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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 ...