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Hospital infection control programs protect patients and staff from acquiring or transmitting infectious diseases.1-4 Through surveillance and reporting, nosocomial infections are identified and policies are developed to limit such infections. The Joint Commission and Joint Commission International inspects hospitals and other health care delivery systems to ensure that appropriate infection control practices are being followed. Infection control is a major patient safety effort that involves all health care providers.5-7

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Infection control is equally important in the outpatient setting.8-17 Although less is written about outpatient clinics and offices, 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 staff and patients from acquiring and transmitting infectious diseases.

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The Occupational Safety and Health Administration (OSHA) is responsible for promoting a safe work environment; they conduct training sessions and partner with employers.18The OSHA blood-borne standards apply to hospitals and all other health care facilities.19Another 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.20

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To practice effective infection control, one must understand the routes of transmission of infectious agents.21 By far, the most common route of transmission is via hands. Hands come into contact with a variety of contaminated objects or body sites; organisms are moved on the hands from one person to the next and from one body site to another. Because hands are frequently implicated in the transmission of bacteria, fungi, parasites, and viruses, hand-washing is central to all infection control programs.22-26

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Some pathogens are aerosolized in small or larger droplets. Small droplets can be carried by air currents and remain suspended; large droplets require relatively close contact (within a few feet) in order for the droplet to move from one person to the next.21 Body fluids, such as oral secretions, nasal discharge, or urine, may be common modes for transmission of infection, both among children and between children and health care 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, pagers,27,28 cell phones, thermometer boxes, and computer mice have been shown to be colonized by pathogens; toys in the hospital or in offices harbor pathogens as well.29,30 These pathogens go from the fomites to a hand and on to another person. Most of the time, this does not result in disease; however, these fomites serve as reservoirs of pathogens.31 Artificial nails and nail extenders have been implicated in the spread of pathogens in nurseries.32

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Transmission of pathogens by food or water is rare in the health care setting; however, outbreaks related to contaminated foods ...

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