged under the
Occupational Health and Safety Act 2004 to provide a safe workplace
for their employees, including the provision of adequate infection
control procedures and the right equipment and training.

INFECTION CONTROL RISK

Infection control risks can stem from a variety of

areas in a healthcare organization, and most can
lead to significant patient (or staff) harm. Some
common examples include:

● Lack of hand hygiene.

● Unsafe injection practices.
● Poor cleaning, disinfection, sterilization of instruments and scopes.

10 Elements to Consider When Conducting an Infection Risk Assessment

Almost everything we do in the healthcare industry is designed around one main

focal point: patient safety. And infection prevention and control (IPC) are no
exception. Industry leaders are developing IPC protocols to keep patient safety
and outcomes at the forefront of all decision making. That is why it is so
important to take a proactive approach to preventing infections from occurring by
assessing the risks that may derail IPC efforts.

What is Infection Control Risk Assessment?

An infection control risk assessment is more than just running down a list of
potential hazards and informing personnel of best practices. A sophisticated

34
infection control risk assessment is a living document that forms the foundation of
any comprehensive IPC program. The policy evolves over time as goals and
measurable objectives change, while maintaining a solid framework for
consistent patient safety.

Often when developing an infection risk assessment, healthcare leaders

understand what the outcomes should be but have no idea where to begin.
Before setting any goals or objectives, leaders must create a structure from
which to work. An infection risk assessment considers potential hazards and
prioritizes them to better guide goal-setting and strategy development.

Infection control risks can stem from a variety of areas in a healthcare

organization, and most can lead to significant patient (or staff) harm. Some
common examples include:
• Lack of hand hygiene
• Unsafe injection practices
• Poor cleaning, disinfection, sterilization of instruments and scopes
• Inadequate environmental cleaning

To understand which risks, pose the greatest threats to your facility, you must
assess your current operations.

Why is an Infection Control Risk Assessment Important?

While the subpar practices listed above may seem like obvious pitfalls to avoid,
IPC protocol is not always adequately enforced. That is why the Accreditation
Association for Ambulatory Health Care (AAAHC) recently added a requirement
for written risk assessments documenting how facilities are prioritizing patient
safety. The new standard underscores why healthcare organizations must have
an infection risk assessment in writing that can be updated annually. A formal risk
assessment:
• Provides a basis for infection surveillance, prevention and control activities
• Identifies at-risk populations/procedures in your facility
• Assists in focusing surveillance efforts toward targeted goals
• Aids in meeting regulatory and other requirements

When conducting an infection control risk assessment, take an interdisciplinary

approach to collecting information and feedback from employees. Once your
team is ready, you can start identifying all potential risks, documenting your
findings and prioritizing processes to improve outcomes.

35
What Elements Should You Consider?
There is a plethora of factors that may impact IPC success, ranging from
procedures performed to earthquake vulnerability. An infection risk assessment
must consider a variety of elements before establishing IPC protocol, goals and
objectives. Here’s what to look for:

1. Geography/Topography/Weather
Depending on where you are located, IPC efforts may be hindered by Mother
Nature. Natural disasters – such as hurricanes, earthquakes, snow, rain and
drought – can disrupt IPC efforts by creating emergency situations. When
resources are limited and personnel is stretched thin, healthcare facilities may
find higher rates of infection than under normal circumstances, and should
therefore plan accordingly.

2. Population
Another aspect of your location that can affect IPC success is the community
your facility serves. When assessing for risk, be sure to take into account the
demographics of patients, their socioeconomic situation, their age and other
factors that directly or indirectly impact health. For example, your infection risks
may change depending on if you treat more infants than adults. 

3. Communications
One element often overlooked when developing IPC protocol is a facility’s
communication strategy – which applies to both internal and external efforts.
Leaders should evaluate how messages are communicated within a facility,
among staff, or between entities in a health system. Within the community, a
healthcare facility should have a comprehensive plan for how to work with third
parties such as emergency management teams, health departments, medical
societies, professional groups and emergency medical services. Not only should
each strategy have clear processes to follow, but offer options for both routine
and emergency situations.

4. Employees
Along the lines of internal communications, healthcare facilities should gauge
how employees are managed and provide services to patients. Managers should
develop strict hand hygiene requirements and monitor for compliance, as well as
assess how well sharps injuries protocol is being followed to avoid unnecessary
risks. Furthermore, healthcare facilities can proactively work to keep their staff
healthy by developing a sick policy that keeps employees away from patients

36
when they have certain illnesses. This policy should include expectations for
proper immunizations, as well as a TB control program that screens staff to
prevent spread.

5. Environment
The efficacy of staff performance is only as good as the tools they use.
Healthcare facilities must look at the working environment to ensure there is
adequate space and resources to clean, disinfect and sterilize all instruments,
scopes and furnishings. A clean, healthy environment may call for a better
biohazard waste management protocol, upgraded ventilation systems or changes
to the construction of the facility itself to support IPC initiatives.

6. Cleaning, Disinfection, Sterilization

Once it is determined there is adequate space to conduct cleaning, disinfection
and sterilization, health leaders should evaluate if these practices are following
AAMI, AORN and CDC guidelines. Facilities can develop procedures to monitor
the use of all disposables, sterilizers and high-level disinfectants, as well as steps
to take for a failed sterilizer or HLD test. In addition, a schedule and log should
be created for preventive maintenance on all equipment to ensure maximum
efficiency.

6. Risks for Infections

There are a handful of major risks for infection any healthcare facility should
be mitigating:
• Surgical and other device-related infections
• Diarrheal diseases (e.g., C. difficile)
• Post-procedure pneumonia
• Respiratory diseases (flu, colds)
• Significant organisms (MRSA, VRE, ESBLs, CRE)

7. Many of these risks may remain prevalent in your facility without you realizing.
For example, the AAAHC Quality Roadmap 2015 found more than ten percent of
ambulatory surgery centers, more than nine percent of primary care
organizations and more than fourteen percent of office-based surgery
organizations surveyed had deficiencies in their safe injection practices.

8. Procedures
Just as you gauged the different populations served, it is equally important to

37
factor in what types of procedures are being performed at your facility. Risks can
vary greatly by type of procedure, and the safety of the patient can be affected
differently after each service provided. Mitigating these unique risks goes beyond
establishing protocol during the actual procedure. Employees should consider
the behaviors and environmental factors affecting the health of the patient
population in the community. Understanding the background of each patient is as
vital as informing them of the risks to avoid and healthy behaviors to follow to
remain safe post-procedure.

9. Emergency Management
Any type of emergency situation places strain on a healthcare facility and can
lead to a higher rate of infection. Healthcare facilities should understand the role
they place in the community in the event of an emergency and coordinate with
the local health department or emergency management team to define
expectations and develop strategies. When planning for an emergency,
anticipate a variety of scenarios that could occur both internally or externally.
Then determine what staff training, supplies and equipment must be prepared to
sustain operations when disaster strikes. Infection Prevention can be adversely
affected if there is no water, ventilation is compromised or there is physical
damage to the facility.

10. Education and Competency Evaluation

Educating staff does not end with teaching the protocol in an emergency
situation. There should be annual or biannual training opportunities and
competency testing for all employees and licensed independent practitioners to
ensure the facility is functioning at top performance. Each staff member must
demonstrate his or her ability to perform assigned duties routinely as well as
whenever tasks, procedures or products change. Just as new staff receives an
orientation on industry standards and policies (e.g., OSHA Bloodborne
Pathogens Standard), patients should also be educated on infection risks and
best practices to reduce threats. Once they leave the facility, much of the IPC
control rests in the hands of the patients themselves and they should have
comprehensive information to strengthen outcomes.

How Do You Assess the Risks?

Documenting all your facility’s infection control risks will help you set priorities
and goals based on relative risk. Rate each risk of the 10 risks on the following

38
criteria using a severity scale of 0-3:
• WHO is at risk for infection or adverse event?
• What LEVEL of risk is present?
• What is the IMPACT on care, treatment or services?
• How PREPARED for this is the organization?
Add up the scores and create a list of priorities placing risks with the highest
number at the top and work your way down.

How Do You Put It into Action?

Now that you understand what the most menacing risks are to your healthcare
facility, you can develop goals and measurable objectives to combat these
threats and improve IPC success.
A goal is a broad statement indicating the change you want to make. Goals are
not measurable as they stand, but rather identify an overarching issue. For
example, goals may include:
• Improving hand hygiene
• Initiating disaster preparedness kits
• Reducing the risk of surgical site infections

A measurable objective specifies quantifiable results over a specific period

of time. It defines the who, what, when, where and how of your strategy. The
measurable objectives that fall under the umbrella of each goal can then become
part of one or more staff management objectives for the following year.
For example, a measurable objective may call for IV antibiotics to be
administered within one hour of incision with a 95 percent threshold. The
objective will be incorporated into the performance goals of affected employees,
and will be monitored for progress and compliance by checking patient charts.
You should evaluate how each goal and measurable objective not only
addresses an infection risk but also promotes change in operations. Many
healthcare organizations will use goal setting as a vehicle for employee bonuses.
Bonuses are not awarded unless both personal and facility goals and objectives
are met each year.

Because each goal and objective will impact a variety of departments and
employees, it is essential to conduct an infection risk assessment and identify
goals in a collaborative manner. Each department will require different solutions
and strategies to combat their unique risks and challenges. Therefore, input

39
should be collected from all levels and teams to ensure nothing is overlooked
and increase the chances of success.

INFECTION CONTROL AND CONFIDENTIALITY

Patient confidentiality is key, but there are several actions to take in handling this
situation. First, you need to separate the infection control aspect of the situation
from the appropriate treatment of the patient. The one shouldn't adversely affect
the other, and it's important that the patient is properly treated regardless of their
status.

It's important to highlight and consider the use of universal infection control
procedures in the practice. If these are adopted and correctly applied for all
patients, the lab shouldn't need to know the patient's status because the risk of
infection should have already been addressed and contained.

This particular patient declared their infective status, but bear in mind that others
may choose not to do so, or may not even know themselves. Because of this, it's
vital that infection control protocols are applied to patients across the board.

While the lab might not need to be informed, this might not be the case for others
involved in the patient's care. A patient's status may have some influence on the
appropriate treatment plan and treatment of the patient, so those involved in the
front-line care should know, including the implant surgeon. Because this means
disclosing confidential information about the patient, seek their consent before
you do so.

There are laws that set out how your medical records and information can be
shared. Any healthcare professionals who you see are bound by these rules.
This means they cannot discuss your health information with anyone else
without your consent. Your medical information must be stored in a way that
protects your privacy.

Medical Confidentiality

Medical confidentiality is a set of rules that limits access to information discussed

between a person and their healthcare practitioners. 

With only a few exceptions, anything you discuss with your doctor must, by law,
be kept private between the two of you and the organization they work for. This is

40
also known as doctor–patient confidentiality.

When you go to a new doctor, you can choose whether to share your previous
medical records with them by giving your written consent to your other doctors,
so that they can send your new doctor the information in your medical file. 

Privacy in Healthcare

Privacy in a healthcare situation means that what you tell your healthcare
provider, what they write down about you, any medication you take and all other
personal information is kept private. You have a legal right to this privacy, and
there are laws that guide health service providers in how they collect and record
information about your health, how they must store it, and when and how they
use and share it. 

You can give any of your health professionals your consent to share your health
information, for example, when you change doctors and you want your new
doctor to have access to your medical history. You also have a legal right to
access your health information.

Definition of Health Information

Health information is any information about a person’s health or disability, and

any information that relates to a health service they have received or will receive.
Health information is sensitive and personal, which is why there are laws to
protect your rights to keep your health information private.

How Health Services Collect, Store and Share Information

A health service is any organization that collects information about people’s

health, such as:

● doctors’ surgeries or clinics

● specialist clinics
● dental surgeries
● pharmacies
● public and private hospitals
● sexual health clinics
● disability services
● nutrition services, such as dietitians and nutritionists

41
 ● maternal and child health clinics
● allied health services, such as optometrists and physiotherapists
● naturopaths, chiropractors, massage therapists and other complementary
medicine providers
● fitness providers, such as gyms, fitness trainers and weight loss services
● healthcare workers in childcare centers, schools, colleges and
universities.

Exemptions to Privacy Laws

There are two types of situations where a health service may use or share your
health information without your consent. These are:

● when your or someone else’s health or safety are seriously threatened

and the information will help, such as if you are unconscious and
paramedics, doctors and nurses need to know if you are allergic to any
drugs
● when the information will reduce or prevent a serious threat to public
health or safety, for example, if you have a serious contagious illness and
the public needs to be warned.

There are certain exemptions that may apply in law enforcement situations and in
a court of law. 

Health information privacy laws only apply rights to living people. They do not
apply once the person is deceased.

Managing your own Health Information

You own your health information and decide who can access it. You always have
the right to access it yourself by asking for a copy. You can keep a personal
health record at home or via the free eHealth system, which is a secure online
summary of your health information, run by the Commonwealth Government.

You control what goes into your eHealth record, and who is allowed to access it.
You can add or delete information or change who has the right to access your
record by changing the information online or by writing a letter stating the
changes to eHealth. It allows you to choose which of your doctors, hospitals and

42
other healthcare providers can view and share your health information to provide
you with the best possible care. 

Managing someone else’s Health Information

If you are a parent or guardian, you can access the health information of the
children in your care. For someone who is over 18 years old, you can become
their authorized representative if you have been given medical power of attorney,
or if they have nominated you in an advance care plan.

Consent, Medical treatment and Health Records in Hospital

When you go to hospital, you can choose to give the staff access to your health
records. You do not have to, but giving them your consent to access your
information will help them provide the best care possible for you. Hospital staff
are required to protect patients’ privacy and confidentiality.

While you are in hospital, staff will create a file that includes information about
any tests, treatment and medication they give you. You can access this
information by asking for a copy and adding it to your personal health or eHealth
record.

There are situations when a person can be admitted to hospital and treated
without their consent. An example of this is an emergency situation where a
person requires urgent treatment and is unable to communicate, for example, is
unconscious. 

Your responsibilities about Confidentiality and Privacy

You can discuss your health and healthcare with anyone you choose, but you
need to keep in mind that people who are not your healthcare providers are not
bound by confidentiality rules. 

If you keep a personal health record, you are responsible for keeping it safe and
private. However, an eHealth record is kept safe and private by the Department
of Human Services.

Breaches to your Privacy or Confidentiality

If you think a healthcare provider is breaking or abusing your privacy or

confidentiality, your first step is to ask them about it directly. Start by talking to the

43
person involved, and then talk to the organization they work for. It can help to
write down your complaint, date and details to discuss as this can make it formal
and you can keep a record of any conversations and correspondence.

HEALTHCARE ASSOCIATED INFECTION PREVENTION

AND CONTROL
The Health Care Infection Prevention and Control Program oversee infection
prevention and control activities in health care settings. Infection prevention and
control demands a basic understanding of the epidemiology of diseases; risk
factors that increase patient susceptibility to infection; and the practices,
procedures and treatments that may result in infections.

General Information

Healthcare Associated Infections (HAIs) are infections that patients acquire

during the course of receiving treatment for other conditions within a healthcare
setting. HAIs are one of the top ten leading causes of death in the United States,
accounting for an estimated 1.7 million infections and 99,000 associated deaths
in 2002. As the Nation's health protection agency, CDC is committed to helping
all Americans receive the best and safest care when they are treated at a
hospital or other healthcare facility. In 1987, CDC introduced the definitions in the
National Nosocomial Infections Surveillance System (NNIS) and were modified
based on comments from infection control personnel in NNIS hospitals and
others involved in surveillance, prevention, and control of nosocomial infections.
The definitions were implemented for surveillance purpose in NNIS hospitals in
January 1988 and are the current CDC/NHSN definitions for HAIs.

Best Practices

Basic infection prevention measures are based on knowledge of the chain of

transmission and the application of best practices in all settings at all times. The
elements of best practices include: hand hygiene, risk assessment of clients, risk
reduction strategies through use of personal protective equipment, cleaning the
environment and equipment, laundry, disinfection and sterilization of equipment

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or use of single use equipment, waste management, sharps handling, client
placement and healthy workplace initiatives, and education of health care
providers, clients and families/visitors/caregivers.

● Hand Hygiene

Main purpose of an infection control program

Infection control program has the main purpose of preventing and stopping the
transmission of infections. Specific precautions are needed to prevent infection
transmission depending on the microorganism.

Infection control program has the main purpose of preventing and stopping the
transmission of infections. Specific precautions are needed to prevent infection
transmission depending on the microorganism.

The following are examples of indications for transmission-based precautions:

● Standard precautions: Used for all patient care. It includes hand hygiene,
personal protective equipment, appropriate patient placement, clean and
disinfects patient care equipment, textiles and laundry management, safe
injection practices, proper disposal of needles and other sharp objects.

● Contact precaution: Used for patients with known or suspected infections

that can be transmitted through contact. For those patients, standard
precautions are needed, plus limit transport and movement of patients,
use disposable patient care equipment, and thorough cleaning and
disinfection strategies. Patients with acute infectious diarrhea such
as Clostridium difficile, vesicular rash, respiratory tract infection with a
multidrug-resistant organism, abscess or draining wound that cannot be
covered need to be under contact precautions.

● Droplet precautions: Used for patients with known or suspected infections

that can transmit by air droplets through the mechanism of a cough,
sneeze, or by talking. In such cases, it is vital to control the source by
placing a mask on the patient, use standard precautions plus limitation on
transport and movement. Patients with respiratory tract infection in infants
and young children, petechial or ecchymosis rash with fever, and
meningitis are placed under droplet precautions.

● Airborne precautions: Use for patients with known or suspected infections

that can be transmitted by the airborne route. Those patients require to be

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 in an airborne infection isolation room with all the previously mentioned
protections. The most important pathogens that need airborne precautions
are tuberculosis, measles, chickenpox, and disseminated herpes zoster.
Patients with suspected vesicular rash, cough/fever with pulmonary
infiltrate, maculopapular rash with cough/coryza/fever need to be under
airborne precaution.

Multiple of those indications might require more than one precaution to ensure
efficient standard and transmission-based precautions. For example, patients
with suspected C. difficile need to be under contract and standard precautions,
tuberculosis need to be under airborne, contact, and standard precautions.

Literacy in Communication
This means they need to be able to speak well, listen to others effectively, read
with fluency, understand what they have read and be able to write skillfully and
with a sense of style.

How does literacy affect communication?

Reading helps build your vocabulary, enhance your sentence-structure abilities

and improve your overall communication skills. As you read, you will become
more comfortable with the English language and be able to use it more
confidently both in oral communication and written work.

Collaboration and teamwork

Collaboration and teamwork require a mix of interpersonal, problem solving,
and communication skills needed for a group to work together towards a
common goal. You might have learned about this much-needed mix of skills while
working as part of a research team or as an executive officer of a campus
organization; you might also have worked with others in writing and publishing a
journal article. However, these skills become even more important when you
work with others on a long-term, sustained basis.

Whether you choose an academic or private sector career, you’ll need to know
how to work constructively with members of a group. To help build a collaborative
team environment, you’ll have to develop and practice the following:

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1. Trust: Be honest; work to eliminate conflicts of interest; avoid talking behind
each other’s back; trust teammates (you must trust them before they will trust
you); give team members the benefit of the doubt.

2. Clarify Roles: Review team member roles frequently; clarify responsibilities

when action planning; relate team member expectations to team’s overall
purpose; figure out ways to help each other.

3. Communicate Openly & Effectively: Work to clear up misunderstandings

quickly and accurately; seek to understand all perspectives; err on the side of
over communicating; reinforce and recognize team member efforts. Learn to
listen well.

4. Appreciate Diversity of Ideas: Evaluate a new idea based on its merits;

remember that reasonable people can and do differ with one another; avoid
remarks that draw negative attention to a person’s unique characteristics; don’t
ignore the differences among team members; try to learn as much as you can
from others.

5. Balance the Team’s Focus: Regularly review and evaluate the effectiveness of

team meetings; design individual performance goals that emphasize both results
and teamwork; praise individual effort; assign specific team members to monitor
task needs and others to monitor relationship needs; hold team celebrations for
achieving results.

Safety Health and Well-being

Health Monitoring Procedures

Pre-placement medical procedures 

The UWA pre-placement medical procedure is to facilitate the gathering of
information to identify:

● Whether or not a particular applicant is able to perform the inherent

requirements of a position.
● Whether (albeit unable to perform the inherent requirements of a
position), any adjustment and/or accommodation can reasonably be
made to enable an applicant to perform those requirements.

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 ● Applicants with a pre-existing medical condition, which condition might
be exacerbated by their employment at the University.
● Applicants with a medical condition, which might cause an unacceptable
increase in the risk of injury.
The pre-placement medical procedure is designed to better manage safety and
health risks in accordance with the Occupational Safety and Health Act 1984
(WA).
Pre-placement medical procedures are as follows:

1. All candidates are required to be advised of the inherent requirements

of the position for which they are applying (eg provided a position
description) and are also provided with a Laboratory Animal Allergen
Information sheet. 
2. Shortlisted candidates must complete a pre-placement medical
questionnaire. The completed questionnaire is handed to the Chair of
the Selection Panel at or shortly after interview.
3. The Panel identifies their preferred candidate, in accordance with the
normal UWA recruitment practices.
4. The Chair of the panel has the responsibility to match the information
on the pre-placement medical questionnaire from the preferred
candidate with their ability to perform the inherent requirements of the
position.
5. If the Chair has reason to be concerned that a preferred candidate
may have difficulty performing the inherent requirements of the
position, this must be documented in the “Recommendation for
Selection Report” that is provided to the hiring manager.
6. The hiring manager then determines whether further clarification or
assessment is required. This decision is to be made in consultation
with the UWA Safety, Health and Wellbeing Office who will arrange
further assessment. The cost for these tests and assessments are to
be met by the center/work area. 
7. Medical advice on reasonable accommodations and adjustments
must be sought. Any determination not to employ a preferred
candidate on medical grounds must be based on objective medical
evidence. 
8. Once a position is accepted by a candidate, they are then required to
complete the self-assessment questionnaire on commencement of

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 their employment (depending on the nature of their role – see criteria
for ongoing health monitoring below).

Security and confidentiality of information

The pre-placement medical questionnaires from the short-listed candidates will
remain with the Chair and not be disclosed to the panel. The personal medical
information obtained is confidential information and is managed according to the
Privacy Principles set out in the Privacy Act 1988 (Cth). The personal medical
information is to be securely stored on the personal file with access restricted to
nominated officers to the University (e.g. Safety, Health and Wellbeing).
Information contained in the statement is not to be made available to any other
third party without the prior written consent of the candidate (or staff member to
which the information pertains), or when the University is required to do so by a
court or tribunal or under law including in the case of a disputed claim for
worker’s compensation, when the information might be provided to our workers’
compensation insurer or Work Cover.

Responsibilities in relation to disclosure

All candidates are responsible for investigating and understanding the inherent
requirements of the position that they are applying for. The employer is
responsible for providing this information. 

The candidate/employee may choose not to disclose a disability, in which case

he/she must recognize that this may lead to the following:

● A missed opportunity to negotiate work related adjustments;

● If there is deterioration in their medical condition or existing disability it
may be difficult to arrange work related adjustments quickly;
● If their disability or medical condition impacts on work it may be
perceived as poor performance; and
● If the disability could reasonably be seen to cause a health and safety
risk for other people in the workplace, failing to disclose that risk may
constitute a breach of the Occupational Safety and Health Regulations.
Where a candidate or employee has not disclosed a disability or medical
condition, employers are not responsible for providing employment related
adjustments. It is not the employer’s responsibility to justify why no employment

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related adjustments were provided during the period when the employee had not
disclosed their disability or medical condition.

The criteria for determining the level and frequency of monitoring required is
outlined below:

1. Low: 
This is appropriate for employees who may need to enter the animal areas very
occasionally as visitors or to carry out maintenance or cleaning work. It will
consist of a information provided at induction and an instruction to report any
symptoms immediately via the incident reporting process

2. Medium: 
This is appropriate for researchers and students, and others who work directly
but intermittently with animals for limited periods. It will consist of a
self-assessment questionnaire to be done annually, and sent to the Safety,
Health and Wellbeing Office and an instruction to report any symptoms
immediately to their supervisor and via the incident reporting process.

3. High: 
This is appropriate for animal technicians and others with potentially high levels
or frequent exposure to animal allergens. It is also appropriate for other people
who regularly enter and work in the animal areas and/or have existing proven
animal allergy. It will consist of a self-assessment questionnaire, and if follow up
testing is required this will be initiated by the Safety, Health and Wellbeing Office.

Animal Care Services roles included in this category are:

● Animal Technicians
● Technicians in Charge (TiC), Senior Technicians in Charge (STiC) and
Coordinators
● Technicians who work in the rodent cage preparation and cleaning areas
● Veterinarian Officer who handles rodents regularly. 

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High risk health monitoring

Health monitoring for high-risk roles will be completed on site during the
employees’ hours of work and employees will be asked to complete a
‘Self-Assessment Questionnaire’

Results will be sent to the Safety, Health and Wellbeing Office and stored on the
Health Monitoring database which is private and confidential.  Employees will be
required to sign an Authority to Release Information form agreeing to the
information obtained from the testing to be released to their Medical Practitioner
and for UWA Safety, Health and Wellbeing to obtain relevant information as it
pertains to their employment. Any recommendation from the General Practitioner
or Specialist will be stored in the Health Monitoring database within the Safety,
Health and Wellbeing Office.   

Workers with suspected animal allergy

Animal allergy may be suspected as a result of the animal worker reporting

symptoms, either spontaneously or at routine health surveillance. Animal allergy
will be confirmed by the history, medical examination and investigations including
blood or skin tests as appropriate. Where asthma is suspected, the animal
worker will be referred for specialist investigation and further testing as
appropriate.

Communicable Disease Transmission

Communicable diseases are caused by infectious agents that can

be transmitted to susceptible individuals from an infected person, or from other

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animals, objects or the environment. Infectious agents include helminths,
protozoa, bacteria, viruses and fungi.
A communicable disease is one that is spread from one person to another
through a variety of ways that include: contact with blood and bodily fluids;
breathing in an airborne virus; or by being bitten by an insect.
Reporting of cases of communicable disease is important in the planning and
evaluation of disease prevention and control programs, in the assurance of
appropriate medical therapy, and in the detection of common-source outbreaks.
California law mandates healthcare providers and laboratories to report over 80
diseases or conditions to their local health department. Some examples of the
reportable communicable diseases include Hepatitis A, B & C, influenza,
measles, and salmonella and other food borne illnesses.

Some ways in which communicable diseases spread are by:

1. physical contact with an infected person, such as through touch
(staphylococcus), sexual intercourse (gonorrhea, HIV), fecal/oral
transmission (hepatitis A), or droplets (influenza, TB)
2. contact with a contaminated surface or object (Norwalk virus), food
(salmonella, E. coli), blood (HIV, hepatitis B), or water (cholera);
3. bites from insects or animals capable of transmitting the disease
(mosquito: malaria and yellow fever; flea: plague); and
4. travel through the air, such as tuberculosis or measles.

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