7 Things Incoming Residents Should Know About Infection Control

It is important to protect yourself, your colleagues, and your patients from SARS-CoV-2 and other infectious diseases. The Center for Disease Control (CDC) has formed Project Firstline, a national infection control training collaborative, to provide all health care professionals with foundational knowledge to implement infection control protocols. The AMA is one of the many diverse health care and public health collaborators that is part of Project Firstline.

The CDC created the Inside Infection Control vlog series to share basic ideas behind infection control and how these ideas apply to COVID-19, with the hopes that they can help you as you begin your residency training.

1. Due to frequent usage, hands are susceptible to spreading germs.

   • Hand hygiene is one of the best ways to protect yourself and keep others from getting sick.
   • Hands can be damp and warm, and bacteria/germs will grow between the cracks and crevices and under the fingernails.
   • By using hand sanitizer and frequently washing your hands, you will prevent the spread of germs within your environment, among your patients and across others you may come in contact.

2. Personal Protective Equipment (PPE) is an important tool for infection control. How well PPE works depends on you. No matter how busy you are, you should take time to use the right equipment, the right way, at the right time.

   Use an N95, a specific type of respirator recommended for COVID-19.

   N95 signifies that a respirator has been tested and approved by the National Institute for Occupational Safety and Health (NIOSH).

   • Use a NIOSH-approved N95, which ensures at least 95% of particles in the air are filtered out so you do not inhale them. They also provide a barrier to prevent splashes to the nose and mouth.
   • There are two types of N95s: standard and surgical. Select the one that best suits your care environment.
   • Fit-testing is used in work settings to make sure the size and model of respirator is right for you.

3. Do a seal check each time you wear an N95.

   • Respirators must fit super-tight against your face, so you breathe through the filter and not around the edges through gaps.
   • To do a positive pressure check, put on your N95 an put your hands lightly over the surface, blocking off the filter. Cover as much of the area as you can, then breathe out gently. You should feel pressure if it is working correctly.
   • If there is a leak, you are going to feel, hear, or see it.
   • If the pressure does not build up, or if you feel a leak:
     • Adjust the metal nose band so that it molds to your nose. Use both hands and start from the top.
     • Readjust the straps. Move them up and down your head to tighten the respirator against your face and seal off the small leaks.
   • If neither of those adjustments work, talk with your fit testing specialists about trying new options.

4. Related

   AMA Project Firstline Interview with CDC’s Michael Bell, MD AMA COVID-19 Update October 29, 2020

   

5. Protect your eyes.

   • Goggles or a face shield are part of COVID-19 recommended PPE, as infectious diseases can enter eyes through respiratory droplets. These droplets can carry the virus and travel into the nose and back of the throat, where cells become infected.
   • You need coverage straight in front of you and on the sides of your face - eyeglasses or contact lenses will not protect your eyes. Also, safety or trauma glasses with gaps between the glasses and your face do not provide good splash protection for infection control purposes.

6. "Environmental hygiene" includes the things we do to keep the physical environment clean and safe, and it’s an important part of infection control in health care.

   Proper ventilation helps keep air clean and decrease the spread of germs among patients and others.

   Typically measured by the hour, nearly every room in a health care facility is measured by air exchange--the time it takes for a room’s old air to be replaced with new air.

   When entering a room, consider the following:

   • If not wearing respirator or other PPE, you must understand proper wait time for that room. You must know how often the air is being exchanged and cleared, as this indicates how long the room should sit after a person leaves and before another one enters.
   • If wearing PPE, you can enter the room before the air has exchanged and while the patient is still in the room.

7. Cleaning and disinfection help prevent patients and others from getting sick.

   Germs are more likely to cause problems for patients with weakened immune systems, therefore it is imperative that we keep the health care environment germ-free. Unfortunately, more germs are becoming antibiotic- resistant.

   Cleaning removes dirt and some germs from surfaces and objects, while disinfection comes after cleaning and kills germs.

   Examples of what/when something should be cleaned and disinfected:

   • After a patient is discharged from a room
   • High-touch surfaces should be cleaned and disinfected more frequently (doorknobs, keyboards, light switches, etc.)
   • Objects that tend to get dirty and have germs on them (toilets, patient mattress, etc.)

8. Contact time, disinfectant type and proper use matter when disinfecting.

   Disinfectants should be registered with the Environmental Protection Agency (EPA) and labeled for a health care setting. Awareness of contact time is key for infection control.

   Follow instructions on the label:

   • Find out what surfaces the type of disinfectant can be used on and what germs it kills.
   • Look for EPA-registered disinfectants for SARS-COV-2.
   • Dilute the solution, if necessary, for safe and correct concentration.
   • Check the contact time and wait to use the surface or equipment with a new patient until the contact time has finished.