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INTRODUCTION

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Hospital infection control and prevention programs protect patients and healthcare providers from acquiring or transmitting infectious diseases. Through surveillance and reporting, healthcare-associated infections are identified, and policies and best practices are implemented to limit such infections. The Joint Commission and the Joint Commission International inspect hospitals and other healthcare delivery systems to ensure that appropriate infection control and prevention practices are being followed. Infection control is a major patient safety effort that involves all members of the healthcare team.

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General principles of infection control and prevention should also be applied in outpatient settings. Although less is written about outpatient clinics, offices, and outpatient procedure and surgical centers, the practice of infection control remains an integral part of patient care in these settings. The goal is the same as for inpatients: protection of patients and healthcare personnel from acquiring and transmitting infectious diseases.

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On a national level, the Occupational Safety and Health Administration (OSHA) is responsible for promoting a safe work environment. The OSHA bloodborne standards apply to hospitals and all other healthcare facilities. Another important federal agency is the National Institute for Occupational Safety and Health (NIOSH), which is responsible for conducting research and making recommendations for the prevention of work-related injury and illness.

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TRANSMISSION OF INFECTIOUS AGENTS

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To practice effective infection control and prevention, one must understand the routes of transmission of infectious agents. The most common route of transmission is by contact with contaminated hands, body sites, or objects. Organisms are carried from the hands of one person to another and are frequently implicated in the transmission of bacteria, fungi, parasites, and viruses. Adequate hand hygiene removes most organisms transiently carried on the hands and thus is central to all infection prevention programs.

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Some pathogens are aerosolized in small or large droplets. Small droplets can be carried by air currents, remain suspended, and infect persons at longer distances than large droplets, which require relatively close contact (within a few feet) in order for the droplet to move from one person to the next. Body fluids, such as oral and nasal secretions, vomitus, feces, or urine, may be common modes for transmission of microorganisms, both among children and between children and healthcare workers. Direct contact between children and caregivers transmits skin organisms such as bacteria, fungi, and mites.

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A variety of fomites can be involved in the transmission of infectious agents. Stethoscopes, equipment, and toys have been cultured and shown to harbor pathogens. These pathogens then can be spread from the fomites to the hands of healthcare providers or body surfaces of patients. Most of the time, this does not result in disease; however, these fomites serve as potential reservoirs of pathogens.

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Transmission of pathogens by food or water is rare in the healthcare setting; however, outbreaks related to contaminated foods, products, or medications have been reported. Intrinsic or ...

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