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INTRODUCTION

The burden of healthcare-associated infections (HAIs) in the United States is staggering. The US Centers for Disease Control and Prevention (CDC) estimates that more than 700,000 patients in the United States acquire a HAI each year (roughly 1 out of every 25 inpatients), and approximately 75,000 patients die as a result of their HAI.1 In response to this profound HAI burden, the science guiding hospital infection prevention and control (IPC) has expanded greatly in recent years. However, most studies are limited to adults, and the science guiding HAI prevention specifically in children is limited. Pediatric IPC strategies are often based on data extrapolated from adults and expert consensus in guidelines from several organizations, including the CDC (www.cdc.gov/hai), the Society for Healthcare Epidemiology of America (SHEA; www.shea-online.org), and the Association of Professionals in Infection Control (www.apic.org). The websites for these organizations should be viewed for the most recent guidance for the prevention of HAIs.

STANDARD PRECAUTIONS

The cornerstone of ensuring a safe environment for patients and healthcare workers (HCWs) is strict adherence to standard precautions to prevent infections transmitted by blood or other body fluids in any healthcare setting, including hospitals, long-term care facilities, ambulatory care, home care, and hospice settings.2 The application of standard precautions during patient care is determined by the nature of the HCW and patient interaction and the extent of the anticipated exposures. Therefore, assessing the risk of exposure to bloodborne, airborne, and epidemiologically significant pathogens before providing care should be standard of care. The key elements of standard precautions are outlined in Box 5-1.

BOX 5-1. Recommendations for Standard Precautions

  • Hand hygiene: Before and after each and every patient contact; after touching blood, body fluids, secretions, excretions or contaminated items; and after removing gloves. See Box 5-3 for specific indications.

  • Barriers: Personal protective equipment is required for certain situations.

    Gloves: Before touching blood, body fluids, secretions, excretions or items contaminated with these fluids; and before touching mucous membranes or nonintact skin.

    Gown: Before doing a procedure and patient care activity when contact with clothing or exposed skin with blood/body fluids, secretions, or excretions is anticipated.

    Mask, eye protection (goggles), face shield: Before procedure and patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, such as suctioning and endotracheal intubation.

  • Patient care equipment: Handle in a manner that prevents transfers of microorganisms to others and to the environment. Wear gloves if visibly soiled. Clean and disinfect reusable equipment before use with another patient.

  • Environmental control: Develop procedures for routine cleaning and disinfection of environmental surfaces, especially frequently touched surfaces in patient care areas.

  • Textiles and laundry: Used linens and hospital garments should be considered contaminated after use. Transport and process in a manner that prevents transfer of microorganism to others and to the environment.

  • Patient resuscitations: Use mouthpiece, resuscitation bag and other ventilation devices ...

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