Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings –Recommendations of the HICPAC

Print version: Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings Cdc-pdf[PDF – 215 KB].

Preface

The Healthcare Infection Control Practices Advisory Committee (HICPAC) is a federal advisory committee chartered in 1991 to provide advice and guidance to the Centers for Disease Control and Prevention (CDC) and the Secretary of the Department of Health and Human Services (HHS) regarding the practice of infection control and strategies for surveillance, prevention, and control of healthcare-associated infections, antimicrobial resistance and related events in United States healthcare settings. CDC has been developing recommendations for healthcare infection control to prevent infections in patients and healthcare personnel since the 1970’s. These recommendations continue to evolve over time as evidence bases are built and serve as a foundation for healthcare safety across settings, a basis for quality improvement efforts, and part of the process that identifies important research gaps. Guideline development methods have since moved beyond expert opinion alone and incorporated systematic approaches to evidence analysis. A number of core practices are recommended by CDC and considered standards of care and/or accepted practices (e.g., aseptic technique, hand hygiene before patient contact) to prevent infection in healthcare settings. These widely agreed upon practices are elements of care that are not expected to change based on additional research, either because of an overwhelming preponderance of evidence (e.g., hand hygiene requirements), or in some cases due to ethical concerns (e.g., randomizing patients to procedures performed by trained versus untrained personnel). Therefore, these accepted practices are categorized as strong recommendations, even when high-quality randomized controlled trials are not available to support them. In an effort to streamline and systematize the process for updating existing guidelines without recreating the analytic process for each of these accepted/core practices, in March 2013, CDC charged HICPAC to review existing CDC guidelines and identify all recommendations that warrant inclusion as core practices. A HICPAC workgroup was formed that was led by HICPAC members and contained representatives from the following stakeholder organizations: America’s Essential Hospitals, the Association for Professionals in Infection Control and Epidemiology (APIC), the Council of State and Territorial Epidemiologists (CSTE), the Public Health Agency of Canada (PHAC), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Hospital Medicine (SHM). The Workgroup provided updates and obtained HICPAC input at the June 2013, November 2013, April 2014, and July 2014 public meetings. HICPAC voted to finalize the recommendations at the July 2014 meeting. Additional information about HICPAC is available on this website.

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Introduction

Adherence to infection prevention and control practices is essential to providing safe and high-quality patient care across all settings where healthcare is delivered. Substantial attention has been focused in recent years on improving infection prevention practices within acute care hospitals to optimize patient safety; many of these practices also need to be applied across multiple aspects of patient care. In addition, changes in healthcare during the past decade, driven at least in part by efforts to contain costs, have resulted in an increasing proportion and range of healthcare services being delivered outside of the acute care setting.1,2 These ambulatory and community-based healthcare encounters also can lead to infectious complications that can be prevented using those same infection prevention and control practices.

This document concisely describes a core set of infection prevention and control practices that are required in all healthcare settings, regardless of the type of healthcare provided. The practices were selected from among existing CDC recommendations and are the subset that HICPAC and its Core Practices Working Group determined were fundamental standards of care that are not expected to change based on emerging evidence or to be regularly altered by changes in technology or practices, and are applicable across the continuum of healthcare settings. This document also is intended to improve consistency of language, reduce redundancy across guidelines, and provide a convenient reference wherein these recommendations are maintained. A review of existing CDC guidelines demonstrated many examples of similar recommendations in multiple guidelines with variability in language. The recommendations outlined in this document are intended to serve as a standard reference and reduce the need to repeatedly evaluate practices that are considered basic and accepted as standards of medical care. Readers are urged to consult the full text of CDC guidelines (see references) for additional background and rationale related to the core practice recommendations captured here.

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Scope

The core practices in this document should be implemented in all settings where healthcare is delivered. These venues include both inpatient settings (e.g., acute, long-term care, rehabilitation, behavioral health) and outpatient settings (e.g., physician and nurse practitioner offices, clinics, urgent care, ambulatory surgical centers, imaging centers, dialysis centers, physical therapy and rehabilitation centers, alternative medicine clinics). In addition, these practices apply to healthcare delivered in settings other than traditional healthcare facilities, such as homes, pharmacies, and health fairs.

Healthcare personnel (HCP) referred to in this document include all persons, paid and unpaid, in the healthcare setting having direct patient contact and/or potential for exposure to patients and/or to infectious materials (e.g., body substances, used medical supplies and equipment, soiled environmental surfaces). This also includes persons not directly involved in patient care (e.g., clerical staff, environmental services, volunteers) who could be exposed to infectious material in a healthcare setting.

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Methods

CDC healthcare infection control guidelines3-19 were reviewed, and recommendations included in more than one guideline were grouped into core infection prevention practice domains (e.g., education and training of HCP on infection prevention, injection and medication safety). Additional CDC materials aimed at providing general infection prevention guidance outside of the acute care setting20-22 were also reviewed. HICPAC formed a workgroup led by HICPAC members and including representatives of professional organizations (see Contributors for full list). The workgroup reviewed and discussed all of the practices, further refined the selection and description of the core practices, and presented drafts to HICPAC at public meetings in June 2013, November 2013, April 2014, and July 2014 to inform HICPAC’s final recommendations. The recommendations (see Table) were approved by the full Committee in July 2014.

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Conclusions

Adherence to basic infection prevention and control practices are essential, not only in acute care hospitals but also in settings with limited infection prevention infrastructure. The frequency of infectious outbreaks stemming from errors in infection control across settings (e.g., reuse of syringes between patients leading to transmission of viral hepatitis23-25) underscores the critical importance of adherence to these core infection prevention practices wherever healthcare is provided. Recommendations highlighted in this document represent minimum expectations, and healthcare personnel and facilities will need to supplement them according to their settings, procedures performed, and patient populations.

Readers should consult the full texts of CDC healthcare infection control guidelines for background, rationale, and related infection prevention recommendations for more comprehensive information. We encourage professional associations and societies and the research community to develop tools to facilitate implementation and maintenance of these core infection prevention practices across the continuum of healthcare.

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Text References

  1. Hsiao CJ, Cherry DK, Beatty PC, Rechsteiner EA. National Ambulatory Medical Care Survey: 2007 Summary. National health statistics reports; no 27. Hyattsville, MD: National Center for Health Statistics. 2010.
  2. Medicare Payment Advisory Committee. A data book: Health care spending and the Medicare program, June 2016 Cdc-pdf[PDF – 4.1 MB]External.
  3. Bolyard EA. Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deitchmann SD. Guideline for Infection Control in Healthcare Personnel, 1998. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1998 Jun; 19(6):407-63.
  4. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999 Apr 20(4):250-78.
  5. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control, Infectious Diseases Society of America, and the Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings: Recommendation of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol. 2002 Dec 23(12 Suppl):S3-40.
  6. Sehulster L, Chin RY, Healthcare Infection Control Practices Advisory Committee. Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee Cdc-pdf[PDF – 2.31 MB]. MMWR Recomm Rep 2003 Jun 6:52(RR-10):1-42.
  7. Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 Cdc-pdf[PDF – 4.2 MB]. MMWR Recomm Rep. 2005 Dec 30:54(RR-17):1-141.
  8. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 Cdc-pdf[PDF – 553 KB]. Am J Infect Control, 2007 Dec 35 (10 Suppl 2):S165-93.
  9. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Cdc-pdf[PDF – 1.42 MB]. Am J Infect Control. 2007 Dec 35(10 Suppl 2)S65-164.
  10. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee, Guideline for Prevention of Catheter-Associated Urinary Tract Infection 2009 Cdc-pdf[PDF – 650 KB]. Infect Control Hosp Epidemiol, 2010 Apr 31(4):319-26.
  11. Centers for Disease Control and Prevention. Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities Cdc-pdf[PDF – 381 KB]. MMWR 2009 Mar 20:58 (10):256-60.
  12. Division of Viral Disease, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Updated Norovirus Outbreak Management and Disease Prevention Guidelines. MMWR 2011 Mar 4:60(RR-3):1-18.
  13. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad I, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee. Guidelines for the Prevention of Intravascular Catheter-Related Infections Cdc-pdf[PDF – 678 KB]. Am J Infect Control. 2011 May 39(4 Suppl 1):S1-34.
  14. Rutala WA, Weber DJ, Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Cdc-pdf[PDF – 1.26 MB]. Am J Infect Control. 2013;41(5 Suppl):S67-71.
  15. Tablan OC, Anderson LJ, Besser R, Bridges C, Haijeh R, Healthcare Infection Control Practices Advisory Committee. Guidelines for Preventing Healthcare-associated Pneumonia, 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 204 Mar 26:53(RR-3):1-26.
  16. World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care Cdc-pdf[PDF – 4.26 MB]External. Geneva. World Health Organization, 2009.
  17. Centers for Disease Control and Prevention. Immunization of Healthcare Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Cdc-pdf[PDF – 705 KB]. MMWR Recomm Rep. 2011 Nov 25:60(RR-7):1-45.
  18. U.S. Public Health Service Working Group on Occupational Postexposure Prophylaxis, Kuhar DT, Henderson DK, et. al., Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. September, 2013.
  19. US Department of Labor. Occupational Safety & Health Standards. 29 CFR 1910.1030, Bloodborne PathogensExternal. March 6, 1992.
  20. Centers for Disease Control and Prevention. Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. MMWR. April 27, 2001/50(RR05); 1-43.
  21. Centers for Disease Control and Prevention. Guide to Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care Cdc-pdf[PDF – 632 KB]. April, 2011.
  22. Centers for Disease Control and Prevention. Basic Infection Control and Prevention Plan for Outpatient Oncology Settings Cdc-pdf[PDF – 1.67 MB]. December, 2011.
  23. 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;150:33-39.
  24. Greeley RD, Semple S, Thompson ND, et al. Hepatitis B outbreak associated with a hematology-oncology office practice in New Jersey, 2009. Am J Infect Control. 2011;39:663-670.
  25. Thompson ND, Perz JF, Moorman AC, et al. Nonhospital health care–associated hepatitis B and C virus transmission: United States, 1998–2008. Ann Intern Med 2009;150:33-39.

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Core Practices Table

Core Practices by Category with Comments.
Core Practice Category Core Practices Comments
1. Leadership SupportReferences and resources: 1-12
  1. Ensure that the governing body of the healthcare facility or organization is accountable for the success of infection prevention activities.
  2. Allocate sufficient human and material resources to infection prevention to ensure consistent and prompt action to remove or mitigate infection risks and stop transmission of infections. Ensure that staffing and resources do not prevent nurses, environmental staff, et. al., from consistently adhering to infection prevention and control practices.
  3. Assign one or more qualified individuals with training in infection prevention and control to manage the facility’s infection prevention program.
  4. Empower and support the authority of those managing the infection prevention program to ensure effectiveness of the program.
To be successful, infection prevention programs require visible and tangible support from all levels of the healthcare facility’s leadership
2. Education and Training of Healthcare Personnel on Infection PreventionReferences and resources: 1-4, 6-8, 10-13
  1. Provide job-specific, infection prevention education and training to all healthcare personnel for all tasks.
  2. Develop processes to ensure that all healthcare personnel understand and are competent to adhere to infection prevention requirements as they perform their roles and responsibilities.
  3. Provide written infection prevention policies and procedures that are available, current, and based on evidence-based guidelines (e.g., CDC/ HICPAC, etc.).
  4. Require training before individuals are allowed to perform their duties and at least annually as a refresher.
  5. Provide additional training in response to recognized lapses in adherence and to address newly recognized infection transmission threats (e.g., introduction of new equipment or procedures).
Training should be adapted to reflect the diversity of the workforce and the type of facility, and tailored to meet the needs of each category of healthcare personnel being trained.
3. Patient, Family and Caregiver EducationReferences and resources: 2-5, 7-8, 10-11
  1. Provide appropriate infection prevention education to patients, family members, visitors, and others included in the caregiving network.
Include information about how infections are spread, how they can be prevented, and what signs or symptoms should prompt reevaluation and notification of the patient’s healthcare provider. Instructional materials and delivery should address varied levels of education, language comprehension, and cultural diversity.
4. Performance Monitoring and FeedbackReferences and resources: 1-14
  1. Monitor adherence to infection prevention practices and infection control requirements.
  2. Provide prompt, regular feedback on adherence and related outcomes to healthcare personnel and facility leadership.
  3. Train performance monitoring personnel and use standardized tools and definitions.
  4. Monitor the incidence of infections that may be related to care provided at the facility and act on the data and use information collected through surveillance to detect transmission of infectious agents in the facility.
Performance measures should be tailored to the care activities and the population served.
5. Standard Precautions Use Standard Precautions to care for all patients in all settings. Standard Precautions include:

5a. Hand hygiene

5b. Environmental cleaning and disinfection

5c. Injection and medication safety

5d. Risk assessment with use of appropriate personal protective equipment (e.g., gloves, gowns, face masks) based on activities being performed

5e. Minimizing Potential Exposures (e.g. respiratory hygiene and cough etiquette)

5f. Reprocessing of reusable medical equipment between each patient and when soiled

Standard Precautions are the basic practices that apply to all patient care, regardless of the patient’s suspected or confirmed infectious state, and apply to all settings where care is delivered. These practices protect healthcare personnel and prevent healthcare personnel or the environment from transmitting infections to other patients.

5a. Hand Hygiene

References and resources: 3, 7, 11

  1. Require healthcare personnel to perform hand hygiene in accordance with Centers for Disease Control and Prevention (CDC) recommendations.
  2. Use an alcohol-based hand rub or wash with soap and water for the following clinical indications:
    1. Immediately before touching a patient.
    2. Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices.
    3. Before moving from work on a soiled body site to a clean body site on the same patient.
    4. After touching a patient or the patient’s immediate environment.
    5. After contact with blood, body fluids or contaminated surfaces.
    6. Immediately after glove removal.
  3. Ensure that healthcare personnel perform hand hygiene with soap and water when hands are visibly soiled.
  4. Ensure that supplies necessary for adherence to hand hygiene are readily accessible in all areas where patient care is being delivered.
Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Hand rubs are generally less irritating to hands and are effective in the absence of a sink.

Refer to “CDC Guideline for Hand Hygiene in Health-Care Settings” or “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007” for additional details.

5b. Environmental Cleaning and Disinfection

References and resources: 4, 7, 10, 11, 13, 21

  1. Require routine and targeted cleaning of environmental surfaces as indicated by the level of patient contact and degree of soiling.
    1. Clean and disinfect surfaces in close proximity to the patient and frequently touched surfaces in the patient care environment on a more frequent schedule compared to other surfaces.
    2. Promptly clean and decontaminate spills of blood or other potentially infectious materials.
  2. Select EPA-registered disinfectants that have microbiocidal activity against the pathogens most likely to contaminate the patient-care environment.
  3. Follow manufacturers’ instructions for proper use of cleaning and disinfecting products (e.g., dilution, contact time, material compatibility, storage, shelf-life, safe use and disposal).
When information from manufacturers is limited regarding selection and use of agents for specific microorganisms, environmental surfaces or equipment, facility policies regarding cleaning and disinfecting should be guided by the best available evidence and careful consideration of the risks and benefits of the available options.

Refer to “CDC Guidelines for Environmental Infection Control in Health-Care Facilities” and “CDC Guideline for Disinfection and Sterilization in Healthcare Facilities” for details

5c. Injection and Medication Safety

References and resources: 11, 17-20

  1. Use aseptic technique when preparing and administering medications.
  2. Disinfect the access diaphragms of medication vials before inserting a device into the vial.
  3. Use needles and syringes for one patient only (this includes manufactured prefilled syringes and cartridge devices such as insulin pens).
  4. Enter medication containers with a new needle and a new syringe, even when obtaining additional doses for the same patient.
  5. Ensure single-dose or single-use vials, ampules, and bags or bottles of parenteral solution are used for one patient only.
  6. Use fluid infusion or administration sets (e.g., intravenous tubing) for one patient only.
  7. Dedicate multidose vials to a single patient whenever possible. If multidose vials are used for more than one patient, restrict the medication vials to a centralized medication area and do not bring them into the immediate patient treatment area (e.g., operating room, patient room/cubicle).
  8. Wear a facemask when placing a catheter or injecting material into the epidural or subdural space (e.g., during myelogram, epidural or spinal anesthesia).
Refer to “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007” for details

5d. Risk Assessment with Appropriate Use of Personal Protective Equipment

References and resources: 7, 11, 20

  1. Ensure proper selection and use of personal protective equipment (PPE) based on the nature of the patient interaction and potential for exposure to blood, body fluids and/or infectious material:
    1. Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, potentially contaminated skin or contaminated equipment could occur.
    2. Wear a gown that is appropriate to the task to protect skin and prevent soiling of clothing during procedures and activities that could cause contact with blood, body fluids, secretions, or excretions.
    3. Use protective eyewear and a mask, or a face shield, to protect the mucous membranes of the eyes, nose and mouth during procedures and activities that could generate splashes or sprays of blood, body fluids, secretions and excretions. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed.
    4. Remove and discard PPE, other than respirators, upon completing a task before leaving the patient’s room or care area. If a respirator is used, it should be removed and discarded (or reprocessed if reusable) after leaving the patient room or care area and closing the door.
    5. Do not use the same gown or pair of gloves for care of more than one patient. Remove and discard disposable gloves upon completion of a task or when soiled during the process of care.
    6. Do not wash gloves for the purpose of reuse.
  2. Ensure that healthcare personnel have immediate access to and are trained and able to select, put on, remove, and dispose of PPE in a manner that protects themselves, the patient, and others.
PPE, e.g., gloves, gowns, face masks, respirators, goggles and face shields, can be effective barriers to transmission of infections but are secondary to the more effective measures such as administrative and engineering controls.

Refer to “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007” as well as Occupational Safety and Health Administration (OSHA) requirements for details

5e. Minimizing Potential Exposures

References and resources: 1, 7, 11, 16

  1. Use respiratory hygiene and cough etiquette to reduce the transmission of respiratory infections within the facility.
  2. Prompt patients and visitors with symptoms of respiratory infection to contain their respiratory secretions and perform hand hygiene after contact with respiratory secretions by providing tissues, masks, hand hygiene supplies and instructional signage or handouts at points of entry and throughout the facility.
  3. When space permits, separate patients with respiratory symptoms from others as soon as possible (e.g., during triage or upon entry into the facility).
Refer to “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007” for details

5f. Reprocessing of Reusable Medical Equipment

References and resources: 2-4, 7-8, 11-13

  1. Clean and reprocess (disinfect or sterilize) reusable medical equipment (e.g., blood glucose meters and other point-of-care devices, blood pressure cuffs, oximeter probes, surgical instruments, endoscopes) prior to use on another patient and when soiled.
    1. Consult and adhere to manufacturers’ instructions for reprocessing.
  2. Maintain separation between clean and soiled equipment to prevent cross contamination.
Manufacturer’s instructions for reprocessing reusable medical equipment should be readily available and used to establish clear operating procedures and training content for the facility. Instructions should be posted at the site where equipment reprocessing is performed. Reprocessing personnel should have training in the reprocessing steps and the correct use of PPE necessary for the task. Competencies of those personnel should be documented initially upon assignment of their duties, whenever new equipment is introduced, and periodically (e.g., annually). Additional details about reprocessing essentials for facilities can be found in HICPAC’s recommendations Essential Elements of a Reprocessing Program for Flexible Endoscopes Cdc-pdf[PDF – 217 KB].

Refer to “CDC Guideline for Disinfection and Sterilization in Healthcare Facilities” for details.

6. Transmission-Based PrecautionsReferences and resources: 7, 11
  1. Implement additional precautions (i.e., Contact, Droplet, and/or Airborne Precautions) for patients with documented or suspected diagnoses where contact with the patient, their body fluids, or their environment presents a substantial transmission risk despite adherence to Standard Precautions.
  2. Adapt transmission-based precautions to the specific healthcare setting, the facility design characteristics, and the type of patient interaction.
  3. Implement transmission-based precautions based on the patient’s clinical presentation and likely infection diagnoses (e.g., syndromes suggestive of transmissible infections such as diarrhea, meningitis, fever and rash, respiratory infection) as soon as possible after the patient enters the healthcare facility (including reception or triage areas in emergency departments, ambulatory clinics or physicians’ offices) then adjust or discontinue precautions when more clinical information becomes available (e.g., confirmatory laboratory results).
  4. To the extent possible, place patients who may need transmission-based precautions into a single-patient room while awaiting clinical assessment.
  5. Notify accepting facilities and the transporting agency about suspected infections and the need for transmission-based precautions when patients are transferred.
Implementation of Transmission-Based Precautions may differ depending on the patient care settings (e.g., inpatient, outpatient, long-term care), the facility design characteristics, and the type of patient interaction, and should be adapted to the specific healthcare setting.

Refer to “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007” for details.

7. Temporary invasive Medical Devices for Clinical ManagementReferences and resources: 8, 1
  1. During each healthcare encounter, assess the medical necessity of any invasive medical device (e.g., vascular catheter, indwelling urinary catheter, feeding tubes, ventilator, surgical drain) in order to identify the earliest opportunity for safe removal.
  2. Ensure that healthcare personnel adhere to recommended insertion and maintenance practices.
Early and prompt removal of invasive devices should be part of the plan of care and included in regular assessment. Healthcare personnel should be knowledgeable regarding risks of the device and infection prevention interventions associated with the individual device, and should advocate for the patient by working toward removal of the device as soon as possible.

Refer to “CDC Guidelines for Environmental Infection Control in Health-Care Facilities” and “CDC Guideline for Disinfection and Sterilization in Healthcare Facilities” for details.

8. Occupational HealthReferences and resources: 1, 7, 16, 20
  1. Ensure that healthcare personnel either receive immunizations or have documented evidence of immunity against vaccine-preventable diseases as recommended by the CDC, CDC’s Advisory Committee on Immunization Practices (ACIP) and required by federal, state or local authorities.
  2. Implement processes and sick leave policies to encourage healthcare personnel to stay home when they develop signs or symptoms of acute infectious illness (e.g. fever, cough, diarrhea, vomiting, or draining skin lesions) to prevent spreading their infections to patients and other healthcare personnel.
  3. Implement a system for healthcare personnel to report signs, symptoms, and diagnosed illnesses that may represent a risk to their patients and coworkers to their supervisor or healthcare facility staff who are responsible for occupational health.
  4. Adhere to federal and state standards and directives applicable to protecting healthcare workers against transmission of infectious agents including OSHA’s Bloodborne Pathogens Standard, Personal Protective Equipment Standard, Respiratory Protection standard and TB compliance directive.
It is the professional responsibility of all healthcare organizations and individual personnel to ensure adherence to federal, state and local requirements concerning immunizations; work policies that support safety of healthcare personnel; timely reporting of illness by employees to employers when that illness may represent a risk to patients and other healthcare personnel; and notification to public health authorities when the illness has public health implications or is required to be reported.

Refer to OSHA’s website for specific details on healthcare standards: Occupational Safety and Health Administration – Infectious DiseasesExternal.

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Table References

  1. Bolyard EA. Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deitchmann SD. Guideline for Infection Control in Healthcare Personnel, 1998. Hospital Infection control Practices Advisory committee. Infect Control Hosp Epidemiol. 1998 Jun; 19(6):407-63.
  2. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Hospital Infection Control Practices Advisory committee. Infect control Hosp Epidemiol 1999 Apr 20(4):250-78.
  3. Boyce JM, Pittet D, Healthcare Infection control Practices Advisory Committee, Society for Healthcare Epidemiology of America, Association for Professionals in Infection control, Infectious Diseases Society of America, Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings: recommendation of the Healthcare Infection Control Practices Advisory committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect control Hosp Epidemiol. 2002 Dec 23(12 Suppl):S3-40.
  4. Sehulster L, Chin RY, Healthcare Infection Control Practices Advisory Committee. Guidelines for Environmental Infection Control in Health-Care Facilities Cdc-pdf[PDF – 2.31 MB]. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2003 Jun 6:52(RR-10):1-42.
  5. Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 Cdc-pdf[PDF – 4.2 MB]. MMWR Recomm Rep. 2005 Dec 30:54(RR-17):1-141.
  6. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 Cdc-pdf[PDF – 553 KB]. Am J Infect control, 2007 Dec 35 (10 Suppl 2):S165-93.
  7. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Cdc-pdf[PDF – 1.42 MB]. Am J Infect Control. 2007 Dec 35(10 Suppl 2)S65-164.
  8. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory committee, Guideline for Prevention of Catheter-Associated Urinary Tract Infection 2009 Cdc-pdf[PDF – 650 KB]. Infect control Hosp Epidemiol, 2010 Apr 31(4):319-26.
  9. Centers for Disease Control and Prevention. Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities Cdc-pdf[PDF – 381 KB]. MMWR 2009 Mar 20:58 (10):256-60.
  10. Division of Viral Disease, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Updated Norovirus Outbreak Management and Disease Prevention Guidelines. MMWR 2011 Mar 4:60(RR-3):1-18.
  11. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad I, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee. Guidelines for the Prevention of Intravascular Catheter-Related Infections Cdc-pdf[PDF – 678 KB]. Am J Infect Control. 2011 May 39(4 Suppl 1):S1-34.
  12. Centers for Disease Control and Prevention. Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care Cdc-pdf[PDF – 49.1 KB]. November, 2015.
  13. Rutala WA, Weber DJ, Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Cdc-pdf[PDF – 1.26 MB]. Am J Infect Control.2013;41(5 Suppl):S67-71.
  14. Tablan OC, Anderson LJ, Besser R, Bridges C, Haijeh R, Healthcare Infection Control Practices Advisory Committee. Guidelines for Preventing Healthcare-associated Pneumonia, 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 204 Mar 26:53(RR-3):1-26.
  15. Centers for Disease Control and Prevention. Immunization of Healthcare Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Cdc-pdf[PDF – 705 KB]. MMWR Recomm Rep. 2011 Nov 25:60(RR-7):1-45.
  16. Centers for Disease Control and Prevention. Injection safety materials.
  17. Centers for Disease Control and Prevention. The One & Only Campaign injection safety training materials.
  18. U.S. Public Health Service Working Group on Occupational Postexposure Prophylaxis, Kuhar DT, Henderson DK, et. al., Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. September, 2013.
  19. US Department of Labor. Occupational Safety & Health Administration. 29 CFR 1910.1030 Bloodborne PathogensExternal. March 6, 1992.
  20. Centers for Disease Control and Prevention. Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. MMWR. April 27, 2001 / 50(RR05);1-43.

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Suggested Citation

Healthcare Infection Control Practices Advisory Committee. Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings–Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) 2017.

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Contributors

HICPAC Workgroup Members

Ruth M. Carrico, PhD, RN, CIC, HICPAC Member (Workgroup Chair); Gina Pugliese, RN, MS, HICPAC Member (Workgroup Co-Chair); Deborah S. Yokoe, MD, MPH, HICPAC Member (Workgroup Co-Chair); Loretta L. Fauerbach, MS, CIC; Susan Courage, Public Health Agency of Canada; Kathleen Dunn, BScN, MN, RN, Public Health Agency of Canada; Neil O. Fishman, MD, HICPAC; Silvia Munoz-Price, MD, PhD, America’s Essential Hospitals; Michael Anne Preas, RN CIC, Association of Professionals of Infection Control and Epidemiology, Inc. (APIC); Mark E. Rupp, MD, Society for Healthcare Epidemiology of America (SHEA); Sanjay Saint, MD, MPH, Society of Hospital Medicine (SHM); and Rachel Stricof, MPH, Council of State and Territorial Epidemiologists (CSTE).

HICPAC Members

Neil O. Fishman, MD, University of Pennsylvania Health System; Hilary M. Babcock, MD, MPH, Washington University School of Medicine; Ruth M. Carrico, PhD, RN, CIC, University of Louisville School of Medicine; Sheri Chernetsky Tejedor, MD, Emory University School of Medicine; Daniel J. Diekema, MD, University of Iowa Carver College of Medicine; Mary K. Hayden, MD, Rush University Medical Center; Susan Huang, MD, MPH; University of California Irvine School of Medicine; W. Charles Huskins, MD, MSc, Mayo Clinic College of Medicine; Lynn Janssen, MS, CIC, CPHQ, California Department of Public Health; Gina Pugliese, RN, MS, Premier Healthcare Alliance; Selwyn O. Rogers Jr., MD, MPH, FACS, The University of Texas Medical Branch; Tom Talbot, MD, MPH, Vanderbilt University Medical Center; Michael L. Tapper, MD, Lenox Hill Hospital; and Deborah S. Yokoe, MD, MPH, Brigham & Women’s Hospital.

HICPAC Ex Officio Members

William B. Baine, MD, Agency for Healthcare Research and Quality (AHRQ); David Henderson, MD, National Institutes of Health (NIH); Elizabeth Claverie-Williams, MS, U.S. Food and Drug Administration (FDA); Daniel Schwartz, MD, MBA, Center for Medicare and Medicaid Services (CMS); and Gary A. Roselle, MD, Department of Veterans Affairs (VA); Rebecca Wilson, MPH, CHES, Health Resources and Services Administration (HRSA).

HICPAC Liaison Representatives

Kathleen Dunn, BScN, MN, RN, Public Health Agency of Canada; Janet Franck, RN, MBA, CIC, DNV Healthcare, Inc.; Diana Gaviria, MD, MPH, National Association of County and City Health Officials (NACCHO); Michael D. Howell, MD, MPH, Society of Critical Care Medicine (SCCM); Marion Kainer, MD, MPH, Council of State and Territorial Epidemiologists (CSTE); Emily Lutterloh, MD, MPH, Association of State and Territorial Health Officials (ASTHO); Michael Anne Preas, RN CIC, Association of Professionals of Infection Control and Epidemiology, Inc. (APIC); Mark E. Rupp, MD, Society for Healthcare Epidemiology of America (SHEA); Sanjay Saint, MD, MPH, Society of Hospital Medicine (SHM); Robert G. Sawyer, MD, FACS, FIDSA, FCCM, Surgical Infection Society (SIS); Margaret VanAmringe, MHS, The Joint Commission; and Amber Wood, MSN, RN, CNOR, CIC, CPN, Association of periOperative Registered Nurses (AORN).

Acknowledgments

Melissa Schaefer, MD; Joseph Perz, DrPH; Michael Bell, MD; Erin Stone, MA; and Jeffrey Hageman, MHS, the Division of Healthcare Quality Promotion (DHQP), the Centers for Disease Control and Prevention.

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